http://online.wsj.com/article/SB1000142 ... _US_News_3

Here's an article in today's paper about medicaid and medicare insanity. Lots of waste in this government run program.

The Medicare plus medicaid budget is $1 trillion per year, and per Ricky's Kaiser study growing on a per person basis by 7% per year. I think enrollment is growing by about 1 to 2% per year. That means at current trajectories, medicare plus medicaid costs will be at $2 trillion within 10 years. I don't see defense reductions or tax increases covering that!

ray

Ricky's Kaiser study growing on a per person basis by 7% per year.

I quoted the study, i didn't fund it.
It also shows that private medical expense is running at 8% inflation a year...
Is 1% a year significant? Consistent performance like this would show that a service that cost $100 for either service in six years would cost $140.45 in Medicare and $146.93 in private....
Ray, the bankrupting isn't due to Medicare, its due the medical inflation. Even under your current environment, medicare is slightly better than the private sector in battling the underlying cause.

The inflation is on the per person cost, not on the per procedure cost. The per person starting point is much higher for medicare and medicaid than it is for the private sector. So, your $100 example shows complete ignorance of how the system works. Complete ignorance. The per person cost for medicare and medicaid is probably 2X the per person cost in the private sector, partially because the population is older for the government programs. Historically it was less than a 1% change. It would take a lot of years (hundreds) to make up for that per person differential.

You are trying to prove that conservatism is not grounded in reality, but frankly you are demonstrating that your thinking process is not even close to understanding this.

rickyp wrote:steve

Newsflash: if Medicare didn't exist, the government would be off the hook for $100T in future bills, so it would NOT be insolvent

Your nation spends 16 to 17% of its GDP on health care. 33% more than any other western nation. Only about 45% is spent by the government. The rest is personall household expendtitures...
Personal bankruptcies due to medical debts is unheard of in western nations outside of the US...
Now ray said, "bankrupting the country" , I asume he took the holistic view. That medicare was causing not just the govenrment deficit but the inability of Americans to maitain their standard of living and guarantee their heal;th care standard.
Bankrupting the nation...

Right. "Nation" as in "country" not as in "every individual."

I think he was talking about Medicare, Richard.

And really Steve, your overall deficits and debt are the result of inadequate taxation, overall spending priorities and the inability to recognize that spending has to be controlled in all areas.

Really, Richard, you don't know what you're talking about. We have government waste on a massive scale. That's not inadequate taxation. Bush and Obama have raised discretionary spending on a pace far exceeding inflation. Obama has sent it through the roof and his proposal for 2012 raises it 10% in a number of areas, including the State Department.

We have a spending problem. We have an entitlement problem.

Look at the "big" tax increases Democrats are pushing. How much revenue would they raise in a single year? Almost none. Their program is "borrow, spend, and pray someday that someone will pay the bill." It's no plan at all. The President, if all Americans were paying attention, would have an approval rating of about 12%.

Why do I say that? Because he has no plan for the biggest problem facing this country. None.

Go ahead. Disagree. Then tell me what his plan is.

I'll tell you what it is: do nothing and demagogue those who propose anything. He is no leader. He is a moral coward.

If you eliminated half your defence spending the security of your nation would still be guaranteed and you could come close to balancing budgets.End agricultual subsdies started years ago and etc. etc.

Let's say that's true and that China would not fill the vacuum internationally, so the world would just exist at relative peace without some guarantor (for the first time in history). Let's ignore all the details, like manpower, and the fact that we have no plans on the boards for next-gen planes and ships. Let's presume, blindly, as is your wont, that this is possible.

Current Defense budget? $671B. That includes Obama's foreign adventures, save Libya.

Let's cut it in half and even round up a bit. Savings: $350B. Great. Just about $1.2T more to go!

Anyone with half a brain knows its the entitlement tidal wave that is going to bury the US. Google "Medicare unfunded liability" and you will get a wide variety of opinions. One thing is clear: the costs of Medicare are going to dwarf anything the Defense Department could dream of.

Seeking to blame Medicare for all the budget woes is needlessly myopic.

True, but blaming low taxation is idiotic. Medicare is more a future problem. Spending, generally, is the problem right now. Look at the 2010 budget. Discretionary spending up 13.8%. I'm sure that doesn't include the Stimulus, the bailouts, TARP, etc.

Let me put it another way: what "tough" spending decisions has the President made since coming into office that had to do with reducing spending?

Answer: if there has been one, it's been in Defense. Every household, most businesses, and anyone with common sense, if they had declining revenues (in the government's case, it's a declining economy resulting in less income taxes), would freeze or reduce spending. Obama has put the pedal to the metal. He's spending our great-grandchildren's money like Canada just gave us a new credit card and offered to pay for it.

Its also myopic to blame medicare for runaway health care costs.

I didn't. However, you cannot think government FORCING doctors to charge less has kept costs down. That's just dumb and not even you believe price controls have no unintended consequences.

Other than the ideological revulsion there hasn't been a response that claims that this method has proven ineffective or inefficient when compared to the US system.

And, no one cares. How many times do you have to read this before it penetrates? Let's say you make me a convert to socialistic medicine. You'd still have about 180 million Americans to go. Democrats who propose "one-payer" systems are, like Schakowsky, on the fringe. Democrats had absolute control of the Obamacare process and even they did not propose pure socialism. So, please, for the 499th time, will you stop arguing for a system that, at best, is many years away?

I don't think the US can possibly move to a single payer system until more household budgets become strained by the cost of insurance or medical bills.... At that point the need for aceptance of reality will lead to a pragmatic approach that ends the stigma.

Or, we could actually try and set the market free? Nah! That's crazy talk.

Steve:

I think he was talking about Medicare, Richard.

Yes, Medicare and Medicaid are bankrupting this country.

Archduke Russell John wrote:

danivon wrote:Do you have a link to that? I'm sure that there is overzealous application of treatments at times

Here is the original article that started it about a doctor who misimplanted radiation seeds in 92 of 116 operations in Philadelphia. I remember seeing more articles after this one but can't find it right now.

OK. So an incompetent doctor. Do incompetent doctors not exist outside VA? Is he incompetent because he is in VA? Is there more about systemic failure that you can't find at the moment that might flesh this out? Or do we have to keep teasing it out.

The problem with your original example here is that it's impossible to refute what's basically a drive-by anecdote. Like your one about the NHS (which luckily, I do recall enough about to be able to address). Ricky (rightly) gets attacked for a lack of cites at times.

My understanding is the decision to issue "food stamps" instead of straight cash was to keep people from using it to buy something other then food.

I understand the reasoning behind it. The fact remains that while in both the UK and the USA specific money is paid for housing costs that can only be used for such, it is America that also gives specific money only for food. Which starts a debate only recently on whether it should be further restricted to the 'right type of food'.

danivon wrote:but you would not agree to a change in the Constitution to enable it. Which suggests to me that if the Constitution did clearly allow a more 'socialist' health system, you would still oppose it.

Further I would go so far as to say there are options available to make changes that would be Constitutional. However, the Republicans won't do it because they are contrary to their belief in governments roll and the Democrats won't do it because they lack the political will to take the hit if if proves unpopular.

So, as you are a Republican, you are associating yourself with that position - "won't do it because they are contrary to their belief in government's role"? If so, then we are back to the point about the Constitution not being the blockage, and if not, what would you actually accept and will you press your party to do so?

Really. And the rich do not have better health outcome then the poor in your country?

Of course they do, they are rich and can afford the best, even if that means looking abroad. But that is not the point I was trying to make. The USA's system is often held up as the best because of the kind of treatments that are available, even if they are only really available to the wealthy or the uber-insured. I've seen that argument from Tom on here, even while he also has a problem with the escalating costs of his premiums for gradually eroded coverage.

My point was not that the rich in the US do so well, it was that everyone else does so poorly.

I read an article recently about a woman in England who has cancer. She wanted to get a specific type of cancer drug that is not on the NHS approved list because it is too expensive. She decided to raise the money to pay for the drug herself while still using the NHI for the rest of her cancer treatments. The NHS told her that if she followed through with her plan to pay for the unapproved drug, she would have to pay for all of her treatments. That seems to me that if a person is rich they would be able to buy better health care then those stuck with just the NHS.

was it this case? http://www.timesonline.co.uk/tol/life_a ... 040146.ece. Chances are that the drug in question was not solely unavailable due to cost, but was not approved because it had not been demonstrated to be that much more efficacious than existing treatments for the condition she had. Our NICE (National Institute for health and Clinical Excellence) does not ration on cost alone. It balances the costs against the outcomes - if a new drug is much better than anything we already know of, then it will be approved. It it's marginally better than a cheaper option, then it may not. But it may do, depending on the extent of the margin (and whether it turns out to be effective when the other is not and vice versa).

I think the ban on co-payments was overturned soon after this article was published, by the way: http://www.google.co.uk/url?sa=t&source ... QJM-ZhpsjA

danivon wrote:I thought Medicaid was very limited anyway.

I am not sure if you mean availability or what it covers. What I am saying is that Medicaid and Medicare Parts A & B offer pretty much the same coverage. Major medical/hospitalization and a limited list of "medically necessary" basic care. What makes Medicare better is Part C which allows for the purchase of private insurance for additional coverage at subsidized premiums.

Also Medicare pays more to the providers then Medicaid so more providers will accept it.

Ok, so Medicaid is more limited than Medicare, in terms of what you can actually get (because there's no scope for adding Part C and because you may not find a provider who'll accept it). Obviously the eligibility rules are different as Medicaid is aimed at the poor, and each State may have their own criteria. Strike my 'very' from the statement.

Ray Jay wrote:Yes, Medicare and Medicaid are bankrupting this country.

Based on back-of-fag-packet projections, yes.

However, overall healthcare is also possibly going to cause a problem. While the Federal Budget can be 'saved' perhaps by reforming Medicare and Medicaid, what about the pocketbooks of the USA as a whole?

steve

However, you cannot think government FORCING doctors to charge less has kept costs down. That's just dumb and not even you believe price controls have no unintended consequences

.

I don't think that Steve. I know that by looking at the costs in nations that regulate versus the USA.
The consequences in places that do are there, yes. But compared to the cosequences of uncontrolled medical inflation not so bad. They mainly have to do with managing ability to provide instantaneous services versus waiting. Problems of availability. Problems which also occur in the US where ability to pay forces many from care.

But Steve, I'm not trying to convince you otherwise. I pointed to this as an area where Fareed Zakkaria's orignal comment has validty. And in your line of argumentation you reinforce his statement. You simply refuse to beleive the validity of the experience elsewhere. Hell even in appealing to the link on defence spending you neglect the evidence that suggests that there is more potential in giovenrment run programs to reduce medical inflation. (Note the savings it reports that been achieved in the Veterans Medical budget..

By the way, taxation revenue as a precentage of GDP is at its lowest point 50+ years. If the imbalance is only expenditures how is this then the case? (And the theory that lower taxes always create more revenues?)

We need conservative ideas to modernize the U.S. economy and reform American government. But what we have instead are policies that don't reform but just cut and starve government — a strategy that pays little attention to history or best practices from around the world and is based instead on a theory. It turns out that conservatives are the woolly-headed professors after all.

danivon wrote:

Ray Jay wrote:Yes, Medicare and Medicaid are bankrupting this country.

Based on back-of-fag-packet projections, yes.

However, overall healthcare is also possibly going to cause a problem. While the Federal Budget can be 'saved' perhaps by reforming Medicare and Medicaid, what about the pocketbooks of the USA as a whole?

What I found interesting about my back of the err, envelope calculation is that it is basically correct. We are spending $1,000,000,000,000 a year on medicare and medicaid; the expense is increasing rapidly with medical inflation and retiring baby boomers. It's going to be $2,000,000,000 in less than 10 years. I hope someone on these pages can disprove it, because this is a very salient fact, perhaps the salient fact, in these current discussions, no matter where you sit on the political spectrum.

If people focused on that number, perhaps they would agree to both unpopular conservative ideas (privatization) and unpopular liberal ideas (effectiveness research). Frankly, I think we need both. This is beyond ideology.

Regarding other medical costs, I agree that they are a serious problem for both US individuals and US businesses. Even though these costs are not bankrupting the US, they do need to be dealt with. It is a huge problem for states and local governments too!

I thought the case study of Ray Jay in Massachusetts was pretty relevant. The Mass insurance requirements, new insurance mandate, and other federal mandates have forced me to spend 3X as before on my health insurance. By requiring that insurance covers more services, it has discouraged me from being more price conscious in consuming health services. (There is elasticity in demand, contrary to Ricky's assertion). If I worked for a company or government I would be even less cost conscious since I would be even more removed from the relevant costs.

Other conservative ideas such as tort reform, and opening up interstate insurance markets would help. Fewer mandates and less regulations would help too. And effectiveness research as suggested on the left is also needed.

Ray you're demonstrating limited elasticity in the health insurance market. But elasticity in the health provision can only come if people refuse treatment because its too expensive. The same way people hold on to a car longer or choose the less expensive cereal... I know some health insruance companies resort to denial, but most people will then bankrupt themselves before accepting a speedy end as a consequence of not meeting the price required.

Doctors and Hospitals don't attract new customers based on a lower price per service. The day that comes, and consumers react to price before deciding on their physician, then you have price elasticity and some hope that
markets will act to end price inflation. Doctors and hiosptials don't market themselves that way, and don't compete on price. There is sufficient demand in the market that they don't have to do so, and as we age the demand is increasing...
Drug companies resist price competition with patents and much research is done just to extend patents. IP protection is very important, but when used as a way to maintain a monopoly and protect margins isn't working...
Everything you've mentioned (tort reform etc) will help a little. But for a fundamental change you'd have to return to a time when medicare didn't exist and people accepted they couldn't get care or used up their old age savings to stave off impending death.. Then there would be elasticity in the demand for medical service - mostly based on inability to meet the prices required...
There's a moral reason that medicare came into existence. Do you remember the debate? How do you retain the moral choice that was made there if you abandon medicare?

Ricky, you read what you want to read, but not what I actually write. I never said "abandon" medicare.

Re elasticity of demand, I think you are fooling yourself if you believe that most medical expenses are life and death. No doubt some are; but most medical expenses are about choices that pertain to quality of life. Quality of life is not binary. Many medical expenses can be avoided or reduced by better food choices. A study was published today on comparative diabetes rates in the US vs. other countries. The US diabetes rate is about 6% higher than the UK. It's something like 7% in the UK vs. 13% in the US. I doubt this is because the US diagnoses better because it is fairly easy to diagnose diabetes, unlike our earlier discussion on prostate cancer.

It would be helpful if you found studies on elasticity of demand in health care. Then compare it to elasticity of demand for other necessities such as food, clothing, and shelter. Only then are you dealing with realism. Otherwise, I think you are guilty of that which you accuse conservatives.

rickyp wrote:steve

However, you cannot think government FORCING doctors to charge less has kept costs down. That's just dumb and not even you believe price controls have no unintended consequences

.

I don't think that Steve. I know that by looking at the costs in nations that regulate versus the USA.

I'm going to try something new. I'm going to simply hold you to what you write. I am tired of guessing what you are writing or knowing that what you are saying is not what you will claim in two posts.

So, based on the above, you believe medical insurance in the US is not regulated, correct?

The consequences in places that do are there, yes. But compared to the cosequences of uncontrolled medical inflation not so bad.

Do you realize how vapid this is? It is nearly meaningless and I refuse to try and interpret it.

They mainly have to do with managing ability to provide instantaneous services versus waiting. Problems of availability. Problems which also occur in the US where ability to pay forces many from care.

Ditto.

But Steve, I'm not trying to convince you otherwise. I pointed to this as an area where Fareed Zakkaria's orignal comment has validty. And in your line of argumentation you reinforce his statement. You simply refuse to beleive the validity of the experience elsewhere.

That is a lie.

I have not refused to believe other countries have positive experiences with socialized medicine.

Hell even in appealing to the link on defence spending you neglect the evidence that suggests that there is more potential in giovenrment run programs to reduce medical inflation. (Note the savings it reports that been achieved in the Veterans Medical budget..

This borders on illiteracy. What is the main idea tying these sentences together? What point are you trying to make?

If you're not going to try and be coherent, don't bother.

By the way, taxation revenue as a precentage of GDP is at its lowest point 50+ years. If the imbalance is only expenditures how is this then the case? (And the theory that lower taxes always create more revenues?)

I'm not accepting this on your say so.

Also, how high is our spending as a ration to GDP?

Answer: the highest since WW2. Now, I'm not sure, but it seems to me that the obligation the US faced was just a bit higher back then. Just have a look at the history of deficit spending:



To me, that's a bit frightening--more now than at any time other than the biggest war the world has ever known? When we were the world's arsenal? To international institutions, it's a bit frightening. We've received all sorts of external warnings: from Moody's, China, many economists. So, what's the plan?

Obama: Keep "investing." Someday all this money down the drain will do us good.

Maybe. But . . .

Entitlements are part of the problem--a major part.

Re elasticity of demand, I think you are fooling yourself if you believe that most medical expenses are life and death. No doubt some are; but most medical expenses are about choices that pertain to quality of life. Quality of life is not binary. Many medical expenses can be avoided or reduced by better food choices. A study was published today on comparative diabetes rates in the US vs. other countries. The US diabetes rate is about 6% higher than the UK. It's something like 7% in the UK vs. 13% in the US. I doubt this is because the US diagnoses better because it is fairly easy to diagnose diabetes, unlike our earlier discussion on prostate cancer.

This is true. However, the basic reason Medicare was adopted in the 60's in the US was to provide for a dignity for old age pensioners. Having earned their place in society, witnessing the old either lose their life's savings OR suffer the indignity of pain or poor health your government decided to invest in providing them a minimum of care.
If you alter Medicare or Medicaid to diminish the delivery of the program, which substantial defunding would probably accomplish, you are betraying this original premise.
You say Medicare is "bankrupting the nation". Essentially you are saying all these old sick people are bankrupting the country. The question being asked is why you would refuse to regulate the providers in order to save the dignity of your elderly?
It may seem to you that there are ways to improve the current system to improve the cost effectiveness and affordability of health care...But, so far its all theories.
For example: More competition in health insurance? You should be able to point to states where there IS more competition versus states where there is little or none and see a difference if this is true. You can't...
And for example: Tort reform. There is an estimate of about 2% savings if tort reform is brought about that we linked to in other discussions... And I think its worthwhile pursuing. But consider this Ray; what is Tort reform except regulation of the legal system's "rewards". (I hope that is the right word,)
Why is it that you are considering regulating the legal profession but not the medical profession, or pharma? They are both, currently , possessed of few if any control on costs. Why is it palatable to regulate one but not the other?

It would be helpful if you found studies on elasticity of demand in health care. Then compare it to elasticity of demand for other necessities such as food, clothing, and shelter. Only then are you dealing with realism. Otherwise, I think you are guilty of that which you accuse conservatives.

It would be helpful; if you found those studies too. What I've pointed to is the OECD comparison between nations of supply and demand. Doctors and imaging tools per 1000 patients... (It was on the wikipedia page i linked .) What I've also pointed to is the plain evidence that the marketing practices that occur in markets where there is elasticity do not exist in the medical services industry.
With the exception of laser eye surgery, which proves the point that when consumers have the ability to delay a procedure with little or no consequence then demand fluctuates and price becomes important. And becomes a part of the business segment. All you need do to prove this wrong is find a lot of cost advertising in any sector of the medical services industry in the US...

Steve

I have not refused to believe other countries have positive experiences with socialized medicine.

Not the impression you've given, but okay.
But you have refused to beleive that they could be applied to the US.
Even though they have..With popular acceptance, from, one can only conclude, generally postiive experiences.