Everyone is entitled to his own opinion, but not his own facts. Founded by Mark Kleiman (1951-2019)
Health care oxen
Many years ago I had a chance to do some work on health care policy and turned it down because it looked too hard.Â I’ve never regretted the decision, but never acquired any special expertise.
Watching the current debate, I’m a little mystified that most of the discussion of insurance companies has focused on underwriting, especially avoiding people likely to get sick, and efforts to not pay claims on existing policies.Â I’ve never been impressed with the industry’s underwriting smarts, especially when I learned that about a third of residential fires are caused by cigarettes and never saw a non-smoker discount offered in a homeowner’s policy, but trying to sell policies at average loss ratio prices to people who will have less-than-average losses certainly makes sense (for them) and so does stiffing existing customers.
What we don’t seem to talk about, to understand the incentives of the parties to this issue, is the centrality of our gross consumption of care to the size of the industry as a whole.Â In the long run, with competition, any given loss ratio, and reasonable underwriting, the profits of the health insurance industry are their premiums times (1 – loss ratio), and investment interest on their reserves, which is directly proportional to those reserves and in turn to their claims payments.Â In the long run,then,Â the size of the insurance business is the size of the medical business.Â Your fire insurance company wants you not to have a fire and will help you avoid one, but their lights and their competitors’ would be out forever if we stopped having fires. There used to be a business insuring against mule kick injuries; now not so much.
Reducing the cost of the health care system is an arrow aimed at the heart of the health insurance industry, not just the health care providers; really bending the curve is pouring red ink all over their financials.
Author: Michael O'Hare
Professor of Public Policy at the Goldman School of Public Policy, University of California, Berkeley, Michael O'Hare was raised in New York City and trained at Harvard as an architect and structural engineer. Diverted from an honest career designing buildings by the offer of a job in which he could think about anything he wanted to and spend his time with very smart and curious young people, he fell among economists and such like, and continues to benefit from their generosity with on-the-job social science training.
He has followed the process and principles of design into "nonphysical environments" such as production processes in organizations, regulation, and information management and published a variety of research in environmental policy, government policy towards the arts, and management, with special interests in energy, facility siting, information and perceptions in public choice and work environments, and policy design. His current research is focused on transportation biofuels and their effects on global land use, food security, and international trade; regulatory policy in the face of scientific uncertainty; and, after a three-decade hiatus, on NIMBY conflicts afflicting high speed rail right-of-way and nuclear waste disposal sites. He is also a regular writer on pedagogy, especially teaching in professional education, and co-edited the "Curriculum and Case Notes" section of the Journal of Policy Analysis and Management.
Between faculty appointments at the MIT Department of Urban Studies and Planning and the John F. Kennedy School of Government at Harvard, he was director of policy analysis at the Massachusetts Executive Office of Environmental Affairs. He has had visiting appointments at UniversitÃ Bocconi in Milan and the National University of Singapore and teaches regularly in the Goldman School's executive (mid-career) programs.
At GSPP, O'Hare has taught a studio course in Program and Policy Design, Arts and Cultural Policy, Public Management, the pedagogy course for graduate student instructors, Quantitative Methods, Environmental Policy, and the introduction to public policy for its undergraduate minor, which he supervises. Generally, he considers himself the school's resident expert in any subject in which there is no such thing as real expertise (a recent project concerned the governance and design of California county fairs), but is secure in the distinction of being the only faculty member with a metal lathe in his basement and a 4Ã—5 Ebony view camera. At the moment, he would rather be making something with his hands than writing this blurb.
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