I am allegedly a human being, and as such I am susceptible to cognitive bias. One of my safeguards against gaining too much confidence in my own mental abilities involves periodically comparing my predictions to actual events.

I will pause here to say I assume that I forget the bad predictions and remember the winners. That's how bias works. That's also why I do this publicly, so you can keep me honest. I'll tell you when I get one right from time to time, and I expect you to remind me of the ones I got terribly wrong.

I've been predicting for some time that healthcare spending was going to drop dramatically in our lifetime. This was a prediction based on the Adams Rule of Slow-Moving Disasters. The rule observes that whenever society recognizes far in advance a coming disaster, the disaster never materializes. That's partly because humans rise to the challenge and partly because we are bad at predicting the future.

In October I predicted that Obamacare (which looked like a slow-moving disaster) would turn out okay. It's premature to claim my prediction was right, but it's moving in the right direction.

Here's my blog prediction and here's an article on the unexpected slowing of healthcare spending.

When doctor-assisted suicide becomes legal in most states, healthcare costs could plunge again because medical expenses are disproportionately allocated to the last months of life that most of us would gladly do without.

Today's prediction is that doctor-assisted suicide will become legal in most of the United States in the near future. The battles over legal weed and gay marriage have proven that the majority of citizens are increasingly biased toward personal freedom and that the majority wins in the long run. And in this blog I've shown that when you ask the question right, nearly everyone is in favor of leaving government out of end-of-life medical decisions for loved ones. Liberals and conservatives agree on the wisdom of keeping government out of this sort of decision. (Some safeguards would be welcome though.)

The alternative to doctor-assisted suicide is a slow-moving disaster in which all of society's resources are increasingly redirected toward keeping seniors alive. That future won't happen. We'll figure it out.


Scott Adams

Co-founder of CalendarTree.com

Author of this book



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Jul 23, 2014
So the artist that makes fun of people that try to predict the future is using the government's predictions of future spending to say that the massive increase we experience last year will suddenly go down and stay down versus other fortune-telling predictions of doom? That's so sad that it's well beyond laughable and has reached the pathetic stage.
Jul 21, 2014

"We're already paying for the uninsured, high-risk and otherwise, because they end up going to emergency rooms." <-- false.

Emergency rooms only provide "treatable, emergent" conditions. If you have lung cancer, you don't get $100k in cancer treatments over the next year from the emergency room. In fact, virtually every "really expensive" problem is going to be denied you, because emergency rooms don't provide those. You can debate whether or not this is ethical, but you can't claim that we were already paying for it. We were not.
Jul 21, 2014
I wasn't attempting to analyze how socialized health care works in countries where people with money flee to other countries when they're sick (such as Canada and the UK). Apparently a study found that from the average time of referral by a GP to treatment across all specialties in Canada averaged 17.7 weeks. That's average, not outlying examples, and that's why I would tend to dismiss Canada as a country where socialized health care doesn't work very well.

Austria, per Wikipedia: The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Some individuals choose to completely pay for their care privately.

So... I don't have any personal experience with Austria (like I do with Scandinavian countries where socialized health care is awesome) and admittedly this source is "just wiki" and not a scholarly source, but my cursory effort to confirm your claim suggests that you're willing to make false statements to support your worldview.
Jul 21, 2014
Terrible, Scott.

You say you are attempting to avoid confirmation bias, but it was like a textbook of it.

An article dominated by the opinion of an Obama administration official trying to brag about a decline in health care spending that has not actually happened and to the degree that the rate of increase has slowed is first and most impacted by the slow economy (note that this slow down has also had a beneficial impacts on pollution and private debt! This is about the "Ill wind" effect not a positive." Did you read that the slowing rate of increase is due to the economy AND low interest rates (also the economy!).

I would love to be less depressed about the future of spending on various things (interest payments, health insurance, college educations and government itself are great examples!), but I am not going to get excited that impending total economic collapse has lowered our cost of anything.
Jul 19, 2014
There has been a lot of debate and pro/con arguments about Obamacare here, so I won't reiterate that. What I will talk about is Scott's analysis of his own predictions.

First, please recall that there are two issues with Obamacare, not one. The first is the cost of health care, while the second is the cost of health insurance. One needs to look at both to get a clear determination of what effects Obamacare is having.

Scott seems to believe that his prediction that health care spending would drop dramatically in our lifetime has somehow come true. I do not think that is correct.

Health care spending, as well as insurance costs, continues to rise. Insurance costs are predicted to increase dramatically once the new rates come out, so Scott appears to be wrong on that one. Healt care costs are still rising, albeit at a slower pace than in the previous decade or so. Rising at a slower pace is not the same as dramatically dropping, so again Scott appears to be incorrect. At least so far, but it's still rising enough for most people to say that his prediction has not come true.

Washington uses the same logic. They call a reduction in the rate of spending increase the same thing as a cut in spending. For those of you who don't know, the US federal government uses something called "zero-based budgeting."

Let me try to explain that simply. Washington uses an unreal projected inflation rates and population growth rate as the basis for setting the following year's budget. Let's say that the Federal Bureau of Booshwah (FBB), which is in charge of providing toilet paper to other federal agencies, had a budget of $10 billion last year.

The feds look in their crystal ball and say that the next year's budget for the FBB is going to be $12 billion, because bureaucrats are so full of . . . well, you get the idea. So along come the crusaders, who think federal spending is excessive. After much wailing and gnashing of teeth, the FBB's budget for next year is rolled back to $11.5 billion. Hooray.

Now, most people would agree that the FBB's budget has increased by $1.5 billion, for the simple reason that that, in fact, is what has happened. But not Washington. Oh, no. They will tell you that the budget has actually been CUT by $500,000,000 dollars. No, I'm not kidding. That's really what they say.

And you wonder why the national debt is over $17 trillion? And you also wonder why Scott believes his prediction is happening when in fact it is not? Confirmation bias, indeed.
Jul 18, 2014

"The people who sign up that previously didn't have health insurance are high risk. Insurance companies will be subsidized based on the risk of this group. Those subsidies will eventually go away and rates will go up. Whether the government subsidizes these people or rate go up, the result will be higher costs through taxes or others paying for the uninsured."

-- I challenge the claim that we're only adding high-risk patients. Do current employer-based plans exclude them on a mass basis? Also, I'd been able to hang onto my last job's plan via COBRA by paying $800 per month (with no other conditions besides mild high blood pressure); when that ended I'd be among the uncovered if it weren't for being able to buy via ACA.

-- We're already paying for the uninsured, high-risk and otherwise, because they end up going to emergency rooms. Also, sick or incapacitated people are a financial drag in workplaces and on the economy in general. Unless you're optimistically assuming packs of wolves will cull them from the population, getting these people into preventive care may well produce large net savings, like any other intelligent infrastructure investment.

-- Yes, rates will remain as high as the industry can get away with, and will spike when the subsidies end. But the major players will see their market share up for grabs, especially with rates so readily comparable. There will be some actual competition, something that effectively didn't exist before. And at the very least, a lot more of the population will have received basic maintenance and repair.

"Remember, the government doesn't have their own money, they have our money, so either way, we pay. The jury is still out on Obamacare, but it's proving it will be unsuccessful already. The government doesn't run efficient or effective business, and Obamacare will prove this again."

-- Remember, we were paying already. Not just to the government, but to an industry that was shafting both patients and actual health care providers while banking huge profits. It was neither efficient nor effective, but highly profitable to its masters.

-- Actually, the postal service was a very successful business and a powerful asset to the entire economy until political con artists required them to fund pension obligations 75 years out to create the illusion of failure. Does ANY business fund its obligations that far out?

-- Also, the government does many things at a "loss" to keep the economy and the country -- OUR economy and society -- viable. Does the government collect payment for, say, establishing and maintaining trade with foreign markets? Or claim up front a percentage of future income from children who grow up sufficiently healthy and literate? Many of the big fish who whine about taxes probably couldn't run a profitable enterprise in any other country, being totally dependent on the stability and (comparative) integrity of the American system.

"The criteria stated to have lower costs will have no impact on the cost of health care. And most importantly, the cost of health care has no correlation to the outcomes of improved health. See the world wide studies on costs versus health."

-- Please point to said studies. And if your point is high cost is NOT an indicator of public health, that kind of shoots the legs out from the case against health care reform. The tragedy of Obamacare is that is was designed on a right-wing model, protecting the toxic business model of the health care insurance industry.
Jul 18, 2014
RayKremer: [ As for the slowing of health care spending, that's pretty much because Obamacare has upended the system and right now a lot of people that need health care have trouble getting it. ]

And your evidence for this is...?

I'm not being snarky, I'm actually asking. I am certainly no fan of Obamacare, but we still need to dispassionately analyze the data. Your statement sounds more like what you want (or fear, if you like) to be happening. Some data that showed, for example, that wait times for access to doctors or hospitals has increased would go a long way toward your point.
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Jul 18, 2014
Doctor-assisted suicide in an insurance-based health care system?
That sounds interesting!
+4 Rank Up Rank Down
Jul 18, 2014
I thought we got to be robots or cyborgs or something with the internet or something! You're bumming me out, man.
+5 Rank Up Rank Down
Jul 18, 2014
While most of the nations that pay less than half the US cost per citizen are "guilty" of subsidizing medical education, I don't think you can call Canada and Great Britian "socialist." The only real difference between the economies of those nations and the US is the public health care system.
I think that only two nations in the industrialized world have citizen paid health care, the US and Austria. Austria btw has a very heavily regulated insurance market, where the insurance companies are required to cover certain things, and not allowed to discriminate against customers for pre-existing conditions.
When the Heritage Foundation was desperately looking for any alternative to "medicare for all," the only example of a functional health care system that wasn't "socialist," was Austria, and you will notice their plan (aka Romneycare, aka Obamacare) is heavily based on that system.
Notice I said functional system, the old US system was both disfunctional and doomed to collapse.
+10 Rank Up Rank Down
Jul 18, 2014

I don't think you understand how those socialist countries work. Healthcare isn't really a function of how they run health care, but of how they run their entire economy. I question whether it works in concept, as it seems to work very poorly in all but a few countries.

But let's look at those countries. Government pays for health care, and they pay what they consider a reasonable price. This is okay, because government owns the hospitals and sets reasonable prices on services by keeping their costs reasonable. They keep reasonable reasonable by being the ONLY EMPLOYER for doctors and other medical professionals. Doctors and other medical professionals accept this, because the government pays for their education, and they don't have any particular investment in their career. The government pays for college because they can control the costs of college by running the colleges. They manage costs by only permitting enough people to major in each field as they expect the economy to support -- since taxes fund education, you need to plan all education to generate an ROI in the tax base. So... you're not college bound, unless you can out-compete other people interested in college in the field you choose.

In a small Scandinavian country, literature might offer 5 spots this year. If that's where your interests lie, and you're not in the top 5 literary high school graduates, you don't get a college education, and you get to spend your life doing trade labor or something unskilled, and you have no real say in that matter. In fact, you're unlikely to start your own business because the economy is tightly structured and they limit that, and you won't have relevant education on how to run a business.

And that's largely why near-zero innovation or invention comes from those economies. Regardless of that point, there's a WHOLE LOT OF FUNDAMENTAL CHANGE that needs to happen in the USA to mimic the health care success of those countries. It's not a matter of government insurance.
Jul 17, 2014

that is math for the illiterate.

if I have 1 apple and I give it to you, then together we have 2 apples?

the basic ideology behind obamacare is to cover more people and it cost less $. ppl who buy into this ponzi scheme are f'ing retarded. not only is it more ppl/service, its a group who is highest risk/already suffering under a disease.

i'm sure some socialist moron can talk about capitalisms effect of decreasing cost as production volume increases. the problem with this is that its borrowing an effect of a paradigm that is driven by self-interest. obamacare is govt and big business interest. NOT PERSONAL. it won't work on masses, its mass effect won't engage.
+3 Rank Up Rank Down
Jul 17, 2014
I suspect US health care costs will go down when we start copying the systems that work better in other nations. Why do we pay over twice as much as the average of industrialized nations for care that ranks 37th?
Well, lets see, in "inefficient bureaucracy socialized health care systems," where the government pays about $3000 per citizen for health care, the focus is on preventation, and on MEDICINE.
In the "efficient, market based system," where a bureaucracy decides what care you get based on profit motive instead of what voters want, the government pays about $3000 per citizen for health care, the customer's employer pays about $3000 each for health care, and the customer pays about $1000 each for health care (total $7,000 per citizen). In this system costs are escalated by the following factors: Medical billing, health insurance overhead, billing based on what insurance will pay for, and often avoiding preventative care (I'm not saying that folks who have insurance avoid it, but the folks without insurance can't afford a doctor until they qualify for ER coverage).
Obamacare, by reducing the number of folks who don't have insurance by 25%, will probably slowly reduce that last inefficiency by 25% (it will start lower, but once the folks who are poor learn that they can get the sore or twisted ankle treated when it first hurts instead of when it hurts to much to ignore, costs will go down).
Unfortunatly, as long as we keep folks like Aetna (administrative cost 20%) as well as Medicare (administrative cost 3%) we will have higher costs.
Of course, we could just legislate that only insurance companies that keep administrative costs below 10% are allowed to offer insurance...grin.
Jul 17, 2014
"That doesn't qualify as a slow moving disaster that WE ALL see coming."

Agreed, not everyone or even most, agree on that. I was just attempting to clarify some tough to process writing style.

@Scott You're an adopted silicon valley nerd; set up a reply option on these comments! It's rather ridiculous the way the comments are left unsorted, even your replies look like nothing more than an administrative edit to an existing comment.
Jul 17, 2014

Isn't climate change the ultimate slow-moving disaster?
+5 Rank Up Rank Down
Jul 17, 2014
Or it could be that healthcare spending is slowing because it's becoming increasingly expensive.
If you can't afford it, you won't buy it.
Jul 17, 2014
Nice rant, but how did Ayn Rand get in there? It sounds like you haven't read much, if any, of Ayn Rand's own writing ...
Jul 17, 2014

[Hitler was a slow-moving disaster that happened.]

But he wasn't a slow moving disaster that people foresaw.

[One could also argue that Hitler WAS stopped early in the unfolding disaster process, and at relatively low cost compared to a scenario in which he continued grinding up other countries. -- Scott]
Jul 17, 2014
Hitler was a slow-moving disaster that happened.

I am not too impressed by this theory that slow-moving disasters do not materialise. I doubt if it will stand up to any sort of rigorous statistical analysis. Even assuming it were true earlier, in the last couple of hundred years, democratic governments have usually failed to act until there was a fire on the platform. It is only after things have reached an unbearable extreme that democratic leaders have perforce had to act. I'm not really judging the leadership quality - this is just the nature of democracy.
+5 Rank Up Rank Down
Jul 17, 2014
So many errors exposing your bias (yes, I have my bias, too).

As Drowlord explains, it's only FEDERAL GOVERNMENT spending being discussed, not what we're spending total.

And it's not "slowing" it's accelerating -- albeit less than previously projected. Big difference.

The article focuses on the CBO's lower projections without exploring the source of them. CBO looks at existing law, even when we know it won't last. For example, if the law says that we're cutting doctors reimbursements by 25% immediately after the next election, then that's what projections will show. But EVERY YEAR they vote to put off such cuts and always will (Google "doc fix"). It makes the budget look good even though we know we'll spend more.

Plenty of sources point to much higher real spending:
Or look at Drowlords below, or just Google it.

The CBO saying that according to the law as it currently stands, FEDERAL spending will GROW less than they previously projected... is very misleading.
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