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Paul Ryan won widespread applause from the Peter Peterson-types some years back for proposing a budget that would virtually eliminate the federal government by 2050, excepting Medicare, Medicaid, Social Security, and the military. According to the Congressional Budget Office’s analysis of the Ryan budget (done under Speaker Ryan’s supervision), spending on everything other than Social Security, Medicare, and Medicaid would be reduced to 3.5 percent of GDP in 2050. With military spending likely running in the neighborhood of 3.0 percent of GDP, this left around 0.5 percent of GDP for federal spending on education, infrastructure, the Justice Department, research and development, national parks, and all the other things we think of the government as doing.
Well, Ryan now has some serious competition from Donald Trump. In his budget, he has these same categories of spending shrinking to 3.6 percent of GDP by 2027, down from 6.3 percent of GDP at present. While Ryan’s endpoint may be more impressive, it is important to remember that he has another 23 years to get there. According to CBO, in 2030 Ryan’s budget has 5.25 percent of GDP going to the same categories of spending, including the military. If we pull out 3.0 percent for the military (Ryan is more hawkish than Trump, who only spending 2.3 percent of GDP on the military in 2027) then Ryan would have 2.25 percent of GDP for this everything else category in 2030.
So we have Trump at 3.6 percent of GDP for the bulk of the federal government in 2027 compared to 2.3 percent in the same categories for Ryan in 2030. If we assume the same rate of decline in the years from 2027 t0 2030 as in the years 2017 to 2027, then Trump’s budget would be down to 2.8 percent of GDP by 2030. It looks like Ryan is still somewhat ahead of Trump in his plan to eliminate the federal government, but Trump can still hope to catch up.
Paul Ryan won widespread applause from the Peter Peterson-types some years back for proposing a budget that would virtually eliminate the federal government by 2050, excepting Medicare, Medicaid, Social Security, and the military. According to the Congressional Budget Office’s analysis of the Ryan budget (done under Speaker Ryan’s supervision), spending on everything other than Social Security, Medicare, and Medicaid would be reduced to 3.5 percent of GDP in 2050. With military spending likely running in the neighborhood of 3.0 percent of GDP, this left around 0.5 percent of GDP for federal spending on education, infrastructure, the Justice Department, research and development, national parks, and all the other things we think of the government as doing.
Well, Ryan now has some serious competition from Donald Trump. In his budget, he has these same categories of spending shrinking to 3.6 percent of GDP by 2027, down from 6.3 percent of GDP at present. While Ryan’s endpoint may be more impressive, it is important to remember that he has another 23 years to get there. According to CBO, in 2030 Ryan’s budget has 5.25 percent of GDP going to the same categories of spending, including the military. If we pull out 3.0 percent for the military (Ryan is more hawkish than Trump, who only spending 2.3 percent of GDP on the military in 2027) then Ryan would have 2.25 percent of GDP for this everything else category in 2030.
So we have Trump at 3.6 percent of GDP for the bulk of the federal government in 2027 compared to 2.3 percent in the same categories for Ryan in 2030. If we assume the same rate of decline in the years from 2027 t0 2030 as in the years 2017 to 2027, then Trump’s budget would be down to 2.8 percent of GDP by 2030. It looks like Ryan is still somewhat ahead of Trump in his plan to eliminate the federal government, but Trump can still hope to catch up.
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If anyone thought that Republicans believed in local rule or protecting the public from criminals, the Texas legislature is working hard to correct this misunderstanding. It just passed a new law that prohibits Texas’ cities from imposing requirements on taxi services like Uber or Lyft.
The law was passed in response to a measure by Austin that required that drivers for Uber and other services undergo a background check that included fingerprints. Uber and Lyft claimed that they were too incompetent to administer the same sort of background checks as their competitors. After spending millions of dollars on a city-wide initiative, which they lost, the two companies chose to end service in the city rather than comply with the ordinance.
They then turned to lobbying the Texas legislature where their millions in lobbying fees paid off. The new law could also override a measure in Houston that requires these companies to service people with handicaps.
Anyhow, this action by the Republican-controlled legislature should make it clear that the core Republican principle is giving more money to those who have money. Anything else is secondary.
Correction:
I wrote this post in haste and likely gave the readers the impression that I thought people who had been convicted of felonies should not be able to drive cabs and should possible be denied other types of employment. I very much regret that. We have had far too many people, disproportionately people of color, go through our prison system. Most have enormous difficulty being employed after they have completed their sentence.
It is entirely reasonable that people convicted of crimes in the past would be allowed to drive Ubers or cabs, if it can be determined that they do not pose a danger to passengers. The key is the ability to do a proper background check of the person, which likely would include fingerprint checks, which was the issue with the Austin regulation.
I wrote the post because it is not plausible that the Texas legislature was motivated by a concern about the employment prospects of people who had been convicted of crimes. They were obviously responding to Uber’s high dollar lobbying campaign. I should have been more careful in writing this post, recognizing the difficulty that many convicted of crimes face in getting jobs.
If anyone thought that Republicans believed in local rule or protecting the public from criminals, the Texas legislature is working hard to correct this misunderstanding. It just passed a new law that prohibits Texas’ cities from imposing requirements on taxi services like Uber or Lyft.
The law was passed in response to a measure by Austin that required that drivers for Uber and other services undergo a background check that included fingerprints. Uber and Lyft claimed that they were too incompetent to administer the same sort of background checks as their competitors. After spending millions of dollars on a city-wide initiative, which they lost, the two companies chose to end service in the city rather than comply with the ordinance.
They then turned to lobbying the Texas legislature where their millions in lobbying fees paid off. The new law could also override a measure in Houston that requires these companies to service people with handicaps.
Anyhow, this action by the Republican-controlled legislature should make it clear that the core Republican principle is giving more money to those who have money. Anything else is secondary.
Correction:
I wrote this post in haste and likely gave the readers the impression that I thought people who had been convicted of felonies should not be able to drive cabs and should possible be denied other types of employment. I very much regret that. We have had far too many people, disproportionately people of color, go through our prison system. Most have enormous difficulty being employed after they have completed their sentence.
It is entirely reasonable that people convicted of crimes in the past would be allowed to drive Ubers or cabs, if it can be determined that they do not pose a danger to passengers. The key is the ability to do a proper background check of the person, which likely would include fingerprint checks, which was the issue with the Austin regulation.
I wrote the post because it is not plausible that the Texas legislature was motivated by a concern about the employment prospects of people who had been convicted of crimes. They were obviously responding to Uber’s high dollar lobbying campaign. I should have been more careful in writing this post, recognizing the difficulty that many convicted of crimes face in getting jobs.
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Yes, it’s yet another example of the skills shortage. In the middle of his review of a new book by Mervyn King, the former head of the Bank of England, Steven Pearlstein tells readers:
“If you are like me, just thinking about the constant interplay among trade flows, investment flows, savings rates, exchange rates, inflation, interest rates and asset prices makes your head hurt. Perhaps that’s because it’s never exactly clear what is cause and what is effect, or whether the effect is up or down.”
For people whose head doesn’t hurt, the chains of causation are actually fairly clear. While Pearlstein tells readers that the United States and the other Anglo-Saxon countries are “saving too little,” in a context where other countries are propping up the dollars (as King claims and Pearlstein apparently agrees), causing us to run large trade deficits, we are saving too much.
The trade deficits the United States and other countries run as a result of having over-valued currencies lead to unemployment unless they are offset by large budget deficits. The budget deficits run in the years after the 2001 recession and 2008–2009 recession were insufficient to restore the economy to full employment. (We did eventually reach something close to full employment in 2006–2007 due to the construction and consumption demand generated by the housing bubble.)
Larger budgets would mean less national savings, although the increased borrowing associated with the deficit would be partially offset by the additional output in the economy, which would lead to more savings. It is also possible to get back to full employment by reducing labor supply through measures such as work sharing, mandated paid vacations, and other measures designed to shorten the average work year. This is how Germany managed to reduce its unemployment in the Great Recession, even though it had a sharper fall in output than the United States.
Pearlstein’s confusion on cause and effect also leads him to claim some sort of crisis is imminent, since at some point other countries are likely to stop propping up the dollar. There is no basis for this assertion. We actually have a clear precedent for this story of adjustment.
In the late 1980s, following the 1985 Plaza Accord, Japan, Germany, and our other major trading partners helped to engineer a sharp reduction in the value of the dollar, which caused our trade deficit to decline from a peak of more than 3.0 percent of GDP in 1986 to roughly 1.0 percent of GDP by 1989. The economy grew at a respectable pace throughout this period and there was no major uptick in inflation.
Yes, it’s yet another example of the skills shortage. In the middle of his review of a new book by Mervyn King, the former head of the Bank of England, Steven Pearlstein tells readers:
“If you are like me, just thinking about the constant interplay among trade flows, investment flows, savings rates, exchange rates, inflation, interest rates and asset prices makes your head hurt. Perhaps that’s because it’s never exactly clear what is cause and what is effect, or whether the effect is up or down.”
For people whose head doesn’t hurt, the chains of causation are actually fairly clear. While Pearlstein tells readers that the United States and the other Anglo-Saxon countries are “saving too little,” in a context where other countries are propping up the dollars (as King claims and Pearlstein apparently agrees), causing us to run large trade deficits, we are saving too much.
The trade deficits the United States and other countries run as a result of having over-valued currencies lead to unemployment unless they are offset by large budget deficits. The budget deficits run in the years after the 2001 recession and 2008–2009 recession were insufficient to restore the economy to full employment. (We did eventually reach something close to full employment in 2006–2007 due to the construction and consumption demand generated by the housing bubble.)
Larger budgets would mean less national savings, although the increased borrowing associated with the deficit would be partially offset by the additional output in the economy, which would lead to more savings. It is also possible to get back to full employment by reducing labor supply through measures such as work sharing, mandated paid vacations, and other measures designed to shorten the average work year. This is how Germany managed to reduce its unemployment in the Great Recession, even though it had a sharper fall in output than the United States.
Pearlstein’s confusion on cause and effect also leads him to claim some sort of crisis is imminent, since at some point other countries are likely to stop propping up the dollar. There is no basis for this assertion. We actually have a clear precedent for this story of adjustment.
In the late 1980s, following the 1985 Plaza Accord, Japan, Germany, and our other major trading partners helped to engineer a sharp reduction in the value of the dollar, which caused our trade deficit to decline from a peak of more than 3.0 percent of GDP in 1986 to roughly 1.0 percent of GDP by 1989. The economy grew at a respectable pace throughout this period and there was no major uptick in inflation.
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It is so annoying when the economy refuses to listen to what the economists say it should be doing. In this case, it seems to be ignoring the insistence that new jobs require more education and typically a college degree.
The problem is that in the last four years the employment-to-population ratio has actually been rising for people with just a high school degree while it is has fallen slightly for people with college degrees.
Since January of 2013, the employment-to-population ratio (EPOP) for people with just a high school degree has risen by almost two percentage points while it has fallen by almost one percentage point for college grads. This certainly doesn’t fit the simple story of people needing more education for the jobs being created in today’s economy.
Obviously, there are other factors at play here, but the most obvious one, the retirement of the baby boom generation, should work the other way. The people who reached retirement age during the last four years were disproportionately less educated, which should depress the EPOP of workers with just high school degrees relative to college grads.
To be clear, people with college degrees are undoubtedly better off in today’s labor market than those with less education. Their overall employment is 72 percent, compared to just 55 percent for high school grads. And, they get paid much more when they do work. But at least by the EPOP measure, it does not appear that the labor market is being increasingly tilted in their favor as often claimed.
It is so annoying when the economy refuses to listen to what the economists say it should be doing. In this case, it seems to be ignoring the insistence that new jobs require more education and typically a college degree.
The problem is that in the last four years the employment-to-population ratio has actually been rising for people with just a high school degree while it is has fallen slightly for people with college degrees.
Since January of 2013, the employment-to-population ratio (EPOP) for people with just a high school degree has risen by almost two percentage points while it has fallen by almost one percentage point for college grads. This certainly doesn’t fit the simple story of people needing more education for the jobs being created in today’s economy.
Obviously, there are other factors at play here, but the most obvious one, the retirement of the baby boom generation, should work the other way. The people who reached retirement age during the last four years were disproportionately less educated, which should depress the EPOP of workers with just high school degrees relative to college grads.
To be clear, people with college degrees are undoubtedly better off in today’s labor market than those with less education. Their overall employment is 72 percent, compared to just 55 percent for high school grads. And, they get paid much more when they do work. But at least by the EPOP measure, it does not appear that the labor market is being increasingly tilted in their favor as often claimed.
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In his Washington Post column today George Will told readers that the problem of rising costs in the U.S. health care system is simply a case of Baumol’s disease. This refers to the problem identified by economist William Baumol (who recently died), that productivity in the service sector tends to rise less rapidly than productivity in the manufacturing sector. The implication is that if workers get paid the same in both sectors, then the cost of services will always rise relative to the cost of manufactured goods. Will tells us that this is the story of rapidly rising health care costs.
There are a couple of big problems with this story. First, it is not always the case that productivity in services rises less rapidly than productivity in manufacturing. ATMs have hugely increased the ability of banks to serve customers without tellers. Film developing became hugely more productive with digital cameras.
It is quite likely in the decades ahead that we will see innovations in technology that will lead to large increases in productivity in health care. For example, improvements in diagnostic technology will likely allow a skilled technician to diagnose illnesses with better accuracy than the best doctor. Similarly, robots will almost certainly be able to perform delicate surgeries with more precision than the best surgeon. In these and other areas of health care there is enormous potential for productivity gains, assuming that doctors and others who stand to lose don’t use their political power to block the technology.
This brings up the second point. While health care costs have risen everywhere, no other country pays anything close to what we do in the United States, even though they have comparable outcomes. The figure below shows per capita health care spending in the United States and five other wealthy countries since 1971. (The numbers shown are from the OECD and expressed in purchasing power parity. I converted them to 2016 dollars using the PCE deflator.)
As can be seen, health care costs have been rising everywhere, but nowhere have they risen anywhere near as rapidly as in the United States. At the start of this period in 1971 the United States didn’t even lead the pack in per capita spending, coming in slightly below Denmark. In 2015, health care costs in the U.S. were more than twice as high as in Denmark and France and almost 2.4 times as high as in the United Kingdom. Even if we compare costs with Germany, the second most expensive country in this group, the savings would still be almost $4,200 a year per person, or more than $1.3 trillion for the country as a whole.
The reason our health care costs have risen so much more rapidly than anywhere else is not Baumol’s disease. Health care is a service everywhere, not just in the United States. The difference stems from the fact that doctors, insurers, drug companies, and medical equipment makers are far more capable of controlling the political process in the United States than in these other countries. They use their political power to restrict competition and get government subsidies. As a result, these actors are able to secure massive rents that come out of the pockets of the rest of us.
It is understandable that columnists and newspapers that would like to protect these rents would try to tell the public that high-cost health care is just a fact of nature, but it is not true.
In his Washington Post column today George Will told readers that the problem of rising costs in the U.S. health care system is simply a case of Baumol’s disease. This refers to the problem identified by economist William Baumol (who recently died), that productivity in the service sector tends to rise less rapidly than productivity in the manufacturing sector. The implication is that if workers get paid the same in both sectors, then the cost of services will always rise relative to the cost of manufactured goods. Will tells us that this is the story of rapidly rising health care costs.
There are a couple of big problems with this story. First, it is not always the case that productivity in services rises less rapidly than productivity in manufacturing. ATMs have hugely increased the ability of banks to serve customers without tellers. Film developing became hugely more productive with digital cameras.
It is quite likely in the decades ahead that we will see innovations in technology that will lead to large increases in productivity in health care. For example, improvements in diagnostic technology will likely allow a skilled technician to diagnose illnesses with better accuracy than the best doctor. Similarly, robots will almost certainly be able to perform delicate surgeries with more precision than the best surgeon. In these and other areas of health care there is enormous potential for productivity gains, assuming that doctors and others who stand to lose don’t use their political power to block the technology.
This brings up the second point. While health care costs have risen everywhere, no other country pays anything close to what we do in the United States, even though they have comparable outcomes. The figure below shows per capita health care spending in the United States and five other wealthy countries since 1971. (The numbers shown are from the OECD and expressed in purchasing power parity. I converted them to 2016 dollars using the PCE deflator.)
As can be seen, health care costs have been rising everywhere, but nowhere have they risen anywhere near as rapidly as in the United States. At the start of this period in 1971 the United States didn’t even lead the pack in per capita spending, coming in slightly below Denmark. In 2015, health care costs in the U.S. were more than twice as high as in Denmark and France and almost 2.4 times as high as in the United Kingdom. Even if we compare costs with Germany, the second most expensive country in this group, the savings would still be almost $4,200 a year per person, or more than $1.3 trillion for the country as a whole.
The reason our health care costs have risen so much more rapidly than anywhere else is not Baumol’s disease. Health care is a service everywhere, not just in the United States. The difference stems from the fact that doctors, insurers, drug companies, and medical equipment makers are far more capable of controlling the political process in the United States than in these other countries. They use their political power to restrict competition and get government subsidies. As a result, these actors are able to secure massive rents that come out of the pockets of the rest of us.
It is understandable that columnists and newspapers that would like to protect these rents would try to tell the public that high-cost health care is just a fact of nature, but it is not true.
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There were a number of articles about the scary news that debt levels are again above their housing bubble peaks. If you need something to be scared about (really?) I suppose you can worry about this, but if you want to seriously consider the economic impact of this data point, there ain’t much there.
There are two big differences between now and our previous peak ten years ago. One is that the economy and income is considerably higher today. The other major difference is that interest rates are considerably lower on average than they were ten years ago.
We actually have a very good summary statistic from the Federal Reserve Board that tells us the burden of the debt level. It is called the “financial obligations ratio.” It measures the ratio of debt service payments, plus rent, to disposable income. (Rent is included since rent and mortgage payments can be seen as substitutes.)
Here’s the story since they started the series in 1980.
Source: Federal Reserve Board.
As can be seen, at 15.4 percent, this ratio is near its low point for the last four decades. It is far below the peaks hit during the housing bubble years. In other words, there is little reason to worry about debt burdens suddenly creating a massive drag on the economy and leading to the sort of financial crisis we saw when the housing bubble collapsed.
This doesn’t mean that many people are not struggling to cope with student loans and other debts. Household income has barely recovered from pre-crisis levels and many families are still worse off than they were a decade ago. That’s a really bad story, but it doesn’t mean a financial crisis is imminent.
Can the picture change if interest rates rise? Sure, but not very quickly. (Most of this debt is fixed rate mortgage debt.) Furthermore, how much do we expect rates to rise and how quickly?
The long and short is that many people (not me) were caught sleeping by the run-up of debt in the housing bubble years. They aren’t making up for it by worrying about debt now, they are just being wrong again.
There were a number of articles about the scary news that debt levels are again above their housing bubble peaks. If you need something to be scared about (really?) I suppose you can worry about this, but if you want to seriously consider the economic impact of this data point, there ain’t much there.
There are two big differences between now and our previous peak ten years ago. One is that the economy and income is considerably higher today. The other major difference is that interest rates are considerably lower on average than they were ten years ago.
We actually have a very good summary statistic from the Federal Reserve Board that tells us the burden of the debt level. It is called the “financial obligations ratio.” It measures the ratio of debt service payments, plus rent, to disposable income. (Rent is included since rent and mortgage payments can be seen as substitutes.)
Here’s the story since they started the series in 1980.
Source: Federal Reserve Board.
As can be seen, at 15.4 percent, this ratio is near its low point for the last four decades. It is far below the peaks hit during the housing bubble years. In other words, there is little reason to worry about debt burdens suddenly creating a massive drag on the economy and leading to the sort of financial crisis we saw when the housing bubble collapsed.
This doesn’t mean that many people are not struggling to cope with student loans and other debts. Household income has barely recovered from pre-crisis levels and many families are still worse off than they were a decade ago. That’s a really bad story, but it doesn’t mean a financial crisis is imminent.
Can the picture change if interest rates rise? Sure, but not very quickly. (Most of this debt is fixed rate mortgage debt.) Furthermore, how much do we expect rates to rise and how quickly?
The long and short is that many people (not me) were caught sleeping by the run-up of debt in the housing bubble years. They aren’t making up for it by worrying about debt now, they are just being wrong again.
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Morning Edition had an interview (sorry, not posted yet) with Republican Senator Ben Sasse talk about the need for honest leadership. He was critical of Donald Trump’s claims that he would help manufacturing workers. While the criticism is justified, Sasse condemned the idea of turning to protectionism.
Of course, the United States would not have to turn to protectionism: it has been practicing selective protectionism for decades. We have maintained the barriers that largely protect our doctors, dentists, and other highly paid professionals from foreign competition. This allows doctors and dentists to earn twice as much as their counterparts in Canada and Western Europe.
We also have been pushing longer and stronger patent and copyright protection in both trade deals and domestic law. This is the reason that we pay $440 billion (2.3 percent of GDP) a year for prescription drugs rather than their free market price, which would likely be in the range of $40 billion to $80 billion.
The protection for highly paid professionals and patent and copyrights are a major part of the upward redistribution of the last four decades. Unfortunately, Senator Sasse was not prepared to talk about this protectionism honestly even if he could condemn Donald Trump’s flirtation with protectionism for manufacturing workers as being dishonest.
Morning Edition had an interview (sorry, not posted yet) with Republican Senator Ben Sasse talk about the need for honest leadership. He was critical of Donald Trump’s claims that he would help manufacturing workers. While the criticism is justified, Sasse condemned the idea of turning to protectionism.
Of course, the United States would not have to turn to protectionism: it has been practicing selective protectionism for decades. We have maintained the barriers that largely protect our doctors, dentists, and other highly paid professionals from foreign competition. This allows doctors and dentists to earn twice as much as their counterparts in Canada and Western Europe.
We also have been pushing longer and stronger patent and copyright protection in both trade deals and domestic law. This is the reason that we pay $440 billion (2.3 percent of GDP) a year for prescription drugs rather than their free market price, which would likely be in the range of $40 billion to $80 billion.
The protection for highly paid professionals and patent and copyrights are a major part of the upward redistribution of the last four decades. Unfortunately, Senator Sasse was not prepared to talk about this protectionism honestly even if he could condemn Donald Trump’s flirtation with protectionism for manufacturing workers as being dishonest.
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Who said it’s not a good labor market when you can get paid hundreds of millions of dollars for losing your investors money (compared with a stock index). The big question is why do the people who sign these contracts (managers of pension funds and university endowments) still have jobs?
Who said it’s not a good labor market when you can get paid hundreds of millions of dollars for losing your investors money (compared with a stock index). The big question is why do the people who sign these contracts (managers of pension funds and university endowments) still have jobs?
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We have all heard the argument from conservatives about the benefits of relying on the private sector rather than the government. Private companies are fast moving and can respond more quickly to changing conditions and technology. By contrast, the government is slow and bureaucratic. And, there is more than a bit of truth to this story.
So what happens when we have the slow-moving bureaucratic government making payments to fast moving dynamic insurers in a program like Medicare. Well, all good believers in the superiority of the private sector will expect the insurers to rob the government blind. And this seems to be the case.
The NYT reported the allegations of a whistle-blower at United Health, the country’s largest insurer. According to the whistle-blower, Benjamin Poehling a former finance director at United Health, the company had a policy of altering patient’s medical conditions to put them in groups for which Medicare provides higher compensation.
The issue here involves Medicare Advantage program, which now includes roughly one-third of the people receiving Medicare benefits. People enrolled in Medicare Advantage get their health care covered by a private insurer. The insurer gets compensated by Medicare, with the fee adjusted depending on the patient’s health condition. The insurers get more money for enrolling a less healthy person than enrolling a more healthy person.
According to Mr. Poehling, United Health would find ways to have patients be labeled with conditions that came with higher reimbursements. He claims that other insurers engaged in the same practice. According to the piece, this could have meant billions of dollars in overpayments over the last 15 years. While this is not a large amount relative to Medicare’s total budget (the program will spend over $600 billion this year), it is a large amount for one company to steal.
This sort of gaming of a government program is exactly the sort of behavior that would be expected in this situation. Since insurers stand to gain large amounts of money by making their insurees appear sicker than they actually are, we should expect that they would engage in this sort of gaming.
While there is no easy way to prevent this sort of practice (the insurer will always know more about the health of the patient than the government), the best route is to have an effective deterrence. Since most cases of this sort of fraud are likely to go undetected, it is important that when individuals are caught, they face serious penalties.
If the higher-ups at United Health could look forward to spending most of the rest of their lives in jail, then it may discourage this sort of fraud in the future. Alternatively, we could look to go back to a single-payer system similar to the traditional Medicare program. Since neither of these outcomes seem likely at the moment, look forward to a lot more taxpayer dollars going into the pockets of corrupt insurance company executives.
Note: Typos corrected from earlier version, thanks to Robert Salzberg.
We have all heard the argument from conservatives about the benefits of relying on the private sector rather than the government. Private companies are fast moving and can respond more quickly to changing conditions and technology. By contrast, the government is slow and bureaucratic. And, there is more than a bit of truth to this story.
So what happens when we have the slow-moving bureaucratic government making payments to fast moving dynamic insurers in a program like Medicare. Well, all good believers in the superiority of the private sector will expect the insurers to rob the government blind. And this seems to be the case.
The NYT reported the allegations of a whistle-blower at United Health, the country’s largest insurer. According to the whistle-blower, Benjamin Poehling a former finance director at United Health, the company had a policy of altering patient’s medical conditions to put them in groups for which Medicare provides higher compensation.
The issue here involves Medicare Advantage program, which now includes roughly one-third of the people receiving Medicare benefits. People enrolled in Medicare Advantage get their health care covered by a private insurer. The insurer gets compensated by Medicare, with the fee adjusted depending on the patient’s health condition. The insurers get more money for enrolling a less healthy person than enrolling a more healthy person.
According to Mr. Poehling, United Health would find ways to have patients be labeled with conditions that came with higher reimbursements. He claims that other insurers engaged in the same practice. According to the piece, this could have meant billions of dollars in overpayments over the last 15 years. While this is not a large amount relative to Medicare’s total budget (the program will spend over $600 billion this year), it is a large amount for one company to steal.
This sort of gaming of a government program is exactly the sort of behavior that would be expected in this situation. Since insurers stand to gain large amounts of money by making their insurees appear sicker than they actually are, we should expect that they would engage in this sort of gaming.
While there is no easy way to prevent this sort of practice (the insurer will always know more about the health of the patient than the government), the best route is to have an effective deterrence. Since most cases of this sort of fraud are likely to go undetected, it is important that when individuals are caught, they face serious penalties.
If the higher-ups at United Health could look forward to spending most of the rest of their lives in jail, then it may discourage this sort of fraud in the future. Alternatively, we could look to go back to a single-payer system similar to the traditional Medicare program. Since neither of these outcomes seem likely at the moment, look forward to a lot more taxpayer dollars going into the pockets of corrupt insurance company executives.
Note: Typos corrected from earlier version, thanks to Robert Salzberg.
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