Wednesday, October 3, 2012

Live-blogging the debate continuing

A few notes:

 - Romney's criticism of Dodd-Frank is, in his words, more nuanced than just repeal the more stringent regulations. He criticizes supporting too-big-to-fail banks through Dodd-Frank. I will look into this more. The phrase "capital requirements" are briefly mentioned than dropped.

- Romney's healthcare discussion ignores the problem of mass, poor, and young uninsured Americans. This is an economic drag on their consumption, in addition to an overall problem.

- Romney and Obama both, paradoxically, praise Massachusett's health plan. This plan has succeeded in raising in the insurance rate (making it worth it in my opinion) and its medical inflation rate has recently slowed even more rapidly than the national rate, likely due income declines. However, they are suffering from a doctor shortage I believe, expected given the dramatic increase in insurance beneficiaries, a national harbinger neither candidate mentions.

- Obama is clearly influenced by the "30% solution" school of thought in health policy (perhaps from David Cutler, an advisor on his campaign): that is, 30% of health care spending is wasted, and we can eliminate it without affecting quality. This result comes from the Dartmouth Atlas studies on regional Medicare variation, and is endorsed at Harvard, Health Affairs, the IOM etc. Some critics, notably Robert Cooper, consider this result fraudulent. This is very interesting, mostly one-sided debate. From what I can gather, Dartmouth Atlas finds that certain regions, mostly in the South, spend far more in Medicare dollars per patient than other regions (typically Northern suburban regions) even when you control for the different risk pools each region faces. Cooper et. al., and his few if any backers, say this is merely a result of comparing low-minority, high-income Medicare spending regions with high-minority, high-risk regions which necessarily have higher spending. Dartmouth says that they control for differential risks in their statistical analysis and that Cooper is ignorant of statistics. I suppose it boils down to whether you believe multiple regression analysis can adequately control for social stratification across the country, by including variables like income in the regression. Cooper points out some strange results from Darmouth such as Mississippi having the highest spending despite its general deficit of medical specialists. Another question about the 30% hypothesis is that it is based on Medicare claims rather than overall expenditure -- possibly not a descriptive sample. Although it did not receive much mention in the debate from Romney or even explicit mention from Obama, the veracity of this 30% hypothesis is crucial. It underlies much of current health policy thought, and is the ideological foundation of the weaker, spending-control aspects of Obamacare. It has led Baicker and Chandra to publish a paper with the famous statement that "regions with higher healthcare spending have lower healthcare quality" to which Cooper has responded, in contrast,  "more is more" in health spending, not less. We will see how it plays out. As a note, Cooper has a track record of success in the field of social prognostication: he predicted the coming physician shortage about a decade ago, recognized only recently by higher authorities.

No comments:

Post a Comment