MaxedOutMama
Wednesday, September 16, 2009
Democrats ARE Stupid (on Healthcare)
This is driving me nearly nuts, but I am laughing at the same time.
First we've got the wild claims that anyone who is not for Obama's healthcare plan is racist. Shrinkwrapped gives an explanation, which may well be true, because according to this Rasmussen poll only about 12% of voters really think most the opposition is racist.
In the meantime, this raft of racism accusations are beginning to frazzle some Obama voters. Ann Althouse seems to be in the frazzled group, observing that a president that we are not allowed to criticize is "revolting". Any moment now the woman will be photographed wandering around waving teabags, wearing a "Don't Tread On Me" t-shirt and brandishing a rifle. This is what happens when you marry a guy who works for a living and suddenly spend a lot of time outdoors.
Now we move on to the ?racists? at DU, who are completely horrified at Baucus' plan. They do not want mandated coverage. They mostly want universal health care, but they generally do not want to pay for universal health care. They want it free, or for maybe 5% of their incomes. Or maybe Warren Buffett should pay for most of it, and Bill Gates should cover most of the rest.
Here's a DU thread that asks people if they would pay 13% of their incomes in order to get on Medicare:
Okay, but some people are a little more clued in, and realize this isn't going to be a bad deal:
Germany's current system is transitioning to a central fund, and the ongoing payroll tax is supposed to be close to 16%. We couldn't possibly do it for less, and in fact it would cost more. For one thing, we'd definitely have to raise a lot of Medicare reimbursement rates. Plus, Medicare is 80/20 coverage, with a premium of about $100 monthly and another premium of about $30 monthly for partial prescription coverage. It costs hundreds more a month if you want expanded coverage over that. Also, 75% of SMI is paid for through general tax revenues, so it would be more like a 20% payroll tax. Right now less than 1/6th of the population is covered by Medicare, so obviously it will cost a great deal to add everyone to Medicare.
The bottom line is that most people don't want to pay more than they are paying now, so the only people really supporting the universal coverage stuff are those who don't realize what it will cost or who are already paying more now.
Under these circumstances, it is unlikely that reform will succeed, because the end result is that the Ann Althouse bracket is going to wind up paying considerably more for their coverage than they do now, either in the form of premiums, or in the form of much higher income taxes.
Actually, the single-payer payroll tax would be much fairer than the proposed system. For example, under the proposed system illegal aliens still get covered but basically don't have to pay. They can't get fined, either. And if they don't have insurance and show up at an emergency room, they will get treated anyway, because that is what the law requires. If it's funded through a straight payroll tax, they'll be paying what they can afford to pay, like everyone else.
Does everyone understand how Medicare is funded? It is completely busted. This is the 2009 full report on Medicare (pdf, 245 pages). If you don't understand, go to page 11 of this file.
Part A (hospital insurance) is paid for by a wage tax of 2.9%. There is no limit on the wages. If you earn 2 million, you pay the 2.9% on all 2 million. In 2008 that payroll tax brought in 198.7 billion. Other payments were taxation of benefits (11.7 billion plus premiums of 2.9 billion for non-qualified retirees). Benefits cost 235.6 billion. The general fund (income taxes) had to pay for the difference which was about 16 billion. Every year that gap will grow.
Parts B and D physican, outpatient and partial drug coverage(or part C, which replaces them, also known as SMI) are supposed to be funded about 25% by enrollee payments and 75% by the general fund (income tax). In 2008, total premiums were 50.2 billion for part B (that about $100 premium paid each month) and 5.0 billion for part D. States paid 7.1 billion, and the general fund paid 146.8 for Part B and 37.3 billion for Part D.
So, total Medicare costs were about 468 billion, and the share paid by income tax was about 200 billion and the share paid by Medicare payroll tax was about 200 billion. .
In 2008, about 45 million people were enrolled. Long term disability recipients also receive Medicare - slightly less than 38 million people were retirees. Total cost per enrollee was about $11,000. Mind you, this is for 80/20 coverage and partial drug coverage only. Most retirees pay additional premiums to cover other expenses, or they pay those expenses out of pocket.
What would it cost to extend Medicare to everyone?
The US population is around 300 million people. Younger people are cheaper, but many of the individuals in their 50s or 60s are not, and Medicaid recipients are often pretty expensive. There are also high costs in maternity, and sick infants can be incredibly expensive. Let's say the average cost per younger enrollee was $6,000 a year. (The average employer plan is well over 10K a year now for a family, so we are not far off, because these are the healthier persons on average).
That is still over 250 million new enrollees, or 250,000,000. 250 * 6,000 = 1,500,000 million, or $1,500,000,000,000. That is an additional cost of 1.5 trillion. Now if you add 1.5 trillion plus .47 trillion ( the 468 billion cost for the current recipients), you get 1.97 trillion. Q2 09 annualized GDP was around 14.2 trillion, so we are looking at about 13.8% of GDP for insurance costs, but the average recipient would be paying considerable dollars out of his or her own pocket (over $1,200 in SMI, plus drug costs, plus the 20% that Medicare doesn't pay. So we are right back at 16-17% of GDP, which ought to clue everyone in right away that universal coverage is not going to lower our medical costs. You can forget about that. It's complete BS.
Mind you, as our population increases the average cost per person increases, so we would expect the percent of GDP to move higher.
The next question is how much would this cost per person who was paying? Obviously you are not going to be charging the children, although they would be covered. Therefore you are somehow going to get it out of payroll (wage tax) or income taxes. Sooooo, the easiest way is to induce the wage tax percentages from the current costs.
In 2008 a wage tax of 2.9% brought in about 199 billion, total premiums for SMI were about 55 billion, and the balance (468 billion - 255 billion) was about 213 billion. The balance came from the general fund, i.e. income taxes. We need to raise another (gasp) 1.5 trillion in revenue, but remember, most employers are paying a lot for insurance now, so it is not as bad as it sounds. Also, we can take back somewhere around 300 billion that is spent on Medicaid, so that helps; it brings it down to 1.2 trillion. There are about 150 million workers. If each of them paid $100 a month in premiums, that is $1,200 a year * 150 million or 180,000,000,000 or 180 billion. Plus we are going to charge maybe another 18 billion for the drug coverage, so that takes us to 198 billion. Let's call it 200 billion. Okay, we are are still looking for 1 trillion.
Now here Richard Cohen, who does not dilly-dally with algebra and who believes writing is the highest form of reasoning, would be flat stumped and resort to writing a column on racism to demonstrate his complete lack of confusion and overall intellectual superiority. (I like Cohen, but I don't understand how one survives without fractions and percentages. How do you even figure out which food container is cheaper, or whether a sale is a good deal?) One suspects that the same process produced the string of Salon articles mourning our collective racism. But we, the cretinous racist math nerds causing Salon so much angst (and epistemological confusion, because so many of us are people who are not Caucasian), are not stumped.
If 2.9% of X wages brought in 200 billion, and 200 billion is one-fifth (20%) of 1 trillion, we redneck gun and slide-rule toting racists know that 5*2.9% in wage taxes is going to net us a trillion. We be brilliant! We can even multiply 2.9 * 5 to get 14.5%, which means our new, universal Medicare wage tax will be 14.5% plus 2.9% or 17.4%. Hokey dokey. If half is paid by the employer, and half is paid by the employee, the new Medicare tax is going to be 8.7% or thereabouts.
Here is where we truly begin to grasp the reason for all of the confusion. We know that the government would be quite happy to get their hands on this extra trillion, but they have so many brilliant plans for it, and yet the cretinous racist math nerds of the nation are going to expect medical care. That alone is reason to obfuscate the issue. And then there is the problem that professors earning 100K and upwards a year would be paying considerably more for less benefits. 8.7K annually plus a $100 monthly premium for 80/20 coverage would be a real comedown for so many higher-paid workers. The employer share would not be a problem, because the employer is probably paying that or more already.
Nonetheless, at this point one begins to suspect that Ann Althouse can handle percents and kind of has already guessed this, and therefore finds the healthcare bills truly confusing and not very inviting, because of course she is going to wind up paying for this.
And then there is another problem, which brings us back to the Shrink's post on McGovern's idiotic proposal to just open up Medicare to everyone. As SW writes:
We are not gonna drown the old people. We are going to pay the doctors. If we are not willing to pay for universal coverage, we are not willing to do it. We should find another way to improve the system, but regardless, we are going to be paying higher tax rates because as the retiree/worker benefit enlarges, the share of costs shifted to the private sector will have to drop and we will be paying relatively more for each retiree as well as having more retirees.
The estimate in the Trustees report is that the 2.9% payroll tax needs to go to 3.88% to cover the HI deficit. We will have to raise premiums to cover the SMI deficit, and make the premium structure even more progressive than it is now. It's doable. And we will have to constrain costs somewhat, but we aren't going to be able to take it out of the doctors' pockets. They're pretty much down to their underwear already.
First we've got the wild claims that anyone who is not for Obama's healthcare plan is racist. Shrinkwrapped gives an explanation, which may well be true, because according to this Rasmussen poll only about 12% of voters really think most the opposition is racist.
In the meantime, this raft of racism accusations are beginning to frazzle some Obama voters. Ann Althouse seems to be in the frazzled group, observing that a president that we are not allowed to criticize is "revolting". Any moment now the woman will be photographed wandering around waving teabags, wearing a "Don't Tread On Me" t-shirt and brandishing a rifle. This is what happens when you marry a guy who works for a living and suddenly spend a lot of time outdoors.
Now we move on to the ?racists? at DU, who are completely horrified at Baucus' plan. They do not want mandated coverage. They mostly want universal health care, but they generally do not want to pay for universal health care. They want it free, or for maybe 5% of their incomes. Or maybe Warren Buffett should pay for most of it, and Bill Gates should cover most of the rest.
Here's a DU thread that asks people if they would pay 13% of their incomes in order to get on Medicare:
66. As a singe person with no dependents, I have paid almost nothing at most employers during my career.Some people are just so clueless that they have never understood any of this. Here's one:
The employer has paid the whole premium for the employee, and then the employee pays for dependents. Or I have paid a small amount, like up to $60 a month for one employer. 13% would come out to about $540 a month (if you take it out of the gross pay). That woud be a HUGE bill to suddenly have when I have been used to paying much less or nothing. So, I would repeat what others have asked... would this be assuming the employer will pass on the savings to me, so whatever was being paid toward my benefit I can now turn around and put toward that 13%? If not, then I would probably have to sell my house, because I can't afford a new $540 per month bill.
10. Isn't it like 2% now? A 600% increase seems a tad steep.Some persons just seem confused about percents:
18. Let's assume for the moment that you don't have health care through your company. That's the situation for a lot of small business owners and their employees, not to mention independent contractors (construction to software)....
Your take home pay (after federal and state and local taxes) is likely $3500 a month, so we are talking about 1/4 of the after tax income. That's what most people in that income range will pay for rent or the mortgage ( they might be at, say $1200/month for that). Combined, it would take over half of their income, leaving $1500 a month for utilities, car payment, gas, car insurance, clothing, and food.
73. No my employer pays 100% of my insurance premium. I pay 10% of my bills up to a yearly maximum of $1000.Another set of posters still think they are in an anti-Vietnam march, chanting "Hell no, I won't go".
76. Hell no. Insurance is a lot cheaper.No one can convince this last person that in fact a payroll tax is a progressive system - right now, with employer-funded healthcare, the employer is basically paying the same for everyone as a cost of employment, which is the same as wages to the employer. Therefore, the low-income person relatively pays more. The attempt to explain is made, but fails.
...
78. I guess they'll do anything not to disturb the rich...Fuck No ! I won't pay.
...
39. It would not be 13% if paid for under a progressive tax system
Yet another benefit of tax-funded single payer.
Okay, but some people are a little more clued in, and realize this isn't going to be a bad deal:
32. In a heartbeat!Unfortunately, these people are a minority, and then some have other problems (as explained by SW):
Right now, I'm paying about 18% for a catastrophic policy.
...
36. Yes. My husband would probably end up with an increase in pay
Right now my husband's share of our health insurance is about 7% of his monthly income. I am sure that his employer pays a far higher percentage of his wages per month for their share. If the employer's share were part of my husband's income, 13% for Medicare would likely give him a net increase in take home pay.
When he paid into COBRA in 2002 while between jobs and while not covered with one job, the monthly payment was 50% of his previous take home. I don't even want to think what COBRA would cost these days. Probably more than he'd get from unemployment.
We would not have to worry about that if we were covered by Medicare. No worry about losing coverage between jobs, or paying massive amounts for COBRA, or being denied coverage, or being turned down for a job because of his age and how that would increase the insurance payments for the company.
31. I think Medicare is not accepted by my doctors.Well, you will be alive, unless you pick your roommate unwisely, but I guess this person has already made the choice. It's no.
so no.
...
37. Same here
Our docs don't take Medicare, Medicaid or TriCare
...
62. Wow! Do these people have any idea how hard it is to survive
on low paying jobs that don't qualify for any assistance? I work as a nurse aide. Government says I make too much money to qualify for a grant towards furthering my education. In fact, on my job the healthcare cost way too much for me to afford.... about the 13% we're talking about. I had to choose between healthcare or an apartment to live in. I choose not to be homeless. The plan my employer has is with Grouphealth... a co-op! Now they want to take that choice away from me a force me to either take on a roommate or take to the streets? What the hell kind of choice is that?
Germany's current system is transitioning to a central fund, and the ongoing payroll tax is supposed to be close to 16%. We couldn't possibly do it for less, and in fact it would cost more. For one thing, we'd definitely have to raise a lot of Medicare reimbursement rates. Plus, Medicare is 80/20 coverage, with a premium of about $100 monthly and another premium of about $30 monthly for partial prescription coverage. It costs hundreds more a month if you want expanded coverage over that. Also, 75% of SMI is paid for through general tax revenues, so it would be more like a 20% payroll tax. Right now less than 1/6th of the population is covered by Medicare, so obviously it will cost a great deal to add everyone to Medicare.
The bottom line is that most people don't want to pay more than they are paying now, so the only people really supporting the universal coverage stuff are those who don't realize what it will cost or who are already paying more now.
Under these circumstances, it is unlikely that reform will succeed, because the end result is that the Ann Althouse bracket is going to wind up paying considerably more for their coverage than they do now, either in the form of premiums, or in the form of much higher income taxes.
Actually, the single-payer payroll tax would be much fairer than the proposed system. For example, under the proposed system illegal aliens still get covered but basically don't have to pay. They can't get fined, either. And if they don't have insurance and show up at an emergency room, they will get treated anyway, because that is what the law requires. If it's funded through a straight payroll tax, they'll be paying what they can afford to pay, like everyone else.
Does everyone understand how Medicare is funded? It is completely busted. This is the 2009 full report on Medicare (pdf, 245 pages). If you don't understand, go to page 11 of this file.
Part A (hospital insurance) is paid for by a wage tax of 2.9%. There is no limit on the wages. If you earn 2 million, you pay the 2.9% on all 2 million. In 2008 that payroll tax brought in 198.7 billion. Other payments were taxation of benefits (11.7 billion plus premiums of 2.9 billion for non-qualified retirees). Benefits cost 235.6 billion. The general fund (income taxes) had to pay for the difference which was about 16 billion. Every year that gap will grow.
Parts B and D physican, outpatient and partial drug coverage(or part C, which replaces them, also known as SMI) are supposed to be funded about 25% by enrollee payments and 75% by the general fund (income tax). In 2008, total premiums were 50.2 billion for part B (that about $100 premium paid each month) and 5.0 billion for part D. States paid 7.1 billion, and the general fund paid 146.8 for Part B and 37.3 billion for Part D.
So, total Medicare costs were about 468 billion, and the share paid by income tax was about 200 billion and the share paid by Medicare payroll tax was about 200 billion. .
In 2008, about 45 million people were enrolled. Long term disability recipients also receive Medicare - slightly less than 38 million people were retirees. Total cost per enrollee was about $11,000. Mind you, this is for 80/20 coverage and partial drug coverage only. Most retirees pay additional premiums to cover other expenses, or they pay those expenses out of pocket.
What would it cost to extend Medicare to everyone?
The US population is around 300 million people. Younger people are cheaper, but many of the individuals in their 50s or 60s are not, and Medicaid recipients are often pretty expensive. There are also high costs in maternity, and sick infants can be incredibly expensive. Let's say the average cost per younger enrollee was $6,000 a year. (The average employer plan is well over 10K a year now for a family, so we are not far off, because these are the healthier persons on average).
That is still over 250 million new enrollees, or 250,000,000. 250 * 6,000 = 1,500,000 million, or $1,500,000,000,000. That is an additional cost of 1.5 trillion. Now if you add 1.5 trillion plus .47 trillion ( the 468 billion cost for the current recipients), you get 1.97 trillion. Q2 09 annualized GDP was around 14.2 trillion, so we are looking at about 13.8% of GDP for insurance costs, but the average recipient would be paying considerable dollars out of his or her own pocket (over $1,200 in SMI, plus drug costs, plus the 20% that Medicare doesn't pay. So we are right back at 16-17% of GDP, which ought to clue everyone in right away that universal coverage is not going to lower our medical costs. You can forget about that. It's complete BS.
Mind you, as our population increases the average cost per person increases, so we would expect the percent of GDP to move higher.
The next question is how much would this cost per person who was paying? Obviously you are not going to be charging the children, although they would be covered. Therefore you are somehow going to get it out of payroll (wage tax) or income taxes. Sooooo, the easiest way is to induce the wage tax percentages from the current costs.
In 2008 a wage tax of 2.9% brought in about 199 billion, total premiums for SMI were about 55 billion, and the balance (468 billion - 255 billion) was about 213 billion. The balance came from the general fund, i.e. income taxes. We need to raise another (gasp) 1.5 trillion in revenue, but remember, most employers are paying a lot for insurance now, so it is not as bad as it sounds. Also, we can take back somewhere around 300 billion that is spent on Medicaid, so that helps; it brings it down to 1.2 trillion. There are about 150 million workers. If each of them paid $100 a month in premiums, that is $1,200 a year * 150 million or 180,000,000,000 or 180 billion. Plus we are going to charge maybe another 18 billion for the drug coverage, so that takes us to 198 billion. Let's call it 200 billion. Okay, we are are still looking for 1 trillion.
Now here Richard Cohen, who does not dilly-dally with algebra and who believes writing is the highest form of reasoning, would be flat stumped and resort to writing a column on racism to demonstrate his complete lack of confusion and overall intellectual superiority. (I like Cohen, but I don't understand how one survives without fractions and percentages. How do you even figure out which food container is cheaper, or whether a sale is a good deal?) One suspects that the same process produced the string of Salon articles mourning our collective racism. But we, the cretinous racist math nerds causing Salon so much angst (and epistemological confusion, because so many of us are people who are not Caucasian), are not stumped.
If 2.9% of X wages brought in 200 billion, and 200 billion is one-fifth (20%) of 1 trillion, we redneck gun and slide-rule toting racists know that 5*2.9% in wage taxes is going to net us a trillion. We be brilliant! We can even multiply 2.9 * 5 to get 14.5%, which means our new, universal Medicare wage tax will be 14.5% plus 2.9% or 17.4%. Hokey dokey. If half is paid by the employer, and half is paid by the employee, the new Medicare tax is going to be 8.7% or thereabouts.
Here is where we truly begin to grasp the reason for all of the confusion. We know that the government would be quite happy to get their hands on this extra trillion, but they have so many brilliant plans for it, and yet the cretinous racist math nerds of the nation are going to expect medical care. That alone is reason to obfuscate the issue. And then there is the problem that professors earning 100K and upwards a year would be paying considerably more for less benefits. 8.7K annually plus a $100 monthly premium for 80/20 coverage would be a real comedown for so many higher-paid workers. The employer share would not be a problem, because the employer is probably paying that or more already.
Nonetheless, at this point one begins to suspect that Ann Althouse can handle percents and kind of has already guessed this, and therefore finds the healthcare bills truly confusing and not very inviting, because of course she is going to wind up paying for this.
And then there is another problem, which brings us back to the Shrink's post on McGovern's idiotic proposal to just open up Medicare to everyone. As SW writes:
Yesterday George McGovern solved the healthcare crisis, obviated the need for any further debate, and simplified the entire problem to one line:So we are going to be raising Medicare provider premiums (if we want to see doctors and have actual hospitals). Perhaps I have enough in my 6K premium per new enrollee to cover it. Perhaps not. I suspect not, after reading the full 2009 Medicare Trustees report linked above. From the introduction:
It's Simple: Medicare for AllWhy didn't I think of that? How obvious, take all that money being wasted on insurance company profits, do away with the middlemen, and "voila," problem solved. Perhaps because Senator McGovern does not work in the Medical field or think too deeply about what he is writing about, such a simple and obvious solution seems plausible. A few points that the good Senator misses should be incorporated into his thinking since the details make all the difference.
First, and most obvious, Medicare is going broke. The current set-up is unsustainable. If we extend it to everyone, it will go broke more quickly. However that is really the least of the problems with the idea. The fact is that the only reason Medicare works for most people over 65 is because private insurance, private payers, and private Doctors all offer the Medicare recipients a hidden subsidy.
The SMI trust fund is adequately financed over the next 10 years and beyond because premium and general revenue income for Parts B and D are reset each year to match expected costs. However, further Congressional overrides of scheduled physician fee reductions, together with an existing “hold harmless” provision restricting premium increases for most beneficiaries, could jeopardize Part B solvency and require unusual measures to avoid asset depletion. Part B costs have been increasing rapidly, having averaged 7.8 percent annual growth over the last 5 years, and are likely to continue doing so. Under current law, an average annual growth rate of 5.5 percent is projected for the next 5 years. This rate is unrealistically constrained due to multiple years of physician fee reductions that would occur under current law, including a scheduled reduction of 21.5 percent for 2010. If Congress continues to override these reductions, as they have for 2003 through 2009, the Part B growth rate would instead average roughly 8.5 to 9.0 percent. For Part D, the average annual increase in expenditures is estimated to be 11.1 percent through 2018.In any case, we already know that people just don't want to pay even 13% of their incomes, so it is clear there is not really popular support for this measure. This was an exercise in futility.
We are not gonna drown the old people. We are going to pay the doctors. If we are not willing to pay for universal coverage, we are not willing to do it. We should find another way to improve the system, but regardless, we are going to be paying higher tax rates because as the retiree/worker benefit enlarges, the share of costs shifted to the private sector will have to drop and we will be paying relatively more for each retiree as well as having more retirees.
The estimate in the Trustees report is that the 2.9% payroll tax needs to go to 3.88% to cover the HI deficit. We will have to raise premiums to cover the SMI deficit, and make the premium structure even more progressive than it is now. It's doable. And we will have to constrain costs somewhat, but we aren't going to be able to take it out of the doctors' pockets. They're pretty much down to their underwear already.
Comments:
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Haha! Joe Klein weighs in on the race thing:
My sense of the teabaggers is more complicated: they are primarily working-class, largely rural and elderly white people. They are freaked by the economy. They are also freaked by the government spending--TARP, the stimulus package etc.--that was necessary to avoid a financial collapse. (I'm not sure Keynes is taught in very many American high schools.) But most of all, they are freaked by an amorphous feeling that they America they imagined they were living in--Sarah Palin's fantasy America--is a different place now, changing for the worse, overrun by furriners of all sorts: Latinos, South Asians, East Asians, homosexuals...to say nothing of liberated, uppity blacks.
Nothing like a party apparatus that decides to commit suicide.
My sense of the teabaggers is more complicated: they are primarily working-class, largely rural and elderly white people. They are freaked by the economy. They are also freaked by the government spending--TARP, the stimulus package etc.--that was necessary to avoid a financial collapse. (I'm not sure Keynes is taught in very many American high schools.) But most of all, they are freaked by an amorphous feeling that they America they imagined they were living in--Sarah Palin's fantasy America--is a different place now, changing for the worse, overrun by furriners of all sorts: Latinos, South Asians, East Asians, homosexuals...to say nothing of liberated, uppity blacks.
Nothing like a party apparatus that decides to commit suicide.
Thanks for a very illuminating post. I haven't been following the health care debate very closely. Obviously, promising to extend coverage is not revenue neutral. I mean, seriously.
Ignoring that for a second, what we seem to have in Medicare is an unsustainable system of transferring wealth to the elderly in the form of subsidies for health care. Your quote: "regardless, we are going to be paying higher tax rates because as the retiree/worker benefit enlarges, the share of costs shifted to the private sector will have to drop and we will be paying relatively more for each retiree as well as having more retirees" hits the nail on the head.
So, what are our options to deal with this?
* cut medicare benefits
* raise taxes
* pay doctors less for existing treatments
* increase the efficiency of the system
#4 is the one everyone loooves to talk about, but it's hard to imagine innovations being enough to save us. We could use some re-aligning of incentives, though (I shop around a lot more now that I pay for my own health insurance). It really needs to be a combination of #1 and #2, perhaps with a bit of #3 mixed in (depending on the situation).
Now, back to insurance for those of us not eligible for medicare.
First off, I really like this link about why health care is not a normal good like bread or gas: http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/
Government is supposed to be a purveyor of social goods, that is things that we all want, but won't pay for out of pocket (or that it is not efficient to pay out of pocket for). Things like defense, roads, etc.
I don't think that health care is a right, any more than roads are. ("I have the right to drive" just sounds comical.) But I do believe that some basic level of health care is a common good, like providing a transportation network, that will benefit the country.
Personally, I'm willing to pay for it, just like I'm willing to pay for roads. Right now, I pay about 10% of my income for health care (catastrophic policy, relatively healthy single male in my 30s). I don't expect my monetary costs to go down under a new system, but I do hope the expenditures of my time will go down (in terms of fighting with insurance companies to get coverage as outlined in the policy, and in terms of choosing a policy).
This is the tack I wish the Dems had taken--basic health care will be a societal benefit. Again, we as a society are willing to pay for common goods, like roads, defense, food inspections, etc. Why not (basic!) health care for everyone. I think a dual system like what Australia has would be preferable. http://en.wikipedia.org/wiki/Health_care_in_Australia
(I guess in a way we have basic health care for all with ERs, but I'd prefer to bring those costs out in the open.)
Again, thanks for blogging--your posts are always interesting.
Dan
Ignoring that for a second, what we seem to have in Medicare is an unsustainable system of transferring wealth to the elderly in the form of subsidies for health care. Your quote: "regardless, we are going to be paying higher tax rates because as the retiree/worker benefit enlarges, the share of costs shifted to the private sector will have to drop and we will be paying relatively more for each retiree as well as having more retirees" hits the nail on the head.
So, what are our options to deal with this?
* cut medicare benefits
* raise taxes
* pay doctors less for existing treatments
* increase the efficiency of the system
#4 is the one everyone loooves to talk about, but it's hard to imagine innovations being enough to save us. We could use some re-aligning of incentives, though (I shop around a lot more now that I pay for my own health insurance). It really needs to be a combination of #1 and #2, perhaps with a bit of #3 mixed in (depending on the situation).
Now, back to insurance for those of us not eligible for medicare.
First off, I really like this link about why health care is not a normal good like bread or gas: http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/
Government is supposed to be a purveyor of social goods, that is things that we all want, but won't pay for out of pocket (or that it is not efficient to pay out of pocket for). Things like defense, roads, etc.
I don't think that health care is a right, any more than roads are. ("I have the right to drive" just sounds comical.) But I do believe that some basic level of health care is a common good, like providing a transportation network, that will benefit the country.
Personally, I'm willing to pay for it, just like I'm willing to pay for roads. Right now, I pay about 10% of my income for health care (catastrophic policy, relatively healthy single male in my 30s). I don't expect my monetary costs to go down under a new system, but I do hope the expenditures of my time will go down (in terms of fighting with insurance companies to get coverage as outlined in the policy, and in terms of choosing a policy).
This is the tack I wish the Dems had taken--basic health care will be a societal benefit. Again, we as a society are willing to pay for common goods, like roads, defense, food inspections, etc. Why not (basic!) health care for everyone. I think a dual system like what Australia has would be preferable. http://en.wikipedia.org/wiki/Health_care_in_Australia
(I guess in a way we have basic health care for all with ERs, but I'd prefer to bring those costs out in the open.)
Again, thanks for blogging--your posts are always interesting.
Dan
# posted by 
: 10:47 AM
: 10:47 AM
All I can tell is that everyone wants to create more
demand for health care. Would it not be better to
create more supply of health care ?
demand for health care. Would it not be better to
create more supply of health care ?
# posted by : 2:54 PM
: 2:54 PM
None of the doctors or dentists I know are hurting and most wear silk underwear. I will not cry if their salaries are constrained by the new health care paradigm. Of course as your slide rule told you, the people without health care will not be able to pay....that's why someone must. Either subsidize care at the emergency room or pay up front through taxes. The govt (through educational subsidies) could flood the market with cheap medical providers, but the health lobbyists, educational organizations, and associations make sure that doesn't happen. The answer I guess is to put a sign out front of each hospital that says: Shut and pay for your medical care or just die already.
I would enjoy hearing the calculus of your enlightened solution?
I would enjoy hearing the calculus of your enlightened solution?
# posted by : 4:06 PM
: 4:06 PM
I love the math. Now run that tax hike into the loop and see what it does to consumer spending and the economy.
Answer? Deflationary Depression.
I like not having any W2 income. No 2.9% Medicare tax on Capital Gains.
Answer? Deflationary Depression.
I like not having any W2 income. No 2.9% Medicare tax on Capital Gains.
CF - that's it exactly. That's why so many are looking at this and saying no. On an individual basis, they know it would disrupt their lives.
My guess is that about 10% of the midline age group with incomes above 100K would lose their homes.
This is why the failure to take the numbers seriously is so fatal to real reform.
And then there's reality. There is no way that senators and representatives are going to vote to subject themselves to this kind of a tax load. That is why we are getting this strange mishmash of public/private/mandated with the fudge factors thrown in.
The money it costs is going to be the money it costs.
My guess is that about 10% of the midline age group with incomes above 100K would lose their homes.
This is why the failure to take the numbers seriously is so fatal to real reform.
And then there's reality. There is no way that senators and representatives are going to vote to subject themselves to this kind of a tax load. That is why we are getting this strange mishmash of public/private/mandated with the fudge factors thrown in.
The money it costs is going to be the money it costs.
>>>As a singe person with no dependents, I have paid almost nothing at most employers during my career.
Not quite. Its the old "broken window" fallacy again.
If your employer weren't paying for your health insurance (which it was), then instead it could have given you that same amount of money in increased wages/salary.
So there was a "cost" to you. . .you just weren't aware of it. Had your employer not been buying you health insurance, you would have earned more money all those years.
Now, if the tax incentive structure for healthcare were changed, such that employee-sponsored healthcare plans weren't given tax advantage in comparison to non-employer sponsored plans, then you probably WOULD get that extra money in pay, and you could have the choice to pick whichever insurance plan you liked.
Not quite. Its the old "broken window" fallacy again.
If your employer weren't paying for your health insurance (which it was), then instead it could have given you that same amount of money in increased wages/salary.
So there was a "cost" to you. . .you just weren't aware of it. Had your employer not been buying you health insurance, you would have earned more money all those years.
Now, if the tax incentive structure for healthcare were changed, such that employee-sponsored healthcare plans weren't given tax advantage in comparison to non-employer sponsored plans, then you probably WOULD get that extra money in pay, and you could have the choice to pick whichever insurance plan you liked.
# posted by : 9:26 AM
: 9:26 AM
>>>None of the doctors or dentists I know are hurting and most wear silk underwear.
I'm guessing you don't know a lot of doctors.
While "hurting" is a relative term (eg if you have a home and a job in this economy, you're doing OK), doctors HAVE been seeing pay cuts both in absolute terms and in relative terms compared to prior years, and this is true for many specialties.
Surgeons, internal medicine docs, etc are earning less today then they did ten years ago. Its a combination of higher expenses and lower reimbursement.
Next issue, and more important than this one, physician pay is really only a relatively small part of the overall cost of healthcare.
Sure doctors get paid, but so do nurses, lab techs, pharmacists, phlebotomists, secretaries, transcriptionists, hospital administration, etc. Medical costs include physician reimbursement, but they also include expensive lab tests, drugs, diagnostic tests and equipment, etc.
You can try to cut doctors pay further, but there is only so much you can cut it before you persuade doctors to leave medicine for other fields and convince college students that pursuing careers in medicine is a bad investment of their money and time.
Its already at the point where medicare reimbursement for certain physician procedures barely covers their costs of delivering them. (EG, reimbursement for a simple office visit with physical is about $14. . .that's less than the cost of a haircut). Guess what happens if you cut the reimbursement further?
Remember it takes about 8 years of post-graduate education, plus another 4 years of college to become a practicing physician, and the average debt load of individuals doing it is about $150,000.
Meanwhile radiology techs earn $60k per year, nurse practitioners $75k, chief pharmacists $100k, and dentists $120k. How much do you think physicians like surgeons ought to be paid, given their 60+ hour work weeks involving night coverage and tremendous responsibilities?
I'm guessing you don't know a lot of doctors.
While "hurting" is a relative term (eg if you have a home and a job in this economy, you're doing OK), doctors HAVE been seeing pay cuts both in absolute terms and in relative terms compared to prior years, and this is true for many specialties.
Surgeons, internal medicine docs, etc are earning less today then they did ten years ago. Its a combination of higher expenses and lower reimbursement.
Next issue, and more important than this one, physician pay is really only a relatively small part of the overall cost of healthcare.
Sure doctors get paid, but so do nurses, lab techs, pharmacists, phlebotomists, secretaries, transcriptionists, hospital administration, etc. Medical costs include physician reimbursement, but they also include expensive lab tests, drugs, diagnostic tests and equipment, etc.
You can try to cut doctors pay further, but there is only so much you can cut it before you persuade doctors to leave medicine for other fields and convince college students that pursuing careers in medicine is a bad investment of their money and time.
Its already at the point where medicare reimbursement for certain physician procedures barely covers their costs of delivering them. (EG, reimbursement for a simple office visit with physical is about $14. . .that's less than the cost of a haircut). Guess what happens if you cut the reimbursement further?
Remember it takes about 8 years of post-graduate education, plus another 4 years of college to become a practicing physician, and the average debt load of individuals doing it is about $150,000.
Meanwhile radiology techs earn $60k per year, nurse practitioners $75k, chief pharmacists $100k, and dentists $120k. How much do you think physicians like surgeons ought to be paid, given their 60+ hour work weeks involving night coverage and tremendous responsibilities?
# posted by : 9:50 AM
: 9:50 AM
My primary doctor is scratching like a chicken in the dirt. He's in the NE, and he does take uninsured, but not Medicaid. He told me yesterday he'll do it for free (and I know he always has, and believes that this is a moral duty), but he won't deal with Medicaid any more because it costs him more to treat a Medicaid patient than it does to treat a patient for free, plus you get harassed.
Also, his office appears to be quite full. I am sure it is because of the high unemployment and his commitment to working things out for his patients. However it meant that he has had to hire more people. In general malpractice rates vary according to the kind of treatment you provide, experience ratings, and the number of patients you treat. I can easily work out a scenario in which my doctor would be paying about $20 bucks out in cash on average for each Medicaid patient he saw, if, for example, he had to pay a higher malpractice rate because of taking those extra patients.
When you create a fiscal situation in which doctors have to pay money out of their own pockets to treat patients, you have a supply problem.
I believe the "silk underwear" comment is really off.
He told me last year that if he were still working off his medical loans, he wouldn't be able to stay in business.
There is no physician offering primary care who is not somewhat strapped. My doctor has a superb reputation - he's the kind of doctor other doctors go to. And he does do a lot of charity work.
In GA, most of the doctors and dentists are extremely strapped, and hospitals and services are being cut way back. There are some areas in which the doctors have folded up, especially the ones with high malpractice rates.
Also the dentists are scratching in SGA. The Chief had to leave the area to get an infected molar extracted, because the malpractice rules forced the dentist to have him stop his meds for a week, but the doctor said no way.
Also, his office appears to be quite full. I am sure it is because of the high unemployment and his commitment to working things out for his patients. However it meant that he has had to hire more people. In general malpractice rates vary according to the kind of treatment you provide, experience ratings, and the number of patients you treat. I can easily work out a scenario in which my doctor would be paying about $20 bucks out in cash on average for each Medicaid patient he saw, if, for example, he had to pay a higher malpractice rate because of taking those extra patients.
When you create a fiscal situation in which doctors have to pay money out of their own pockets to treat patients, you have a supply problem.
I believe the "silk underwear" comment is really off.
He told me last year that if he were still working off his medical loans, he wouldn't be able to stay in business.
There is no physician offering primary care who is not somewhat strapped. My doctor has a superb reputation - he's the kind of doctor other doctors go to. And he does do a lot of charity work.
In GA, most of the doctors and dentists are extremely strapped, and hospitals and services are being cut way back. There are some areas in which the doctors have folded up, especially the ones with high malpractice rates.
Also the dentists are scratching in SGA. The Chief had to leave the area to get an infected molar extracted, because the malpractice rules forced the dentist to have him stop his meds for a week, but the doctor said no way.
Dan - not only is basic health care a societal BENEFIT, but a public health system is a NECESSITY. Since early detection and treatment is the key to controlling community health problems, it follows that a policy that denies health care to those in jeopardy is the most expensive option.
Communicable diseases like TB and various STDs force it. If you let an infectious TB patient go without treatment, you are going to produce a number of others.
So this is not even a questionable point - a basic health care system is a necessity. There will always be people who can't afford the treatment, but you have to treat them anyhow. The earlier they are treated, the less it will cost and the fewer other people will need treatment.
There is a reason that hepatitis carriers aren't allowed to work in food services. One typhoid-infected food service worker can produce a hideous outbreak. Here's a blast from the past on that heading. In the era before antibiotics, the only way to treat epidemic diseases such as TB and typhoid was to isolate the infectious. We spent then and we are still spending now to detect, trace contacts and treat.
I stick to my point that a great deal of this debate is silly and ungrounded in reality. You can't yawp about denying illegal aliens healthcare benefits when you've got a high number of illegal aliens working in restaurants and food processing plants, can you? You've also got a high number of illegal aliens in the population, and many of them are carriers of TB, E. Coli and so forth.
One of the reasons why US health care costs would be somewhat higher than those of say Sweden regardless of our delivery methods is our higher population percentage of recent immigrants from countries with high rates of diseases that are rare in the more highly developed countries.
Communicable diseases like TB and various STDs force it. If you let an infectious TB patient go without treatment, you are going to produce a number of others.
So this is not even a questionable point - a basic health care system is a necessity. There will always be people who can't afford the treatment, but you have to treat them anyhow. The earlier they are treated, the less it will cost and the fewer other people will need treatment.
There is a reason that hepatitis carriers aren't allowed to work in food services. One typhoid-infected food service worker can produce a hideous outbreak. Here's a blast from the past on that heading. In the era before antibiotics, the only way to treat epidemic diseases such as TB and typhoid was to isolate the infectious. We spent then and we are still spending now to detect, trace contacts and treat.
I stick to my point that a great deal of this debate is silly and ungrounded in reality. You can't yawp about denying illegal aliens healthcare benefits when you've got a high number of illegal aliens working in restaurants and food processing plants, can you? You've also got a high number of illegal aliens in the population, and many of them are carriers of TB, E. Coli and so forth.
One of the reasons why US health care costs would be somewhat higher than those of say Sweden regardless of our delivery methods is our higher population percentage of recent immigrants from countries with high rates of diseases that are rare in the more highly developed countries.
45,000 deaths from not being insured
First, that's a highly questionable figure. The underlying study gives a 95% confidence range from 1.06, 1.84 (ratio of deaths among uninsured to deaths among insured).
One reason why the study is flawed is that many persons have insurance but don't have insurance that pays for access to regular and efficient primary care. That is, if they get ill, they will get treated, but essentially unless they have money to pay themselves, they won't regularly be able to see a doctor for proper treatment of chronic health conditions.
Another reason for the doubtfulness is that they are attempting to control for socioeconomic factors, but the incomes in the data from which this study was done are imputed close to 30% of the time, and there is no data about assets. A third reason is that duration of not being insured was not apparently accounted for although it appeared to be available from the survey? Here's the NHSR homepage. That is startling and would make many people question the conclusions.
However, I believe that there are higher rates of serious illness from non-insurance. I also believe that insurance reform is necessary. I have a non-partisan view of this, in that I think we have to rule out what is not possible politically or economically, and rule in whatever is clearly going to save money.
Finally, I have to tell you that 45,000 excess deaths correlated to not being insured at the time of the survey is a screaming testament to the quality of the acute and urgent and non-urgent care in this country given to the poor. Some numbers:
Hospital-acquired infections that result in deaths in acute-care patients are estimated between 17,500-70,000. The incidence rate is 5% in acute-care patients, and the estimate is that there are over 2 million a year. Link. A more recent estimate from the CDC came in at about 100,000.
There have been reports in varying studies over the last decade suggested 44,000 to almost 200,000 deaths annually from hospital error. 2000 discussion.
Overview article 2009
First, that's a highly questionable figure. The underlying study gives a 95% confidence range from 1.06, 1.84 (ratio of deaths among uninsured to deaths among insured).
One reason why the study is flawed is that many persons have insurance but don't have insurance that pays for access to regular and efficient primary care. That is, if they get ill, they will get treated, but essentially unless they have money to pay themselves, they won't regularly be able to see a doctor for proper treatment of chronic health conditions.
Another reason for the doubtfulness is that they are attempting to control for socioeconomic factors, but the incomes in the data from which this study was done are imputed close to 30% of the time, and there is no data about assets. A third reason is that duration of not being insured was not apparently accounted for although it appeared to be available from the survey? Here's the NHSR homepage. That is startling and would make many people question the conclusions.
However, I believe that there are higher rates of serious illness from non-insurance. I also believe that insurance reform is necessary. I have a non-partisan view of this, in that I think we have to rule out what is not possible politically or economically, and rule in whatever is clearly going to save money.
Finally, I have to tell you that 45,000 excess deaths correlated to not being insured at the time of the survey is a screaming testament to the quality of the acute and urgent and non-urgent care in this country given to the poor. Some numbers:
Hospital-acquired infections that result in deaths in acute-care patients are estimated between 17,500-70,000. The incidence rate is 5% in acute-care patients, and the estimate is that there are over 2 million a year. Link. A more recent estimate from the CDC came in at about 100,000.
There have been reports in varying studies over the last decade suggested 44,000 to almost 200,000 deaths annually from hospital error. 2000 discussion.
Overview article 2009
A recent study suggested that as many as 195,000 people might be dying annually as the result of hospital errors. I think this was overblown, but that is just my guess. If I were to derive from my own experience, I would put it considerably higher, but since I have substantial personal exposure to an area of the country that is already suffering from low public reimbursement rates, it is likely my experience is skewed. It seems clear the number is rapidly rising.
From the 2004-2006 data the percent of population uninsured for more than a year is 11.6%, which is the rate at which most uninsured people with low incomes would have trouble with access to doctors. 16.6% were uninsured at the time of the interview. 20.5% were uninsured for some part of the previous year.
If only 45,000 are dying correlated with uninsured status, whereas over 100,000 are dying due to hospital error, a logical person would deduce that the actual impact of not being insured is very low. They correlated for 16%, and they came up with a rate of deaths that is very close to the rate of deaths that might reasonably extrapolated from receiving care.
I would argue that not having access to primary care is a very bad thing that costs us all a lot of money, but I have to tell you that I would not be using this study to argue my point.
One problem with this study is that it is the portion of the population that is not insured and has income and/or assets sufficient for primary care that has the most incentive to control their health risks. Of the total insured, that number appears to be well over 30%. incomes correlated to insurance
Nonetheless, I do believe that lack of access to primary health care is a strong risk factor for those with chronic health conditions. If you want to explain to me how MA's increasingly long wait times for the putatively insured aren't a similar risk factor, have at it. If you don't want to deal with the reality that we have created a situation in which many people are theoretically insured but still don't have access to quality primary care, then I think you're bucking for the ID 10 T error award of the week. Here are some articles about the problem in MA:
Primary care & defensive medicine
GOP propaganda outlet NPR Five year waiting list in one MA practice?
A 44 day wait time to see a family medicine doctor in MA? Quote:
"With our state health reform initiative, we quickly learned that universal coverage doesn’t equate to universal access," Dr. Mario Motta, president of the society, said in a statement. "Our analysis can be instructive on a national level about what physician supply means for access to care when universal coverage is implemented."
Boston has longest physician wait times in nation.
Don't try and jerk me around with the numbers. You'll lose. The only thing I do well is numbers. Plus, this is serious personal and professional issue for me, so I've been pouring over these numbers.
If you seriously believe that access to primary care is the goal of health insurance reform, passing a national version of the the MA plan (all current Dem proposals) is obviously not the way to go. Note also that the average Medicaid acceptance ratio in metro areas is 55%.
Fake insurance is not the answer. Fake insurance reform is surely not.
From the 2004-2006 data the percent of population uninsured for more than a year is 11.6%, which is the rate at which most uninsured people with low incomes would have trouble with access to doctors. 16.6% were uninsured at the time of the interview. 20.5% were uninsured for some part of the previous year.
If only 45,000 are dying correlated with uninsured status, whereas over 100,000 are dying due to hospital error, a logical person would deduce that the actual impact of not being insured is very low. They correlated for 16%, and they came up with a rate of deaths that is very close to the rate of deaths that might reasonably extrapolated from receiving care.
I would argue that not having access to primary care is a very bad thing that costs us all a lot of money, but I have to tell you that I would not be using this study to argue my point.
One problem with this study is that it is the portion of the population that is not insured and has income and/or assets sufficient for primary care that has the most incentive to control their health risks. Of the total insured, that number appears to be well over 30%. incomes correlated to insurance
Nonetheless, I do believe that lack of access to primary health care is a strong risk factor for those with chronic health conditions. If you want to explain to me how MA's increasingly long wait times for the putatively insured aren't a similar risk factor, have at it. If you don't want to deal with the reality that we have created a situation in which many people are theoretically insured but still don't have access to quality primary care, then I think you're bucking for the ID 10 T error award of the week. Here are some articles about the problem in MA:
Primary care & defensive medicine
GOP propaganda outlet NPR Five year waiting list in one MA practice?
A 44 day wait time to see a family medicine doctor in MA? Quote:
"With our state health reform initiative, we quickly learned that universal coverage doesn’t equate to universal access," Dr. Mario Motta, president of the society, said in a statement. "Our analysis can be instructive on a national level about what physician supply means for access to care when universal coverage is implemented."
Boston has longest physician wait times in nation.
Don't try and jerk me around with the numbers. You'll lose. The only thing I do well is numbers. Plus, this is serious personal and professional issue for me, so I've been pouring over these numbers.
If you seriously believe that access to primary care is the goal of health insurance reform, passing a national version of the the MA plan (all current Dem proposals) is obviously not the way to go. Note also that the average Medicaid acceptance ratio in metro areas is 55%.
Fake insurance is not the answer. Fake insurance reform is surely not.
PS: And don't try to be climate scientist about it and claim that the high hospital infection rates are due to uninsured people, because the UK's acute-care nosocomial rate is estimated at 10% versus the US' 5%.
Power Point presentation
Power Point presentation
The entirety of the thought of most people bitching about the cost of health care: It's expensive so someone else should pay for it.
These are the same people who think real estate investment amounts to "Pay 5K, pay rent, and years later you get 500K back."
Whether you're an empty-nester in your 50's or a twenty-something with a couple kids, you're going to be paying around 6K a year for health care no matter who administers it. Even when it's a "free" benefit. I have a smidgen of support for taxing health benefits - just so people get a dose of reality of what they are getting in benefits; too many people think health care costs their employers about $100 bucks a month.
These are the same people who think real estate investment amounts to "Pay 5K, pay rent, and years later you get 500K back."
Whether you're an empty-nester in your 50's or a twenty-something with a couple kids, you're going to be paying around 6K a year for health care no matter who administers it. Even when it's a "free" benefit. I have a smidgen of support for taxing health benefits - just so people get a dose of reality of what they are getting in benefits; too many people think health care costs their employers about $100 bucks a month.
# posted by : 4:05 PM
: 4:05 PM
I'm guessing you don't know a lot of doctors.
Well, I DO know a lot of doctors, and none of them are driving Ford Focuses. Most of their pay cuts are cuts in bonuses (just like Wall Street!) due to decreased revenues at hospitals, most of which is incomplete Medicare payments and legal claims.
Well, I DO know a lot of doctors, and none of them are driving Ford Focuses. Most of their pay cuts are cuts in bonuses (just like Wall Street!) due to decreased revenues at hospitals, most of which is incomplete Medicare payments and legal claims.
# posted by : 4:10 PM
: 4:10 PM
There is no physician offering primary care who is not somewhat strapped.
There's your supply problem right there. Fewer doctors offering primary care because of the red tape involved. Some of the doctors I know would rather do primary care than their specialties but the choice between making a great living and having to run a business on a tight margin is a no-brainer. A doctor just starting out learns quickly that primary care is 20% medical work and 80% drudgery. In short, law has made the primary care practice too difficult for an individual to handle.
The best way to do primary care is in a large partnership but the personal care gets compromised and it becomes a logistical problem for lower-income people because a large outfit generally means fewer offices so more traveling for the patients.
There's your supply problem right there. Fewer doctors offering primary care because of the red tape involved. Some of the doctors I know would rather do primary care than their specialties but the choice between making a great living and having to run a business on a tight margin is a no-brainer. A doctor just starting out learns quickly that primary care is 20% medical work and 80% drudgery. In short, law has made the primary care practice too difficult for an individual to handle.
The best way to do primary care is in a large partnership but the personal care gets compromised and it becomes a logistical problem for lower-income people because a large outfit generally means fewer offices so more traveling for the patients.
# posted by : 4:20 PM
: 4:20 PM
Charles - you are right that a large practice or at least a group practice allows some economic efficiencies, but in smaller areas the money is even tighter and the efficiencies, whatever they are, will be less.
Having really good doctors in primary care is one of the ways in which we could cut overall costs, but we are failing on an epic basis.
Many of these people start out with hundreds of thousands of dollars of debt. To that overhead you have to add malpractice insurance.
There are doctors practicing in rural areas who are older and couldn't make it up, so stripped themselves of assets and dropped their malpractice insurance. Of course you have to REALLY trust your wife to do that.
I get a little hot under the collar over the imputation that all we need to do is cut doctor's salaries.
Having really good doctors in primary care is one of the ways in which we could cut overall costs, but we are failing on an epic basis.
Many of these people start out with hundreds of thousands of dollars of debt. To that overhead you have to add malpractice insurance.
There are doctors practicing in rural areas who are older and couldn't make it up, so stripped themselves of assets and dropped their malpractice insurance. Of course you have to REALLY trust your wife to do that.
I get a little hot under the collar over the imputation that all we need to do is cut doctor's salaries.
What we need to do is create more supply of primary care providers by subsidizing medical education and providing other incentives for those in needed disciplines and locations. If doctors didn't graduate with so much debt, we wouldn't need to pay them as much; keeping the supply up would also help keep a lid on price.
There are other ways to address rising costs by subsidizing the development and production of drugs and medical technologies in return for lower prices later on--these are also large drivers of costs.
(Oh, and I'm a Democrat, so wonder whether these ideas are stupid ;)
There are other ways to address rising costs by subsidizing the development and production of drugs and medical technologies in return for lower prices later on--these are also large drivers of costs.
(Oh, and I'm a Democrat, so wonder whether these ideas are stupid ;)
Joy - oh, I don't think the Democratic VOTERS are stupid at all.
What interests me about this particular set of memes is that first, the Democratic voters don't seem pleased with the plan(s) as they are currently developing, and second, the Democratic leadership is strikingly poor at listening to its own voters. The voters are not hostile, but they are highly doubtful, and after wading through all this I think the voters are right.
There really should be a "Leadership" in the title.
Barring the people who just don't know how Medicare is funded and thus think McGovern's proposal makes sense (and it does make more sense than the plan proposed), most people seem more alert to the problems than the policy wonks.
This is, to me, a striking proof of the vitality of democracies. Even though on average the public is not well informed on this topic, and even though the political debate is devoid of facts and genuine parameters, nonetheless the public is doing a better job of assorting possibilities than our leadership.
I think this issue, if handled at all credibly, is a huge winner for the Democratic party. However, they seem to distrust the public and are forming the circular fire squad Mark Twain wrote about.
My personal preference, at this stage, would be a mix of expanding and greatly raising funding to Medicare. As I just pointed out in this post, I am not going to get my preference.
If it makes you feel better, I've got the stupidest suggestion yet from a conservative coming up next. It is awesomely stupid. It is superlatively, time-and-space bendingly stupid.
What interests me about this particular set of memes is that first, the Democratic voters don't seem pleased with the plan(s) as they are currently developing, and second, the Democratic leadership is strikingly poor at listening to its own voters. The voters are not hostile, but they are highly doubtful, and after wading through all this I think the voters are right.
There really should be a "Leadership" in the title.
Barring the people who just don't know how Medicare is funded and thus think McGovern's proposal makes sense (and it does make more sense than the plan proposed), most people seem more alert to the problems than the policy wonks.
This is, to me, a striking proof of the vitality of democracies. Even though on average the public is not well informed on this topic, and even though the political debate is devoid of facts and genuine parameters, nonetheless the public is doing a better job of assorting possibilities than our leadership.
I think this issue, if handled at all credibly, is a huge winner for the Democratic party. However, they seem to distrust the public and are forming the circular fire squad Mark Twain wrote about.
My personal preference, at this stage, would be a mix of expanding and greatly raising funding to Medicare. As I just pointed out in this post, I am not going to get my preference.
If it makes you feel better, I've got the stupidest suggestion yet from a conservative coming up next. It is awesomely stupid. It is superlatively, time-and-space bendingly stupid.
Okay, I'll try and be brief, since my husband is part of those statistics. He died in October last year from pneumonia. I had insurance through work, but could not afford the tab to add him on what I was making. He spent two weeks in the hospital and racked up over $170,000 before he died. WA state picked up the tab.
I could not have gotten him in to the doctor earlier if he'd been insured. He didn't want to go when he became sick. I don't understand why the health care debate for the uninsured doesn't center around a way to fund states with emergency assistance programs (and help states that don't have it create one.) Those programs work. It would also help if catastrophic illness insurance was easier to get. The main thing that I know is that the mere fact of having insurance really doesn't do much except make sure that someone gets payment. People are going to get sick and die. We need a way to make sure that they aren't thinking about how they are going to pay for that ride to the emergency room when the worst happens. We can do that without creating a new bureaucracy to suck up the dollars.
I could not have gotten him in to the doctor earlier if he'd been insured. He didn't want to go when he became sick. I don't understand why the health care debate for the uninsured doesn't center around a way to fund states with emergency assistance programs (and help states that don't have it create one.) Those programs work. It would also help if catastrophic illness insurance was easier to get. The main thing that I know is that the mere fact of having insurance really doesn't do much except make sure that someone gets payment. People are going to get sick and die. We need a way to make sure that they aren't thinking about how they are going to pay for that ride to the emergency room when the worst happens. We can do that without creating a new bureaucracy to suck up the dollars.
More #s for MOM's slide rule
Health Care Costs (Kaiser Foundation 2004 rounded)
USA Total:$1.6 Trillion
Hospital Care 36.5%
Physician and Prof Services 28.8%
Drug and Medicines 14.3%
Nursing Home Care 7.4%
Dental 5.3%
Home Health Care 2.8%
Medical Durables 1.5%
Other 3.4%
The savings to help pay for the uninsured will have to come from the larger expense categories: hospitals, doctors, and meds.
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Health Care Costs (Kaiser Foundation 2004 rounded)
USA Total:$1.6 Trillion
Hospital Care 36.5%
Physician and Prof Services 28.8%
Drug and Medicines 14.3%
Nursing Home Care 7.4%
Dental 5.3%
Home Health Care 2.8%
Medical Durables 1.5%
Other 3.4%
The savings to help pay for the uninsured will have to come from the larger expense categories: hospitals, doctors, and meds.
# posted by : 9:24 AM
: 9:24 AM << Home
