Health Reform and Medicare

[Geo Patric]

"One of the traditional methods of imposing statism or socialism on a people has been by way of medicine. It's very easy to disguise a medical program as a humanitarian project. . . .Now, the American people, if you put it to them about socialized medicine and gave them a chance to choose, would unhesitatingly vote against it. We have an example of this ...compulsory health insurance program for all people in the United States"

if this sounds familiar, it should. This is what we have been hearing about the Health Care Reform Bill recently signed by the president. It should be noted, though, that this particular quote does not derive from the current debate, but goes back to 1967 and the debate about medicare, which the Republican party was then calling "Creeping Socialism". The speaker was Ronald Reagan, who dropped the ominous warning: "one of these days you and I are going to spend our sunset years telling our children and our children's children what it was once like in America when men were free." Again, sounds familiar, don't it?

Of course, these days Medicare is considered one of the most successful and most popular social programs ever enacted. So much so, in fact, that the current batch of Republicans tried to use it as a foil, suggesting that HRC would destroy the very program their party fought so hard to defeat, just as they are now trying to defeat HRC.

Reagan was at the time, in the employ of the AMA. So... was he just doing what he was paid to do? Or was he trying to establish some political cred with the right wing, who would eventually put him in the whitehouse?

and today's republicans? They cannot claim the ignorance that Reagan could, they have a fine example of the success of STATE MEDICINE; Medicare itself.

What then, is THEIR motive in employing the same disingenuous rhetoric, the same divisive lies, in inciting their constituents toward hateful name calling and even incipient violence?

geo.

 

[Baffled]

if this sounds familiar, it should. This is what we have been hearing about the Health Care Reform Bill recently signed by the president. It should be noted, though, that this particular quote does not derive from the current debate, but goes back to 1967 and the debate about medicare, which the Republican party was then calling "Creeping Socialism". The speaker was Ronald Reagan, who dropped the ominous warning: "one of these days you and I are going to spend our sunset years telling our children and our children's children what it was once like in America when men were free." Again, sounds familiar, don't it?

Of course, these days Medicare is considered one of the most successful and most popular social programs ever enacted. So much so, in fact, that the current batch of Republicans tried to use it as a foil, suggesting that HRC would destroy the very program their party fought so hard to defeat, just as they are now trying to defeat HRC.

Reagan was at the time, in the employ of the AMA. So... was he just doing what he was paid to do? Or was he trying to establish some political cred with the right wing, who would eventually put him in the whitehouse?

and today's republicans? They cannot claim the ignorance that Reagan could, they have a fine example of the success of STATE MEDICINE; Medicare itself.

What then, is THEIR motive in employing the same disingenuous rhetoric, the same divisive lies, in inciting their constituents toward hateful name calling and even incipient violence?

geo.

Medicare has a very poor reimbursement history resulting in nearly 1/3 of physicians not accepting Medicare patients any longer. Medicare has significant out of pocket expenses; certain pharmacies decline to fill Medicare prescriptions; numerous Medicare patients have to obtain supplemental insurance; and according to the Medicare Board of Trustees, the program's hospital insurance trust fund could run out of money by 2017.

"The CBO also projects that "total federal Medicare and Medicaid outlays will rise from 4 percent of GDP in 2007 to 12 percent in 2050 and 19 percent in 2082—which, as a share of the economy, is roughly equivalent to the total amount that the federal government spends today."

How is this disingenuous rhetoric and how does this sound like a successful program? I think Ronny baby was correct, its just that his timing was off a little. Cut him some slack... it's not like he was Barney Frank or something and could see everything coming (well, except for large real estate collapses and such)

 

[Geo Patric]

heh... i wrote a long detailed response ... and then found the simplest response possible in a column by Ezra Klein over at the Washington Post:

Wendell Potter worked in the health insurance industry for more than 20 years. He rose to be a senior executive at Cigna.

What drove Potter from the health insurance business was, well, the health insurance business. The industry, Potter says, is driven by "two key figures: earnings per share and the medical-loss ratio. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits."

Think about that term for a moment: The industry literally has a term for how much money it "loses" paying for health care.

The best way to drive down "medical-loss," explains Potter, is to stop insuring unhealthy people.

an industry founded on a policy that pursues of profit on sick people by people who do not make sick people well and a policy of reducing cost by not paying for sick people to get well.

succint.

m. Potter's quote is taken from a Senate Commerce Committee investigation. my original rather more tedious post follows.

geo.

 

[Geo Patric]

yes, medicare has problems, but not because of the principal behind medicare, but because of the way it is implemented. You have to read more carefully:

as a share of the economy, is roughly equivalent to the total amount that the federal government spends today

yes, medicare actual dollar costs will increase, but stay the same as a %GDP. Let us look at some of medicare's "problems".

Although Medicare is a national program, there are substantial variations across states and regions in terms of beneficiary characteristics, health needs, and utilization of Medicare-covered services..
- Kaiser Family Foundation (KFF)

consolidate management, funding, spending and you will eliminate many of the problems Medicare has. What does a commercial insurer do faced with this same problem? It simply raises premiums, reduces coverage or both. Medicare does not have these same options. consider:

Nationwide, annual premiums averaged $2,985 for single coverage ... to $9,952 for families headed by persons aged 60-64.
(KFF)

These are individual plans. Employer bases plans including deductibles and copays:

have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job.
- KFF

the RATE of increase is the good part. that "roughly equivalent" begins to take on a little bit of meaning, dunnit? So, what are the trends, for both?

According to Commonwealth Fund, Health Care Insurance and personal out-of-pocket costs are now consuming as much as 18 percent of an individual's income (when Employer provided coverage is considered as income). Keep in mind that Insurance premium costs do not vary as greatly by region as does income. Some folks are paying more the 20% of income towards health insurance.

and Medicare?

Medicare per capita spending has grown at a slightly lower rate, on average, than private health insurance spending, at about 6.8 vs. 7.1% ...Medicaid expenditures, similarly, have grown at slower rate than private spending, though enrollment in the program has increased
- KFF

Doesn't sound like much, does it. But that is percent of increase. What about actual dollars out and services in? One way to look at medicare vs private in terms of return on the dollar would be non-medical costs, such as administrative costs. Medicare will tell you it is as low as 2% but a private actuarial study suggest 5% as more realistic. And Private insurers? 17%

and projections are even more revealing. According to the selfsame independent report:

Medicare administrative costs decrease because Medicare benefit costs increase at a higher rate than administrative cost increases. Benefit costs have typically been about double normal inflation (CPI increases) whereas administrative costs typically increase near the CPI rate.

Did you get that? Admin costs (as a percentage of overall costs) decrease as services increase. Medicare overall cost increase percentages are not that different, but because the actual spending is so greatly different, that percentage results in substantial dollars.

makes sense, dunnit? because Medicare is non-profit. Projections are for a admin cost of about 1.6% by 2025 where private insurer costs will rise, staying at about the same rate. Of course, Medicare is smaller. The same reports suggests that if Medicare were to operate on the scale of private insurers, its admin costs would go up considerably... to about HALF of private insurers.

now, take the relationship between costs and scale and rate of increase, put them together and the picture becomes clearer.

The problem is not so much how much Medicare spends, its how much is available to spend and how many it serves. Pull that paycheck outta yer pocket, get out you calculator and... well... hell... I'm a nice guy. I'll just tell you what it says. 1.5% of your income is deducted for medicare. (with matching employer contributions) as compared to 20% for private insurance.

Of course, with medicare, you have lots more paying than receiving. You can expect that percentage to rise should you make coverage universal. Probalbly to about half of what we pay private insurers.

ahem. yes... The problem is relationship between FUNDING and SERVICES, not management, not spending. The problem is the MODEL.

Although some experts claim that greater efficiency results from reliance on market forces and managed care techniques rather than on government administered tools in a fee-for-service environment, Medicare can claim that it has constrained spending growth per enrollee better than the private sector in the long term.
- NIH

Private insurance cost more because it depends on profit. period. Profit, not medical care, is its reason for being.

take all that money you are sending to WellPoint and direct it to a non-profit, tax funded, independently operated single payer system and you will get what many other people in the world get; more for less.

I suggested that Reagan can be forgiven for his inability to see the value of non-profit, tax funded social services. But... those rabid Republicans out there making the same old claims that have proven untrue... they cannot be forgiven. they are simply lieing.

geo.

 

[Baffled]

I could not get through the last post, but what I did gather is that you seem to be upset that a company providing a service would have the audacity to make a profit. Doctors profit on sick people and don't always cure them - should we do away with them as well? Making a profit and not losing one's ass... what a concept - I wish the government would catch a clue. I don't think the answer here is to allow the government to run things at an astronomical loss.

Now, I'm not defending insurance health insurance companies and at times it seems like cutting out the middle man in this situation seems reasonable, but philosophically I have a problem with a business (health care) running at a loss, which will be the case once the government takes over - guaranteed. I think government sponsored programs outside of this topic should be cut if there is no way to pay for the program - they just linger and add the the deficit. What this really means is that people with jobs who work hard or especially businesses who keep themselves in check (unlike the finances of the government) will have to foot the vast majority of the bill. I don't buy into this idea one bit. 40% of Americans already do not pay any taxes and now we will be giving them free health care at the expense of those already mentioned - What one person receives without working for, another person must work for without receiving. If we choose to live in a society, we must also accept that we will have to take care of those who cannot take care of themselves, but what we have here in this country is entitlement of a large portion of the population who can take care of themselves, but don't really have too.

True health care reform should involve health insurance company reform, medical liability reform and reducing the excessive waste that goes on in the health care industry (this is a huge problem in my opinion). Why not make a concerted effort to change these things in the system that is currently up and running instead of throwing the baby out with the bath water?

 

[Geo Patric]

I could not get through the last post

don't blame you. told you it was tedious. but, that is part of the problem. it is a hairy assed issue and NO ONE really wants to wade through it. Fortunately, the fella in the prior post summarized everything nicely.

you seem to be upset that a company providing a service would have the audacity to make a profit

not at all. I am upset that the well-being of people depends on others making profit. make profits on jaguars, silicon chips, potato chips. make money on bad movies, prostitution... sell liquor... but to make money betting that someone will not get sick, aside form being morally grotesque is simply bad policy.

What this really means is that people with jobs who work hard ... will have to foot the vast majority of the bill.

now, if you are awaitng the standard, stock denial, I am afraid you will have to wait at least a bit longer. Yes, that IS what it means. But not WILL, DO. Working people DO foot the vast majority of the bill. Anyway you cut the deck, it works out the same. Viewed economically, Healthy is a crappy hand. There are four ways of getting medical care.

pay the bill outta yer pocket. This if course is the least common way. only a very small fraction of the populace do this. So small, in fact, that we can leave them out of our discussion.

buy insurance or have your employer buy insurance for you or some combination of the two.. Effectively these are the same, as employer provided insurance is merely a form of deferred compensation. But, here, the many pay for the few; insurance is a form of 'wealth redistribution'. . HAS to be that way or insurance companies make no profit. So, stay healthy and you are one of the many that foot the bill. Or get sick and be one of the few that benefit from the contributions made by others.

leave the medical bill unpaid. Least desired, but an increasing percentage of people. Of course, the medical care does not really go unpaid, it goes unpaid by the recipient, but MOST of this care is given in Emergency rooms, the option of last resort for the uninsured. It is also 2 to 5 times more expensive than comparable treament, made in a timely manner in a regular doctors office or clinic. it IS paid, by state and federal governments... taxes. According to the Urban Institute, that amounted to $62.1 billion in 2009. so, you see, we pay anyway. You put it quite nicely yourself:

What one person receives without working for, another person must work for without receiving.

and we practice it all the time. I pay for roads, i do not drive on, buses i do not ride, schools i do not attend. And i do it without complainging, NOT because i am such a superior human (really, really good, but not THAT good) but because it is beneficial to our nation as a whole. Most education is wasted, but the portion that isn't allows us to be better productive and competitive (no, i am not anti-capitalist). A better educated citizenry makes for a stronger nation. A healthier citizenry makes for a stronger nation.

Why not make a concerted effort to change these things in the system that is currently up and running instead of throwing the baby out with the bath water?

but it is NOT working.

40% of Americans already do not pay any taxes

This, i think, deserves a thread of its own.

geo.

 

[Deuce]

40% of Americans already do not pay any taxes

Is there a source for this? It's not that I don't believe the number, it's just higher than I would have expected and I'm interested as to how someone came up with that number.

 

[Baffled]

Is there a source for this? It's not that I don't believe the number, it's just higher than I would have expected and I'm interested as to how someone came up with that number.

Number of Americans Paying Zero Federal Income Tax Grows to 43.4 Million

by Scott A. Hodge

Fiscal Fact No. 54

With the April 17th deadline for federal tax returns looming, Americans are sharply aware of their federal income tax liabilities. However, one aspect of federal income taxes they may not be aware of is the growing number of Americans who pay zero federal income tax after taking advantage of deductions and credits.

During 2006, Tax Foundation economists estimate that roughly 43.4 million tax returns, representing 91 million individuals, will face a zero or negative tax liability. That's out of a total of 136 million federal tax returns that will be filed. Adding to this figure the 15 million households and individuals who file no tax return at all, roughly 121 million Americans—or 41 percent of the U.S. population—will be completely outside the federal income tax system in 2006.1 This total includes those who pay no tax, and those who pay some tax upfront and are later refunded the full amount of the tax paid or more.

The Tax Foundation - Number of Americans Paying Zero Federal Income Tax Grows to 43.4 Million

 

[Geo Patric]

i posted a separate thread to follow-up on that.

HEY... same source! great minds, eh?

geo.

 

[Harry Guerrilla]

Is there a source for this? It's not that I don't believe the number, it's just higher than I would have expected and I'm interested as to how someone came up with that number.

Adding to that, approximately 60% of people receive more in benefits than they pay in taxes.
We are setting ourselves up for a disaster.

 

[Geo Patric]

hehehe... yesssssss.... think about that!

how much have YOU dead Iraquis have are you personally responsible for? Only a very small percentage of americans are killing Iraqis, but we all benefit.

what a country, eh?

good grief.

geo.

 

[Baffled]

don't blame you. told you it was tedious. but, that is part of the problem. it is a hairy assed issue and NO ONE really wants to wade through it. Fortunately, the fella in the prior post summarized everything nicely.


not at all. I am upset that the well-being of people depends on others making profit. make profits on jaguars, silicon chips, potato chips. make money on bad movies, prostitution... sell liquor... but to make money betting that someone will not get sick, aside form being morally grotesque is simply bad policy.


now, if you are awaitng the standard, stock denial, I am afraid you will have to wait at least a bit longer. Yes, that IS what it means. But not WILL, DO. Working people DO foot the vast majority of the bill. Anyway you cut the deck, it works out the same. Viewed economically, Healthy is a crappy hand. There are four ways of getting medical care.

pay the bill outta yer pocket. This if course is the least common way. only a very small fraction of the populace do this. So small, in fact, that we can leave them out of our discussion.

buy insurance or have your employer buy insurance for you or some combination of the two.. Effectively these are the same, as employer provided insurance is merely a form of deferred compensation. But, here, the many pay for the few; insurance is a form of 'wealth redistribution'. . HAS to be that way or insurance companies make no profit. So, stay healthy and you are one of the many that foot the bill. Or get sick and be one of the few that benefit from the contributions made by others.

leave the medical bill unpaid. Least desired, but an increasing percentage of people. Of course, the medical care does not really go unpaid, it goes unpaid by the recipient, but MOST of this care is given in Emergency rooms, the option of last resort for the uninsured. It is also 2 to 5 times more expensive than comparable treament, made in a timely manner in a regular doctors office or clinic. it IS paid, by state and federal governments... taxes. According to the Urban Institute, that amounted to $62.1 billion in 2009. so, you see, we pay anyway. You put it quite nicely yourself:


and we practice it all the time. I pay for roads, i do not drive on, buses i do not ride, schools i do not attend. And i do it without complainging, NOT because i am such a superior human (really, really good, but not THAT good) but because it is beneficial to our nation as a whole. Most education is wasted, but the portion that isn't allows us to be better productive and competitive (no, i am not anti-capitalist). A better educated citizenry makes for a stronger nation. A healthier citizenry makes for a stronger nation.



but it is NOT working.


This, i think, deserves a thread of its own.

geo.

A central Florida urologist has posted a sign on his office door warning supporters of President Barack Obama to find a different doctor.

The notice on Dr. Jack Cassell's Mount Dora practice says, "If you voted for Obama, seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years."

This is what I'm talking about. Regardless of the fact that this guy is a Republican, he understands the true significance of what is going on here and isn't afraid to put his money where his pen is (pen is... not penis, he is a urologist you know). Don't put this on his political affiliation... I don't see a sign on his door that reads if you voted for someone who campaigned for no drilling off of the US coast only to flop after being elected, go see another doctor; or if you voted for someone who was running against someone who touted a governmental spending freeze as part of his platform and then flopped and acted like this was a good idea after being elected, go see another doctor; or... this could go on forever, but I think you get the point

 

[Geo Patric]

Well, he gets to do that. to say it is not a political statement though, is ridiculous. A urologist practices urology (nice pun, btw). A urologist is as political an animal as the rest of us, of course, but his local medical board may look askance at his denying service to people who differ politically from him.

i will try to keep an eye on this, as i would be interested in the potential blowback. not for any personal reason, though. I live a continent away and my pen is working just fine.

geo.

 

[Geo Patric]

an upate... the good doctor is backpedaling... a lil,

"I'm not turning anybody away, that would be unethical," he told the Sentinel. "But if they read the sign and turn the other way, so be it."

Patients who continue past the sign on Cassell's door find a waiting room stacked with Republican pamphlets opposing health care reform, underneath a sign reading, "This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it."

Rep. Alan Grayson (D-Fla.) told the Sentinel he was "disgusted" by Cassell's behavior.

"Maybe he thinks the Hippocratic Oath says, 'Do no good'," Grayson said. "If this is the face of the right wing in America, it's the face of cruelty. ... Why don't they change the name of the Republican Party to the Sore Loser Party?"

geo.

 

[Baffled]

He's not backpedaling, he is playing the ethics game with the state board of Florida. He is not asking questions or quizzing anyone about this. They can read the statement and if they voted for Obama and in essence, HCR, they should just look elsewhere for medical attention.

I think this is pretty funny, but pretty sad at the same time. Thinks about physicians who work as hard as anyone and the idea that if working with controlling insurance companies wasn't bad enough, now they are looking at having to yield to an entity with not a stellar track record when it comes to managing things in the private sector

I don't know what the right answer is and for all I know, maybe socialized medicine is best (if this turned out to be the case in my lifetime, at least I would be covered for medical care used to treat my shock), but instead of excessive spending, formation of new partially funded programs, raising taxes and piling up debt, I would like to see someone grow a spine and take a hardball approach at significantly cutting spending in general. If this were done to a significant degree and a lot of entitlement fat trimmed from our budget, then I would probably be a little more receptive to a lot more of the opposing ideas in this forum - is that too much to ask or is this considered rightie whining - I think I know what your response will be.

What would be the three top things you would suggest cutting as far as the budget is concerned in order to help me see the light and accept HRC among other things a little easier? Off the top of my head I would cut military spending, foreign policy spending and cut my pick of about 1000 superfluous programs out of 200,000 funded by the government.

 

[Geo Patric]

good question. and no, i do not think of your complaints as "rightie whining".

there are three good reasons, that I can think of, for opposing UHC, at least right now, one of which is the cost of the transition. and it IS the transistion that will be the major cost. I will be honest and say that I do not understand WHY it costs so much.

Yes, it is going to cost a bunch of money and the timing is bad, but the timing is best because this president has shown himself willing to go the distance, put his cred on the line. When we had the money, we had a president that didn't have the balls. we can more easily afford the cost of the plan than the cost of waiting for another opportunity, which might never come.

Mellie recently pointed out that this isn't over. I think, i hope she is right. To really make it work obliges taking the inessential profit making out of essential services. For decades, we have been paying commercial lenders to make loans to students. the loans were 100% guaranteed by the Treasury. No Risk Lending. Good rates. We slipped them a key to the back door of Fort Knox.

That is over. The federal government will now manage the loan program, saving a very substantial amount of money (est 50b over 10 years). We do not need the commercial lenders. We can do it ourselves. And that perspective is key, i think. We have to stop seeing the gummint as THEM and begin seeing it as us.

So, cuts in spending have begun, at least. The right wing is screaming 'socialism' now. Ten years from now, they will be fighting the next program on the basis that it will put the student loan progam in danger.

so it goes.

I am not as concerned with cutting spending as your may be, but i can certainly see benefits to identifying valuable but poorly run programs and making them more efficient. It may occur to one that taking every meal in restaraunts is not the most economically efficient way to meet one's caloric needs, but we don't stop eating.

Yes, military spending. End these damned wars. They are accomplishing little but death. Yes, terrorism is a real threat, but destroying entire nations is not the answer.

End the ideological programs. The U.S. Chamber Of Commerce estimates the cost of the embargo against Cuba at more than a billion a year. That is a LOW estimate. Others set it at as high as 5b a year, and that is to us... another 3/4 of a billion or so to Cuba. Radio Marti is wholly and completely useless, it cannot be heard in Cuba. We still spend close to 30 million a year running it.

Farm subsidies always come up in these discussions. Most of the monies go to farmers who grow a single crop or few and increase in dollar amount as the extent of the farming increases. What kind of farming does that sound like to you? Subsidies STILL go to not grow crops. How much sense does that make?

Subsidies should be restricted to independent (not corporate) farmers with broad crop plantings and should go to grow stuff, not to not grow stuff.

yes, there are lots of areas where we can look and find waste. But, monies going to help provide the fundamental needs of people are not wasted, even when they are not the most efficient. Monies that go to make rich folk richer are waste. I have no problem with rich folk. I wish i was one. I have less of a problem with giving to those who do not "deserve" it than I do those giving to those who already have far more than they need.

geo.