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- Doctor Fate
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20 Jan 2011, 2:42 pm
Is it the end of the world as we know it? Will thousands, or more, of Americans die if the Healthcare reform act is repealed?
Certainly, the Democrats and their demagogues think so.
Watch Sheila Jackson Lee and watch the background!
On the other hand, listen to
the number-crunching by Paul Ryan.
Which is more believable?
Did anyone ever believe 30-50 million more people could be insured at a savings?
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- Neal Anderth
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20 Jan 2011, 3:58 pm
Factually speaking enough is already being spent to cover universal healthcare if you compare the GDP contributions. Just because people don't have insurance doesn't mean they aren't getting healthcare.
For example what's better, cheap interventions when someone is younger and it can be managed with $0.10 pills, or major inventions later on because the person wasn't getting regular checkups?
The poor get healthcare for free, seniors the most expensive group are covered, the middle aged middle class pays for it all and yet faces healthcare insecurity. I'm guessing many people in the 50-65 age range face a lot of fears with that kind of thing, especially with healthcare being tied to employment.
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- GMTom
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20 Jan 2011, 6:28 pm
Myself, I am all for a real basic somewhat crappy universal plan with all sorts of low cost adders we can buy if we like, like a menu. My fear however is if this happened, the level of care for all would drop to that basic crappy plan, the costs for the adders would skyrocket to unaffordable. I doubt employers would buy into the adders and doubt any savings they made would be passed along to employees either. The end result would be lower health care for the majority while the poor move up very slightly.
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- danivon
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21 Jan 2011, 2:44 am
So, Tom, you think the plan you favour will end in disaster. I think you need a better plan.
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- GMTom
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21 Jan 2011, 6:41 am
actually, the current Obama plan is just a stupid mess that does nothing but cost us more. It is simply a mish-mash of ideas that just don't work or make sense, universal coverage for free, fine, make it happen and people will accept it over time, this current "plan" is a joke that does nothing to fix the problem. My suggestion is what I would like to see, I do see the pitfalls and can almost assuredly point to lesser coverage in the end. Because I am realistic, I see disaster in the Canadian style and the UK style and the French styled plans as well. You may be happy with what you have in those nations, they simply are not acceptable to me. Because I see problems that you are willing to accept, I think you guys need a better plan as well.
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- danivon
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21 Jan 2011, 8:36 am
Problem was that universal coverage for free was not only vehemently opposed by the minority party in Congress, but by a significant minority of Democrats as well. It would never have passed. It's been mooted before, under Nixon, under Clinton, and last year. It always gets nowhere.
Political reality and the power of inertia built into your system means that it is going to be complex fudges all the way...
As for our system, it is about to be overhauled by the Tory government, introducing far more 'competition' and removing a lot of the national guidelines and controls. I'm so glad I got my hernia repaired last year...
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- Archduke Russell John
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29 Jan 2011, 6:53 pm
A friend on another message board posted the following information that I think is interesting in regard to Federal spending.
Figures are from the CBO - Congressional Budget Office. Numbers are in Billions and don't cover TARP or the 2009 Stimulus. Some figures (specific military breakdowns) come from the Pentagon Operational Budget Document. Both the Federal and Pentagon budgets can be described as deliberately obfuscatory.
VA Benefits - 70
Military Facility Maintenance - 228
Military R&D - 21
Military Equipment Costs - 171
Military Operations Costs - Afghanistan: 191
Military Operations Costs - Iraq - 66
Military Operations Costs - Korea - 7
Total Military: 785 billion
The largest expense in the US military isn't CVBGs. It's keeping bases open, both in the US and around the world. Most of those bases are political pork - each represents a cluster of jobs important to someone in Congress. That Facility Maintenance line item more or less covers the salaries of all military personnel who aren't deployed overseas, including the Federal budget for National Guard units.
Cancelling LCS, or the CVN in the docks, would free up about 2 billion. Cancelling the F-35 would, due to the way the program is structured, probably cost about as much as buying the entire US production run over the next ten years - except it'd come out of one year's budget instead of 10.
When operations in Afghanistan and Iraq wind down, the military budget is going to shrink by about 20% the first two fiscal years and then by 30% thereafter.
While there are lots of web sites that talk about how wars have cost us a trillion dollars, they are incorrect - the current tally over 9.5 years is about 2.1 trillion, not a measly 1 trillion, and in no single year has there been a trillion dollar aggregate military budget.
Social Security - 615
Health, Hospitals - 284
Medicare - 396
Disability - 7
Cash and Food Stamps - 6
Social Services - 132
Housing - 41
Unemployment - 37
Police, Fire & Corrections - 31
Education - 104
Total entitlement budget: 1,622 billion. If you remove Social Security (because you believe the fairy tale that it's self funding), you're at 1,007 billion.
Some interesting slicing and dicing: Between the two items above (Health, Hospitals and Medicare) we spend 680 billion on 'socialized medicine' for about 100 million people - about 35% of the US population, or about 6.8K per beneficiary. If we put the VA in there, it's about 750 billion on 120 million people. (Yes, the VA serves about 16% of the people getting direct health benefits from the government on about 9% of the budget).
We spend more on socialized medicine than the UK, France and Canada combined. We also cover more people than the combined populations of those three countries.
Historical trends on the entitlement programs are that they grow at about 4-6% per year in cash outlays.
There has never been a fiscal year where they have NOT grown; some years their growth has merely matched inflation rates. Most years, they've exceeded the inflation rate in their rate of by 2-3%.
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- rickyp
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30 Jan 2011, 10:01 am
Archduke, the problem with both the health budget and the military budget is that they dpon't really operate in a market. There are no competitive forces that help bring about efficiencies the way free ebnterprise usually does...
In the case iof the military I guess that leads to feather bedding and corruption and inefficiency that can be rooted out in a top down, willful exercisae of discipline... (Just tell them to make do with 80% of the money and they will...)
In the case of the medical industry it means that someone has to go in and negotiate with all of the providers on behalf of the stake holders. In a complete socialized system that means the tax payers.... And I guess mostly in the US, although you'd need to seperate thaty between tax payers and insurance company clients.
The reason most other nations deliver health services more cheaply on a per capita basis (and resulting less expenditure overall in GDP) is that places like France and Norway etc. negotiate reasonable costs/fees...and make the providers lives easier in some ways too. (Efficiencies gained in dealing with one payor are myriad. Including the elimination of risk of payment which is rampant between doctors and insurers in the US).
Its simply the recognition that a market doesn't and never will exist for something that inevitably becomes essential. With no elasticity in the market created by price sensitive demand....costs have gone crazy.
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- rickyp
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30 Jan 2011, 4:32 pm
Just finished the Munk Debates, which included a debate on health care...
One of the speakers explained the lack of market forces in health care this way:
A new ford dealership comes to town and there's immediately price competition in the town.
A new CT scanner is put into a clinic in town and all that happens is more scans get ordered.... (Price for service)
When you go to a car dealer you tell him what kind of car you want, how much you want to spend, and what accessories and warranties you want. When you go to a doctor he tells you what tests he's ordering, what therapies and remedies to take and there is no discussion of price.... and seldom of options...(certainly not as much as in the car dealership)
Waiting for surgery? One has to wonder if a surgeon who can book you into surgery next week, is doing so because the surgery is absolutely necessary or because he needs to fill up his OR schedule...
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- Archduke Russell John
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30 Jan 2011, 8:18 pm
rickyp wrote:. When you go to a doctor he tells you what tests he's ordering, what therapies and remedies to take and there is no discussion of price.... and seldom of options...(certainly not as much as in the car dealership)...
And why is that? Is because the consumer, i.e. patient, isn't concerned about the cost due to insurance coverage and therefore shops with other issues in mind. For example, on the old boards I commented on how I have 3 hospitals all within an equal amount of driving distance and how I choose which I go to for different issues. The comments was that my shopping around had nothing to do with cost. My response at the time was "Well no crap because it all costs me the same - $25".
I just did the shop around again. I have been having back problems for years. My doctor sent me for an MRI. I shopped around for a place to go. I called three different locations (run by 3 different companies). However, my criteria for the search had nothing to do with cost. I was more interested in location relative to my home, ease of getting an appointment and close v. open machine (touch clausterphobic). The reason cost was not a consideration was because no matter where I went the out of pocket cost was the same for me - $0.
Now my brother on the other hand lives in California dong the trying to be an actor thing. He has no insurance so when he needs something medical he shops around with cost being the biggest criteria. So if the biggest issue is cost containment wouldn't forcing all health expenses to be out of pocket with patient negotatied fees make the most sense.
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- Machiavelli
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30 Jan 2011, 10:23 pm
How could he have no insurance in the socialist utopia that is California? That's about the bluest of the blue states; surely they've long ago realized the enormous cost-savings offered by free public health care for everyone and are now rolling in the wealth amassed through all of that "reform."
Query: will ObamaCare cover my medical marijuana?
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- GMTom
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30 Jan 2011, 10:29 pm
Interesting timing, my wife was just in the hospital a few days ago. Wednesday night she was throwing up like you wouldn't believe. After 5 hours of it and no relief from the intense pain, we had to get her to the emergency room. We have 3 hospitals withing a 10 minute drive or less (and another maybe 15 minutes away) we went not based on costs, as far as I know the cost is the same at all and I do have insurance so the cost is assuredly the same. But if we had none, did we have time to shop around? Of course not, we did have a choice and went to the one that's the nicest balance ...the "best" hospital is huge, less personal, always has a busy ER, one isn't known for being that good if you need anything more than basic, so we went to that middle one (it's a partner of the "best" hospital, down the road a ways so it's the best of all worlds)
Anyways.... we did not check, should we have had no insurance we would not shop either.
She ended up requiring an appendectomy, the symptoms were completely atypical of her condition, if not for really good care and a freaking CAT scan, they would not have guessed what was wrong. It's going to cost me $500 (maybe a bit more depending on other costs?) but I'm quite happy with her care and the result. That being said, I still think our system needs an overhaul. For example, we got her care well before they even checked on our insurance, if we had no insurance, I'm guessing this would have cost us several thousand dollars ...ER visit, CAT scan, blood and urine tests, two days in the hospital, an appendectomy, all sorts of drugs and pain killers and IV fluids. It would just kill us, she's a healthy woman, exercises and is in great shape. It can and does happen to anyone, insurance costs us a boatload, the system stinks.
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- Archduke Russell John
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31 Jan 2011, 8:54 am
Tom, I would argue you did shop around but that cost was not a criteria. It seems you chose which hospital to go to based on a criteria of reputation of healthcare and customer service provided.
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- GMTom
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31 Jan 2011, 9:57 am
yep, but not price and that is the issue here.
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- Archduke Russell John
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31 Jan 2011, 12:52 pm
Tom,
But that is the point. Ricky's position is that prices are so high because there is no free market price competition so only government can lower the prices by mandating a price (because let's be honest there would be no negotiation of prices. The Gov't will say this is what we are paying you if you don't like it don't see patients). My counter is that the free market competition is there but because cost is not an issue for most people due to insurance, it is not one of the market effects.
