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.
You missed one. They demonize saturated fat, the only fat that can't be oxidized.
What's one of the big scares in "natural" health today? Oxidation! Wow. Think about it.
Think of fatty acids as a chain. Say, 15 links. Of those links, all are closed, except one. Think of the side of the link being missing. That link is "closed", that side is filled in, by picking up nutrients. The fatty acid then proceeds to its designated part of the body and deposits the nutrients it picked up. The body says thanks for the nutrients, and proceeds to repair itself. That is a primary function of fatty acids.
When the one link in the chain is open and available for picking up nutrients, it is said to be unsaturated. When that link is closed with say, hydrogen (hence, hydrogenated), it is said to be saturated. That is why foods made with saturated fats are unhealthy/ dangerous. The link is closed, so the fatty acid chain cannot carry nutrients to the body in the way it was intended to.
Unprocessed butter starts out with the fatty acid link open (unsaturated). But that open link can quickly be filled with oxygen - and you end up with oxygenated, saturated fat. When the open, unsaturated fatty acid link in butter is filled with oxygen, we call the butter rancid. Rancid butter tastes horrible, and most folks won't eat it. To give butter a longer shelf life, they fill the link with hydrogen (so that oxygen cannot attach) - and you have a saturated fat. Can't carry nutrients, and so does your body no good to eat it.
It is appropriate to demonize saturated fat.
You're right - no wonder we are all so sick, all the time.
Not to forget being told not to go into the sun... so now we are deficient in Vitamin D... or not to eat salt, which is where we used to get most of our Iodine...
Then there is raw milk... Bad ! Bad ! Bad !
Bottom line with all "Health" care plans is that they do nothing to contain costs. Nothing! the problem with healthcare in America is COSTS. Nothing has been done to address this. Obamacare does not address this, a big part of this was the republican (and complicit democrats) insistence on framing the problems as a "lack of insurance" problem. That was just BS, but both parties want the campaign monies/retirement funds that big pharma, insurance companies, and HMOs, etc. provide. If CONgress were really concerned about cutting costs, they would first throw out the legal limitation in Bush's Medicare pharmacy law that says the Government cannot negotiate with drug companies about prices. Ask your reps and senators what they have done to eliminate this law, and you will see that they are more concerned with protecting the horribly huge profits bleeding our systems dry. How to kill a program? Kill it from within, causing the high prices that make it too expensive. Look at health care costs in other countries. They are better. Medical tourism is becoming the way to go!
Precisely the problem. And zip has been done about it.
My cousin is a doctor and cannot even practice her specialty in the profession because of the pill pushing is standard operating procedure. We have talked about it for years now. My sister has been a nurse for 30 years and currently runs around making a pittance in wages dispensing medications. All the medications are overpriced scams whether the 'medication' works or not ... like stocks in the stock market with an avg p/e of 21 and same time of manipulation, only done by the 'healthcare' industry and its sock puppets in govt.
I'd rather spend the FRNs on Lipitor than have to undergo heart surgery. Check your premises, costs avoided by relatively inexpensive treatments are not visible, by definition.
Stuff in Lipitor comes from Red Yeast Rice. Ask your doctor if you can take that instead. Health Food store. Inexpensive. At least Google it to educate yourself.
Dean Baker rails about the patent/pharma monopoly all the time, goes as radical to say we could nationalize pharm business, do research on govt dime and they sell drugs at cost to manufacturer. It would save govt and private insurers 100s of billions, presumably then this money could be spent on something more helpful to life like food, and Ipad or infrastructure.
"block grants to your Governor." the money is meaningless, no?
At best it's money stolen by government from folks who earned it and ought to be able to use it for their own needs.
Go live in isolation in a wilderness. You can live by your own rules there, until mother nature imposes her rules in place of yours. Otherwise, the price of admission to a society has always been part of what you produce/earn, plus adherance to commonly-agreed-upon rules. Societies have benefits, but they also have costs. It is not stealing to expect the beneficiaries to pay for part of the cost of the benefit. It has always been this way. It always will be this way - for societies.
Civilization 101.
Only a foolish person would become a physician today.
Already, medical schools are seeing a decline in the applicant numbers and also a strong decline in the academic abilities of the applicants.
I have a nephew who is in the second year of medical school. He told me half of his class think they may have made a mistake entering the field of medicine. Most of the doubters intend to not practice medicine when they graduate. Mosat of them intend to work for medical equipment companies.
True story. Neighbor kid is in college, pre-med, dad paying the bill. Several months ago kid told me he was studying to be a doctor. I asked why? Told him edited version of much that has been said here about where the economy is headed, and health-care in particular. Just found out that dad checked his grades for last semester (dads who pay can do this at this college). All "Fs" for last semester. Kid had dropped out and is making a rap record with a friend. "More money in rap than in medicine". Dad has disowned son. Has stopped paying all his bills, including rent. Son is now going to get the education that he actually needs.
You mean we tied up congress in a rancorous, year long debate instead of focusing on the economy for this?
If, by "we", you're referring to Decepticrats and Republicons in Govt, then the answer is yes.
yes
Once insurance is taxed as wages, I can go to my boss and say take me out of the insurance pool and pay me my wages. It will only take a small percentage of people pulling out of the system to collapse the healthcare bubble.
We already have Death Panels at work in the hospitals.
Nurses and Doctors going from patient to patient passing along the likes of C-Diff.
Under obamacare, hospital caused infections will not be covered, In other words, the hospitals will not be paid for infections they cause. The brainless idea is: If we don't [pay them, then the hospitals will be more careful not to get people infected.
The real result will be: people discharged with infections who will die at home; people will be discharged but readmitted thru the ER and "reclassified" (ERS are mostly independent and billed separately from hospitals); People are kept in, but given shoddy treatment because its not paid for.
Love unintended consequences.
I attended a long workshop on the implementation of Obamacare and I can aSSURE you, the hospital admin and the folks on the ground have NO clue. There is no guidance from Obamacare at all.
Godspeed.
There is no "Oboecare". This is a faction-related term.
Please keep language concise when referring to current law - cite enacted ones.
"Oboecare"? Of course there's no "Oboecare", but OBAMACARE, the 2700+ page abomination perpetrated by a clueless Congress and an ignorant administration certainly exists! You political troll - spew your fake "conciseness" and "accuracy" to the gullible. I know better - and your "social engineering" is every bit as useless and repulsive as you are. Do you really think that when the healthcare system collapses amid a horde of unpaid obligations incurred on the behalf of illegal aliens that YOU will somehow get your conditions treated, magically, without delay or difficulty? Idiot.
XenO is correct. You are not. You either missed his point or are intentionally evading it. The cost is not going to come in generalities. The cost is going to be specific - each cost tied to a specific regulation that can be cited by its location in the CFR. The cost doesn't exist until the regulation does. If you are talking health costs, cite the regulation that the cost comes from.
XenO is simply asking for an informed conversation. I support him/her in that request.
Wow, yes, a very relevant point.
Keep out of hospitals folks.
Let's now hear from all the ugly partisans bashing Sarah Palin for her astute observation on death panels she made when Obamacare was legislated with absolutely no transparency.
Every doctor I know has predicted this and most are retiring before their time. They cannot meet their overhead (including significantly higher reporting/accounting costs) on the CURRENT reimbursement schedule, much less the new one.
Yep. But the so-called health care system's already effed; a bigger more-effed system isn't going to help anyone and probably a smaller more-effed system may not hurt as many people soooo... If it all collapses, there's the possibility of starting over and doing better.
I really have to pity the "poor" doctors in their rich houses and elegant lifestyles. I have seen doctors in the rest of the world, able to live their lives in a happy and fulfilling way, who make far less than US doctors. The problem is our system, and the hidden exorbitant costs throughout.
Man, your moniker is quite descriptive of your knowledge!
Those exorbitant costs are Doctors and Hospitals passing on the costs generated by the indigent clogging up emergency rooms (the most expensive health care route!), because emergency rooms have to treat them (for free!), BY LAW!
Our work, or your (Big Brother) guns: Choose one, you can't have both!
That's the way it was in the US, decades ago, before "everyone" went on insurance. Now, most people pay more in insurance premiums than they would have paid for their own health care (Insurance 101).
That's the way it was in the US, decades ago, before "everyone" went on insurance. Now, most people pay more in insurance premiums than they would have paid for their own health care (Insurance 101).
That's the way it was in the US, decades ago, before "everyone" went on insurance. Now, most people pay more in insurance premiums than they would have paid for their own health care (Insurance 101).
dude, you live in unreality. Having represented doctors for 10 years now, I can assure you that this is no longer the case. There are some that do well, IE--plastic surgeons. But your typical doctor is not luxuriating in bon bons and McMansions.
That stereotype is very 1980s.
In fact, here are large shortages of docs in many areas. I know a guy who retired because his malpractice insurance was going to run over $500,000 a year. These guys can't keep up.
You need to do more research before sounding so retarded.
Do you live in the USA? Why would you when there are so many other countries that cater to your socialist politics?
The fed holding interest rates artificially low forces millions of people near retirement into the ponzi market and wipes out your retirement funds. Then the government makes you pay for the medical services that will (or in this case won't) save your life. Isn't that murder?
Tea Party idiots when fucking nutz over a provision inserted oddly enough by a Republican that would allow Medicare to pay for a consultation visit between patient and doctor to discuss advance directives and end of life issues...simply discuss...the options that the patient might choose.
Somehow they decided this was equivalent to or the beginning of "Death Panels".
Now we have a real "Death Panel" in the state of Arizona that determines which Medicaid patients are elligible for transplants based on cost. Two people who were on the transplant list died because the state government wouldn't assist or pay for the transplant.
Where are these fucktards now that a government Death Panel is making decisions?
Nowhere to be found.
But then again, Arizona has a Republican govenor.
So, I suppose this is "fiscally sound".
eternal student and flattrader = misinformed citizens. Pathetic to have to read their political hack rants about evil republican nonsense. What a bunch of crap.
And alas, you apparently don't have the intelligence or knowledge to debate the issues. Apparently facts and logic are too much for your religious, unfounded beliefs. The very best you can do are just ad hominem attacks?
But hey, if I'm wrong, do make your argument. If I can't argue with your logic or facts, I'll change my mind.
What will you do?
Here, place your feet close to this blowtorch:
[quote]
As it turns out, "universal coverage" may not be so inevitable after all. Much to the chagrin (and apparent surprise) of President Obama and congressional Democrats, squabbling has erupted in earnest over who will spring for the exorbitant cost.
Fortunately, Obama has an exit strategy: "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their plans, and we could do that entirely through the market, I'd be happy to do it that way."
Well, there is a way: Let individuals control their health care dollars, and free them to choose from a wide variety of health plans and providers. If Congress takes those steps, innovation and market competition will make
health care better, more affordable and more secure.
Experts suggest that one-third of U.S. health care spending, or about 6% of GDP, is pure waste. The reason is simple: Government controls half of our nation's health care dollars, and lets employers control an additional quarter.
And nobody spends other people's money as carefully as they spend their own.
Office of Management and Budget director Peter Orszag told Congress last year: "Imagine what the world would be like if workers (understood) that today it was costing them $10,000 a year in take-home-pay for their employer-sponsored insurance, and that could be $7,000 and they could have $3,000 more in their pockets today if we could relieve these inefficiencies out of the health system." Nothing will increase consumers' understanding like giving them that $10,000 directly.
Letting consumers control the money requires two steps.
First, Congress should give Medicare enrollees a voucher, let them choose any health plan on the market, and let them keep the savings if they choose an economical plan. Medicare could even give larger vouchers to the poor and
sick to ensure they could afford coverage.
Second, Congress needs to give consumers who purchase their own coverage the same tax break as workers with job-based coverage. Leveling the playing field — whether with tax credits, a standard deduction for health insurance or "large" health savings accounts — would boost purchases of
non-job-based coverage, which is critical to cutting the overall number of uninsured.
As important, it would give workers control over the entire $10,000 Orszag mentioned, for a total effective tax cut of $532 billion each year. Consumers would eliminate wasteful spending quickly, because they would keep the $3,000 in savings.
We should also eliminate harmful regulation. State health insurance regulations prevent people from purchasing health plans available in other states, and increase premiums by 15%. Similar regulations block competition from more efficient health plans and providers by preventing doctors from taking their licenses from state to state.
Americans deserve the freedom to purchase coverage across state lines. One study estimated that that move alone could cover 17 million uninsured Americans without costing taxpayers a dime. Compare that with Sen. Ted Kennedy's reform bill, which spends $1 trillion and covers just 16 million uninsured.
Giving clinicians the freedom to practice medicine across state lines would eliminate barriers for retail clinics and economical health plans like Kaiser Permanente, which leads the market in electronic medical records and coordinated care. If we did that, Congress wouldn't need to throw $30 billion at ineffective pilot programs that try to coordinate care.
Critics fear that market-based reforms would leave sick workers unable to obtain coverage. Yet that is already happening as employers drop coverage or eliminate jobs. In reality, these reforms would relieve, if not erase, that problem.
Leveling the playing field will force employers to give sicker workers more than the average $9,000 or $10,000 "cash-out," which will help them purchase coverage. When workers buy coverage directly from an insurer, far fewer will end up uninsured when they lose a job.
Finally, large HSAs would provide a tax relief even to those who are too sick to obtain coverage at all.
Perfection is not possible, of course. Former Senate Majority Leader and would-be Obama adviser Tom Daschle acknowledges, "Even if we achieve 'universal' coverage,
there will be some percentage of people who still fall through the cracks." The same is true of a free market. The advantage of markets is that innovation and competition fill in those cracks. A government-run, "universal" system makes them wider.
Michael F. Cannon is director of health policy studies at the libertarian Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It.
More by Michael F. Cannon
[/quote]
Solutions were offered, and promptly ignored, by a Decepticratic administration hell-bent on creating yet another super-sized Govt program!
You know, you could've spared us all by just posting a link, and highlighting the main points you wanted to make.
Sorry, but the free market solutions are what got us into this mess in the first place. We had an absolutely better system in place back in the 1960's. Similar to what you describe but without the monopolies. Then Nixon gave the OK to Kaiser to form HMO's, and it has been a disaster ever since. You're proposing to make Kaiser even bigger, which will ultimately lead to higher costs for patients, and/or lower quality. That's always the case whenever a corporation takes over what should be a public utility.
I won't say that Obama's approach is ideal. But broader coverage for all is far better than what the market approach has given us so far.
Um, dipshit, EVERY transplant list is vetted. No one wants to put an organ in someone who is fucked anyway, when it can go to someone who has a better shot. Thats just the way it is. It has to do with medical chance, scarcity of organs, and yes there is always a cost assessment. I don't give a fuck what state you're in. Go educate yourself, its not a TP thing.
Hey, asshole. Check the news. These people were vetted. They were at the top or moving up.
It was the State of AZ declining to pay.
http://www.cbsnews.com/8301-504763_162-20027668-10391704.html
Try again.
I'm too lazy to look - does AZ have helmet laws for donorcycle riders?
Bob Casey, Sr.
Sorry, Bruce. You are rather clueless here. The fact is that we already have death panels. It's called being without health insurance.
You are such a fucking retard. There is no constitutional right to health insurance, dipshit.
Let me tell you something from working with them, an HMO's only goal is to get you off their rolls, or kill you as quickly and efficiently as possible if you are sick.
Ifyou think Obamacare is any different, you're a clueless prick who should move to Cuba and enjoy the difference between rich man poor man health care.
Heh. Your ignorance is vastly amusing, but that's to be expected from the Rush Limbaugh dittoheads. All talking points. No abilitiy to think or reason, especially based upon the facts.
I take you're not familiar with the U.S. Citizens who have had to go to Cuba to get treatment, because they couldn't get it here.
Good luck in your old age. You don't have a Consitutional Right to that either.
[quote]
In March 2009, President Barack Obama said, "If there is a way of getting this done where we're driving down costs and people are getting health insurance at an affordable rate, and have choice of doctor, have flexibility in terms of their
plans, and we could do that entirely through the market, I'd be happy to do it that way." This paper explains how letting workers control their health care dollars and tearing down regulatory barriers to competition would control costs, expand choice, improve health care quality, and make health coverage more secure.
First, Congress should give Medicare enrollees a voucher and the freedom to choose any health plan on the market. Vouchers would be means-tested, would contain Medicare
spending, and are the only way to protect seniors from government rationing.
Second, to give workers control over their health care dollars, Congress should reform the tax treatment of health care with "large" health savings accounts. Large HSAs would
reduce the number of uninsured Americans, would free workers to purchase secure health coverage from any source, and would effectively give workers a $9.7 trillion tax cut without increasing the federal budget deficit.
Third, Congress should break up state monopolies on insurance and clinician licensing. Allowing consumers to purchase health insurance licensed by other states could cover one-third of the uninsured without any new taxes or government subsidies.
Finally, Congress should reform Medicaid and the State Children's Health Insurance Program the way it reformed welfare in 1996. Block-granting those programs would reduce
the deficit and encourage states to target resources to the truly needy.
The great advantage of a free market is that innovation and more prudent decision making means that fewer patients will fall through the cracks.
Michael F. Cannon is director of health policy studies at the Cato Institute and coauthor of Healthy Competition: What's Holding Back Health Care and How to Free It. More by Michael F. Cannon
[/quote]
Admit it, you're an apologist for Leviathan Govt!
Oh gawd, not the Cato institute. You actually take that stuff seriously?
You know, I find the Free Market Libertarians vastly amusing. A fundamentally logically flawed philosophy, which has failed over and over again. Yet despite the reality, or the fact that it's logically inconsistant, you guys keep clinging to that nonsense no matter how many disasters you cause.
The highlight of the movement was when Ayn Rand's love child, the Libertarian poster boy, Alan Greenspan, destroyed the economy and was shocked (shocked, I tell you!) that the Free Market didn't work.
Seriously, how many disasters does it take before you get a clue?
Name one that's alive.
Well, how about Reggie Cervantes, John Walcott, or John Graham? There's three for ya.
All three of them were 9/11 first responders. Got sick because of the dust, and were denied help by our government. Went to Cuba and received treatment.
What was your point? That Cuban health care is substandard to ours? You might find this educational if you actually read it:
http://en.wikipedia.org/wiki/Healthcare_in_Cuba
10 years ago I got sick. Big time. 30 days in ICU unit. They did everything to keep me alive. It worked.
Cost? 240K. (400k+ today, $15k/day Minimum) Cornell Hosp in NYC would never have admitted me without A+ insurance. I was dead without it.
So you are right. Not at all sure what to do about that. Let the chips fall maybe?
Not clueless on the problem. Clueless on the solution.