Meanwhile, while you were Comeytose

While everyone in Washington is getting their Sam Ervin on, an inconvenient truth:

Aetna is saying goodbye to Obamacare.

The insurance giant announced Wednesday that it would not offer policies in Nebraska or Delaware next year, completing its exit from the exchanges. Earlier this year, Aetna (AET) said it would pull out of Iowa and Virginia in 2018.

The company said it expects to lose more than $200 million in its individual business line this year, on top of nearly $700 million in losses between 2014 and 2016. Aetna withdrew from 11 of its 15 markets for 2017. It has 255,000 Obamacare policyholders this year, down from 964,000 at the end of last year.

These customers, however, continue to be costlier than the company expected, Aetna said during its earnings call earlier this month. It had to set aside an additional $110 million to cover larger-than-projected losses for this year.

If you care to do that math, it means Aetna has lost over a billion dollars on the Obamacare exchange business. And other insurers face similar issues. Walter Russell Mead knows why:

American health care costs too much. Solving this problem isn’t just about litigating the merits of Obamacare or Trumpcare; it’s about ensuring that the American people have access to the health care they want and need while keeping the country solvent.

We can’t do this all at once by some mighty government fiat—or, for that matter, through a blind faith in private markets. It took two generations for us to work ourselves into our present mess, and it will take time to work our way back to a sane and sustainable system.

I would quibble with the term "blind faith," but we can set that aside. The Econ 101 issue of scarcity is not going away, but Mead has a few ideas that would help:

Some promising areas for future policy innovation include: regulatory reforms that encourage disruptive forms of health care delivery, tort reform that eliminates the distortions that “defensive medicine” imposes on the system, and efforts to “push competencies down”—with help from computer assisted diagnostics, for example, registered nurses (RNs) can do more things that only doctors could do well in the past, and licensed practical nurses (LPNs) can do things that used to require RNs.

To a large extent, this is already happening. A typical visit to a doctor's office usually means much more time spent with a nurse than with the doctor. My doctor spends more time in a typical visit with data entry than with conducting an actual examination, while the nurse does most of the heavy lifting. I'm supposed to be a human being, but for most of these transactions I'm just that, a transaction. If the majority of the work can be handled by an RN or LPN, that's how it will be handled. And documentation rules the terms of the transaction.

We can spend hours in the weeds on these issues. And we probably will.