Wednesday, November 25, 2015

Four Health Law Questions with Applied Math Answers

Mathematics may be defined as the subject in which we never know what we are talking about, nor whether what we are saying is true.

Bertrand Russell (1872-1970), Recent Work on the Principles of Mathematics

I read today what an advocate of the Health Law and what an opponent had to say about the effect of the law (Affordable Care Act’s Next Phase: Leslie Dach Says It Has to be about Quality, not Quantity”; “Sen. John Thune Says Republican Alternatives Do A Better Job by Relying on Market Forces, “ WSJ, November 24), and I decided to apply a little math. After all, as a sage said, “In God we trust, all others use Data.”

Leslie Dach, a senior counselor for HHS observes that since the Law went into effect, 17.6 million more people now have coverage, a 45% drop in the uninsured rate.

Yes, says Senator Thune, that’s true but the cost has been $1.3 trillion, and 35 million are still uninsured, and, according to the Congressional Business Office, there will still be 27 million uninsured by 2015.

The first question. Has the cost of covering 17.6 million over the last 5 years been worth it? If you divide $1.3 trillion by 17.6 million, that amounts to $73,864 for each newly insured person.

The second question. Is this $73,864 worth the massive disruption it has created for the middle class, tax payers, patients, physicians, and hospitals. If one assumes America has a population of 320 million. $1.3 trillion divided by 320 million comes to $4062.40 per person. Whatever happened to that original ObamaCare promise that the health law would reduce premiums for a family by $2500? Instead the opposite has occurred, with premiums up $4865 for the typical family.

The third question. Has the spike in costs translated into increased quality and satisfaction ? The American people as a whole apparently think not since the average of national polls indicate 43.4% approve of the law while 50.0% oppose it.

The fourth question. Here we leave solid mathematical ground, does centralized national government or decentralized market forces do a better job at reforming health care? The question is moot since only the first has been tried.

Leslie Dach claims government is better because it incentivizes to pay for “quality not quantity” by doing away with fee-for-service medicine and by incentivizing care to be “integrated and organized.”

Senator Thune insists markets will do better through interstate competition, reduced regulations, doing away with mandates, grouping small businesses into high risk pools, expanding health savings accounts, having states regulate Medicaid according to the particular needs of each individual state.

Who knows the answers? The ultimate jury, the American people, are still out, at least until 2016 and undoubtedly thereafter. Until then, as the Mock Turtle in Alice in Wonderland, remarked, there will be “Reeling” and “Writhing” in the different branches of mathematics – Ambition, Distraction, Uglification, and Derision.” In the modern era of digitization, another branch, Big Datafication, may hold the answer.

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