morning on Medicare. I think he gave us a window into what is coming.
He outlined a number of measures that would help to put Medicare on
firmer footing.
The federal government will spent north of $1 trillion in 2011 for
health care (7% of total GDP!). Half of that will go to Medicare. That’s
a bad result. But it is nothing compared to what will happen in the
coming decade. The cost of all medical treatment will rise substantially
above Mr. Bernanke’s measurement of inflation and there will be many
more people on the Medicare line due to the rapidly aging population. So
what does Doug suggest?
Cut payments to Medicare providers for services they provide.
There have already been cuts made. But they are temporary. Elmendorf
wants more. This makes sense. Cutting payments to Dr’s, hospitals and
service providers like nursing homes would make a big difference on the
financial side. It would also make a big difference to Granny in that
nursing home. It’s worth noting that Elmendorf doesn’t think this is
likely to happen:
Whether the reductions will be sustained over a long period of time remains to be seen.
Another suggestion is to extend the eligibility schedule for Medicare from 65 to 67.
I am quite certain this will happen. The only question is how soon it
will happen. Some smart fellow will do an analysis on the proposal and
conclude “It will save us X dollars, but Y people will die as a result”. The X in this calculation will be big. The Y will also be big.
This recommendation will strike a dagger at the Administration and all those Dems who supported Obamacare:
Reverse the expansion of Medicaid and the subsidies for purchasing insurance that were enacted in last year’s legislation.
The suggestion is that we will have Universal Health Care “Lite”. It also implies that Obamacare comes up for some redrafting. If they start messing with this it will be the death of it. (Politically this would suit the Republicans and Tea Party set-ergo look for it to happen)
A separate suggestion is to treat employer contributions to health insurance as income and tax it accordingly. This is just a tax increase for workers. It will go over like a lead balloon.
But we need to remember that this concept is already part of the
current law. It was part of the Obamacare stealth tax increases. These
tax increase are scheduled to go into effect in 2018. This could happen
much sooner according to Elmendorf:
Last year’s legislation changed the tax treatment of employer-sponsored health insurance, but only in 2018 and beyond. That provision could be accelerated and strengthened.
The most significant recommendation (to me) is the suggestion that
Medicare will not cover new treatments under some circumstances. This is
the Death Panel concept of rationing health care that everyone has been taking about.
Currently,
Medicare pays the costs of nearly any medical treatment or procedure
that a doctor recommends. An alternative would be for Medicare to pay only the cost of existing ways of dealing with a specific health problem
I was surprised that Elmendorf made it clear that if someone on Medicare
had the money to pay for the better, newer treatments they could do it.
But they had to shell out of their pocket. In this plan, what happens to those who don’t have that money? Easy, they die or get inferior treatment.
Under such an approach, patients would be able to use their own money to pay for the more-expensive care, but the federal government would not pay more
Elmendorf acknowledges the difficulty in making the choices of which treatments are covered and which are not:
It
would be an immense challenge to formally classify treatments and
procedures into sets that address the same health problems and to
evaluate whether some treatments and procedures are better for some or
all patients.
Yes Doug, it will be an “immense challenge” to come up with that list. But that list is coming. And again, as a result of the list, some will die.
We have to make hard choices. Ones that will result in suboptimal health
care and yes, premature death. It’s good that the CBO put this on the
table. It’s still not easy to read. Anyone who says that America is such
a wealthy country ought to look at it. We’re not as rich as we’d like to think we are.
Yes. Saw palmetto will drive your PSA readings lower as well. As for vinegar, it's been in use for health purposes since the Romans and before. I don't know whether it affects the prostate, but it's been tested and shown to counteract insulin resistance. No small benefit there. Yeah, it tastes bad -- so what? The diabetes 2 epidemic in this country may contribute more to future health costs than any other single factor.
Vinegar would be about changing your body's Ph balance, no? Better check to see if that balance needs to be changed before you change it. And there may be tastier ways to change the balance if change is needed.
Medical advice from a stranger on an internet conspiracy/finance page?
Wow, our system must be worse than anyone thought.
Of course there's death panels in it, LaRouche has been on point with it since day one, everybody else has been Gumping it about 'death panels'.
CER, QALY, and all of wall street's brightest statisticians making sure they set up some really fucked up shit to 'save money'.
All fascist, all unnecessary.
Single payer under hill-burton standard. Enough said. (oh except one thing, we do arbitrarily have death panels at every hmo, it's just you can switch, appeal, or pay for it....somehow...but they're trying to make it so the feds authorize a legal death panel, which there is no escape from).
So we do already have death panels, its just not the gov't....but that's a changing, and BOTH sides will go for it.
pay taxes to corporations
.
OR DIE
"We give him a choice: use the medical care or we can not treat you, but will provide $250,000 of life insurance for the beneficiaries of your choice."
This is part of the solution, yes. I have had many encounters with friends and family making end of life decisions and, without choices, all too many very ill, very old people will simply make the choice to have heart surgery at 90 or other, incredibly costly, proceedures simply because its there and someone else is paying for it.
Worse is the situation where medical providers schedule various proceedures regardless of the overall condition of the patient. Example: An 90 year old, severely compromised, man was scheduled to be moved to a urologist office for a prostate exam. His son, wisely, questioned the necessity and they backed off. The patient died a few weeks later of all the other complications.
Had the son not bothered to intervene thousands of dollars would have been completely wasted. His incentive to intervene? Simply common sense and the realistic fear that his father would have suffered during the trip to the urologist. I've seen other examples of completely specious, incredibly expensive, "treatments" recently that people have declined in the face of pressure from physicians. It seems some are running up bills without any regard to need (this includes public as well as privately financed health care).
Incentives AND some kind of "watchdog" for these corrupt practices need to be in place or theres no "friction" on the other side of this equation.
Wow, every idiot can find the one exception. Sadly, they got you propagandized so badly, you seem to think this 'happens all the time', or 'most of what they'll cut is exactly this'.
WRONG. What you describe, isn't what they'll cut..but they'll be HAPPY to let you THINK that. In reality they'll cut people from life saving treatments/surgeries, etc.
Yes, there are some people who can have surgeries in their 80's and 90's and live another 5, 10, 15 years.
If money is the issue (why? it's all bullshit monetarism that won't be paid off) then the care of the patient, certainly isn't.
Then you should know that this is done by the doctor because the patient's family will sue him for not doing all he could have done if he chooses otherwise. It is the unspoken negotiation between family and doctor. The doctor educates the family to what can be done. It is up to the family to choose whether to do it. In this way, the doctor reduces the liklihood that he will get sued for incompetence and the family gets to make an informed choice about the care of their loved one. This process is often facilitated by the doctor's staff who whispers you're supposed to say 'thanks but no thanks' to the family of the patient as they leave the doctors Suite.
Yes it does happen quite often, as verified by two Dr. relatives who work in hospitals.
What if they lowered the Medicare age to 60 and changed the progams mission from health care assistance to assisted suicide? Would that help the budget? What if we sold our kids into slavery and prostitution? Would that help the politicians out? Could we donate our healthy organs to richer nations to pay our debt off? I'll do anything to help our Ponzi scheme. So proud to be an American.
Might as well legalize abortion up to 16 too, while ur at it.
I am moved and humbled by your patriotism. The rest of us must stand in the shadow cast by your greatness.
We could begin pop control by limiting number of children to less then 5! Why is it I see some of the poorest people popping out babies they cannot afford placing a heavier burden on our Medicaid system? This owuld be a good beginning.
Of course, Medicaid pyaing $93,000 for the prostate cancer drug they MAY extend a persons life 4 months borders on the irrational.
I also suggest we tax all Wall Street bonuses over $ 5 million at a higher rate then it is now.
"Of course, Medicaid pyaing $93,000 for the prostate cancer drug they MAY extend a persons life 4 months borders on the irrational."
It doesn't 'border' on irrational, it is square in the middle of irrational.
Not if the expected value of that life is worth more than $93K to the person recieving it. It usually is when its other people's money.
There's a different way to ration all this health care. its with prices and markets but apparently thats too easy and straight forward for the USSA.
But, but the Ignorati that are counting on "free" health care, vote for the Decepticrats! It's all too easy to see the quid-pro-quo going on...
Death panels may make intuitive sense to some, but as a practical matter they will overstep their mandate and turn hospitals into abbatoirs. And they will solve nothing permanently. America's health care system is broken. Badly. It has wrecked this country's economy. Obama care and Bush's medicare drug initiative did nothing to address the issues. In fact they may have worsened and institutionalized problems.
It is time to reform the health care oligarchy.
There was no health care crisis, until Medicare/Medicaid was created by the US Govt. They've sown the Nanny State, now we reap the destitution!
To what study are you referring? And how did that study define "health care crisis"?
Most medical costs occur last 6 months of life so that is where cost cutting should be concentrated as well as manditory health prevention. If you are volunarily overweight, you should have higher premiums, just like life insurance for smokers. Other areas should be explored, such as banning expensive drugs that extend life by a couple months . Abuses abound--- some Doctors in the last phases of cancer ,for instance, call in Speech Therapists, Psycologists and continuous X-rays to pad hospital bills. These abuses are widespread and when reported to Medicare, are ignored as a matter of routine because they dont have staff, time or interest from supervisors to pursue. Medical profession doesnt care to cut costs because it reduces their earnings and polititians do nothing because it doesnt get them reelected---a perfect scam.
>>>Most medical costs occur last 6 months of life so that is where cost cutting should be concentrated...<<<
Yes, exactly...and when a draft of health care reform contained a provision (inserted by a Republican) that would pay for a separate visit for Medicare patients to discuss with their doctor advanced directives and end of life issues, fucktard Tea Party idiots went nutz screaming the it was equivalent to "Death Panels".
An individual and their doctor...discussing medical options...that a patient might accept or decline at end of life.
A private discussion between two parties directly involved in a decision=a Death Panel?
These fucktards ruined an opportunity for people to make an informed decision.
This nonsense has set back the cause of infromed patient self determination for years.
No politician will want to touch it.
WTF! People have been talking to their doctors for hundreds of years. What kind of moron needs a federal law to tell you you can talk to your doctor?
Medicare will pay a doctor for sewing up an arm after a dog bite. There is a code for that. Medicare will also pay a doctor for talking to a patient. There are codes for that also. What did you talk about? Managing diabetes. Code correctly and doctor gets paid. Managing hypertension. Code correctly and doctor gets paid. Managing end-of-life decisions. Oops. There is no code for that. Can't begin to bill for it, much less get paid.
You have to know how doctors get paid from CMS (Medicare) for this discussion to make any sense. Doctors can and do talk to their patients about end-of-life decisions. The point is that there is no Medicare code for such a discussion so there is no way the doctor can get paid from CMS for the discussion. Such discussions still take place tho.
WTF is wrong with Medicare picking up the tab for a consulatation between patient and doctor (when the patient is not ill) for the sole purpose of discussing and advanced directive and end of life options?
Patients would get only the care they want--no more, no less.
I suspect it would save billions.
And we needed to Patient Self Determination Act of 1990 to put doctors, hospitials and family members on notice that a patient's directives are to be respected with the force of law if needed.
Even with that legislation, it can still be difficult to get their wishes enforced. I know from experience.
We need to come up with more creative solutions.
How about this one:
The person is covered by health insurance, and we know the costs to stabilize him are $500,000.
We give him a choice: use the medical care or we can not treat you, but will provide $250,000 of life insurance for the beneficiaries of your choice.
Don Levit
(A compassionate conservative).
what can I say....
CAN'T SAVE EM ALL!!
MEDICAL CARE FOR THE MILLIONAIRES,
CREMATION FOR EVER OTHER DOUCHE!!
Cremation is energy/carbon intensive--how about composting?
Solar cremation ovens - another future market!
Hey, hey, hey...
Slaves have always received the best veterinary...er...medical care available.
It should be obvious to all that the federal government has become a black hole of promises that it shouldn't have made and cannot fulfill, given the fact that if anyone had cared to do the math, adding up the rate of live births and substracting the deaths, the annual number of abortions, and the projected fatal accident and war casualty figures might have given government some idea of what was coming.
The glory days are over. Fewer people working (and keep in mind that the "new normal" of unemployment -- much higher instead of much lower -- means fewer people paying into the pot of tax moneys used to fund the promised services, therefore less money for those who are getting services.
Some who are getting services are paying big time for those who are getting services and not paying; the billings that go out from D.C. for medicare are NOT allocated on a 1:1 basis. For everyone who pays a small amount there are just as many who pay double or triple or perhaps more. This is the joy of "fairness" in the US social system.
At the same time, many it not most who never will get any services, ever, are paying large percentage of their annual gross into the pot for everyone who's getting services ... whether recipients pay big-time, small-time, or don't pay at all.
Those who will be on the service-non-receiving end because of US demographic stasis know they're getting screwed because the country is neither growing nor shrinking but is (or recently was) simply at a point where deaths about equalled births, and with the larger numbers of folks being 50 or beyond, so obviously the smaller number of younger people are getting shafted by both the federal government and their elder fellow citizens via payroll taxes -- that is, IF they can find jobs. And since they'll get nothing but will pay a fortune for those who will endlessly drain money from their pockets, why should they work, marry, have children, and support the mother of all Ponzi schemes? I wouldn't.
This obviously just isn't going to work out and the sooner it ends, the better off the country will be. The US claims that children are the future of the country, and while this is true, look what awaits US children. Lives of indentured servitude, courtesy of the stupes who run our completely dysfunctional and corrupt so-called government.
Honestly, folks, what are you thinking when you prattle on about how to "fix the system"? Please DON'T dream on! Wake up. Somehow it has to end, if the US is to stay alive as a nation. Choices must be made. The best one is NOT to continue indentured servitude as we have it now. And I assure you that I worked and paid into the system all my working life.
At 66, and would be thrilled to give up any government "benefits" so that my fellow citizens would not be forced to pay one cent for me, if I could stop paying into the system myself, but that is not allowed. I would gladly sign a waiver agreeding to be 100% responsible for myself. Perhaps if enough folks agreed, that would be one way to make the burden smaller on the screwed part of the population; in return for opting out and getting no further benefits, those who opt out can keep their money and make their own choices.
Amen - very few on this site want to take 100% responsibility for themselves.
I have long wished I could have opted out of Social Security and waived all future benefits -- I would come out way ahead.
But government knows what is best for us. We are incapable of taking care of our selves. We need government to help us find our way through all areas of life. While they suggest they are just being compassionate, they really have a very low view of the average person's capabilities. And as the masses become more dependent on government, they start to believe and behave as though they do need government to find their way through life. It is the dependency agenda.
We are in trouble.
Just the other day, Harry Reid (D-NV) stated that Republicon budget cuts were "cruel and mean-spirited". I submit the Republicons did not go far enough! Great Implosion, please suck down the Leviathan US Govt!
Much like the American justice system if you have the $$ you can play otherwise you're at the mercy of the system.
yep. And if you don't have the bucks, the justice system has no mercy. Ashcroft not only covered Lady Justices' tit, he took her blindfold off
People over 50 who lose their jobs cannot, in general, afford health insurance. Raise it another couple of years and that will be just that many more people using the emergency room for treatment instead of a doctor's office.
I know many people who are cashing out everything they own and renting because tptb are now targeting anyone with assets of any kind by stripping them thru "health care". It's not enough to just take them in the ponzi called Wall Street or in taxes anymore.
I givethis shit show another 3 years and this country is absolutely done.
"I givethis shit show another 3 years and this country is absolutely done."
Let's hope you're right, but sooner.
Usually I appreciate much Krasting's essays for both their perspicacity as well as their equanimity expressed in a moderate tone, but this recent essay offends me with its deferring to a universal Libertarian policy and its invocation of "Death Panel" a Libertarian fiction provocative violent odious: if I wanted to be reminded of Libertarian Party's violent and divisive and often seditious policies and rhetoric, I would view idiot clowns Glenn Beck or Sarah Palin and not Zerohedge. Let Krasting know that decisions about Life and Death and Budgets are now made every day at hospitals, but these decisions are now usually not made by dutiful Bureaucrats or ethical Doctors but by avaritious Health Insurance Corporate Officers; and these avaritious Officers have a duty only to their bonuses determined by how much healthcare they deny and a duty to corporate shareholders, so while markets provide well for discretionary goods and services markets should never be used to provide basic necessities such as non-elective basic healthcare. Remember, the primary cause of a Healthcare System--while perhaps entrepreneurs shuld have opportunites for great profits and doctors should be granted high incomes--the primary cause is to provide healthcare to the citizens of the United States.
True what you say about the Ins. Cos. They are crooks who look to avoid expenses. But medicare is 4% of the GDP. That number is going through the roof.
You libertarians read me like I have an axe to grind. I 'm just trying to report on what is happening. And more importantly what will happen.
"We are going to triage health care for older people in a big way."
Does that sound better to you? I call that a death panel. Let's not mince words.
Bruce, let's face it: since the days of the first medical treatment ever, there has been rationing going on in one way or another.
Implying there is a way at all to go without rationing is just dishonest and pure hyperbole.
BK - what you say has been proposed before - by Hitler in Nazi Germany. It makes sense - until you put it in the hands of politicians. Solutions: put medicine BACK in the hands of RESPONSIBLE physicians (or physician panels). When POLITICIANS control the practice of medicine you have situations like Edward Kennedy (and ALL OTHER members of congress). Millions of taxpayer dollars were spent on prolonging his life by a few months. Let's talk about this!
Put it in the hands of patients -- not the government nor the doctors making decisions for everyone. Some will choose to spend their last dollar to try to buy time, others will not.
If the state is responsible for healthcare, they then have an insurable interest in lots of things -- hence the mandate to buy insurance and a slippery slope to other consequences -- maybe a tax on french fries and potatoe chips, penalty for being over-weight, etc. Crazy you might say, but the rationale for such would be clear IF the state is responsible for healthcare.
No thanks.
Guess that means you're NOT a fan of the "Nanny State", then. :>D
Bruce,
Many more older people would triage themselves if given the information and the options from professionals. I've seen it in my own family.
Tea Party "Death Panel" hysterics prevented a Medicare paid consultation visit between patient and doctor to make an informed choice regarding end of life decisions.
Yep, it insures that we will eventually get some sort of triage, death panels, etc...on a bigger scale than already exists...look to the State of AZ and Medicare transplants as your future.
Insurance companies do not deny one from purchasing the medical treatments they want to buy.
We have to answer the question -- does everyone have the equal right to state of the art medical care? I think not, but the only way government can accomplish this is through rationing. I don't know why they do not admit this.
Government is equally afraid of a two tier medical system evolving -- those who are willing to pay more for higher care level vs those who stay in the government system.
I really do not want the government picking winners and losers generally and particularly in this area. I will rest my chances on the vagaries of market forces (reasonably unfettered by government dictate) than on some guy the President picks to set regs.
You're too funny!
I assume by Libertarian you are also referring to Krugman's musings on the topic of death panels
begin at minute 1:10
http://www.youtube.com/watch?v=tDnvmOQDkkw
The Doc Fix was always a fraud, just meant to make it all seem less budget busting.
Go long state-of-the-art medical facilities just across the border.
Medical tourism for the rich is gonna be a growth industry.
We are all soviet peasants, now.
My wife and I already are getting some of our routine health care in Peru. Cheap!
I've been thinking about heading to Brazil for dental work.
What I save on the work, I can spend on...entertainment. :)
the death panels are already here.
they decided to process magnesium out of food.
they decided to feed cows corn --> the 'bad' version of ecoli likely evolved from this practice in the cows alimentary tract.
they have fluoridated water.
they increase pesticide loads (anticholinesterases) in foods.
they allowed subnatural saturated fats (trans) in the food supply due to increased oxidation resistance and longer shelf life.
consciously or unconsciously, they have systematically and relentlessly destroyed the food and water supplies.
and theres more.
and in doing so destroyed the atoms of which we are all made.
and like the boiled frog, or inflation, or watching a seed for weeks, gradual change goes unnoticed until it screams on a mountain with a megaphone.
junk in, junk out.
totally junk.
out.