The doctor is in, apparently. Appalled by what he calls a "hate piece" against Adam Searing, the good doctor rushes to a defense like he’s on duty in the emergency room. Cape flying in the wind and everything. Alas, he brings little to the frey: half-truths, conspiracy theories, lies, and colorful ad hominem–the usual. It’s wearying in its banality and predictability. But I will defend myself:
"He published a hate piece recently on our own Adam Searing, titled Mandate Mania: Does Adam Searing Hate People? Max implies that, yes, Adam does hate people."
Actually, I don’t. I say specifically that he doesn’t. One need only read carefully where I write "Does Adam Searing Hate people? No, he hates freedom." But if Turner could see beyond his own guilt-goggles and his own Goebbels-esque manner of writing, he might see that my question – Does Adam Searing Hate People? – was an allusion to Searing’s own dubious tactic of accusing everyone of "hating children" (examples here, and here). It’s a ridiculous tactic, which is why I rather enjoyed the parody. Perhaps before Turner accuses me, he should turn his hate-filled rant on his colleague-in-propaganda, the "gentleman" Adam Searing.
"In addition, Max knows this about Adam: he lies to himself, he wants you to pay for things you don’t need, he wants poor people to be uninsured (an odd accusation against the Director of the North Carolina Health Access Coalition), he hates freedom, and finally, Max knows that "Adam thinks he’s smarter than you.""
Yep. I know he thinks he’s smarter than us and so does Turner, otherwise they would’nt advocate for people and their families to be FORCED into buying chiropractic coverage and marriage therapy in their health plans. It’s in their natures. They think they know better, which is why that type craves domination over others and their sovereign choices.
"Adam is too much of a gentleman to rebut Borders’ vitriolic post. But I’m not."
No, no one can accuse Turner of being a gentleman.
"Never forget…the only thing they care about is their free-market ideology. Everything else is irrelevant."
Perhaps the only truth Turner has ever spoken or written: Yes, I care only about free-market ideology because such is the only ideology that respects an individual’s right to live his or her life as he/she chooses, to exchange, collaborate, and cooperate freely with others — with as little coercion from elitist, arrogant nanny-statists like Turner as humanly possible. I call that caring about human beings and desiring to live in peace.
"Borders responded to a straight-forward post from Adam which asked gubernatorial candidate Bob Orr which mandates he was willing to eliminate in his "market based" health plan."
False, Searing didn’t ask Orr to eliminate his market based plan. Go back and read the post. Typical example of wishes fathering lies.
"Borders’ venomous response included this bullsh*t quote: N.C.’s mandates account for 45-50% of premium costs in North Carolina.This is a lie."
Oh, really?
"When I asked Max where his data was generated, he referred me to this report by this organization [CAHI]. Borders’ "data" is from a health insurance lobbying group [false], who describe their mission as "an active advocate for market-oriented solutions to the problems in America’s health care system."
People lobbying for affordable healthcare? Oh, the ignominy. But Turner had better watch himself. Quick to don the tinfoil hat, he doesn’t realize that CAHI more often than not works against the interests of health insurers who benefit from complex state regulations.
"Hardly an objective source, don’t you know, since their clients stand to benefit directly from their "research findings." Max is the ever useful tool to be exploited for special interest profit."
One wonders if Turner has ever read this blog. If he knew me, he would know how I feel about special interests. Nevermind that special interests can’t exist in a truly free market. But what’s worse is that he is one himself. As a doctor, he won’t benefit quite so much from a choice-based, competitive, consumer driven system. He won’t be able to milk the system, to ding the insurance pool for god knows what to suppliment his lavish lifestyle. Sorry pot, I’m no kettle… But let me not detour any longer:
Steve Turner’s favorite fallacy is to question data because they are assembled by organizations he doesn’t like. But this is a time-tested fallacy — time tested, because the stupid both believe it and wield it. I don’t think Turner is that stupid, so he must be calculatingly fallacious. Nevertheless, any analyst worth his salt checks the data not the source. Nevermind that CAHI’s a reputable organization whose credibility rests entirely on thorough, well-collected, well-documented data. Turner’s too lazy to check their data, so he resorts to typical tactics like the genetic fallacy. But it get’s better…
"Alas, the little Emperor has no clothes, and Max has no data specific to North Carolina."
Cute, but here’s the pdf again, and it is NC specific. One need only see the column for NC among 49 other states. If one wants to question CAHI’s data, go with god, but treat the data.
"By the way, if you want a list of other treatments considered "optional" (ie. mandated) by Max’s resource, they also list: chemotherapy, emergency services, prescription drugs, well-child care (including immunizations), hospice care, diabetic supplies, cleft palate repair, and mastectomy, among others. I don’t know about you, but most of my patients would consider these mandates essential to care, not Cadillac care."
Interesting. Turner’s failed to explain why people wouldn’t or couldn’t choose such "essential" services freely. After all, I’ve called for a compromise found in many, many other states called mandate lite. But Turner’s more interested in vitrol than ideas. More importantly, he’s also failed to tell us why a 55-year-old couple is worried about cleft palate coverage when they need other services. Why any man is worried about mastectomy? Why single people should be worried about well child care? Is this a failure of his medical school or of common sense? In any case, one wonders if his passion to defend his friend has gotten Turner in over his head. You might think doctors understand the minutiae of the healthcare system. They don’t. They just benefit from it — and benefit well. (Another reason I never fail to be astounded at how wealthy folks can be so sanctimonious from the third stories of their million dollar homes.)
"The majority of so-called mandates are part of standard insurance coverage."
I think I’ve already debunked this claim.
"What Max calls "coercive" the rest of us, physicians and patients alike, call "standard of care.""
Funny how menopausal women should have standard cleft palate care, according to Turner, but I digress… Leftist legerdemain is self-parodying.
"Two respected resources regarding health care costs (unlike Max Borders sham resources) do not even mention insurance mandates as cost drivers. Adam links to them here in his latest post. Neither report references mandates, which would be hard to believe if they actually accounted for 45-50% of premium costs as they do in Max’s imagination."
Wow! Now Turner is citing research that isn’t there! Shockingly ignorant. But it gets better…
"[B]ut what is a reasonable estimate of the cost of mandates? It is likely somewhere between 5% and 7.6% of premium costs according to The New York Times, the Congressional Budget Office, and the Minnesota Department of Health."
Okay, let me collect my breath from laughter. First, the Grey Lady a paragon of truth seeking and objectivity? Cute, but if North Carolina’s mandates cost between 5% and 7.6% that would mean we only had mental health parity, which is estimated to cost in that range in most states. We’ll take a closer look at Turner’s references, later, but we can see straight away that the Texas study he cites from 2000 was only looking at 13 mandates. North Carolina has 47.
"Think of it like this: these mandates function as a consumer protection program."
You have to buy x, y, z, and we’re protecting you. Paternalism at its best. Please get out of my life!
"They are nothing more than partisan hacks, as blinkered by their hate-filled ideology as any tribal leader in Northwest Pakistan."
That sort of nonsense speaks for itself. Turner and the leftist MO has boiled down to this: if you don’t comply, you’re ‘hate-filled.’ But free people know better than this and we are not prepared to let the Steve Turners of the world order us around from their mansions or their bland bureaucratic offices like we are either chattle in need of their help, or sacrificial animals from which resources may be taken willy-nilly to their pet projects and utopian plots done in the name of actually caring (name only). No, I don’t hate people like him. But I have nothing but contempt for everything he stands for, because what he stands for is contrary to freedom and human dignity.
-Max Borders
More on Turner’s tirade….
Turner writes:
“So Max doesn’t do truth and doesn’t do research… no surprise there, but what is a reasonable estimate of the cost of mandates? It is likely somewhere between 5% and 7.6% of premium costs according to The New York Times, the Congressional Budget Office, and the Minnesota Department of Health.”
Hmmm, looks like the doc did some “research” of his own. But let’s take a closer look, shall we?
From the NYT:
“In a 2000 study for the Texas Insurance Department on the impact of mandates, the health care consulting company Milliman USA found that they accounted for less than 6.5 percent of health insurance premiums in Texas.”
How about more detail on that study cited by the Minnesota Dept of Health?:
“One of the most comprehensive and well-documented studies of the cost of benefit mandates was a September 2000 actuarial
study commissioned by the Texas Department of Insurance and conducted by Milliman and Robertson. The study examined 13 mandated benefits: chemical dependency,complications of pregnancy, oral contraceptives, congenital defects, HIV/AIDS,mammography and prostate screening, serious mental illness, minimum hospital stays for maternity and mastectomy, reconstructive
breast surgery, handicapped dependents, and childhood immunizations….This study found that direct premium costs of the mandates were estimated to account for a combined total of 7.6 percent for large group premiums and 7.2 percent for small group premiums”
So let’s overlook the fact that two of his three listed sources actually refer to the same study.
The study examined 13 mandates? Uhh, Doctor Turner, there are 47 in NC. And by the way, this is the year 2008, not 2000 – you’re not exactly using current data. Citing an eight-year-old study that tallies only 1/4 of the mandates currently imposed in NC falls embarrassingly shy of any sort of rebuttal to Max’s data.
After no doubt furiously googling “cost of mandates not that bad” for hours last night, that’s the best you can come up with?
Also note in the Minnesota Dept. of Health report there is a chart on Page 5 clearly showing that as the number of mandates rise, so does the average premium cost.
It’s quite amusing to watch the good doctor become unhinged. I also get a chuckle every time he insinuates that we are somehow blinded by our ideology, when he has already admitted he “doesn’t know or care” about what is causing the escalating costs of health care.
By the way, Max, you owe me $10 – I told you he would revert to the lame tactic of questioning the data because it comes from a source he doesn’t like. How long before he starts in with his “your ideas are irrelevant because my team is gonna win!” rhetoric?
Gentlemen,
Nicely done, I think, and even I got the parody of Adam’s previous statements (which is saying a lot).
I do have a quibble, however. As far as I can determine, mandating a benefit that a patient cannot possibly use has no cost consequences. If you mandate that a woman be afforded coverage of prostate disease, that may be silly but it doesn’t raise the cost of the insurance because insurers can expect no additional consumption of prostate-disease treatment as a result.
Mandates increase insurance costs because they make available a no-price or low-price treatment to patients who would otherwise not consume it. If mandates don’t increase consumption, they don’t increase projected hits on the insurance pool. Am I missing something?
No, that’s a good point, I think, except that “so-and-so wouldn’t consume that anyway” only gets to count as a response to a charge that those populations are being forced to bear those costs, not to the notion that the things Turner lists are “essential”, which seemed absurd on its face. One might argue that 2-day post partum stays – for example – are critical to some populations, but not basic to everyone. But again, you make a good point. Perhaps I was unfair.
Of course, mandates scare of competition by potential entrants, too, keeps monopolists around. But you knew that.
Boys,
About your impartial source, CAHI. go to their website:
http://www.cahi.org/cahi_contents/issues/
They list 10 goals. Number five is:
“Eliminate State Mandates.”
Does that sound like an objective source to you? This is similar to quoting figures from the Association of Personal Injury Attorneys on the true cost of medical malpractice. Is that a figure you would respect?
CAHI also note that they advocate for insurers in the “individual and small business group” which would stand to benefit directly from elimination of mandates. (They also represent HSA and senior markets, and I don’t know what effect mandates would have on these.)
I’ll say it again…you have no data specific to North Carolina. CAHI admits as much in Max’s link: “It would be impossible to make a detailed assessment of the cost of each state’s mandates without evaluating each piece of legislation.” Doesn’t sound to me like they are mining NC data to me, Max. Therefore, you have no NC specific data to claim that “45-50% of NC premiums are due to mandates.” If I’m wrong … prove it.
In fact, find a state legislature anywhere in the country that has commissioned a legitimately objective study (not connected to the insurance industry or to a “free-market health solutions advocacy group”) to evaluate the cost of mandates. Someone let me know if they reach the same conclusions as Max.
Brian is finally right about one thing, though, my research consisted of googling in my spare time. The most relevant objective resource was this: In a 2003 report to Congress from the General Accounting Office, three states have studied the impact of mandates on health premiums specific to their states. All 3 states have more mandates than North Carolina: Maryland (14% increase in premiums)…note that Maryland has more mandates than any other state in the country; Texas (6%); Virginia (29%). In a best-case scenario, Max is wrong by almost 50%. Also, the marginal increase (over and above what small and large businesses would offer if mandates did not exist…are estimated at less than 5% of premium costs).
Note also that these figures (from 2000-2003) are likely overestimations compared to current premiums. Why? The rapid increase in healthcare costs over the past 5 years have been prescription medications and increased utilization of new technologies (medical devices…stents and defibrillators; medical imaging…MRI, CT, PET scanning). None of these are mandated benefits in North Carolina.
President Hood, glad to have you join the conversation (and a relevant point that you made, too). Why don’t you loan out some of your researchers at the John Locke Foundation, your excellency, so Max can find his data?
Finally, Max, whether or not you want to admit it, your attack on Adam was personal and hate-filled. I understand parody…you’re just not very good at it. As such, I don’t really think you’re the worst person in the world.*
But you’re in the Top Ten.
Actually, Steve, Virginia – though it may have more mandates – has less expensive ones, making it a good state to shop in. Know how I know? I just moved from VA. So if it’s 25% the cost in VA, it’s probably more in NC.
Now, if what you want are data specific to NC, suppose you’re right and it’s just a little more than VA’s — say 30%. Don’t you think that a little flexibility in NC’s mandates would allow cost savings for people to get insurance? I know you have this ‘theory’ that all mandates are essential. But suppose we could agree that 10 mandates were NOT essential (like chiropractic, marriage counseling, and drug abuse). Do you think perhaps there might be room for making these optional so more people could afford insurance? Sounds like a pretty progressive solution to me. And ‘progressive’ states like NY, Conn, and Wisc have all done this sort of thing to control costs.
In short, if I agree that we need to do a state-specific study on NC, would you agree that some mandates are not ‘essential’ and could allow people greater access to healthcare?
Oh, and by the way. Why would you suggest that Locke lend me their research staff… If they reached a conclusion you didn’t like, you’d just accuse them of bias. How do I know? You’ve already committed the genetic fallacy on a couple of occasions.
Indeed, that’s what you did with CAHI’s data. And while you were right to say that there are no data specific to NC, there are no data specific to NC that I’m aware of. CAHI is the only one who looks at this stuff, really. But I’ve met Merrill Matthews and I know he, like me, is very concerned about getting people health insurance and that mandates are probably a barrier to that. Hell, call him up. I’m sure he’d talk to you about the problem.
All I did with CAHI’s data was show that you used it improperly (to make claims which you can’t validate) and without proper context. Don’t YOU think it’s important that your data came from an insurance industry advocate, who did not have NC data, and lists as a goal “elimination of state mandates?”
Your readers deserve better.
I would say that the data from GAO and CBO are less biased than your source, whether I agree with their findings or not.
I’ll let my readers look at the CAHI data and decide whether it’s credible. It is an imperfect proxy because it extrapolates costs in ranges — but you’ve given me no reason that these should be radically variable from state to state.
But more to the point: you are the one who used 2000 data from other states, focusing on far fewer mandates. That’s nowhere close to intellectual honesty, Steve. (Never accused you of that, either.)
So, if you can find me some NC-specific data from the CBO and the GAO for 2006-2008, I’m happy to take that data and use it to my advantage. (I couldn’t find it, though it may be there.) But if it’s out there, I don’t think you’ll like what you find. Again: Bring it on.
When I Google “cost state health insurance mandates”, CAHI comes up first page. Again, their credibility rests on being accurate in their estimates. Now, how are you going to explain your way out of the genetic fallacy? I won’t hold my breath. Your silence on that lil pecadillo has already spoken volumes — and given me my answer.
Max…
You say “I’ll let my readers look at the CAHI data and decide whether it’s credible.”
Funny thing is, you didn’t provide any data for your readers to decide anything, at least until I asked you for it. How, exactly, were your readers going to judge the accuracy of your statement?
As I now know, you didn’t even understand the data when you wrote your original post or Turner’s tirade above. I had to point out to you there was no data specific to NC. You’re wrong about CAHI’s analysis of Virginia mandates, too. According to their own spreadsheet, Virginia’s are estimated to be greater.
I only quoted 2000 data because it was all I could find, and I provided the link to let the readers decide for themselves if it was accurate and to put it in its proper context.
To my knowledge, there is no specific data on NC, so any statements in this regard are guessing and should be acknowledged as such. In my opinion, the GAO and CBO studies seem to be the most relevant data from an objective source to try to document ACTUAL costs of mandates.
The burden of proof is on you, Max. You’re the one who made the claim (stated factually, without resources). I just questioned the validity of your resource and provided alternative resources with links so folks could decide for themselves.
Now I see Bob Orr is quoting mandate costs similar to yours, so I guess I’ll go ask him where he gets his figures.
In the initial post, I didn’t provide the source because I was in the heat of blogging. But since you wanted to know it, I gave it. Now, I don’t understand why it’s so hard for you to understand that Virginia could have more mandates and yet be less expensive. Mental health parity, for example, raises the costs much more than say five other mandates.
Curiously, now you’re referring to CAHI to prove me wrong on the VA’s costs? Either it’s valid or it ain’t, Steve. Besides, you say the burden of proof is on me to provide some evidence of the costs of NC mandates, which I did. And yet once you challenged the CAHI estimates the burden of proof fell on you to show that those estimates were inaccurate for some other reasons besides the vast right wing conspiracy — which – again – is fallacious.
That burden of proof is still on you. You are right in that there are no current mandate data specific to a NC (i.e. a NC mandate study). That would be a very valuable thing and I wish I had it, because ultimately I could show conclusively how much cost savings there would be if people were out from under the statist yoke. Alas, I must rest on cost estimates extrapolated over the whole US. Yet I don’t see how this is damaging to my underlying argument: that more people could afford to get insurance if there were fewer mandates. And this is the point you’ve willfully ignored whilst quibbling over CAHI’s data. And that’s why you lose, I’m afraid.
Nevermind that you haven’t found me any good alternative data — which I would welcome. (GAO, CBO, or otherwise — God forbid, George W. Bush may have had a hand in biasing these numbers!)
“I just questioned the validity of your resource..”
Actually, I believe you called him a liar.
“No, Brian and Max, I’m not interested in arguing with you.”
Posted by: Steve Turner | January 10, 2008 at 02:40 PM
“Nevermind that you haven’t found me any good alternative data…”
Actually, I provided to you documented mandate costs from three states with the GAO and CBO data.
You provided estimated ranges of costs of diverse services and benefits, extrapolated across the 50 states. All from a single source with a vested interest in the results. In my opinion, the actual data I provided cast doubt on the validity of CAHI’s estimates.
I’ll discuss mandates and your sources further in another post.
Hmmm, I don’t see any NC-specific data. Sorry, you just cannibalized your own argument. Do me the favor of >>linking<< these government data again. I seem to remember your dropping something about Virginia — which had percentages in the 20-some percent range. Not exactly helping you're case.
Post away. I look forward to fileting that one too.
“No, Brian and Max, I’m not interested in arguing with you.”
Posted by: Steve Turner | January 10, 2008 at 02:40 PM