Medicare Reform: Paying for the Cake You Want to Eat
Since Medicare and Medicaid became law in 1965, people have been told: “You can have your cake and eat it too.” You can have the medical care you need and not have to pay for it. (You may think you are paying for Medicare with your payroll taxes, but in fact those taxes cover less than 1/3 of your projected health care costs.)
For decades, Medicare and Medicaid have been paying for health care with no one facing the difficult question: “Is what we are purchasing worth the cost?” Not the doctors, nor the “beneficiaries” — and especially not the politicians. Doctors get income; patients get health care; politicians get votes — all with the carefree ease of paying for it with other people’s money while simultaneously ignoring the debt looming larger and larger behind the proverbial curtain.
Before the government created the means to “tax, spend and go into debt” for health care, people had to make those difficult decisions for themselves looking at their own resources, unable to take advantage of their neighbors’ bank accounts — at least not without directly asking. The family’s doctor would talk with his patients about the pros and cons of various treatment options, including the cost. Some of the time that meant forgoing treatment in order to “save the widow the farm.” Tough choices? You bet. Sometimes tragic? Without a doubt. But it kept us living consistent with the reality of limited resources and personal responsibility, preventing the drift off into fantasy land where every need can be met by reaching into our neighbor’s (or our children’s) pockets while they aren’t paying attention.
America needs to grow up. Or maybe people just need to understand the problem better. Polls show that a majority of people want to cut the deficit but not touch the two biggest expenditures of federal money. This illustrates just how out of touch with reality we have let ourselves become. Medicaid and Medicare are 23% of the federal outlays. Add in Social Security and we’re up to 43%. Even if we eliminated the entire “discretionary spending” category we’d only be cutting out 18% of the budget.
Even the New York Times is starting to acknowledge the problem:
Sooner or later, Democrats will have to admit that Medicare cannot keep running as it is — its medical costs are running out of control.
- The Democrats get the public addicted to something.
- Then the Republicans try to beat those same people senseless because they need it.
“If we ever slow health care cost inflation to a sustainable pace, it will be because we learn how to ask 3 simple questions when thinking about a medical treatment:
• Does it improve quality of life for the patient?
• Does it extend the patient’s life?
• How much does it cost?”
Who gets to ask these questions?
Who gets to answer them?
Who owns the magic crystal balls that will give everyone the correct answers and solutions to all of their problems? The Republicans? Democrats? A bi-partisan panel of a bunch of all kinds of experts?
The Chinese?
“The family’s doctor would talk with his patients about the pros and cons of various treatment options, including the cost. Some of the time that meant forgoing treatment in order to save the widow the farm.”
Dr. Haynes didn’t mention that this was the acceptable normal way of life that applied to every aspect of it no matter who you were or where you were at.
It was the time when if you didn’t have the cash to pay for it that meant that you didn’t need it.
Each woman would manage one new Maytag wringer washing machine in her lifetime; which meant one marriage united by hard work and fidelity forever. Water was drawn from a well in a bucket and everyone used the outdoor privy around the hill until most of the 9, 10 or 11 kids were in their teens because that is how long it took to scrimp and save enough money to put indoor plumbing and one toilet in the old house.
Then someone (important) said, “This sucks.” and things started to happen.
- The government invented plastic and convinced people that it wouldn’t hurt if they used it.
- The government decided to throw God out of the schools in order to make room for liberals.
- The government held a huge rally about living conditions. It was called “Woodstock”.
America was maturing, entering into a new world of international harmony and respect for each other. aka: The United Nations – but without Israel.
And now:
“America needs to grow up.”
We need to give each person a big knotty club, choose sides then go out and beat the living snot out of anyone 62 years or older, all government workers and people with any kind of disorder; except liberalism.
We need mo change..
But, don’t you know, according to Obama and his minions in the media, the Republicans want to “end” Medicare? Please, nothing meaningful will happen with Medicare until after the election. And, even after that, no reforms will take place unless the Republicans hold Congress AND the White House. The days of bipartisanship are long gone. If (God forbid) Obama is re-elected, we will live in a European-style welfare state and go bankrupt. Even if the Republicans win Congress, they may not have enough votes to override a presidential veto. But if the Republicans win everything in 2012, we may still have a shot at reforming Medicare and actually saving it. Republicans MUST win everything in 2012, or else there isn’t much hope left for us.
One must respect your opinions as they are based on fact and well thought out.
Your faith in the GOPhers, is not, I think, warranted.
For example, Ryan’s crazy, unnecessarily complicated health insurance scheme mirrors obamacare closely and is just as wasteful and government- intrusive.
What we want is a free market, where supply, demand and capacity to purchase determine cost. Over time the free market self adjusts according to the interplay of its factors. It is not possible for government to intervene without putting additional and unnecessary spoons in the soup. We need to do all that we do as efficiently as possible, eliminating unnecessary, duplicatory, backtracking, etc. activities. As soon as, “We need to ADD…” appears, we know it is a bad idea. We need to SUBTRACT persons, procedures, costs; not add.
Aside, the GOPhers will roll over again, hypocritically claim a resounding victory, and assent to an expanded national debt coupled with tremendous annual deficits. The objective is to remain in power as long as possible by robbing Peter to pay Paul.And when they have robbed all that Peter has, they will just print some more, until even that is worthless. We will then live in an economic Hell; and who is in charge of Hell?When your family is hungry and your money won’t buy anything, what will you do? Starve? Or steal? Or rob? Will you grab an acre or two and farm it with subsistence crops? Who will guard its produce while you sleep? How many starving neighbors must you shoot to survive?
Folks, we live in a real world, with real limitations. The global economy is far too complicated for men to manage. Let free markets adjust as they will
under the imperatives, “You shall love the Lord your God with all your heart, mind, strength and soul; and you shall love your neighbor as yourself”.
It must be understood that to love God is to obey Gog, and that love consists in selfsacrificial pursuit of the longrange best interests of ones neighbor.
Who will be the person who decides the answer to those 3 questions.
You just gotta love the Dems. First they take a half Trillion Dollars out of Medicare Advantage to pay for Obamacare, and then they go around yelling the Rats are going to kill Medicare. Their motto ought to be: Scaremongering, its what we do best.
The Dems must be defeated at all costs. Get involved, stay engaged, and donate to conservative candidates. Your country depends on you. And, prepare for the worst. The economy is sinking and Obama is tanking. Not a pretty picture. They will cling to power with all their skills and charms (lying, cheating, demogoguing, obfuscating, and denial).
Absolutely first-rate piece. A superb synopsis of the issue. Should be required reading for the 535 who for years have been administering the ‘free lunch,’ which of course turns out not to be free.
Don’t blame them. Blame the voters who put them in there because they wanted the goodies.
Then the #1 solution to this and every other welfare-state mess is to change the franchise laws so that those receiving govt. benefits cannot vote. In his book Representative Government</i), John Stuart Mill advocated just that, along with also disqualifying those who had recently declared bankruptcy or who didn't pay taxes. (To insure the latter, he recommended a voluntary poll tax proportionate to govt. spending. Unfortunately, that would require repealing the 24th Amendment.)
Or maybe people just need to understand the problem better. Polls show that a majority of people want to cut the deficit but not touch the two biggest expenditures of federal money.
Then they have to suck it up and accept massive increases in taxes. On EVERYONE, not just the rich. It’s that freaking simple.
Please take a look at the Laffer Curve. You can argue where the peak tax rate is – but not with the phenomenon. There is a practicle limit to how much you can increase actual tax revenue by increasing the tax rate. At some point, people just stop working – and then we will have Greece and the Soviet Union rolled into one. With trillions in annual deficits, with government spending approaching 50% of GDP, there is no way back except to reshuffle the deck and start over.
Mike G;
Almost half the people exempt and deduct their way out of paying any federal income tax. That’s where we need to get the revenue from – the half that’s not contributing.
It would be nice if the MSM were not “stuck on stupid” in this fight. I would think that they might have something more than just a passing interest in the “truth” especially one that promises to destroy our economy and cover us with ruinous debt. Medicare is “unsustainable”. It already has about $50 trillion in unfunded liabilities-promises to pay money for which there are NO funds currently available. Hello Media!! Anyone at home.
Now also it would be good if some good democrat or HHS person (like Kathleen Supercilious) to explain how taking $500 billion from Medicare which they used for Obama Care somehow helps the Medicare situaion. This is the Democrats way of creating money and wealth by wishfull thinking.
When the adults of the USA answer this “wake up call” it will be no thanks to the media who are blatantly doubling down on their bet that somehow the liberals will be able to “lie” their way out of this. Remember this when you buy a subscription to the NYT or turn on CNN.
These people are a disgrace!!
Unfortunately, very few people actually understand what’s going on here. Let’s do a little reality check:
1. The combination of the FDA and the Medical Practice Acts grossly limit competition in the medical marketplace. This has driven, and continues to drive, up the cost of medical care to the point where the average family perceives it to be difficult to purchase medical care for even relatively minor items. This then led to the passage of Medicaid, Medicare, health insurance, and gov’t regulation of health insurance. In fact it should be blatantly obvious that government is not designed to, and is grossly incompetent to, manage, supervise, pay for, or have anything to do with medical care, with the possible exception of combat wounds etc. Yes, I’m saying that medical care should be unregulated by the gov’t. Stop forcing other people to pay for your own incompetency in choosing a physician. This is America, not China; I should be free to go to the village idiot for my appendectomy if I’m stupid enough to do so. Government has, and should be perceived as having, no role in it.
2. At the Federal level, it should be blatantly obvious that Medicare and Medicaid are grossly unConstitutional. We shouldn’t be trying to ‘fix’ them, we should be having a national conversation on how most equitably and quickly to end them.
3. If we actually followed the Constitution, so many Federal regulations and other interferences with commerce of all kinds would drop away, that businesses of all sizes would boom, wealth would spread, freedom would reign. We’d have a big problem with the unemployment rate: it would be too low. Businesses would be screaming for workers, who could just about write their own ticket.
But we won’t do that. We are a wicked people, who can’t be bothered to understand Who designed gov’t and what for, or to read, understand, and follow our own foundational Law, which was written by men who did understand. This does not end well.
Amen, Doc! Medicare and medicaid need to disappear altogether. I am 79 and have been paying into Medicare since it began in 1965. Take it away! Shrink federal expenditures by 23% in one swift blow. Provide myriads with the opportunity to produce something of real value, rather than just to push government forms around. That means I probably won’t be able to afford some needed care, and that okay, too. For thousands of years such has been the case. And, in a state of socialized medicine, rationed, delayed, denied, I wouldn’t get it anyway.
But I would rather die free than enslaved. And everyone dies.
Doc…hard to tell if you’re a ‘Doc’ or not but, from your writing I’ll assume you’re not.
Getting beyond the superficial rhetoric, the problem is the underlying causations of health cares arbitrary inflated values of goods and services. Until this is seriously addressed, rational advances towards any transition away from government health care is NOT going to happen without grave consequences. Likewise, private sector health care insurance is caught in the same inflationary trap as the government and is equally unsustainable at the group or individual levels.
If folks don’t get on the right track of relevancy, inflated health care costs are going to eventually ‘force’ a government run public health care system that few will like or benefit from.
Furthermore, private sector health care ‘insurance’ as we all know it today, is proven, a failed mechanism and solution to control arbitrary inflated values of goods and services!
In all fairness, this same arbitrary inflation ‘cancer’ resides in all sectors of America’s economy.
By the “reasoning” of T.T. Thomas here, every time anything goes wrong in this world, by anyone for any reason, big or small, we “nationalize” the activity, enslave every one of those who engage in it, and put it all under the control of an all-knowing, wise, benificent bureaucrat (or committee of same), who arrived to that celestial position through their honesty, diligence, hard work, great sacrifices, devotion to the general welfare and proven ability to do good and never do harm.
Yes.
Or not.
Great comment, Doc. Dead on.
Doc…..sorry, I forgot to address your conclusions regarding FDA and Medical Practice Acts. You are correct! However, their ‘direct’ influences are fractional. I would ask you this question. Would the profession or comsumer population at large, benefit better without the safeguards they provided?
I think any studies indicate that the overwhelming costs of health care are influenced by inflated costs of diagnostics and treatment protocols. What factors and their variables causes this inflated value for goods and serices to the consumer is where the dicussion needs to be in my opinion. Maybe, start at the beginning….education and progress upward through consumption.
As is always the case in more modern times, high density populated ‘cancer-centers’ (in the socio-economic sense) creates the nations crisis and the government response is to develop an one-size-fits-all solution. This will not be a good approach to care nationwide.
Expensive new technologies stay expensive in part because of the third party payment system and the consequent lack of competition in health care. Also in part because of almost instantaneous application of new technologies etc. to everyone under the belief that health care is a right and it is wrong to have some treatments available only to the “rich.” When medicine is isolated from normal market forces, it should come as no surprise that the system stays inefficient.
Dr. Haynes….I couldn’t agree more that non competitiveness for health care consumerism is a major problem. People today think I’m crazy but, I’ve lived in the decades before health care insurance and very much government interventions. Wealthy or poor, we all got the same levels of health care from our doc’s and if money was ever a ‘real’ problem, a little bartering or community charity was quietly in place. Of course for all the nations concentrated and over populated scio-economic ‘cancer-centers’ there is no possibility of yesterdays simplicity in health care today.
The government and insurance one-size-fits-all solutions is not addressing the core underlying causations of the arbitrary inflated values of health care goods and services. Government and insurance perpetuates most of the core problems with such degrees of complexity today, that I’m not sure how any of it can be fixed in a rerasonable balance between the consumer and the provider.
TTT
I am a physician. Many of my patients suffer daily b/o lack of access to specialists, Rx’s, and technology b/o the restriction on the supply of such imposed by the FDA and the med practice acts. Eliminate those, and all the unConstitutional medical-related Fed rules/regs, and watch the supply of all kinds of med care skyrocket, costs plummet, all citizens especially the poor benefit. I might or might not make less money, since I would no longer be protected from competition by the state. But I would eliminate those twin pillars holding up the cost of medical care in a heartbeat if I could.
Doc…Thanks! I understand and concur with your points. However, I’ve not seen any data that suggests that those components are more than fractional in the overall costs of health care. If there is any reasonable means by which employers, insurance companies and the government have no or less influences on health care I’m aboard.
A million here a billion there and soon you are talking about real money.
“Regulations cost $1.75 trillion in compliance costs, according to the Small Business Administration.” http://pajamasmedia.com/blog/the-hidden-tax-regulation/
“Using a “top-down” approach, one can arrive at a “back-of-the-envelope” estimate that health services regulation imposes an annual cost of $256 billion per year (with a range of $28 billion to $657 billion), suggesting that health services regulations could increase estimates of overall regulatory costs by more than 25 percent.” http://www.cato.org/pubs/pas/pa527.pdf
Hardly chump change.
It is not a matter of data, fractional influences, etc. It is a matter of principle and of justice. It is unjust for government to interfere with the free choices of citizens concerning their health care. Regardless of what one thinks will be the outcome, we should abolish the FDA and the medical practice acts, as well as every unConstitutional Federal involvement in medical care. Then we wouldn’t have to argue about data, we would simply see what happens. That health care costs would plummet such that employers and insurers would no longer even be involved in health care is my expectation. Let’s try it and see, since it is the right thing to do.
You sound like a man of principle, and you also make a lot of sense.
Doc….I’m on your team! The only conflict I have is over matters of goods and services safety. Unfortunately, we live in a world and time when moral and professional irresponsibility is the order of the day in free enterprise capitalism. I have a family member who is an appellate judge who only hears medical industry filings. In his private practice of years in personal injury, his firm represented over time, both the medical and consumer sides. In the case of ‘practioner’ he declares that frivolous is fairly discerable but, as you know, reversing ‘evidence’ is quite difficult in a jury case short of some accompanied judical error. IF, the judical system were not corrupted, I’d advocate for a system similiar to those states that have separate personal injury courts or incorprate such cases into a WC court system. Wouldn’t that offer a greater degree of judicial balance and possibly lessen the practioiners liabilities…..I don’t know!
There has to be some parameters of safety in all areas representing the health are industry…does there not? Especially, when it comes to health care products including pharma, I think it far to risky to rely upon self policing. Look for example, how corrupted or sloppy in the very least, ‘some’ research is done and presented.
I don’t know! Again, I’m certainly on your side but, I simply don’t know how we are to get there…safely.
Don’t forget to add in the cost-increasing effects of licensing laws, and how fallout from the Flexner Report shut down half of the medical schools in the country, and how minimum insurance laws (http://tinyurl.com/min-ins-laws) contribute to the numbers of uninsured.
All these government actions, purportedly done to keep us safer, add to rising costs which make health care less affordable.
Dr. Haynes is spot on with her analysis. What she implied but did not state is that Medicare is a Ponzi scheme of the first order. Bernie Madoff was a petty criminal compared to the clowns who administer this $800 Billion annual travesty.
Unfortunately the bill is now due on this program and there is no way to pay for it. But just like crack cocaine, people are hooked on this and will do anything to keep “free” stuff- even if it means living on the street. And the government, just like a drug peddler, wants to keep everyone dependent so that they remain in control.
The media is complicit in this crime against our citizens and makes anyone who wants to save it, like Paul Ryan, appear to be an ogre.
We are at a crossroads where the people can rise up and demand that healthcare remains the right and responsibility of individuals under the guidance and advice of their physicians, and not controlled by faceless bureaucrats sitting in a cubicle thousands of miles away.
As Dr. Haynes notes, the key question is “Who decides?” All systems of government-run health care eventually lead to rationing, because the government pays the bills. We have but to look at Canada and the UK to see our own future, if we don’t change course now.
Thanks to Dr. Haynes for continuing to sound the alarm, and thanks to groups like Docs4PatientCare.org for promoting alternatives to socialized medicine.
Rationing is already here. And it’s really going to hit the fan July 1st. Anyone here heard of HCAHPS?!! uggg It’s making nursing hell! Read it and weep.
http://www.amazon.com/Hcahps-Handbook-Hardwire-Pay-Performance/dp/0982850301/ref=sr_1_1?ie=UTF8&s=books&qid=1307028864&sr=1-1
I rather disagree that this is hell. Why shouldn’t infection, fall rates, and surgical errors be tracked? Would you like to know that the hospital you’re being admitted to has one of the highest rates of infection in the country? I would. Wouldn’t having this make us better informed?
Great. So, since you want this, regardless of what anyone else wants, we all have to bear the increased costs of dotting the gov’t eyes and crossing the gov’t tees so that a hospital will shine according to whatever data some gov’t bureaucrat thinks is relevant.
Sorry. Gov’t is incompetent to monitor, regulate, provide, or pay for medical care. That they occasionally do something right is not surprising: even a stopped clock is right twice a day. But whatever they do right they do at an exorbitant cost, and with unintended consequences that are ruinous.
What I want is more competition. If a rich man wants to build a hospital, he should be able to do so, without some gov’t bureaucrat telling him whether or not he can and what color the walls should be. Then let patients vote with their feet.
Thank you for this, Dr. Haynes!
Pretending that there are rights to goods or services (vs. to freedom of action) always puts these types of debate into the fantasy land you describe. Indeed, economic and social disasters always ensue when we dispense with justice, i.e. when those who produce and earn the wealth don’t get to decide what to do with it.
“America needs to grow up.” You can say that again. When Americans finally realize that Socialism is immoral, that your life belongs to you, that you are not your brother’s keeper, things will change. Until then, things look pretty bleak.
Oh, but we ARE our brothers’ and our neighbours’ keepers. Note well, however… the government are NOT. Part of what made America possible, and once great, was precisely THIS mindset. Every colonial dedicated to liberty (essentially the right to determine for one’s self how one would live… and bear one’s OWN consequences for their choices) valued their neighbours’ and family’s well being… and made sacrifices to bear that out. How else could fourteen thousand armed men be mustered and on the field in less than twelve hours from the time General Gage’s plan to raid Lexington and Concord were first known? Two men left Boston at ten PM Tuesday, 18th April, and by nine thirty AM Wednesday, 19th April, fourteen thousand armed men were on the field to fight off Gage’s men. And guess what? Not one got paid a nickel to do that. It was for the protection of their way of life, their communities, each other…. that all men might live in peace and liberty. They, all of them, WERE their brothers’ keeper… some sixty of them dying that day, another hundred fifty or so suffering injuries from the battle, many of them dying… some of them months later. Many medical perofessionals also served, patching up the wounded as best they could… and not one of them held out their hand for a penny for their trouble. It is THIS heart and mindset that led to the founding of the greatest nation on the earth.. these “states united” as sovereigns. The central government was given a small handful of very specific and limited powers….
The reason we have come to this ugly pass is that far too many have left off from BEING their brothers’ keepers, looking instead to “government” to bear that responsibility. Neighbour is sick? Fine.. let “the government” take care of them. Not MY problem. Neighbour out of work? Fine… let Unemployment feed his family. Grandma too old and feeble to feed herself anymore? “convert” her possessions and turn her over to the government. They will maintain her in a “home”. Well, whatever happened to the “old ways” of sharing YOUR food with your hungryb neighbour, giving him some references to find a new place to work, taking care of their kids whilst out on the hunt…. or asking your own family doctor to help with his medical needs, striking a deal with him for a lower price that YOU would help pay, as a favour to yourself? Or asking your own doc to care for the guy and extend payment plan to him. And, about Grandma… not that long ago, she’d have found an eager and caring family household to move in with….. which family members would care for her until she eases out of this life and into the next… surrounded by her loving and caring kin? But no, even death has been institutionalised and government regulated. No more wakes in the home, the remains gently laid in a casket made by her Son and two grandsons… at the same place she lived out her last weeks.. or years. And, the family have lost the joys of having her about, her wisdom, family history, humour……
no longer seeoing ourselves as our brothers’ keeper is part of the problem. Grow up and BE that keeper once more. Personal responsibility is critical.. we’ve lost it and MUST regain it.
Who is the “brother” we are obligated to be keeping?
Is it a common criminal, a moocher, a looter, a bureaucrat, or just the average guy who votes for Obama so that we can all be enslaved to provide for our “brothers” at the point of a government gun?
Or is the “brother” we are keeping someone we value — a family member, a close friend, an acquaintence who shares our own convictions and ideas and values and returns the favor with love or appreciation or simply the inspiration of their own integrity, goodness or other virtue?
The first example is a sacrifice. The second is not.
No one should be sacrificing. We should be *trading* — exchanging value for value, including the spiritual values of honesty, integrity, independence and justice.
If we help someone — to the extent we can afford it — it is justice to their *character* that make them deserving.
But to insert the dictates of the government into that equation short-circuits the entire process of individual judgment. If I can’t judge who deserves my help by *my* standards and by *my* judgment of what I can afford to help them, all becomes sacrifice. I become a slave to their need and a slave to the bureaucrat who forces me to help them at the point of his gun.
To quote John Galt (Atlas Shrugged),
“I am the man who loves his life. I am the man who does not sacrifice his love or his values. …You have cried that man’s sins are destroying the world and you have cursed human nature for its unwillingness to practice the virtues you demanded. Since virtue, to you, consists of sacrifice, you have demanded more sacrifices at every successive disaster. In the name of a return to morality, you have sacrificed all those evils which you held as the cause of your plight. You have sacrificed justice to mercy. You have sacrificed independence to unity. You have sacrificed reason to faith. You have sacrificed wealth to need. You have sacrificed self-esteem to self-denial. You have sacrificed happiness to duty.
“You have destroyed all that which you held to be evil and achieved all that which you held to be good. Why, then, do you shrink in horror from the sight of the world around you? That world is not the product of your sins, it is the product and the image of your virtues. It is your moral ideal brought into reality in its full and final perfection. You have fought for it, you have dreamed of it, you have wished it, and I -I am the man who has granted you your wish.
“Whoever is now within reach of my voice, whoever is man the victim, not man the killer, I am speaking at the deathbed of your mind, at the brink of that darkness in which you’re drowning, and if there still remains within you the power to struggle to hold on to those fading sparks which had been yourself–use it now.
“The word that has destroyed you is ‘sacrifice.’ Use the last of your strength to understand its meaning. You’re still alive. You have a chance.
“‘Sacrifice’ does not mean the rejection of the worthless, but of the precious. ‘Sacrifice’ does not mean the rejection of the evil for the sake of the good, but of the good for the sake of the evil. ‘Sacrifice’ is the surrender of that which you value in favor of that which you don’t.”
“….To achieve the virtue of sacrifice, you must want to live, you must love it, you must burn with passion for this earth and for all the splendor it can give you–you must feel the twist of every knife as it slashes your desires away from your reach and drains your love out of your body. It is not mere death that the morality of sacrifice holds out to you as an ideal, but death by slow torture.
“…this double-jointed, double-standard morality splits you in half, so it splits mankind into two enemy camps: one is you, the other is all the rest of humanity. You are the only outcast who has no right to wish or live. You are the only servant, the rest are the masters, you are the only giver, the rest are the takers, you are the eternal debtor, the rest are the creditors never to be paid off. You must not question their right to your sacrifice, or the nature of their wishes and their needs: their right is conferred upon them by a negative, by the fact that they are ‘non-you.’
“…Your code declares that the rational man must sacrifice himself to the irrational, the independent man to parasites, the honest man to the dishonest, the man of justice to the unjust, the productive man to thieving loafers, the man of integrity to compromising knaves, the man of self-esteem to sniveling neurotics. Do you wonder at the meanness of soul in those you see around you? The man who achieves these virtues will not accept your moral code; the man who accepts your moral code will not achieve these virtues.
“…”Such is your morality of sacrifice and such are the twin ideals it offers: to refashion the life of your body in the image of a human stockyards, and the life of your spirit in the image of a dump.
“…”This country-the product of reason-could not survive on the morality of sacrifice. It was not built by men who sought self-immolation or by men who sought handouts. It could not stand on the mystic split that divorced man’s soul from his body. It could not live by the mystic doctrine that damned this earth as evil and those who succeeded on earth as depraved.
“…In the name of the best within you, do not sacrifice this world to those who are its worst. In the name of the values that keep you alive, do not let your vision of man be distorted by the ugly, the cowardly, the mindless in those who have never achieved his title. …man’s proper estate is an upright posture, an intransigent mind and a step that travels unlimited roads.”
Neither the author nor anyone else has mentioned it, but the doctors could end Medicare in short order simply by refusing to accept Medicare patients. (Many have turned away Medicaid patients for years, so the precedent is there.) Had they banded together and done so in 1965, the whole program would have been stillborn.
Stridor,
What you say is true —and more and more physicians are choosing to opt out of Medicare. The problem is that you are talking about people who have dedicated their lives to caring for people and opting out of Medicare can feel like abandoning one’s patients. This is esp. true when you consider that most of the patients on Medicare paid into the system for decades, that Medicare has destroyed the market for private medical insurance for the elderly so there is very little alternative except for the very wealthy, AND if, as a patient, you choose not participate in Medicare, you are also denied your Social Security payments. As physicians, we have to completely opt out of all Medicare for 2 years and get patients to sign a contract to that effect as well. Although I applaud physicians who do not accept Medicare, I also support those who try to change the system while continuing to work within it.
Dr. Haynes….you stated ["AND if, as a patient, you choose not participate in Medicare, you are also denied your Social Security payments."]
I find that a bit confusing! Are you stating that, if [eligible] for social security and medicare and you opt out of the [medicare] provisions, you will not receive your alloted monthly social security benefit?
At 83 I’ve not elected to use any social security benefits but, its my understanding that having reached age 65 and eleiblbe for medicare, Part A is automatic and medicare Part B…. are all optional and has nothing to do with receiving ones monthly social security benefit.
Am I just reading the comment wrong?
T.T. Thomas:
You are automatically signed up for Medicare when you apply for Social Security. You do not have to take advantage of the Medicare benefits, but if you try to dis-enroll from Medicare, you will find that you will have to surrender your Social Security payments as well.
From the WSJ “Forced into Medicare:
http://online.wsj.com/article/SB10001424052748704461304576216872954763388.html?mod=wsj_share_facebook#printMode
“Yet in a stunning reversal, Judge Collyer last week revisited her decision and dismissed the case. In direct contravention to her prior ruling, the judge said the Medicare statute does—with a little creative reading—contain a requirement that Social Security recipients take government health care. The Medicare statute provides that only individuals who are “entitled” to Social Security are “entitled” to Medicare. Therefore, argues the judge, “The only way to avoid entitlement to Medicare Part A at age 65 is to forego the source of that entitlement, i.e., Social Security Retirement benefits.”
This is convoluted enough, but Judge Collyer’s truly novel finding comes with her implicit argument that to be “entitled” to a government benefit is to be obligated to accept it.”
Read the rest of the article. it is quite informative. This is not the only pace where I have come across this, but it is the most recent.
The other thing is that if you are on Medicare and accepting treatment from a Medicare provider, you can not pay more to side step the system. Say a test or procedure costs enough more than Medicare reimbursement that the provider will not provide it at Medicare prices. There is no way for you to make up the difference in order to obtain the treatment other than finding someone or some place that has completely opted out of Medicare. I realize that is rather abstract. I will try to find a concrete example which I read recently, but not promises that I will be able to track it down.
Anyone else have one?
Dr. Haynes….Thanks! Okay heres some background. I retired in 1977 from 32 years of militaty service so both myself and my wife have ‘available’ to us TriCare. We used the old system for three years after that retirement. I then, began careers taking over the operations of our family’s corporate farms and ranches in conjunction with consulting for three international agri companies for some of their international agri projects. During this time to present we have been self insured. However, my wife at age 65 applied for social security. Part A is automatically applied without a premium and she has never opted for Plan B or the other premium plans. Several years ago she attempted to ‘retire’ her social security benefit and what a nightmare of details that was for which I’ll not go into…..so we opted to put those funds back into some charities and the government seems to be happy they were able to ‘convince’ her to remain on the nanny roles.
Thanks for the links and we’ll read them soon. Hopefully, she’s not destined to the jailhouse because of some lovely judge!
Excellent article. Clear, concise, and compelling. America, we can’t have our cake and eat it, too. Thanks to Beth Haynes for saying it.
A short, well-written & concise piece that is generating this kind of dialog is fantastic. What were our forebears thinking when they let all this stuff start? We are just seeing the tip of the 80+ yr old iceberg. I am excited to see which leaders are real leaders who will NOT be afraid to take on the media when they slam them for standing up against this nonsense.
What were our forebears thinking when they let all this stuff start?=quote
What a very good question. Let’s start with SS. At the time of its implementation, the average American lived less than 50 years, the average couple had over 3 children, and many of our people were disillusioned with free markets due to the recent Great Depression. They were fooled and bought hook line and sinker the bait fed to them by the central bankers and power mad politicians. They did not consider the long term implications future Americans would suffer from the incentive couples had to stop having as many children (the old type of SS). They had no way of knowing Americans would one day live an average of over 70 years. Having children has its own blessing, but you must confess it has some high cost of its own. Why worry? The giverment has provided for your future. Let someone else have the children.
As for Mediscare, the imbalance in population caused by SS and the resultant loss of incentive to have children created a large voting block for American socialist to exploit. Old people were rallied to the polls to vote themselves largess from other peoples children. These tactics are still in vogue today, as Repubs were portrayed as pushing granny off a cliff in the recent special election in NY.
We will be remembered in history as the rottweiler generation of Americans, for we despise and love to eat our own young. If they survive the womb, they will be enslaved to the inconceivable debt and loss of liberty this generation voted for. May God forgive us.
That was in the day when children took care of their elderly parents. That’s a lot less common now. The widowed elderly live alone and when they crash (i.e. heart attack or stroke) it’s off to the nursing home. Fine, but there has to be a way to pay for it.
HCAHPS is a survey about the patients perception of quality care. Has nothing to do with infection rates or real healthcare for that matter. The survey with its false assumptions will lead to false conclusions. All the changes the hospital/gov’t has forced on the nursing staff has turned my best floor into the worst floor….you’d have to be in nursing to understand. Lord have mercy!
http://www.hcahpsonline.org/qaguidelines.aspx
More government involvement ALWAYS a bad move:( FYI
I worked in a health care environment in the 70′s and 80′s. In the space of one year, 1979, the cost of a procedure (not needing specialized equipment or technology) went from $400 to $1200.
Avarice on the part of medical providers and bureaucrats having all four feet in the trough brought us to this point, in my view.
I loved Dr. Haynes final observation – the real issue in health care is “who decides whether the cost is worth the benefit?” Much as we hate to admit it to ourselves, health care is a scarce commodity. Who is better at allocating scarce resources, the market or the government? And which system will lead to better outcomes for everyone in the long run?
I am currently what some people would call “lower middle class”, I guess.
My current annual income is approximately 1/10 of what it was during the DOT.COM bubble.
Be that as it may, the more government involved itself in the medical system, the more expensive and less efficient the medical system became. Who their right minds would advocate *more* government interference in the medical system under the delusion that even more of a bad thing will, magically and counter-intuitively, somehow, become a good thing?!?!?
Yes, the medical system needs change.
But the change it needs is to remove any and all government interference, of any form, from the medical system.
Let’s try freedom for a change.