Comments on: It’s Nice That the USPSTF Isn’t NICE … For Now

By: Caitlin Hartsell

Caitlin Hartsell — Tue, 08 Dec 2009 18:49:38 +0000

Perhaps I was not clear: the thesis of this post is that it is a bad idea to let a government entity (like USPSTF) make decisions about what should or should not be included in health insurance/care, because they are very inept at it (case in point: bad mammography recommendation). They (questionably) recommended against mammograms; this lowers the mandate in this one instance. But when this is the group making health insurance decisions, who is to say they won’t keep making bad recommendations, but in the other direction? (I don’t have any of their data off hand on other recommendations.)

They WILL be the decider when the bill is passed. There is no “rule that does not allow participants to purchase insurance that covers mammograms” but there is a rule that patients cannot use their own money outside of Medicare. Medicare currently follows the USPSTF recommendations, and will after the bill is passed.

This is more of an illustration of what can and will happen if the bill passes and the USPSTF decides what a “proper” insurance package covers: it will have things people don’t want and won’t include things that people need.

By: Andrew Hanson

Andrew Hanson — Tue, 08 Dec 2009 02:58:06 +0000

Caitlin,

Your position is still a bit unclear to me. It seems like you’re trying to come at this beast from two incompatible angles.

First, you’re giving a free-market-equilibrium analysis about health care. “If the government mandates X minimum of coverage, it will effectively be a price floor that will result in a supply shortage of health care that will increase costs and lower the quality of care.” Note that this argument doesn’t work in the current context. If the government reduces or restricts its mandated minimum (i.e., its recommendation), equilibrium will be unaffected.

Second, you’re arguing that government should increase its mandated minimum because–well, the ACS thinks people of ages 40 to 50 should get mammograms. I’m not clear on how you’re reconciling these two positions.

Perhaps it’s this: “the recommendations DO have ramifications, especially for Medicare/Medicaid, which have specific rules for what participants can do outside of it.” I’m not aware of any rule that does not allow participants to purchase insurance that covers mammograms. In either case, individuals can seek supplemental insurance or pay out of pocket.

By: Caitlin Hartsell

Caitlin Hartsell — Mon, 07 Dec 2009 14:26:29 +0000

Also, I pointed out the implications of the USPSTF being the decider of what “needs to be included” as an issue overall. They were wrong here, and recommended against something. But what if they are wrong in the other direction, and recommend things that the public does not need? Then we have the issue of every health insurance package coming with things people don’t need, and not including things people need. That is hardly a market situation, and it will be extremely expensive for people to find the appropriate equilibrium.

We do not know whether the insurance mandates in the new bill will be like Canada (where you cannot go above it) or the UK (where you can purchase another tier of private insurance.) Our governmental insurance is currently like Canada, but if our private insurance becomes more like the UK, than the mammography wouldn’t be as big of an issue. (But as I said before)

By: Caitlin Hartsell

Caitlin Hartsell — Mon, 07 Dec 2009 05:38:39 +0000

Andrew,
I wasn’t making an argument in that line. I was only making the point that the recommendations DO have ramifications, especially for Medicare/Medicaid, which have specific rules for what participants can do outside of it.

By: Andrew Hanson

Andrew Hanson — Sun, 06 Dec 2009 21:30:46 +0000

I don’t think your interpretation of the legislation is correct.

It says, “private insurers, Medicare and Medicaid would only be required to cover services receiving a specific grade from the U.S. Preventative Services Task Force.” This does not mean that private insurers cannot go beyond what is required.

I am confused by your argument. Didn’t you earlier suggest that the government should limit its requirements and let the market and individuals decide how much coverage they consume?