Lori Montgomery of the Washington Post summarizes a report prepared by the Center for Medicare and Medicaid Services which attempts to estimate the effect of President Obama’s healthcare “reform” efforts. The Center is part of the Department of Health and Human Services. According to Montomery, the report says that half a billion dollars in “savings” will come from reductions in medical benefits to seniors. But despite the lower payouts, the reduction in total spending will be much less than advertised.
In the face of greatly increased demand for services, providers are likely to charge higher fees or take patients with better-paying private insurance over Medicaid recipients, “exacerbating existing access problems” in that program, according to the report from Richard S. Foster of the Centers for Medicare and Medicaid Services. …
Democrats focused Saturday on the positive aspects of the report, noting that Foster concludes that overall national spending on health care would increase by a little more than 1 percent over the next decade, even though millions of additional people would gain insurance. Out-of-pocket spending would decline more than $200 billion by 2019, with the government picking up much of that. The Medicare savings, if they materialized, would extend the life of that program by five years, meaning it would not begin to require cash infusions until 2022.
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But that misses one of the major points the CMMS report was trying to make. Costs will be kept down because benefits will be redistributed. Some may pay for others. “In the face of greatly increased demand for services, providers are likely to charge higher fees or take patients with better-paying private insurance over Medicaid recipients, “exacerbating existing access problems” in that program, according to the report from Richard S. Foster of the Centers for Medicare and Medicaid Services.” What the actual report said (on page 15) was:
Price reactions — that is, providers successfully negotiating higher fees in response to the greater demand — could result in higher total expenditures or in some of this demand being unsatisfied. Alternatively, providers might tend to accept more patients who have private insurance (with relatively attractive payment rates) and fewer Medicaid patients, exacerbating existing access problems …
Despite a provision to increase payments for primary care to medicare levels, most Medicaid payments would still be well below average. Therefore, it is reasonable to expect that a signficiant portion of the increased demand for Medicaid would not be realized.
We have not have not attempted to model that impact … such as supplier entry and exit or cost-shifting toward private payers.
But the agency warns that little, if anything is certain about the future. Although it asserted that “most of the provisions of HR 3962 that were designed, in part to reduce the rate of growth in health care would have relatively small savings impact” it made it clear that the “actual future impacts of HR 3962 on health expenditures, insured status, individual decisions, and employer behavior are very uncertain. The legislation would result in numerous changes in the way that health care insurance is provided and paid for the in US, and the scope and magnitude of these changes are such that few precedents exist for use in estimation.” (emphasis mine)
The empirical difficulties notwithstanding, Robert Samuelson writing in Newsweek says “it would create new, open-ended medical entitlements that would probably expand deficits and do little to suppress surging health costs”. Samuelson calls it a self-inflicted wound.
Obama’s advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with no legislation. The studies estimate the extra spending, over the next decade, at $750 billion, $525 billion, and $114 billion, respectively. The reasoning: greater use of the health-care system by the newly insured would overwhelm cost-saving measures (“bundled payments,” “comparative effectiveness research,” tort reform), which are weak or experimental.
But if “reform” doesn’t solve the health care problem then what problem does it solve? The idiosyncratic Terry McGarty, a blogger who is affiliated with MIT, has actually tried to read through HR 3962. He says, “I thought it would be educational just to present the Table of Contents of the Medicare section. Remember what our current President said, if you like your current health care you can keep your current health care. Not if you are on Medicare! And those fellows at the AARP, shame of you! The following is a massive change in Medicare and the seniors just do not know what is happening to them. This Bill goes well beyond HR 3200 in making Medicare a straight jacket for physicians and is a clear example of what will happen to a public plan.”
His short view of the HR 3962 is that “this is a large taxation bill … most likely the sickest will seek the Government plan because of its costs. This the statistics of the plan will make it difficult to attain the overall mix to be able to predict the costs. Thus it will always run a deficit and one knows where that will come from.”
Given these uncertainties the safest course is to look at health care “reform” very carefully for at least two reasons. First, as the HHS report noted, the bill’s effects are so large that they will transform the landscape forever. There are no past models that can be used to model its effects accurately. Second, it appears to reduce the benefits of one group of people for a possible increase in benefits to another. In other words the medicine in the bottle can do a lot of things. It can shrivel your hand at the expense of maybe healing your foot. But nobody can tell with any degree of real certainty what its long term effects will be. By itself, that defect isn’t fatal. Public policy experiments always carry with them an element of risk. However, there are some experiments whose consequences should be carefully examined. There are some bottles of medicine left undrunk. Yet one thing everyone should agree on is that it’s worth reading the label, even if it is thousands of pages long.
But even if HR 3962 doesn’t solve the “health” problem, it may solve a political problem. Think of it, a source of money and entitlement that can be squeezed for decades! How many politicians on both sides of the aisle could resist its lure?
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Isn’t it amazing that the champions of the “precautionary principle” in regards to the environment and things like genetically altered crops have no such qualms when it comes to social engineering?
Ah well–build the ant farms and the ants will come. And if they are ungrateful enough not to come, go outside and kick down the ant mounds that they made for themselves. That will show them.
Its an attitude that can be excused in a five year old child but its inexcusable in people who claim to be our leaders. A growing majority of the American public is against the “health care reform” that the Democrats are pushing down our throats, but they don’t seem to care.
We, the little unimportant people who are not members of the political class, are not ants, but we do share something in common with them. Under the right circumstances we can sting pigs to death and strip them down to the bone within a fairly short period of time.
Beware the ants Oh Great Ones–they can be far more dangerous to your political careers than you can ever imagine.
The Democrats don’t care what the voters are against because they never expect to face them again in a free and fair election.
The fix is already in.
Maybe the whole thing is a farce. Current insurance has major disincentives to actually making claims. If I avail myself of a drug that costs $10k/year, I know (on an individual policy, and groups work the same way on aggregate claims) my premiums will go up at least $5k a year, … maybe $10k, maybe $15k, I’ve never gotten a clear answer. But Obamacare claims you can’t be “dropped” for illness – did they forget to mention that you can still have costs raised for usage?
Increased coverage will result in a huge increase in demand, that probably cannot be met in any case! Now, it is just barely possible that if we struggle to meet demand, a huge increase in expenditure – will buy some extra degrees of health, especially in the illegal alien population.
But the idea that there are ANY savings in this bill must be entirely fradulent, making the real costs immensely higher than estimated. Even a Ponzi scheme works for a little while, but Obamacare will fail on day one.
… only the various parts phase in over several years hiding both costs and benefits so the Dems can preen for a little while until brute arithmetic rears its ugly head. Then, they can simply pass an amendment: by royal degree, and to the benefit of the population, henceforth 2 + 2 = 3.
… btw, ever see the TNG episode(s) where the Cardassians are torturing Picard, asking him over and over how many lights does he see? And even after being freed, he admits, that there at the end, he wasn’t just ready to say whatever was necessary, he really was seeing what he was demanded to see. OK Orwell beat them to it, but it was an excellent portrayal of the same theme.
… oh, and I accidentally watched the first few minutes last night of the Wanda Sykes show, where she did about ten minutes (before I flipped) about health care, and how it should be a utility, like police or fire. Does the fire department ask about your deductible before they answer the call?
One simple-minded way to think about the health care “reform” is as a way of allocating resources. If the absolute level of resources is kept the same or reduced then the only way more people can be served is to increase efficiency. When the HHS observes that increased demand without an increase in resources will lead to some demand being “unsatisified” it is a long winded way of saying that, given a fixed capacity, there is no obvious way the medical system will produce more outputs. So the fact that more people will be inducted into the system doesn’t necessarily mean that more medicine will be delivered. It just means the butter will have to be spread more thinly over a greater amount of toast.
Imagine a situation where there is food at a party for a hundred people. If you bring in thirty more persons that doesn’t necessarily mean the hungry will be fed. Once it becomes clear there isn’t enough for everyone on the tables, then whether you get food and how much you get depends a lot more on the rules of distribution. But one thing that will be invariant, at least in the short term, is that the quantity of food unless you are the feast of the loaves and fishes.
Ultimately, providing more medicine for more people either means doing it better or putting more resources into the system. The Obamacare machine, the HHS concludes, won’t necessarily produce something out of nothing. Even the belief that the total amount of money in the system won’t increase doesn’t necessarily speak to the point. It’s like saying you’re household food bill is pegged to a ceiling. Hooray! The bad news is that your cousins are moving into the house and will eat. We all know how that might work. So to some extent the quality of health care may be traded off to spread the butter over greater area of bread.
It would wonderful if someone could estimate how much of the butter sticks to the knife. That is, whether Obamacare increases or decreases the cost of administration, torts, bureaucracy, lost opportunity, innovation, etc. But as the HHS actuary said, soon we won’t be in Kansas any more, so nobody can say for sure. But we can drink down the medicine and find out. Things may not go well. In the immortal words of the Three Stooges. “It’s Dr. Jekyll. Let us Hyde.”
Wretchard writes
In the immortal words of the Three Stooges. “It’s Dr. Jekyll. Let us Hyde.”
I missed this–when did Obama/Pelosi/Reid come out with this statement? Do you have a link?
Resources will be increased by fiat. That is to say that either doctors will be provided by a European car company in alliance with a corrupt American union or the standards for entry into medical school and the rigors of the licensing boards will be adjusted until enough of the right people get admitted. Of course the pay will go down, the working conditions deteriorate, quality providers flee or retire, and the professional atmosphere corrode. Those admitted will complain about the cruel trick being perpetrated on them, until the next time the government rides to their rescue.
The Laws of Economics may not have all the testable rigor of the Laws of Physics but they are not mere literary constructs that can be altered by the will of a narrow elite. That doesn’t work even in a true collectivist dictatorship, where the General Will, or content of the set of general utilities as expressed in “Utiles,” is highly responsive to central control. They certainly are not subject in a modern complex liberal (meaning free) society to significant short term change from pressure by a narrow political movement reliant on highly perishable propaganda forces. Costs to some consumers may appear to decline and revenues to many suppliers will decline. The results will be increased demand and decreased supply.
As the economy shrinks under the pressures that these and other policies inflict on it living standards will decline. That will make people less healthy, although I expect to see an article touting the popular and healthy rise of the low meat diet. A less healthy and poorer population will be more susceptible to the vices associated with poverty and concurrent health effects. That will further increase demand. Iterate as needed. Dr Jekyll’s drug is addictive and eventually he withers away as Mr Hyde grows.
Feel sorry for the poor souls who have devoted their lives to studying medicine and are now finishing their residencies with mountains of debt (200K is a common amount) and hope to pay these loans back at some time. What options do these suckers have but put their nose to the grind and continue with the 80 hour work week, ruining their family life in hopes of paying back outrageous loans with draconian payments from medicare and medicaid that are about to get significantly worse.
And to question the authority of the New England Journal’s editorials on how great this reform will be is like admitting you listen to Rush Limbaugh in the middle of a DC cocktail party.
The Laws of Economics may not have all the testable rigor of the Laws of Physics but they are not mere literary constructs that can be altered by the will of a narrow elite.
Note well how the people who laugh at Creationism and Intelligent Design and worship at the Church of St.Darwin are often the same people who believe in Marxist Intelligent Design and are more than willing to break a lot of eggs in pursuit of the perfect omelette.
And here I thought that I read where Wanda Sykes would be “funny and irreverent”. Sounds like orthodox propaganda supporting the government line of reasoning. Not very funny or irreverent.
This has been repeated over and over, but it really doesn’t matter if the whole thing “works” or not, because that is not the point. The point is to get and keep more power for the Federal Government. And I know that James Carville said that he thinks and hopes the Democrats will maintain their majority for 40 years. Gee, is he thinking too small?
It is only important to keep up the charade for a few more election cycles about the whole thing “working”. It will never “work” for obvious reasons:
1) The whole thing is not even remotely based on any meritocratic notion. Civil service employees and political appointed mediocrities will run this system. There is no hope that there will be any intelligence, innovation or inspiration within this “plan”. It will be run “by the numbers” by a bureaucracy that will be regressing to the mean of IQ.
2) Gosh, if the “seniors” don’t like the fact they’ve just been screwed, I guess they can vote against the Party involved. Good luck with that. I know plenty of “seniors” that vote the straight Democrat ticket and have for most of their years. By the time they start to realize that their benefits have actually been trimmed, they are likely to all be terminal in some hospital.
3) If and when this all becomes law, it will permanently change the relationship between our government and the people. When the government can compell you to purchase insurance (ask Roland Burris, junior Senator from Illinois where that is in the Consititution), is there really anything that they can’t do? Does the Constitution and the Bill of Rights actually mean anything anymore?
So the principle behind this is wrong, the intent is wrong and the outcome will be wrong. Sounds like a plan to me.
If one recognizes how to boil a frog by witnessing the heat being turned up one degree at a time, too slow for the frog to notice and hop out…does not necessarily guarantee that the same process would be noticed…if they were in the pot themselves.
There is no “reform” in health care reform. What the frogs don’t notice…is that there is no “health care” at the heart of health care legislation.
If one defines “insurance” as the Edward Lloyd’s coffee shop, betting on ships at sea or against them.
Or perhaps more accurately, we frogs are now “the action” for the pari-mutuel bettors of the nanny state parasol and mint julep crowd.
We are having our resources “redistributed” or boiled away…one degree at time. And in ways hidden in little itsy bitsy bits of legislation and in great big behemouth legislations.
The nanny goats who not only eat this garbage but like it…will not be heard to bleat a single complaint.
“Health care reform” is not about health, is not about care and is not about reform. It is about time we take a long hard look into why it’s starting to feel a little warm in this pot, though.
Last time I checked, the Law of Supply and Demand was still in effect. And last time I checked, when you want speed, quality, and price in a job, you are fortunate if you can get two out of three.
The supply question was decided wrongly three decades ago when it was decided to limit the number of medical specialists and decided not to build new medical schools. While the population increased, got older, and introduced more individuals with illness coming from third world locations, the number of physicians remained about the same — only worse.
Worse because the balance between male and female physicians shifted such that now 45 – 55% of medical students are female. Nothing wrong with that — my wife is a physician and one of my daughters is applying to medical school. But women will log fewer patient hours during the course of their career life than men. (The very fact that women can ramp down or up on their hours during their “mommy” years makes it extremely attractive for female physicians. But that also reduces, perhaps by as much as 30%, the total patient hours they work during their career.)
So add it up: more people, more older people, more unhealthy legal and illegal immigrants, fewer medical specialists, no meaningful increase in physicians, a gender shift toward female physicians, and a lower total for patient hours per career lifetime. Even without Obamacare this creates a relative shortage. It was partially compensated for by importing physicians from other countries. But with the increase in demand that will be created by Obamacare (or Pelosicare) plus whatever John Galt effect lower payments will have, is almost certain to create shortages.
I’ll offer a few potential solutions next, so as to keep this post from being too long.
LoTM,
“Resources will be increased by fiat.”
Er, in the case of my state California, or your pre-Giuliani New York City, the long term evidence strongly indicates that health care resources will not be increased; they will simply be distributed to those deemed by our betters more equal, with the rest left to die or suffer. Your presumption is logical, but contradicted by the behavior of our Stalinist overlords.
Cannoneer’s
“The Democrats don’t care what the voters are against because they never expect to face them again in a free and fair election. The fix is already in.”
is the logical conclusion of their actions.
Some solutions that will never be implemented.
1. Increase the number of medical schools and expand the number of graduates. This can still be done without diluting the quality.
2. Unlink medical insurance from employment so that people can take it with them with or without a job.
3. Make higher deductible policies more attractive. If people have to pay for the first $2000 to $25,000 of their health care costs themselves, insurance for serious problems will cost less and frivolous uses of emergency rooms will decline. This carries the analogy with automobile insurance further. We do not generally insure oil changes, lube jobs, or tire replacement.
4. Medical savings accounts must be made extremely tax advantageous. The more people become partially self-insured the lower the burden on insurance and the more things will return to patient and doctor interaction without interfering third party payers.
None of this will ever be enacted. It creates too much freedom.
Batman @ 13
The solution is simple – get government out of the picture.
This means – no government regulations, licenses or money.
Do not make the practice or purchase of medicine a crime.
People can make and learn from their own choices.
And the irony is that, assuming individual freedom and competition in the marketplace are maintained, the result really is a miracle of the loaves and fishes.
Only those trapped in a materialist faith could fail to notice this obvious aspect of reality.
What vile ninnies.
It has been obvious for some time that one political requirement for any “reform” proposal for welfare services will be to make sure the problem is not fixed.
If it does get fixed it will not serve as an issue for future promises. Deprived of a welfare issue, politicans will lose a means with which to buy votes.
During the Clinton Admin there were constant cries of the need to Save Social Security. No answers were offered, and when Pres Bush offered one it was shouted down by the very people who claimed to be so concerned – and who then said there was nothing to be worried about.
Any issue, from space exploration to Medicare , faces major challenges in Wash DC, the worst of which are the competing special interests. But in the case of welfare payments in their many various forms the problem is exacerbated by the fact that many of the political class don’t want it solved at all.
In a converstation with my MD he said if this passes he’ll move to the Bahamas. I countered that Costa Rica was a better bet. Big US expat population, stable govt. I thought that US developers would swarm the place with new hospitals.
Now I hear on the radio that a large US health insurer is offering a policy that says if you get any of a number of high cost common procedures (bypass, valve replacement, hip or knee job etc.) done in their Costa Rica facility, there’s no deduct /no copay /no impact on your policy limits. They’ll even arrange travel.
I expect that this will become common but will require some sort of finesse of the proposed system. If the policies are offered as part of the Congressional Health plan, ’twill really be greased.
Costa Rica?
I was sure it would be Mumbai.
But Costa Rica is a lot closer, and I speak at least a little Spanish. Though I suppose, in theory, many people in India speak English.
Far more intelligent people than I have made incredible posts here at BC. I’m just a non-college educated senior-citizen still-working guy. Over the past six to eight months, the general population has begun to come around to what is being done to us, mostly evident in the health care fiasco currently in Congress. Action has come mostly in the name of Tea Parties.
I can’t count how many topicss here, and at many other blogs, say in essence, “the time has come to rise up” or words to that effect. Phrases like “the frying pan is getting warm,” “wake up, people,” etc., etc. Unfortunately, they don’t mean a thing. We are preaching to the choir.
I believe Wretchard well understands this, and has recently attempted to move us beyond writing, to action. The majority middle class is like a benevolent monster without a head. Almost every thread expressing outrage, shock, or anger at some political event ends up with “I won’t vote for that person again,” or “just wait until next November!” We should explore additional legal resources that are available to us in this country, besides the vote. Recall elections come to mind. Pardon my ignorance in these matters, but there must be many other courses of action to pursue, as well. I don’t mind being called a dummy if it will help to reveal resources.
Whatever courses of action become evident, the time will be at hand for us to put down our keyboards, and actually go “out there.” I think many of us are suffering from stage fright. I fear this will also have to change. That includes me, and I live in Silicon Valley.
A strong national leader wouldn’t hurt, either. After being burned by Perot, and even Fred Thompson however, my trust will be hard to earn.
I have to make a small slightly OT apology, because this post could have been made in any number of threads created here at BC.
Herb #17:
What do you suppose would happen if you tried to sue a doctor or hospital in Costa Rica?
When Al Gore said that his dog got the same drug as his aunt at a far cheaper price, the first thing I thought of was “How many dogs sue the drug makers?”
Another reason to move to a country less infested with legal leeches.
Norm,
We should explore additional legal resources … besides the vote. Recall elections come to mind.
Welcome to the Club,
California had a recall provision. I do not know who else does. NY does not. It would be on the dream list for Constitutional reform. Should not be easy to do but should be feasible to get done when needed. The other alternative is to shorten the term of office. Governors used to be elected for two year terms and the State Legislature was often elected annually. Keeping the leash shorter might help.
RWE,
Another reason to move to a country less infested with legal leeches.
Is it Andorra that has a law against lawyers? Maybe that was just a line in Heinlein.
If the prescription laws are eliminated, then many people will be able to obtain needed medication without having to visit their doctor every six months. For chronic conditions there is no justification for this except what goes into the doctor’s wallet. Elimination of these “unnecessary” visits will give doctors more time to treat those who actually do need their services. The prescription laws didn’t exist in the US until 1938, and were passed at the urging of the AMA to increase doctor’s incomes…
wretchard wrote:
I do believe that is exactly where The Won and The 0bamanation think they are. The pathological narcissists think they are miraculous saints.
We are so screwed.
Norm @ 19: You are correct. I am working at the state level and talking to the GoP locally to find out if they can summon the courage to sue the Feds over a number of issues. HealthScare being un-Constitutional is one. Our local ward is a national GoP test base for getting organized at the smallest local level and seeing what methods work.
O/T – I said the the ward Pres. that I thought all citizens should be compelled to be armed. She looked at me like I had 3 heads and spoke in Aramaic.
What we have to have is not the same end state as the DNC only slower but an entirely new way of communicating who and what “Conservatism” means. (BTW, how do you message it as ‘Classical Liberalism’?)
clear….
It seems to me that the only way to reduce the total costs of medical care and yet have quality care for those who are sick or injured is to have fewer persons needing medical care at any given time–in other words, to have a healthier population. If the estimate that 40% of all medical care costs stem from unhealthy behaviors is anywhere close, then there is the potential for huge reductions in the costs of medical care.
The problem is that persons may be even more reluctant to part with their unhealthy behaviors than to part with their money. And to the extent that it is grandchildren’s money that will be spent, there is even less motive to give up unhealthy behaviors.
Still, I would like to think that there are some ways that the financial burdens of unhealthy behaviors could be borne by those making those unhealthy choices rather then shifted off to others, including to future generations. It would not be easy. We certainly do not want an intrusive nanny-government. But we do have differential premiums for life insurance; why not for medical care insurance?
Stay healthy,
Jim
I would go wretchard @ 4 one further– The ONLY way for a non-specialist to look at this is as a matter of resource allocation. If you try to get into the details you just lose the forest for the trees.
It’s really as simple as wretchard makes it: more demand and price controls mean less supply, making the disconnect between a market-clearing price and the controlled price even greater… positive feedback loop (vicious circle, if you prefer) as providers cut back or leave, waiting lists grow, working conditions deteriorate, more providers leave or cut back, etc. Govt deperately pumps in more money, so price caps move toward market clearing price, but high taxes start inducing people to move into underground economy or reduce work because there’s so little marginal benefit—often a combination of the two. Everyone who can, starts working “off the books” as much as they can—and you would be surprised how much of the economy can become gray if not black market, and lost to the taxman.
Eventually you either explode or reach some sort of near-equilibrium with long wait lists to get poor service, at incredible social expense. And, you’ve crippled the economy and the rest of the government due to cost and the fact that you’ve effectively shrunk the tax base and starved the rest of the government.
Really, all the current arguments are just about how to game the CBO scoring, and what path we take to get to that destination.
The more interesting question is why do they want to do this?
With reference to my post @25, there is a partial alternative, which is to deny lots of services to lots of people, the Ezekiel Emmanuel approach. He didn’t put it this way in his famous article, but what he really said when you chop out the fluff, was that society (i.e., govt) should assess people’s worthiness based on age as a surrogate for future lifetime productivity. The very young (who impose a lot of costs for lots of years before they start producing, and therefore do not have a high NPV) and those approaching retirement (not many “productive,” taxpaying years left, but a fair number of years taking out of the system before they have the grace to die, so a low or negative NPV) do not qualify for expensive treatments or procedures. People nearing and in early adulthood are the best on an NPV basis, and worth spending on.
Of course, as soon as they start making a decent buck, they’ll be paying through the nose in taxes.
Big question whether this is politically possible, of course.
Norm @ 19
I think we all feel helpless to some extent but there are a few ways that we might be able to help until something better comes along.
One obvious action is to attend any Tea Party in your area and lend whatever support is requested within reason.
Another is to contribute to people who are running against entrenched politicians. Be forewarned however that a contribution to one such candidate will unleash a torrent of mail requests for contributions from many others claiming to be the only alternative to X (X being a name that triggers alarm by any conservative, i.e. Pelosi, Reid, Murtaugh, etc.).
One problem with this is that one wants to contribute to worthy candidates that might have a chance to win and it is difficult to tell a) who is worthy since many of the new candidates do not have any track record and b) it is even harder to tell if they really have a chance of winning.
American Solutions is a web site that is trying to mobilize action from individuals but it seems to me to be struggling between selling ideas, selling books, and actually taking actions such as signing petitions (who knows if these are effective?) or calling congress-critters (the effectiveness of which depends on where you live and how your representative votes). For us Californians, it will do little good to email or call Boxer or Feinstein even though I do it all of the time. I’m fortunate to live in a solid Republican district so McClintock is a dependable NO vote.
Palin seems to be the only national figure to consistently represent common sense principles but it remains to be seen as to whether she can lead or even contribute to a national effort.
Gingrich speaks effectively against many of the proposed policies but he is a much-hated figure from the Contract with America days and recently went badly astray in NY supporting the good ole boy Rs when they screwed up as usual.
Sending emails to your friends to help them understand what is happening is another thing that might help. I’m not sure whether I’ve actually converted any votes but I’m in there trying. It’s important if you do this to check your facts because there is a lot of drivel floating around emails. Just because you want to believe something doesn’t make it true.
I know these are small actions but they say that mighty oaks grow from small acorns. “They” don’t mention that it takes a long, long time to do so.
(previous thread closed)
Why Does He Hate Us?
It must be an odd thing to be President of a country that you think has an evil history. The roots of President Obama’s anti-Americanism.
In the area of foreign and national security policy, however, Obama can operate largely unchecked. And a weak, guilt-ridden policy toward our foreign adversaries is almost certain to produce grave consequences.
To some extent, we have seen this act before. The damage of just four years of Jimmy Carter’s America-effacing presidency included Soviet expansion, communist inroads in Latin America, the replacement of a friendly government with a virulently anti-American theocracy in Iran, and a prolonged hostage crisis that came to symbolize the new American impotence.
But although Carter was ambivalent about America, his efforts to promote democracy abroad showed that he thought we had something to offer t[he] world. Obama will not grant America even that.
Emulating Carter the ex-president, rather than President Carter, Obama has shown essentially no interest in human rights or democracy promotion. His belated support of the Iranian protesters following this summer’s election could hardly have been more lukewarm.
It seems that, in Obama’s view, all we have to offer the world is our non-interference in its affairs, except perhaps when it comes to bullying our allies.
Read it all
This has to be a dream. The world’s finest medical industry, and engine of growth and innovation, to be crushed out of recognizable shape for want of a simple, easy, accretive tweak.
Solve the excess useage, ”tragedy of the commons” effect, and (*poof*) the end of the supply/demand problem. Dems say no no, two party transaction would mean people would go from overuse to underuse. What horsehit, what utter complete horshit. Sure, yer rule-or-ruin talking head will have an anecdote from somewhere but we are simply INSANE to keep losing to such a cheap emotional blackmail tactic. Where’s the love going to be in a bancrupt crashed system? Nowhere, that’s where.
In reforming away from third party, the insurance portability and the uneven taxation (self insured alone pay in after tax dollars) problems will be solved a priori. The resultant HSA system is asset building, moral hazard reducing, and in all ways character building rather than destroying, and the increased individual private property will go toward solving the retirement problem. Just a huge virtuous circle is within our reach if only we can do it. The other problem, the third problem, is basically not related except by opportunism to the healthcare industry at all but is more akin to civilization’s ancient problem with mounted nomad raiders, now longingly hoped to be fought off not with pikes and clubs but with “tort reform”.
that’s it –those are the problems, 1- 2- 3!
(1) supply/demand (under this heading, third-party payer reform, and the need to stop the $60 – 120 bbl –or about 20 to 40 times the ‘slippage’ experienced by the private sector –in medicare fraud, and a sustainability fix for the actual services rendered –AKA the tail of the medicare Hell Hound).
(2) IRS rules (that unequal tax policy and insurance portability under this heading).
(3) the predatory plaintiff bar industry that creates problems wherever it can so it can fix them, charging fees on both sides of the equation, in and out, to and fro. Need tort reform, and quickly available, with a body of case law already old & well-tested, and in the English language to boot, and a GOOD app of federal one-size-fits-all, a quick fix, low down dirty and effective as all hell: the “English Rule” –”loser pays”.
or try the Texas Plan for tort reform –it has borne great results –take a look –and no ‘harmed’ people left bereft of justice either –which is of course the problem that the two decades abuilding of legal assault supposedly addresses.
But nevermind the dubious truth of that picture, let’s have a look at the negative, and tell me, where is the justice of chasing off thousands of would-be doctors who could have treated hundreds of thousands of patients and saved many thousands from living thru an anecdote you’ll never hear, the one about no doctor in the small town –mereluy in order to scrape a dynamic system down so deep into the quick and bone that there cannot even be an ANECDOTE left around for the lawyer agents to drag onto the tube and beat us to death with?
It’s as simple as one two three, 1- 2- 3!
But here’s the kicker –guess what isn’t EVEN MENTIONED in the ObamaCare bill?
–as otherwordly inclusive of every detail, and accountable of every human act as it is and will grow to be, it does not even TOUCH the 1- 2- 3! that COMPRISE the ACTUAL problem.
GOOD GOD A MIGHTY THIS MUST BE A DREAM
Wretchard #4 In regard to the resources, the bill provides millions of grant $ to anyone who wants to enter the health care field to pay for their education. So it appears the writers of the bill realize that there will be a greater demand for the resources than are currently available. Those new health care workers will most likely be hired by the Govt to service the growing number of people switching (only choice because of cost) to the govt plan. The all those govt workers will be members of SEIU and the plan will have been meet its goal.
When a government decides it wants more availability of one thing, and decides to get it by throwing a ton of money at, prices always rise. When they perceive we need more help on tuitions, they throw money into them, and tuitions skyrocket accordingly. When they perceive we need more homeownership, they prop up freely available credit for mortgages and first-time buyers. Home prices skyrocket across the board. When they decide we need cash for clunkers, they pour money into the showrooms — and then we pay full sticker price for a change.
Health care is no different. More dollars chasing around existing health services can only mean prices will rise. New rounds of scapegoating, and ‘cost cutting’ measures (rationing), and new cash-infusions (even more money pumped in the system — for even higher prices!), and finally maybe even expanded price controls. All this stuff is in our future if we let these guys have a bigger stake in our health care than they already do.
Every move they’ll consider will exacerbate the problems, and thus solidify the justification in their minds for more and more controls and interventions in a spiralling doom-loop. It is classic Hayek, and it happens everytime, everywhere it is tried. The brighter ones know this. But it is not going to stop them from trying.
R/31; –the language is, the gov’t-paid nurse training is thru hospitals, and is only available to hospitals that have contracts with SEIU.
I know –doesn’t sound possible does it. yet that’s exactly what some of the better newsfolk analyst types were evincing some shock over, during the wkend.
Andy Stern, a long, long, longtime associate of Bill Ayres, is the president of SEIU. When the White House finally broke down and acceded to practice and published the visitors list awhile back, Andy Stern had logged in 22 visits –most of which, it was reported, were closed door meetings with Obama (as of the list’s cutoff, which iirc was already some few months past-current when the list was released a couple weeks ago).
brings to mind: the hush hush scandal of underfunded union pension plans –could half of the 20 largest unions really be underfunded by up to half? THIS may be why Andy Stern gave Obama’s campaign $400,000,000 of his rank and files’ hard-earned money, and the reason he keeps dragging Obama off into private skull sessions. Stern wants to take over some or all of the other unions, it is said, and is trying to ‘show power’ –possibly via the ObamaCare bill (half the SEIU rank and file are healthcare workers).
Of course, if unions weren’t a third of the media-DNC-unions Tammany-like troika, the media would be screaming bloody murder about an underfunded pension problem of such magnitude.
About five years ago I was predicting that the next big ‘above the fold’ collapse would come from within the Pension Benefit Guarantee Corp (PBGC), the GSE that insures private pension plans. Default of the underfunded airlines and steel industry plans pretty much broke the back of PBGC in the late 1990′s, but it’s still hobbling along – on life support I believe is the metaphor du jour.***
The only reason nobody knows the acronym is that the F/F stuff collapsed first.
I have nothing more to say about the pending health care/insurance reform. Congress has my letter. I’m on record. Really, there is so little gravitas left in any of the federal legislation that it is Jon Stewart’s show now. What is a serious person to say about a 2000 page bill that omits critical structural details while making room for ‘end of life consultations’ and gets read by every third or fifth staffer?
Real reform has certain definable parameters. The studies are 16 years old and counting. I’m not going into detail here. Real reform wasn’t even a twinkle in the eye of the Bush Republicans so now we have Democrats under Obama attempting it. Be careful what you wish for.
***Critics of the union plans claim that they over-promised. The business model could not support the retirement funds which quickly became accounting liabilities. Probably. But think of the millions of wage-earners who made their monthly contributions over the course of a forty year career only to see their pensions default to the PBGC for 10 cents on the dollar. Don’t get me started on the retirement mansions conveniently waiting for the layers of multiple management teams that breezed in and out of their offices with the cleansing force of a brisk and efficient chinook wind.
By the time they start to realize that their benefits have actually been trimmed, they are likely to all be terminal in some hospital. — E Nigma
It is optimistic to believe that the truly terminal will be allowed in hospitals once their diagnosis is made. The NHS is all about declaring people ‘terminal’ and then withdrawing money, I mean, care. The name of the protocol, the Liverpool Care Pathway, tells you that this is the product of “comparative effectiveness research”, intended to broadcast best practices and see that they are implemented. Things like the Liverpool Care Pathway are a feature, not a bug, and we may well see the LCP be among the first things to be adopted, once the research behind it can be duplicated by a US provider. It may be called the ‘Livermore Compassion Plan’, but the function will be the same. And you are absolutely correct about people still voting for FDR. Shortly before he passed away in 2003, my wife’s arch-conservative grandfather announced that he was not going to vote straight-ticket Democrat any more, he was going to vote for the candidate he liked better. He also didn’t believe that Al Gore was pro-choice in 2000, so I’m not sure that was a particular advance for him.
1. Increase the number of medical schools and expand the number of graduates. This can still be done without diluting the quality. — Batman
This assumes that medicine remains an optimal choice for the best students. I would argue that the loss of autonomy implied by state imposition will decrease the applicant pool, at least the quality of the applicant pool, by some margin. And when you increase the number of positions you increase the number of people in medical school who otherwise wouldn’t have been in medical school. You will pick up a few folks who were inappropriately overlooked by the admissions process, and collect up a bunch of people who for various reasons shouldn’t be in medical school. Both of these forces will act to decrease quality. Not only that, but people with MD degrees are dangerous until they can be further trained, so you have to increase the number of residency and fellowship training positions as well. Both this and the construction of new medical schools come at significant cost, and academic physicians are already in fairly short supply — to have more students you need more teachers, and those are also hard to come by.
Everything else you say is spot-on, especially this: “The very fact that women can ramp down or up on their hours during their “mommy” years makes it extremely attractive for female physicians. But that also reduces, perhaps by as much as 30%, the total patient hours they work during their career.” Absolutely true, and the glaring hole in physician supply for the last ten or more years. In terms of FTEs, a class of 200 that is 80/20 male-female works out to 188 FTEs, a class that is 55/45 female-male works out to 167 FTEs. Our training system is no less expensive, but now measurably less efficient. The medical schools are awarding degrees, but the number of providers is lower. Increasing medical school classes will only increase the number of medical school graduates, the downstream effect on the number of medical providers that are active will be lower than expected and most medical schools can’t handle a 30% increase in student volume.
But we do have differential premiums for life insurance; why not for medical care insurance? — Jim Nicholas
There should be, but making it harder for unhealthy people to get insurance means they are less likely to get insurance — and they will continue to become less healthy, making their impact on the system much greater when they finally present for treatment. Quite frankly, risk pools depend on people who are healthy to subsidize the unhealthy, risk pools need people to pay for insurance and then never use it. Risk pools are unaffected by people who are unhealthy and don’t have insurance, but providers tend to get hit disproportionately by the resultant costs of the uninsured.
The glaring strategic error in any national health care system is first-dollar coverage. When there is no penalty, some people will overuse the system. There are some patients well-known to me simply because they are ER Frequent Fliers, when their name pops up on the PACS I recognize them even if I do not see them face to face. When people have to pay cash up front, they show up when they are sick. A regular health maintenance visit with a PCP should be covered up to every six months, but everything after that should come with a cost.
Phil Gramm said it best: “If I only paid 5% of my grocery bill, I would eat differently and my dog would, too.”
More dollars chasing around existing health services can only mean prices will rise. — Cowboy.
This presupposes the ability to balance bill, or charge more than a health insurance plan provides. In 1986, the province of Ontario passed the Balance Billing Act, and eliminated the right of physicians to set their own fees AND accept payment from OHIP, the single-payer provincial health system. Physicians could opt-out of OHIP, but OHIP (the only insurance anyone in the province had) would not pay them a dime. Their patients would have to pay the full physician fee.
There is a similar opt-out for Medicare, but opting-out for even one patient means you cannot accept Medicare payment for ANY patient for a two-year period. Balance billing is required for prices to rise, but Medicare pretty much disallows it and opting-out is a fairly drastic step, many seniors have no health insurance other than Medicare.
Basically, it’s even worse than you think it is.
Darren,
When people have to pay cash up front, they show up when they are sick.
This is all true but it does not take into account one of the major distortions in the pricing system that we face. The cash prices assigned to people who do not assign their bills to a 3rd party are simply divorced from the actual value of the services rendered. A few months ago I shared with the Club how I went to a local ER for a cut finger, that turned out to look bad but only needed Bacitracin™ and a bandage. Unlike most people who walk in uninsured I honestly showed my ID. The result is a bill for $1,100 that may sit out there until I take a dirt nap.
If you walk into a restaurant and they don’t show you a menu before you ask a cup of coffee but then hand you a bill for a thousand dollars people would say “No way.” That doesn’t happen anywhere in America anymore outside of a hospital. Even the hotel minibar has a price list warning you before you drink the bottled water. You hear stories like that from people who ate the peanuts in a bar in Japan.
The problem isn’t with the physicians but with the regulated administrators. There should be standard costs for common services published by region and any deviation from those fees should be prominently advertised before any services are rendered. We need more daylight on the costs being charged. That is the opposite of a controlled government system that increases the distances between consumers, practitioners and payers.
Blogged under the title “The Peanut Bar”
I figure $1K is ante for an ER visit. Your best bet is to go to the hospital and say, “What discount do you offer (the largest insurer in your area)? If I pay cash, will you write off the difference?” Most likely they will say yes, and the discount may be significant.
I broke my left arm in a fall this past March. ER visit, surgery, and about 30 hours in the hospital afterward came to a total bill of $45,000, of which Humana paid $11,500, I paid $2000 and the hospital wrote off the rest. Medical billing is Kabuki theater of the worst kind. Your bill is outrageous because higher write-offs likely benefit the hospital in some way, the insurance companies can say to their insured “We got you a 65% discount!” and the hospital folks can say “We wanted X, so we set our charges at 3X and negotiated back to X. Mission Accomplished!” A person who intends to pay cash is not a part of the equation. They will likely write off your bill eventually, though they have to make an effort to collect because if they don’t then they can be prosecuted for Medicare fraud — they cannot bill anyone less than they bill Medicaid.
My radiology practice would do just as well to charge $40 cash for any procedure, from finger films to angiography. Patients are frequently insulated from the BS that is medical billing, and so they don’t care. The idea that paying $40 is a better deal than they or their insurance company would get otherwise is lost in the fact tha
Sorry — postus interruptus. Continuing…
…lost in the fact that THEY have to PAY FORTY DOLLARS.
Darren,
an effort to collect because … they can be prosecuted for Medicare fraud
If they had looked at me and said “We will charge you $200 to have an Intern (he may have been a Resident or a 4th year Med Student, one never knows) look at it, or you can go to the Municipal, which is it?” I would have said “Fine, go ahead” and paid for my folly. If I needed a stitch they could have looked at me and said, “A stitch will cost you $100. Do you want us to do it or will you go elsewhere? You’ll live so either is medically OK.” That would be OK also. By not giving up front pricing information and then quoting a price they knew they wouldn’t collect they were making me a party to their perpetration of fraud against the Medicare system.
We should explore additional legal resources that are available to us in this country, besides the vote.
Norm, sounds to me like you are just starting your transformation from “conservative” to “radicalized ex-conservative.” The term “radicalized conservative” is an oxymoron. I’d bet that back when you were a “conservative”, you were too busy working your tail off to acquire the wherewithal to provide necessities and a very few luxuries for your dependents, playing by the rules, paying your own way, and generally living a quiet and peaceful life. Probably the only thing you wanted from The State was sufficient law enforcement and justice to deter the rapacious from plundering what you had worked so hard to acquire. That was essentially the Social Contract the Federal, State, County and Municipal Governments signed with the citizens: You pay your taxes, don’t cause problems, don’t make waves, and Government will protect your life, libery and pursuit of happiness.
Governments are reneging on that deal.
If Government is no longer bound by the Contract, why are you?
Run down this list of 198 Methods of Nonviolent Action. You will likely find most of them crap that only lefty activists would consider, but some of them you could really do.
“Nonviolent” does not necessarily equate to “legal”, but who still has the legitimacy to differentiate the “legal” from the “illegal”?
How are they supposed to give you up-front information when they haven’t even seen you yet? “I have a cut on my hand” can mean various things, from a superficial injury that needs to be cleaned and dressed to an infected mess that needs to be drained and packed to a tendon and nerve damage that needs to be repaired by a hand surgeon.
I’m not disputing the insanity of the bill, just pointing out that if anyone can come into the ER, then anything can come into the ER and there’s no telling what something that appears simple by description will turn out to be. Like I said, $1000 for an ER visit is close to the lowest charge I have heard. It’s crazy, but it’s also how things are. I’m all for changing that, but then again, I’m only the one guy.
OT – but the History Channel is having a long, excellent, all-day and night series on WWII right now.
OT
This is (potentially) huge:
instapundit
THE HILL: Hoffman “Unconcedes” in NY-23. It’s getting close as they count the votes….: THE HILL: Hoffman… http://bit.ly/3RJ0Je
7 minutes ago from twitterfeed
Richard @ 31
Yes, there is something to encourage supply, but it will be swamped by the need to restrain costs and therefore payments to providers—some people will get through med school/internship/residency or nursing programs with less debt than now, but their earning potential will also be far less.
If the law doesn’t prohibit it, some will “go rogue” and provide care outside the govt system, but the market for that will be small (in part because high taxes to pay for all this scheiss will make it hard for people to save enough to afford such care) and most providers and patients will just be stuck.
Again, don’t concentrate on the trees, concentrate on the forest. Total societal cost will soar, supply will be pinched, and the govt will become (even more than it already is) a pension and health care provider, with a few other, fiscally minor functions like defense, regulation, justice and parks. All the rest of these bills is just kicking dirt in the CBO’s and your eyes.
Much like the joke about Ford or GM a few years back, when they noticed employee and retiree benefits were their biggest expense items: a health care plan that also made cars.