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tv   Peter Van Doren Discusses Health Care Reform  CSPAN  January 26, 2017 8:00pm-9:02pm EST

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[inaudible conversations] one good afternoon everybody i am the director of congressional affairs and thanks for coming. this is the capital held briefing on health insurance reform the repeal in replacement of the affordable care act is up for discussion in as we speak they are huddling in philadelphia to repair the damage done despite the of larger array of the critics state they don't have a plan democrat say it is unviable. there is some truth to that to require implant the current take no prisoners
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approach to prevent that possibility but add that to the mix promising an outline of his own that could unify and time will tell. but the pure libertarian position that prices are clear and entrepreneur and competition is nominal to those that our less distortion very for those to optional functioning market. but understand how the health insurance market works in the real effect on
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the patient's health. as a senior fellow at the cato institute of fascinating journal of regulation. en the expert the housing land and teaching in princeton at yale and a university of north carolina at chapel hill and "the washington post" and the "new york post" and also appearing on cnn, fox news and cnbc. earning him is doctorate from yale we will leave time for questions that the and. [applause]
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>> i am not a podium kind of speaker. put the microphone confines me to be here. i like to think i am teaching the class. so i thought i would start with some humor that is an adjective sunglass couple of weeks we have had some soul alive using the term the economist uses why do they always use the term style by fact perhaps i had no idea and i would look up the origin it comes from the article of the nobel prize-winning columnist and
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used the term to refer to the results of the alleged extend these that economists have come to expect as true. they are facts from the analytic studies that the economics profession will come to. so we start off from those congressional offices or anyone that claims to want to do something first we have to start with the facts and you can read what i have written but those expenditures from 2012 far 35 french red under the age of 19 or 4400 and so on and
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so one finally over age 84 the average of expenditures is a lot of money. first of all, the average divided across the of population is 10 grand. guess what? so we basically have endless bytes for everybody to pays 10 grand. right? that is pretty much it. and some people pay less than some have to pay more that people fight over this in the end we have to pay
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per capita. c. i have drifted away from that microphone the second fact about expenditures is extremely concentrated of most people are not set -- set i want to rank the order all americans 325 million to make believe we put them all in a row to the highest we
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spend millions of dollars if you look at that outline data the first 50% something non-ec order of 160 million americans they don't spend any thing on health care at all $264 per year.
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how to struggle laugh fluff to deal with this free laugh and if everyone says there are flavorful full-size if -- both sides and i will try to do that there are two papers you have never read i have been getting a
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inversion of this talk over 20 years. the first paper i will talk about was published 1995 but i bet a lot of money none of you have ever read that paper even though his york job to figure this out. so that it is but should the wisdom is that the only solution you will not buy anything called health care insurance because you are
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healthy you do not need it. because that means sick people between 50 and one coat and thousand dollars per year nobody would want to and many could not afford some that solution is coercion repaid 10 grand per year but the conventional wisdom pdf as libertarians
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we have to use that coercion half don't think of laugh for -- have added your first for of for so that sounds fine life foot here is what has facilities that there is the alternative for of fed ... -- that did fistful of that did exist there was and i said then stop talking
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berger you cannot talk about the possibility renewable health insurance markets unless you have read that paper. he said saddam have to read and he walked out. cannot trying to win you over today but to say that you owe your cells to read those paper that it did exist. how was that possible? the cost is that it is it concentrated so health-insurance contracts
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the first is the health care cost if you are formal and not sec faugh faugh -- and not six from that medical expenditure so the data off for we have a complete data set we know how much we will
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spend some uh key is what would induce everybody to sign up? even all the spending 200 and $64 per year if you are young there are rates of $200 per year cancer, said repro palsy, cerebral palsy palsy, autoimmune we know that probability of every age group the cost of treating that disease they don't last forever people
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get better or they die uh good news is there is an end and one way or the other two times the probabilities then add that to the low-cost premium that is the guaranteed premium for you and we can do this for 20 year-old source 63 year olds it would be more expensive but we know that transition of probability and i gave you some of so he price to
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doubt and said in my hypothetical insurance world every age group would look like this would you charge for guaranteed renewable contracts? it was more or less exactly what he predicted.
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no gouging in node baird this but he said the debt this puff pdf the most important paper you have forever heard of that you have never read the second paper for five at the scene of aloof period save here if they fear if fluff and debt
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paper is available for you. bottom line. individual guaranteed renewable contract did exist
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and did work that it is incapable of existing or working is and correct her home negative incorrect but most of us are in the employer market it isn't a random sample of society the transitions between these two types of health insurance are difficult. we will end end employer coverage to have everybody find their own insurance but all the little pockets of cash attached to make insurers eager to find even the most sick patients because they blue the leave them to cover them because
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they come with the present value of the future cost because we know that. we on a trek -- a deal the trick is a private -- suppose the don't buy that product with guaranteed renewable vouchers attached. the truth is i don't know. going back to subsidies or mandates that is freely sf felice that to apolitical decision.
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so i want to disabuse you of the notion that that the cadence to two world of people buying and selling his imaginary it is not it is reputable people kaifu you do not have to pull in the same committee roof free-for-all stuff puff insurance plans. puff everyone comes with a pile of cash positions to pay for them with negative free is fairly rare fluff
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but if health-insurance reform takes that to flavia puff off puff for tonight that his lead at one flu / off to another part of the for. >> eric is a line of work that says of what i called medical that looks like defense is unwarranted there were many middle-class
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voters you cannot do enough prevention. is remarkable for that position so i will do my tirade so maybe entirely. but first if you read the need your times that prostate cancer screening is a good investment. it is very rare.
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they have taken off with back pain or those not exhibiting back pain. of those with no symptoms but now we find no clinical significance. if you tell a patient they have found something they never say we don't we should not do anything. they found a lump. they found this or that. most of us will die from something different than what the image will find. if people have cancer most
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of it is not a clinical significance blah, blah, blah. some diet deadly prostate cancer and it is not pretty but to detect those rare cases for every positive test it is only a 2 percent chance to prevent death. talk about a false positive. with that unwarranted expenditure. and chasing a needle in the haystack but a physicist who realize those searches have a laugh in common.
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and we believe that mass screening but they're not likely to find anything. but now for women and mammograms you can read is lark -- as well as i can but there was no difference in mortality or death rates of breast cancer puff from uh 25 years steady no difference. so why do they keep pushing it? pledges the middle-class
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thing to do fly the american cancer society nonprofits raise money by scaring people. you cannot raise money to say libertarian is some, on be are losing the struggle in to raise money for nonprofit is difficult to guess he does not like the of findings? the advocates or nonprofits. if for the messaging on their part.
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i would ask my own doctor i which showed him the data do you have a physical? he said no. licet why am i here? he said this is what we do. the ritual was. that is what it is all about. fourteen clinical trials 22 years of routine checkups between experimental and control groups.
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when i give this talk and new employees are coerced them human-resources person is new and came up to me and she wagged her finger at me say you undermine those messages. what do they do? go get a check up. so a colonoscopy those do matter. they really do they reduce colorectal cancer but they
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don't change the fourth half to die at the same age that the would have. so we have to talk more basically how you want to die. and actually washington d.c. that may be the adult discussion to have. and the of medicaid experiment that or again ran out of money but rather than the social scientist to
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intervene can we randomly a sign people? it is part the big team over the experiment of the health journal and i am giving you the results so they did not have of fund to the new medicaid funds some were denied up until now. people on medicaid spent more money, edged did that change? with no significant defect
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of high cholesterol cardiovascular even to risk. increased diagnosis of diabetes but no effect on blood sugar levels. and then no question. can you imagine tooth me very pour. so to be on medicaid certainly to believe that one measure percent says that change anything medically? oddly enough the story is no.
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here in is of a kicker what is thought rationale? it cost a the rest of us money? look at what the oregon medicaid case experiment found no difference. i m evidence based politics is less five and in the end they will come no matter what your views are. i will end with the real kicker about the m.i.t. health care economist i like
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is papers the most interesting paper you have never read he steadied if the uninsured was a net spurted to of massachusetts taxpayers for cohan. so i'm probably have fed move deaf to prices -- off to prices for the day benefits david for $7,000 tax-free share in fiscal of. net foster is $10 for a vote yes food pays those absurd prices? faugh if you go into debt er or the doctor's office they gave the the price you don't pay attention to guess what?
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one-third of the uninjured and massachusetts 25% pay nothing but two-thirds paid more under the rates of the insurance. they would pay more under the complicated price discrimination but the net revenue was greater than if they had been insured. that is a head scratcher. if i had steadied hospitals
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i think at would have found this same thing. for this is the architect so intellectual to say that is a problem remember that created is so high not like the states in the south toward the of west. but certainly it is an interesting paper. and a guy have reached the end of what i want to say. and tell your boss kept that there are economist who may
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help implement less coercive ness. [applause] somebody wants to say you are full of it? >> howdy you go on about to attack on the physicals of the screening? >> how old? do you smoke? how long has it taken to get
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middle-class people to smoke less? fifty years. change change the way people think about stuff could take a longtime. people call of the think-tank said get the annoying phone calls from people on the hill what clever cute thing that you know about that can change the world? there is no such thing. slowly country has to change the way that it thinks because they said don't think it is a great thing to smoke. i remember i was eight years old 1963.
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my father gave me a mitt cigarette. i inhaled and i die. ps said dealer anything? said it is horrible he said it you are right. i never smoked. he quit to but how can we get with conversations with liberals? the passion on public policy that people makes up the modes of thinking they know what they want they're not thinking about the way it is. they are not the best listeners. cough. [coughing]
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-- have but i have faith to think there is some wisdom now there and i guess in the end the facts and the evidence will come to persuade people of the kind of view that i had is impossible. so that taskforce is based on the child that i described don't do prostate cancer screening what did say poor person supposed to
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proof the average reader of the newspaper is not that sophisticated and does not have the capability and it is unclear they trust clinical trials. if it took 50 years to reduce smoking and will take a long time for people to change their behavior of all middle-class responsible people should do. my own doctor said that. he said you should see that he tells his own patients not to do stuff he gets pushed back. so to have health care 17% of cheapie we have a problem
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we will fix it don't get in my way. there are people on the right to believe that they would call them a death panel. this is now gotten to be very partisan. it is a good stuff. >> i believe that highly credible statistic the top 5%. >> and with thoughts of managed the those cost?
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and from the insurance perspective should look at a more comprehensive insurance policy based on those circumstances? >> the high-risk pool is-- system to be deemed -- a game they want the cost to be transparent fuhr hall itself for a tooth period fa a transparent costs through the public sector is hero.
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if dave realized how much we spent and the only way is to hide that. you don't want to take this san block it up because then suddenly the incentive is is:prof fetches an answer to the first question puffed what do we do with the $100,000 per year case? among the general magazines having the best columns on health care, of one of the
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articles was on how futures he deals with the one felicia dollar per year for the decay of medicare and it was the creation of the opposition off faugh a fistfight pdf pdf pdf pdf pdf so the patient was profiled averaging 100 days in in dog hospital. then they go back in their back and then they go home. they weigh 370 pounds everything goes wrong.
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can we make is cheaper? that experiment was insightful providing a lot of answers. i forget what they are. so go back and read what journal articles. >> what is the implication of that study? >> one of the rationale of the affordable care act that they are a burden as a net cost to the taxpayer. that is why we need to insure everyone because that is cross subsidized. the uninsured provided more
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revenue to doctors than if they were injured - - in shirt and negotiated to pay some version of that. fate would pay more than if they had been injured. for -- insurance and then said the insured and not part of that burden and then stop worrying about that. i am scheerer you have dinner parties. people say we know that. that is the middle-class suburban version.
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they had a homogenous conversation that we all know that the insured are a problem. if you read the paper then he stopped to say that. so inside the beltway conversation these papers are not new. i have been talking and i give a lecture every year to the policies fellows chosen from the united states to spend one year to be in congressional offices puff
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and defense highways of of paper cup and i say have you ever heard of these? nobody has in in 10 years. these are not weird journals faugh because teaching now wharton this is not the men school from route the type of school. sari a rebuff. savate as an intellectual is that knowledge to get into that of policy process and they don't make it.
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why can't we have a more neutral discussion? that is one possibility with the guaranteed renewable contract. >> with your need for tort reform? >> if favorite claim of the right is exactly that. some doctors claim it because doctors hate lawyers that is what i found out that right of center doctors
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because civil liability lawyers and this has become wrapped up. all they say is we have liability before. -- reform so what is that the evidence to many judgments? it is overwhelming lead nonexistent and the opposite is barrett is a lot of injury and hard in the and from it ever appears in the courts. fact and he has published a
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lot for from uh database as you quoting the work force that i could give him the study. politically because they are democrats. pop is much to do with the medical expenditures or anything of the sort. >> for faugh of the individual behavior?
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>> day have talked to me about being held accountable with the affordable care act there is a shift of leaded think is the good idea but the province is that doctors and doctors alone are responsible for the outcome but patients have a lot to do with that. i was a teacher. and all my years i always knew within two or three weeks to the best students were. i could add value to the worst or to the best but i would rarely e reduce the variant.
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if i word to outcomes based teaching writing not make the phone keys look good but then i would make sure that they didn't sign up for my class. there is one called that cardiac cripple or card is steady and tells you about in an effort have one that is the ratio. i will tell you where talking about. cardiac surgeons do better with more surgery's. so or i grew up with they did not do very many but then they had made gazillion per day plight that is harder.
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your state said we will issue a cardiac report card and tell everyone to tell people that your hospital staffs for coke fear is the of problem because there salary depends on this so they stopped operating on the worst patients on less sick patients the mortality rates went down the sickest people were not operating on. don't ever use the ratio of standards. the thinking of the legislator is mess with the new raider know. the denominator roof tran4 / f for of his staff
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israelites' if life from bashful so i will not do that. if doctors are held accountable then we will have very controlling doctors and the patience will not like that. said it makes libertarians worry everybody takes their pills. in the end is personal responsibility. it does matter. we want to be careful. i increase. [applause] faugh steven fed is a good
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note to and don. if you are interested in any of the papers that he mentioned and that week from today we well unchanged years everything you wanted and from the center of freedom and prosperity. thanks for coming. [inaudible conversations]
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. . of hatred activated under the political circumstances, formed
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by a regime that was capable of whipping up the population to participate. then undertook the war into the region where there were hundreds of thousands of people tha but t had defined as enemies and resolved under the conditions of wartime to wipe these people out. at 10 p.m. eastern on afterwards mack alford university professor looks at the philosophy behind frugal living in his book "why less is more more or less." interviewed by the "washington post" syndicated columnist. >> the crucial thing is to never spend money on any luxury at all but to be self-aware about what it is you really evaluated what is worth spending money on and something that you're just wasting money or spending is because people tell you it's the kind of thing you ought to be
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doing or ought to be buying. >> sunday at 7:30, georgetown professor michael eric dyson, author of tears we cannot stop the sermon to white america looks at the racial divide in the country. >> what we want is a cessation of the philosophy of stereotype and a grand thing to us of the same humanity that you grant each other. go to for the complete schedule a panel of budget and tax policy analysts looked at state government budgets in 2017 and the possible effects of economic growth forecasts, infrastructure spending and changes to the federal tax code. "washington post" national editor lori montgomery moderates this discussion from the urban institute.


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