Comments on: Testing the Public Option http://www.concurringopinions.com/archives/2009/06/testing-the-public-option.html The Law, the Universe, and Everything Tue, 14 Feb 2012 13:59:42 +0000 hourly 1 http://wordpress.org/?v=3.2.1 By: Frank Pasquale http://www.concurringopinions.com/archives/2009/06/testing-the-public-option.html/comment-page-1#comment-64076 Frank Pasquale Tue, 09 Jun 2009 21:18:04 +0000 http://www.concurringopinions.com/?p=16953#comment-64076 HHS has some experience in planning pilot programs (e.g., in gainsharing), and perhaps this idea could be modeled on that policy experience. My worry is that the private plans would treat the experimental subjects better than they treat customers generally. I think it would be hard to keep the subjects from telling their private plans that they were part of this experiment, and that the plan had some stake in their health status. I'd also focus this on the chronically ill, where most of the costs come from. Finally, I think that the public plan has many other goals aside from improving health outcomes. For example, even if the experimental subjects in the public plan did not have measurably better outcomes than those in private plans, they would have much more financial security than they would have without that option (something that would have many other benefits for the economy: (see http://www.concurringopinions.com/archives/2007/05/entrepreneurs_f.html and http://www.prospect.org/cs/articles?article=a_strong_safety_net_encourages_healthy_risk_taking not to mention our moral standing in the world. HHS has some experience in planning pilot programs (e.g., in gainsharing), and perhaps this idea could be modeled on that policy experience. My worry is that the private plans would treat the experimental subjects better than they treat customers generally. I think it would be hard to keep the subjects from telling their private plans that they were part of this experiment, and that the plan had some stake in their health status.

I’d also focus this on the chronically ill, where most of the costs come from.

Finally, I think that the public plan has many other goals aside from improving health outcomes. For example, even if the experimental subjects in the public plan did not have measurably better outcomes than those in private plans, they would have much more financial security than they would have without that option (something that would have many other benefits for the economy: (see
http://www.concurringopinions.com/archives/2007/05/entrepreneurs_f.html and
http://www.prospect.org/cs/articles?article=a_strong_safety_net_encourages_healthy_risk_taking

not to mention our moral standing in the world.

]]> By: Michael Abramowicz http://www.concurringopinions.com/archives/2009/06/testing-the-public-option.html/comment-page-1#comment-64072 Michael Abramowicz Tue, 09 Jun 2009 18:07:39 +0000 http://www.concurringopinions.com/?p=16953#comment-64072 JP, I agree that ex post both sides will be able to come up with some argument for why they are still right. That's why it's important for policymakers to try to come up with measurements on which they have different predictions for 3-5 years out, and make policy contingent on that. I disagree that results are likely to be statistically insigificant. If we have a sufficiently large sample (say, 200,000 insureds), we should be able to measure even slight differences in effectiveness. Meanwhile, if public advocates believe that the public option will only work with a "much larger program" (i.e., single payer), then it would be helpful if the debate forced them to say that. JP, I agree that ex post both sides will be able to come up with some argument for why they are still right. That’s why it’s important for policymakers to try to come up with measurements on which they have different predictions for 3-5 years out, and make policy contingent on that. I disagree that results are likely to be statistically insigificant. If we have a sufficiently large sample (say, 200,000 insureds), we should be able to measure even slight differences in effectiveness. Meanwhile, if public advocates believe that the public option will only work with a “much larger program” (i.e., single payer), then it would be helpful if the debate forced them to say that.

]]> By: JP http://www.concurringopinions.com/archives/2009/06/testing-the-public-option.html/comment-page-1#comment-64071 JP Tue, 09 Jun 2009 18:01:57 +0000 http://www.concurringopinions.com/?p=16953#comment-64071 This sounds like the proposals for school-voucher pilot programs, and seems likely doomed to the same inconclusive fate. Outcomes after 3 or 5 years will likely be remain very similar; it seems probable that any disparity will be statistically insignificant. Market advocates will argue that individual health doesn't change in a material way in such a short period of time. Public option advocates will argue that the test was too small; the program will only really work if they have the economies of scale and data aggregation from a much larger program. This sounds like the proposals for school-voucher pilot programs, and seems likely doomed to the same inconclusive fate. Outcomes after 3 or 5 years will likely be remain very similar; it seems probable that any disparity will be statistically insignificant. Market advocates will argue that individual health doesn’t change in a material way in such a short period of time. Public option advocates will argue that the test was too small; the program will only really work if they have the economies of scale and data aggregation from a much larger program.

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