Here are the facts. Medicare is a critical program that helps people age 65 or older achieve health security. But it’s headed for a painful collapse. Independent experts and leaders in both parties agree that if we do nothing, Medicare will exhaust its trust fund in nine years, putting enormous pressure on the federal budget as health-care costs continue to rise. Unless we act, we’re moving toward a debt-fueled economic crisis, harsh cuts that affect today’s seniors and enormous tax increases that diminish the dreams of the next generation.
We can save Medicare, but we have to reform it so that it delivers the high quality we expect, at a price we can afford.
Medicare is one of the worst examples of forced cost-shifting at the point of a gun. It creates monstrous distortions in the delivery of health care and, when coupled with a legal environment that permits behavior illegal in other fields (anti-trust exemptions, demands to provide service to those who cannot pay, including those who can't pay by choice and explicit legal support for price-fixing across international boundaries) we have created a "free money spigot" that has cranked up the cost of health care at multiples of the general inflation rate while failing to materially improve the quality of care.
But compound functions like this cannot go on forever. The solution is not "vouchers", which simply shift the cost yet again, this time onto the back of seniors instead of the population generally. Nor can we realistically exempt anyone 55 and older - the bulk of the boomers are in the bracket from 55-65, and they will enter the system over the next ten years.
We must fix the structure of health care in the United States.
But neither the left or right is interested in doing this. Fixing the structure of health care means telling the medical industry to stick it. It means repealing EMTALA and forcing level pricing and billing for everyone, forbidding medical providers from forcing you to pay for Juanita's illegal entry to the United States which she did for the explicit purpose of obtaining "free" medical care when she gave birth. It means telling the pharmaceutical and device firms that if they are going to sell drugs in other first-world nations like Canada for $2/pill they cannot price-fix here, and that if someone buys those drugs in another nation and re-imports them, that's perfectly legal. It means having the conversation with the American public we needed to have two decades ago, explaining that Grandma cannot have two new hips and Grandpa a quadruple-bypass - we simply don't have the money to provide one hundred million of those over a space of 20 years, and that's what the current system is demanding we provide.
It requires that we have an honest discussion about not only personal responsibility, but also a full and robust scientific review of what we're telling people about diet and exercise. Does everyone need that 30 minutes of moderate exercise at least three times a week? Yes. But is the "food pyramid" as currently constructed and promoted valid? That's a better question, especially in the world of engineered "foods" such as high-fructose corn syrup and other high-glycemic-index processed foods that do nothing about satisfying hunger but do plenty to fatten both waistlines and "food" company balance sheets.
Never mind the other problem we have with the medical industry - being sick is big business. Especially if you're "chronically" sick but the industry can give you a nice pill and make it all better. For a while, anyway. We have a diabetes epidemic in the United States but much of it is self-inflicted. It's easier to demand a $300/month prescription for some wonder drug (even with its risks and side effects) than to buy a $100 pair of running shoes and get off your ass, even though a huge percentage of Type II diabetics are 50lbs or more overweight and if they lose the weight their blood sugar will either come back into balance or they will be able to control it with older, generic medications that cost pennies. What is our social responsibility as a nation to provide? The running shoes, the $300/month pill, or nothing, since the solution is as close as the suffers' pie hole?
None of this is easy and it sure as hell is tougher than simply running the common demagogue positions on the left and right. The right wants to throw Granny down the stairs. The left wants socialized medicine.
The truth is that if we don't cut the crap we're going to wind up both ridiculously ill and broke. Our nation cannot continue on the path we're on. We cannot "get our health care costs under control" while maintaining the system for health care as it exists now in the United States.
There's no way to solve the cost escalation problem, with near-double-digit increases every year in actual cost, without shutting off the cost-shifting and changing the paradigm on how health care works in the United States. EMTALA may have been well-intentioned but it has become of the biggest drivers in the escalation of hospital costs, rendering nearly anyone, even those who are insured, subject to instant financial ruin should they have a medical emergency.
The common tonics dispensed by the left and right sound good but they're both wrong and time is running out to do the right thing.
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That's a lie. I want Granny to pay for the care she can afford. I don't want to burden the next generation with paying for obscene amounts of medical care for a non-productive member of society.
If she can't afford care then she doesn't get any. If she chose not to save then she doesn't get care. If she stood idly by and watched politicians make decisions that destroyed her standard of living (thereby making it difficult for her to save) then she doesn't get care.
The right wants to throw Granny down the stairs, the left wants socialized medicineto throw the young down the stairs, and the voters want free **** and will go along with any attack on their freedom to get it.
FIFY
The Humongous wrote..
Two party nation, what's your retardation? You won't vote to stop the looting operation. You see, Wall Street and DC are a grift, but they don't want the status quo to shift, so some of the tax and borrow spending is given as a "gift" to give you a lift. Who cares if it's an intergenerational standard of living shift? If you think you got some of the loot, you won't give those assclowns in DC the boot, or worse yet start to shoot, that's why no one gives a hoot, until the bond market runs out of luck, then we're all ****ed, but you don't give a ****, because you're addicted to the wealth transfer tit...
Tesla
Posts: 15560
Incept: 2008-04-03
State of Disbelief
Look at NY-26. There's the result. The FSA came out full force to keep their entitlements.
No current politician has the guts to stand up to the electorate, because we've passed the magical 50% FSA mark. Few are so "selfless" as to want the freebies to stop.
Bring on the collapse. Please, everyone who can, sign up for all the free government cheese you legally can so we can get this over with sooner.
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"Even a dog knows the difference between being stumbled over and being kicked." -Justice Oliver Wendell Holmes
"Neither the wisest Constitution nor the wisest laws will secure the liberty and happiness of a people whose manners are universally corrupt." -Samuel Adams
As I'm 'in the field' I'll share my 2 cents. First, as Karl stated, we must stop treating those who can't (and won't pay). However, this responsibility falls squarely on the shoulders of the government, not doctors. Doctors take a hippocratic oath; we can't simply let someone die in our OR or ER. Doing such would undermine the reason(s) we went into medicine in the first place. Our elected officials need to pick up their slack and lock down the borders, so doctors don't have to make such decisions. Second, for those who are legitimate US citizens and try to shirk the system (not pay for ER visits), hospitals need facilitated means of recourse. Often, a hospital won't even try to collect on a known deadbeat, as they believe they can simply pass that cost on to the next individual who does pay. That can only go on for so long. I do disagree, once again, with the bypass surgery reference. This is a hugely successful surgery that can add decades to an individual's life. The cost benefit ratio is realistic. Heart disease is often not someone's fault. Get the wrong genetics, and you're prob. going to visit the OR one day for open heart. Lastly, we ABSOLUTELY need to reign in pharm costs. The fact that the US bears such a huge cost in the development of these drugs while the rest of the world simply reaps the benefits is absurd.
Tesla - EXACTLY right - Maddow was creaming her jeans last night - she must have said "Republican plan to kill Medicare failed" 200 times- THIS is their plan to win 2012 - the oldsters are scared ****less that they will have their skittles cut back - **** the future generations! just don't touch MY free **** - it's time for a reality check - it's obvious that the majority is STUPID and GREEDY - we need a good war or pandemic.
Full Disclosure...my bias is for a single payer system like Canada.
Our health care system is broken. Canada can cover 100% of the population for 8.5% of GDP. The US costs 14.5% of GDP and has millions of uninsured.
I don't want to go back to an 18th century Charles Dickens world where there was a vast chasm between rich and poor, child labor was the norm and there was no safety net.
Karl's plan is a practical, middle-of-the-road solution that is doable.
Chemistryken
Posts: 11
Incept: 2010-12-16
North Central Oklahoma
Great post Gen, but I also agree with Corn. If you can't pay then you can't play. Why must I pay, with a gun pointed at me, someone else's health care costs. Why do I have to pay for the alcoholic's liver transplant, the smoker's lung transplant, the fat man's insulin and his scooter? BS! That ain't throwin' grandma down the stairs.
Also, last time I looked fructose and HFCS were LOW glycemic index foods.
Quads - good luck getting the AARP crowd to vote for THAT - I agree but they will never willingly give up what they have and too many of them vote - hell, most of them are retired what else do they have to do.
Anecdotal - I used to be a rep for a publishing company, I called on hospitals - I always was amazed that the Sun City hospital waiting area was JAMMED every time I showed up - JAMMED - I asked one of the admins about it - "it's all Medi-care, it's free and 90% of them are bored or are here for a hangnail"
It's what you get when you have a program like this.
Mortgageguymn
Posts: 1583
Incept: 2009-03-09
North Coast
I gotta go with Corn (mostly anyhow) on the "throwing granny down the stairs" characterization. If someone is born with a severe handicap and can't earn an income, I'd be OK with paying for their care through taxation, but in general people need to pay more of their own costs. Ryan's plan can be said to only "shift costs" (true) and ignores the need to "fix the structure of medical care" (also true), but shifting the cost to block grants (and thus onto seniors themselves) would increase the incentive to reduce costs -in the same way that local units of government are far less likely to accept wasteful public transit schemes when the money is not coming from the federal government. Here in MN, we have a scheme of "LGA" (local government aid): state money paid to (some) localities, ostensibly to defray increases in property taxes. The dems claim that cutting $1 in LGA will "force" property taxes up by 60 cents. (That's why they say Pawlenty "raised property taxes" - which is BS). To most logical people, cutting a subsidy by $1 only to see another tax raised by 60 cents is a savings of 40 cents. In the same way, changing Medicare to a block grant will tend to reduce overall outlays - and that would be good.
That doesn't change the fact that we should simultaneously make other sensible changes that KD has suggested including: allowing drug reimportation (to disallow "arbitrage") , repealing EMTALA and eliminating the medical industry's exemption from the Robinson-Patman Act. In fact, an army of angry seniors PO'd about their rising costs may be the only way to bring about those changes. To the extent that Ryan's plan would mean more angry seniors, it's a small step toward making those changes happen. Ryan's craven policy of exempting those over age 55, however, dilutes what little possibile efficacy his plan might otherwise have.
Dmj625
Posts: 447
Incept: 2010-03-01
New Orleans, LA
Quote:
It requires that we have an honest discussion about not only personal responsibility, but also a full and robust scientific review of what we're telling people about diet and exercise. Does everyone need that 30 minutes of moderate exercise at least three times a week? Yes. But is the "food pyramid" as currently constructed and promoted valid? That's a better question, especially in the world of engineered "foods" such as high-fructose corn syrup and other high-glycemic-index processed foods that do nothing about satisfying hunger but do plenty to fatten both waistlines and "food" company balance sheets.
Never mind the other problem we have with the medical industry - being sick is big business. Especially if you're "chronically" sick but the industry can give you a nice pill and make it all better. For a while, anyway. We have a diabetes epidemic in the United States but much of it is self-inflicted. It's easier to demand a $300/month prescription for some wonder drug (even with its risks and side effects) than to buy a $100 pair of running shoes and get off your ass, even though a huge percentage of Type II diabetics are 50lbs or more overweight and if they lose the weight their blood sugar will either come back into balance or they will be able to control it with older, generic medications that cost pennies. What is our social responsibility as a nation to provide? The running shoes, the $300/month pill, or nothing, since the solution is as close as the suffers' pie hole?
^^^THIS^^^ is spot-on.
Michael Pollan has written extensively about the distortions in the American diet being largely caused by US agricultural policies and subsidies. He contends that subsidies promote production of the greatest number of calories at the lowest cost, primarily in the form of corn, wheat, and soy. All of these are calorie-dense, but none are particularly nutritious.
In The Omnivore's Dilemma, Pollan examines the sources of several meals. His examination of a fast food chicken nugget meal finds mechanically-separated chicken bound with corn starch, battered in corn meal, fried in corn or soy oil, and served with a soda sweetened with corn syrup. He argues that the average American gets >60% of his/her caloric intake from corn/soy/wheat.
Politicians (and there wives) who advocate healthy eating and lifestyles without realizing that it is the very policies that they created and supported that destroyed family farms, seasonal diets, and nutritional variety.
If you are interested in diet and nutrition getting beat over the head by cruelty-free granola-crunching vegan hippies, I highly recommend:
The Omnivore's Dilemma, by Michael Pollan Nourishing Traditions, by Sally Fallon
Dmj625
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"The more that laws and regulations are given prominence, the more thieves and robbers there will be." -Lao-tzu
If Ryan is one of the bad guys he's the most evil kind. In the past I've always thought Paul Ryan was a patriot. I'm not so sure anymore. Personally I'm a rip the band-aid off kind of guy, and this appears to be that they're trying to distract you while they peel it back a little at a time. I wish they would just all leave and let some people in the room with some big boy pants on to address the problems.
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I'm already visualizing you with duct tape over your mouth.
People are rationalizing creatures. We never ever think it will happen to us - whatever it is. But, one day soon, the Medicare coverage will stop. Social Security coverage will stop. Food stamps will stop. All the free **** will stop. And a lot of old people will die. There is no beating death. Everyone dies ... eventually.
You can't really argue with old people who receive Medicare and go to the doctor once or twice a month for a checkup and their $1,000 pill refill. They aren't going to stop until forced. But Reality will put a stop to all this nonsense and a lot of old people will die. Such is life and death.
In the past, I don't think as many people feared death the way our Godless culture fears death today. But have no doubt, you will die. All the surgeries and medicines and hip replacements and exercise and diet, none of it can stop the inevitable end that comes to all men - DEATH.
Illness is profitable, wellness isn't. We're getting the worst of both worlds with the current system, a blindingly expensive system with inequities that no other civilized nation tolerates.
Ideally we need some sort of commission that takes a holistic approach to how we can provide healthy living to our citizens and reasonably priced effective and fair treatment. Of course special interests would pick this apart like crows on a dead squirrel.
Starvingartist
Posts: 3430
Incept: 2011-01-03
Puff The Magic Dragon
Yeah, it must be our Godless culture.
Let's not forget that retirees are forced into Medicare by their employer at a certain age. You don't enroll, you lose the coverage you arranged for your retirement years through the employer.
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"The only solution that is mathematically sound is politically impossible. All the should's in the world ain't gonna change that."
Canada and the EU can "cover" everyone at half the price because canes, grossly obsolescent chemo, and forcing people with operable tumors to wait for months to see a surgeon is cheaper than providing 98 year old americans hip replacements, state of the art chemo, and quadruple bypasses at taxpayer expense on demand without waiting.
I'm helping a newly diagnosed diabetic with the Gerson Therapy. His fasting glucose has gone from 330something to 119 in three weeks, has lost a few pounds too.
I don't think he will become a long term customer of the medical industry.
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Health is better than health insurance http://gerson.org/ Over the past 60 years, thousands of people have used the Gerson Therapy to recover from so-called “incurable” diseases such as cancer, diabetes, heart disease and arthritis.
The fact that elected officials can't even talk honestly about any of these problems leads me to believe that the lies will continue until they have no other option but to tell the truth. Once the government can't issue new debt at less than 10%, things will change pretty fast.
"You can't really argue with old people who receive Medicare and go to the doctor once or twice a month for a checkup and their $1,000 pill refill. They aren't going to stop until forced. But Reality will put a stop to all this nonsense and a lot of old people will die. Such is life and death. "
There are a lot of old people(I have them in my family) that go to the doctor constantly because they can't rationalize that they are old. They think they should feel like they did when they were 20 and a lot of pill pushers out there ready to accomodate their desires. Get over it, suck it up, you're old and you should have some aches and pains. Try getting off the sofa for a few hours a day
If I got sick, in the USA, without insurance, I would be forced, hounded out of all my savings and assets so that all those wonderful people working in the health industries would be able to continue their lifestyles that I can only dream of having.
Hummm, Maybe the health care system could take everything before the undertaker and inherence taxes?
I'm an American who grew up under the cover of Kaiser, and now I'm down in Australia under the one-payer(-ish) system which is generally speaking like Canada.
The thing I **HATE** about the American "debate" is that it's presented in black and white; "We can have private cover, or we can have socialized medicine". Bull. ****.
Here in Australia, we get hit with a 1.5% income tax for medical cover off the top. If you earn over the threshold ($50k-ish) and you do not hold private cover, then you are hit with an additional 1%. For my family of 4, we pay about $120 a month for this private cover (though I think it is somewhat subsidized, so call it $160/mo).
So, here's some examples...
When I busted my nose, I went private so as to guarantee treatment within the 2 week window (else the nose has to be re-broken to be reset). I was out-of-pocket about $500-ish in "copays". Had I gone public I'd have not been out of pocket but may/probably have missed the 2 week window.
When the wife was pregnant, we went public. Had we gone private we'd have been out-of-pocket $3000 or so (as there are a butt-load more OB visits, where as we went the dirty-hippy route of a midwife).
Anyway... I told the above to illustrate that Australia maintains a dual system of public and private hospitals very successfully and as a consumer I am able to not only get reasonable private cover, but it allows me to pick-and-choose the route I wish to take depending on the deficiencies of the public system. Don't like the waiting times? Go private and copay.
So, what's the bad? Well wait times can be. "Coverage" in rural areas are difficult mostly due to very low population densities in the outback (can you really have a cardiologist within 100km of everyone?). Also there are times where public beds/NICU space is limited (there was a case here recently where a woman in Sydney with triplets was presented with the likelihood of having them spread across 3 NICUs due to availability, she ended up in Canberra which had space for 3). Is it perfect? No. But there is a focus on preventive care, so a problem that can be fixed with a $50 procedure is done before it becomes a chronic issue that costs $1000's. And since by default all are covered, there is no fear of going to the ER (and in my experience of 3-4 ER visits, they are not overcrowded like the 3 ER visits I've had in the states). Now... Australia has a "moat" as an additional advantage, and save the Kiwi's generally speaking we don't have to treat "fer-a-ners" but I'd have to think very long and very hard about returning to the US because I know down here my ass is covered (medically speaking).
Now... why in the hell is the US too stupid to take on a system like this? Well, the fact that so much of GDP is routed into medicine, and that some 30%+ is eaten up by management overheads; that's big money (and therefore big lobbying $$) folks.
Senate_GOPs Senate Republicans .@SenToomey: "We cannot kick this can down the road anymore." http://bit.ly/jwPc4Q#757Days #NoDemBudget
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"The politicians are put there to give you the idea you have freedom of choice. You don't. You have no choice; you have owners. They own you. They own everything." - George Carlin
