Paul Krugman; Medicare needs DEATH PANELS

[Bob Hubbard]

Well Shag, we agree on the problem, now if there were some sort of solution that could be put into play.
Obviously going after the insurers isn't the answer, but try and get the politicians to go along with that.
Actually the hands of the political factions in this country are tied.
They can't dictate price, or policy of the medical field.
In a free capitalistic society, business for the most part runs with few regulations .
Those of us who do not have our heads buried in the sand, realize the problem is far greater than medical insurers.
The entire situation is based on a global economy, and there isn't a process in the world that is going to make health care affordable for anyone.
We see a stay in a hospital costing well over a thousand dollars a day, and ask ourselves why is it so expensive?
Are the hospitals overcharging us?
I DO believe that some (not all) hospitals and doctors defraud the medicare system, and that tends to increase cost, but that alone is not the problem.
I honestly feel we are at the point where we just have to settle for these high medical cost, because there is no fix.
A fix involves all in the medical field to take drastic cuts, and that will never happen.
Lower insurance cost also will never happen, no matter how administrations package it.
The truth is, medical services cost big bucks, and someone has to pay for it.
Group policies are a step that could lower some cost, but the bottom line is, insurers have to make a profit, and if they find group policies do not meet their profit margin, they will cease to offer them.
Government needs to stay out of the medical procurement business, and leave it to the private sector.
Those that can afford coverage will get it, and the rest won't.
That is harsh, but that is reality.
Government can no longer afford to subsidize the populous that can't afford to pay for medical insurance.
The reality is, the country must face it, we are on the verge of becoming insolvent, and can no longer spend money we don't have.
Regardless of what the politicians say, they can't fix this one.
On a moral basis, it is unthinkable that the government would allow people to die because they have no money for medical coverage, but that is where we are , or soon will be.
I for one am glad that I am old.
I am 72, and know my remaining years are but a few (perhaps 20 or so).
Even at my age it is scary to even think of the medical crisis we find ourselves in, but I would hate to be in my twenties or thirties now.
Unless one is born too wealth, one needs desperately to plan for those years ahead.
Your future medical needs will have to be addressed, and careful planing now, will most certainly be to your advantage when a medical crisis arises.
Bob.

 

[foxpaws]

Those that can afford coverage will get it, and the rest won't.
That is harsh, but that is reality.
<snip>
On a moral basis, it is unthinkable that the government would allow people to die because they have no money for medical coverage, but that is where we are , or soon will be.

So, Bob, you will be willing to die outside the hospital doors? Unless you are an incredibly wealthy man, one good stint in the hospital will bankrupt you, and if the chips fall as you see them, you won't have health insurance (you won't have medicare, and no private insurer will insurer you).

More importantly - are you willing to watch your children or your wife die outside the hospital doors?

 

[shagdrum]

So, Bob, you will be willing to die outside the hospital doors? Unless you are an incredibly wealthy man, one good stint in the hospital will bankrupt you, and if the chips fall as you see them, you won't have health insurance (you won't have medicare, and no private insurer will insurer you). the portion in parenthesis is a lie that has already been highlighted in this very thread (post #5). Bob is 72 and Ryan's Medicare overhaul "leaves the basic Medicare benefit guarantee in place for current retirees and people 55 and older"

More importantly - are you willing to watch your children or your wife die outside the hospital doors?

It seems pretty clear that the Left is not interested in the the truth or in fixing things for future generations when it comes to healthcare. They are only interested in mythmaking, psychological manipulation through fearmongering and demagoguery in order to defend the indefensible.

The recent MediScare tactics creating myths about how the healthcare market and the health insurance industry work as well as the lies about the effects of policy changes (derived from those myths) are all prime examples of this. If these were more then mere myths they could be logically defended against counterpoints when they are raised.

As this thread demonstrates that those "evil private insurer" myths cannot be defended and no actual argument can be made for them. Otherwise the counterpoints to the myths brought up in this thread would have been honestly and logically confronted instead of simply downplayed, dodged and ignored.

Of course, treating their loaded statements/questions as honest attempts at discourse only legitimizes those myths as premises to any discussion, facilitating their manipulation. You cannot accept the premises and disagree with the conclusions.

"If you tell a lie big enough and keep repeating it, people will eventually come to believe it. The lie can be maintained only for such time as the State can shield the people from the political, economic and/or military consequences of the lie."
-- Joseph Goebbels​

 

[Bob Hubbard]

So, Bob, you will be willing to die outside the hospital doors? Unless you are an incredibly wealthy man, one good stint in the hospital will bankrupt you, and if the chips fall as you see them, you won't have health insurance (you won't have medicare, and no private insurer will insurer you).

More importantly - are you willing to watch your children or your wife die outside the hospital doors?

Obviously no one wants to be left to die because they lack medical coverage, but looking at it realistically, what other alternative is there?
If one doesn't have sufficient funds to cover medical cost, obviously they aren't going to get the medical treatment or the drugs needed to prolong life.
This is the sad truth that many people are going to have to confront in the not to distant future.
This isn't meant to scare anyone, but rather to "wake" those to what may be ahead.
As with any budget,be it household, or government, one must not pay out more than they take in.
That is a menu for disaster.
The government has but one choice if they ever intend to get some sort of medical coverage for it's citizens, and that is, cut spending in other areas, or find ways to bring in more money into the system.
Those are the only choices, and once again, the sad truth of that is , the politicians can't decide on how to proceed.
Meanwhile, the populous is in limbo waiting for the government to do something.
So what gets cut, defense spending, education, government grants etc.etc?
Cuts in government spending are not going to solve the problem in and of itself.
The bigger problem is getting the industry responsible for goods and services in the medical field to make drastic cutbacks.
I don't ever see that happening, and without that little piece of the puzzle, there will be no fixing healthcare in this country.
Sad, but true.
Boy, I am glad I am old.
Bob.

 

[shagdrum]

Well Shag, we agree on the problem, now if there were some sort of solution that could be put into play.
Obviously going after the insurers isn't the answer, but try and get the politicians to go along with that.
Actually the hands of the political factions in this country are tied.
They can't dictate price, or policy of the medical field.

But with medicare and medicaid, the government IS dictating price in the medical field and has been doing so for decades. Specifically, they set reimbursement rates for procedures paid out under the two programs that don't cover the actual cost of the procedure. This necessitates that the medical provider make up the costs on the backs of those privately insured. The fact that government is the largest purchaser of medical services (and is only growing in that regard) doesn't help things.

This dynamic is the biggest reason for the rise in medical costs.

Bob, we agree in general terms on the problem but I think you are missing the bigger picture.

In EVERY market that lacks regulation the historical trend is for prices to drop and for services to become more widely available as they do.

We even see this in isolated examples in the healthcare industry. MIR's, Lasik eye correction surgery, etc. have dropped in prices and become more widely available.

You point to the high costs of all the various inputs for healthcare, but those all generally tie into the same problem; market distortions leading to higher costs.

Those market distortions effect the cost of medical care because they raise the cost of all those inputs.

• Licensing fees, excessive litigation, etc. raise the cost of labor for the services of doctors
• Excessive litigation also necessitates unnecessary diagnostic procedures to cover the doctor's butt, legally
• Excessive FDA regulations and absurdly draconian testing standards and practices raise the cost of drugs in this country
• Collusion between larger insurers and state governments create barriers to entry in the market for would-be competitors
• Arbitrary low medicare/medicaid reimbursement rates (and delayed reimbursements) dump the costs of procedures for medicare patients onto the backs of non-medicare patients, raising overall costs to insurers, necessitating higher premiums for consumers (again, the biggest factor in rising healthcare costs)
• Employer provided insurance hides the true costs of medical care from the consumer, thus inhibiting the price system, mal-distributing resources and raising costs.

Should we not attempt to fix these problems?

The government has but one choice if they ever intend to get some sort of medical coverage for it's citizens, and that is, cut spending in other areas, or find ways to bring in more money into the system.
Those are the only choices, and once again, the sad truth of that is , the politicians can't decide on how to proceed.

Is that a sustainable business model or are we simply kicking the can down the road?

One fundamental truth of economics is that when you subsidize an activity, you get more of it. As you increase subsidies you get more of the activity with the subsidies being forever increased in a reactionary attempt to chase the increase of activity. This is why the initial estimates of the cost of Medicare in 1990 were off by 800%!

Is medicare in it's current form sustainable? If we simply raise spending, is that going to provide a permanent fix or will we simply be revisiting this issue in a few years and need to cut some other program?

As to raising revenue, how do you propose we do it? There is no direct correlation between raising tax rates and raising tax revenue. All else being equal, a tax rate increase is just as likely to decrease tax revenue as it is to increase it. At best, it is a crap shoot.

Considering the economic conditions we are in and the fact that tax rate increases tend to work against economic growth, it is more likely that a tax rate increase would lead to tax revenue decreases.

Why is raising spending and/or raising revenue the only options? Why not try and mitigate those factors that increase healthcare costs and empower the free market forces that reduce healthcare costs?

Why does medicare have to be treated as a simple accounting calculation when the reality is that is a much more complex economic issue?

The bigger problem is getting the industry responsible for goods and services in the medical field to make drastic cutbacks.

Wouldn't allowing them to cut out the increased costs they incur due to government interference create those "drastic cutbacks"? The healthcare industry is the most heavily regulated industry in this country.

Why does every market uninhibited by excessive regulation see dropping prices and expanding services, historically? You seem to ignore that fact.

Wouldn't increased competition provide incentives for healthcare businesses to lower costs and offer better value or see their business go elsewhere? That is what is happening in the Lasik market.

 

[Bob Hubbard]

I guess one major question would be, why does government regulate business?
Answer, to keep it honest, and in the case of the medical field, to stop fraud.
Doing away with any facet of regulation over the medical field would be an open door to misuse.
Hypothetically, let's say you head up a company that manufactures brain scan equipment.
You have a work force of 125 people.
Each of these employees makes an average of $75,000.00 a year.
These employees, like employees all over the country have mortgages, car payments, household expenses etc.etc.
Now here comes rep Paul Ryan and he wants you to charge less for what you are charging hospitals for your machines.
What are you going to tell him?
"Sorry Paul, I just can't do that and stay in business"
Now multiply that by all the service providers across the country.
So Paul tells you, "drop your prices or another start up company may well take your business from you"
Now, if you are going to stay in business, you have to tell your 125 employees that they will be getting a cut in wages
They in turn have to tell their creditors to wait a little longer for payment, which most, because they too have a bottom line, will be hesitant to honor the request.
Do you see where I am going with this?
Any cutbacks in the medical services field, be it through attrition, or competition, is not going to happen.
Again, it boils down to budget.
If enough money is not there to cover expenses, the budget will fail, and we are on the verge of that presently.
The cutbacks in the medical industry aren't going to happen, so it appears the government is the one that will be forced to do the cutting back on expenses.
I have no idea what is in the Ryan plan, except it effects those 55 years or younger.
Obviously any plan calls for cuts in medicaid and medicare.
That is a positive step toward less government spending, but that in itself won't solve the problem.
Again, if the government intends on providing some sort of medical services to it's citizens, they have to draw the line as to how much they are going to spend.
Set a figure, and stick too it.
Shag, you mentioned earlier in this thread, competition in the field would ultimately lower prices.
History bears this out but, times are a lot different now, then back when competition did indeed lower prices.
The medical field is in the position where the auto workers were about 15 years ago.
Wages skyrocketed in the automotive industry, and that is what killed it in this country.
Foreign makers took the lead by offering a better product at lower prices because their wages were much lower.
Unlike the auto industry, the medical field is wide open to fraud and misuse.
Government regulations must be in place to limit the amount of fraud.
Many of these regulation are in place to protect both parties.
It is doubtful the government will curtail oversight of the medical industry.
They will continue to be regulated, and they will also continue to charge what they do for their services.
It all falls back on the government to come up with a viable solution, and to date they have failed miserably.
Bob.

 

[shagdrum]

I guess one major question would be, why does government regulate business?
Answer, to keep it honest, and in the case of the medical field, to stop fraud.

Yes, but, generally speaking, the government need not go much beyond the enforcement of contracts to avoid most cases of fraud in a free market. When going down the path of government regulation, you very quickly get to a point of diminishing returns for two reasons; A)because of the distortions of the economy, and B)because the regulations/regulatory organizations start magnifying the problems they are supposed to "fix".

Government regulations distort the market and increase costs. Since the market is always looking to reach an equilibrium between supply and demand, these regulations work against nature itself. More regulations increase this problem. Overzealous regulations (such as the Fed dictating the interest rate, and the government creating "too-big-to-fail" institutes like Fannie and Freddie that create moral hazard in the economy) create MASSIVE economic distortions leading to the boom/bust cycle and prolonged, deep recessions and depression (especially when government tries to "steer" the economy out of recession).

Government regulation of business, especially in how it is viewed and applied today, is built upon flawed assumptions. Mainly in blind faith in the purity of government overseers. The flaws in Big Business do not stem from the institutions of big business but from the people making up the institutions; from the very flaws in human nature itself.

It is absurd and logically inconsistent to assume that human nature in the private sector is evil but human nature in the public sector is altruistic. However, that is the assumption behind calls for more regulation.

You get to that point of diminishing returns very quickly with regulation also because the regulations/regulatory organizations start magnifying the problems they are supposed to "fix". This is due to those very flaws in human nature.

The bureaucrats, regulators and politicians are just as prone to corruption as anyone in the private sector. The problem is, they also have the power to write and enforce the laws and, in the case of politicians the verbal skills to cover it up enough for a friendly media to whitewash. This is how you get collusion between government and business.

How do you think GE avoided paying any taxes this year? Why do you think state governments generally stifle health insurance competition (example, California only has 6 health insurance providers)? How do you think Amtrak is still around? I could spend all night citing examples but I think the point has been made.

Unaccountable bureaucracies bring out the worst in human nature and the law writing/enforcement abilities of the bureaucracies that are removed from the political process enable those human failings. Government is able to start picking winners and losers and when losers are bailed out there is no end to the cost to society.

In that corporatist system the worst in both business and in government rise to the top and work to protect one another and serve their own agendas on the backs of everyone else. Corruption and unethical behavior are rewarded and encouraged.

Capitalism and corporatism are far different things. Capitalism, while not perfect, works far better and more efficiently then most imagine. Unfortunately, for longer then both your lifetime and mine combined, we have had an economy closer to corporatism then to capitalism.

It is very simple, more regulation means more collusion between big businesses and government against the middle class and the taxpayer. That is a recipe for disaster. Regulation, in so many ways, is much more destructive to a society then it is productive to it.

 

[shagdrum]

Shag, you mentioned earlier in this thread, competition in the field would ultimately lower prices.
History bears this out but, times are a lot different now, then back when competition did indeed lower prices.

In some sense times are always different. But economies do not function any differently. They comport to the same basic rules they always have. They respond the same way to incentive structures as they always have.

For that to change, either we have to move beyond scarce resources or humans would generally have to stop attempting to realize their own self interest.

The medical field is in the position where the auto workers were about 15 years ago.
Wages skyrocketed in the automotive industry, and that is what killed it in this country.

Why did automotive wages skyrocket in this country? Are those same factors present in the healthcare industry?

While I am no expert in the automotive industry, I do know that sort sighted concessions to absurd union demands, increased CAFE standards, the oil crisis in the 1970's (as well as further problems in the oil market) and increased competition from foreign car manufacturers played a large part in the increase in prices and decrease in quality that killed the American car company.

Is there anything analogous to those factors in the healthcare industry?

 

[shagdrum]

Sounds real similar to some of the lies spread in this thread. Hmm...

DNC Chair Throws Truth to ‘Wolves’

May 31, 2011

Rep. Debbie Wasserman Schultz falsely claimed that seniors with preexisting medical conditions would be denied Medicare coverage under the GOP's plan. The House GOP plan specifically says insurance companies “must agree to offer insurance to all Medicare beneficiaries.”

She also repeated a false Democratic talking point that future beneficiaries — those who are now younger than 55 — would be left on their own to buy insurance in the private market. The GOP plan, as we have written before, would provide subsidies for future beneficiaries to buy private insurance from a Medicare exchange set up by the government.


* * *

The Republican plan — dubbed "Path to Prosperity" by its chief architect, House Budget Committee Chairman Paul Ryan of Wisconsin — would make no changes in Medicare for those 55 and older. But it would make significant changes to Medicare for those younger than 55 — just not as described by the Florida Democrat. The plan would provide future beneficiaries with government subsidies to purchase health insurance through a Medicare exchange set up by the government.

Path to Prosperity: Health plans that choose to participate in the Medicare exchange must agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking and ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage.​

DNC spokesman Hari Sevugan said "we stand by the statement" that the GOP plan would deny coverage to future beneficiaries with preexisting conditions. Sevugan provided excerpts of testimony given April 5 by Michael F. Cannon, director of health policy studies at the libertarian CATO Institute, at a hearing of a House oversight subcommittee. But in that testimony, Cannon said that "all seniors under the chairman's proposal, as I understand it, will be able to obtain health insurance coverage." And those with preexisting conditions "will get larger vouchers" because payments will be "risk-adjusted so that people with severe illnesses will get larger vouchers."

Sevugan made the point that the government subsidies — or "vouchers," as Cannon calls them — won't keep up with insurance premiums and, as a result, seniors would be forced to go without coverage. But that's not what the DNC chairwoman said. She said the GOP plan would allow private insurers to "drop you for preexisting conditions," and that's just not true.

Wasserman Schultz also misrepresents Ryan’s plan when she says it tells future beneficiaries: "You’re on your own. Go and find private health insurance." This mischaracterization of Ryan's plan has become a Democratic talking point — one we wrote about when President Barack Obama made a similar inaccurate claim. As we described earlier, Ryan’s plan would provide federal subsidies to private insurance from a government-created Medicare exchange.

It's fair game to debate whether the subsidies are adequate to cover insurance costs. But it's wrong to say that the GOP plan would "throw you to the wolves and allow insurance companies to deny you coverage."​

 

[foxpaws]

Path to Prosperity: Health plans that choose to participate in the Medicare exchange must agree to offer insurance to all Medicare beneficiaries, to avoid cherry-picking and ensure that Medicare’s sickest and highest-cost beneficiaries receive coverage.​

Well, shag - there in lies the rub - Plans that 'choose'....

How many plans do you think will choose to be part of this exchange pool? None if they can't cherry pick. The vouchers, even the 'larger vouchers' won't even come close to covering the insurance needs of those seniors with pre-existing conditions, i.e., most seniors, so they will be uninsurable. I have heard that vouchers for seniors with pre-existing conditions would need to be well over $20,000 to be realistic.

Yes, the insurance companies won't outright deny seniors coverage - they just won't participate in the plan. Same difference...

Oh, as far as that capitalist utopia of an unregulated, unlitigated healthcare industry - I give you one major illness - and you would be either dead, or disabled for the remainder of your rather short life...

You first shag...

 

[shagdrum]

How many plans do you think will choose to be part of this exchange pool? None if they can't cherry pick. The vouchers, even the 'larger vouchers' won't even come close to covering the insurance needs of those seniors with pre-existing conditions, i.e., most seniors, so they will be uninsurable.

Here is some more of that leftist mythmaking.

Insurers will only seek to make a profit if it is on their terms? Sorry, the economy doesn't work like that.

Also the idea that the vouchers "won't even come close to covering the insurance needs of those seniors with pre-existing conditions" is rooted in mere assertion and speculation. There is NO logical proof given to suggest that such a thing would occur...unless one ignores economic reality.

 

[Bob Hubbard]

Presently medicare and medicade are funded till 2030 I think.
Where is the government going to get the money for these vouchers?
If they know how to raise the money for these vouchers, then why are they not going to use that same money to continue medicare and medicade in it's present form?
They keep saying medicare can not continue on it's present path without major overhaul.
That's fine, so where is the future money to fund it coming from?
Bob.

 

[shagdrum]

Presently medicare and medicaid are funded till 2030 I think.
Where is the government going to get the money for these vouchers?

Paying for these vouchers is not in addition to current medicare spending.

 

[cammerfe]

The FIRST function of any bureaucracy is to perpetuate itself. The second function is to expand itself. ANY benefit to anyone outside is so far in the distance as to be infinitesimal. And that benefit will be by accident.

KS

 

[shagdrum]

The FIRST function of any bureaucracy is to perpetuate itself. The second function is to expand itself. ANY benefit to anyone outside is so far in the distance as to be infinitesimal. And that benefit will be by accident.

Mission creep is the expansion of a project or mission beyond its original goals, often after initial successes. The term often implies a certain disapproval of newly adopted goals by the user of the term. Mission creep is usually considered undesirable due to the dangerous path of each success breeding more ambitious attempts, only stopping when a final, often catastrophic, failure occurs.​

This is a large part of why bureaucracies/various Federal organizations need to be defunded, they have grow well beyond their original intent.

Another part of the Medicare lie is found in Section 1801 of the 1965 Medicare Act that reads: "Nothing in this title shall be construed to authorize any federal officer or employee to exercise any supervision or control over the practice of medicine, or the manner in which medical services are provided, or over the selection, tenure, or compensation of any officer, or employee, or any institution, agency or person providing health care services." Ask your doctor or hospital whether this is true​