Tag: Healthcare

The hard truth about health care

Everyone knows — or should know — that the United States spends much more than any other country on health care. But the Kaiser Family Foundation broke that spending down into two parts: the government’s share and the private sector’s share (both measured as a percentage of total gross domestic product), then compared the results to figures from 12 other countries that are members of the Organisation for Economic Co-operation and Development. And here’s the shocker: Our government spends more on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada or Switzerland.

Think about that for a minute. Canada has a single-payer health-care system. The government is the only insurer of any note. The United Kingdom has a socialized system, in which the government is not only the sole insurer of note but also employs most of the doctors and nurses and runs most of the hospitals. And yet, measured as a share of the economy, our government health-care system is the largest of the bunch.

And it’s worse than that: Atop our giant government health-care sector, we have an even more giant private health-care sector. Altogether, we’re spending about 16 percent of the GDP on health care. No other country even tops 12 percent. Which means we’ve got the worst of both worlds: huge government and high costs.

It’s also important to note that, even with this high spending, we’re getting worse outcomes than all the Western countries spending 5-7x less than we do. And, of course, if we had the costs of any of these countries we’d be facing surpluses today instead of deficits. But we’re told the only road forward for our country is to slash Medicare, Medicaid, and the rest of the social safety net and give the money to the richest 1%. Saying anything else isn’t Serious.

The hard truth about health care

With regard to the idea of whether you have a right to health care, you have realize what that implies. It’s not an abstraction. I’m a physician. That means you have a right to come to my house and conscript me. It means you believe in slavery. It means that you’re going to enslave not only me, but the janitor at my hospital, the person who cleans my office, the assistants who work in my office, the nurses.

Basically, once you imply a belief in a right to someone’s services — do you have a right to plumbing? Do you have a right to water? Do you have right to food? — you’re basically saying you believe in slavery.

I’m a physician in your community and you say you have a right to health care. You have a right to beat down my door with the police, escort me away and force me to take care of you? That’s ultimately what the right to free health care would be.

Rand Paul in remarks to the Senate Health, Education, Education, Labor, and Pensions Subcommittee.
This is what they believe. If you can’t pay me up front, preferably in gold, kindly go die in the streets like the trash you are. That is all.

Oh, and if Rand Paul is found down, be sure to check his wallet before assisting him in any way. Anything else is tantamount to slavery.

Rightward Lurch

And so it begins:

Obama will not blaze a fresh path when he delivers a much-anticipated speech Wednesday afternoon at George Washington University. Instead, he is expected to offer support for the commission’s work and a related effort underway in the Senate to develop a strategy for curbing borrowing. Obama will frame the approach as a responsible alternative to the 2012 plan unveiled last week by House Republicans, according to people briefed by the White House.

Just as we predicted a few days ago, your choices, the entire extent of the debate will be between a center-right proposal (Simpson-Bowles) and a far-right proposal (Ryan plan). Where do you think the Serious Person “sensible middle ground” will be in that fight? Left unsaid will be any discussion of the true driver of deficits: individual healthcare costs. Left unsaid will be: if we had individual health costs of any other Western democracy we’d be facing surpluses and not deficits. Limit rate of growth in healthcare and you fix everything we’re currently fighting over, and without doing it on the backs of the poorest.

It’s now down to just how much of Medicare we will eliminate (er: “privatize”) and what percent of older Americans still get access to it. Then, a couple of years down the road: fewer. In a few more years: gone, because it only serves the poor and they don’t vote. Legislative inertia is literally the only chance that program has for survival.

The old will kindly go die in the streets.

Medicare and the Overton Window

This Pelosi post got me thinking about just what a Democratic response to a Ryan-style plan on Medicare should even be. After all, if you work from Ryan’s far right starting point and counter with “well, let’s just privatize x% of Medicare for this set of individuals” or some other “sensible middle” type compromise, then you’ve already lost. You’ve advanced the GOP’s idea of the program (which is a bad one) significantly and at the expense of the better solution: Medicare as it stands or Medicare plus substantial improvements.

It is a fact that the real driver of deficits in this country are healthcare expenses. Don’t take it from me, here’s the CBO’s report (PDF link):

Medicare and Medicaid are responsible for 80 percent of the growth in spending on the three largest entitlements over the next 25 years and for 90 percent of that growth by 2080.

But if we could achieve the per patient healthcare cost of most of the other developed nations in the world, we’d be facing yawning surpluses in this country, not deficits, and we’d very likely have better individual health outcomes to boot.

Therefore: the Democratic response to Ryan’s “privatize Medicare” should in fact be: Medicare For All. Period. We don’t want to reduce this program. Like 87% of all Americans, we think it should at the bare minimum stay just as it is. Preferably, we’d like to massively expand it. This has the dual benefit of covering medical expenses for everyone in the country and relieving the number one deficit driver in the economy: everyone’s medical expenses. Plus this means we eliminate the dread ACA and its totalitarian horrors. Everyone wins!

Now, of course, I don’t really think Medicare For All has any particular chance of becoming law; what using this sort of proposal does do is set the limits of the debate more appropriately and in ways that tend to favor outcomes preferable to the Democrats.
On the right: Eliminate Medicare and let the wealthy fend for themselves.
On the left: not only keep Medicare, but make it the healthcare provider for all, with tremendous humanitarian benefit but also knock-on budget benefits.
Then you’d be down to arguing about whose plan actually saves more money long term and how that impacts health outcomes in America. Which is precisely where the debate needs to be.

Welcome the Responsibility

E.J. Dionne posits that the coming “Ryancare” enforced destruction of Medicare will either be Obama’s defining moment or the final end of progressive government in America:

Americans are about to learn how much is at stake in our larger budget fight, how radical the new conservatives in Washington are, and the extent to which some politicians would transfer even more resources from the have-nots and have-a-littles to the have-a-lots.

And you wonder: Will President Obama welcome the responsibility of engaging the country in this big argument, or will he shrink from it? Will his political advisers remain robotically obsessed with poll results about the 2012 election, or will they embrace Obama’s historic obligation — and opportunity — to win the most important struggle over the role of government since the New Deal?

And that’s exactly what this is. If you “privatize” Medicare, you are in effect creating a real live death panel for those individuals who cannot afford to pay the difference between the arbitrarily low payments (pegged to the dollar circa 2010) that will be made in the name of “cost containment.” Scare quotes there because such a move is categorically not cost containment; it is payment containment, or total government outlay containment, if you will. Costs will still rise, whether that rise is at the rate of inflation or at some other rate doesn’t really matter: the payments are locked, now and forever, to roughly today’s value. It is therefore only that fraction of individuals that are capable of paying the difference between real cost and subsidized value that will be “contained.” This number of individuals will, of course, be diminished day by day, year after year after year, as the subsidy represents lower and lower actual healthcare buying power. This is how Ryancare “works.” Hope you’ve been rather aggressive and uniformly successful with your by then privatized “Social Security” 401(k). Because you’re going to need it. Cat food doesn’t buy itself, after all. Otherwise, kindly go die in the streets.

In a decade or two, yes, even the very wealthy will begin to feel that pinch and there might be some movement to address the issue. But, by then, assuming all goes to Ryan’s master plan, tax revenue will have ratcheted to such historic lows (the other part of this “plan” is to limit next year’s spending to a fractional percent of the previous year’s, regardless of inflation and actual vs. projected economic output or overall economic conditions) that the federal government will have drowned itself in a teacup and will be laughably incapable and plainly impotent relative to doing anything about it. Problem solved! Think of how free we’ll all feel on that wonderful day!

And but so: do I think Obama will rise to this particular challenge? No I do not. Nothing coming out of the administration leads me to believe he or his advisers have any interest whatever in fighting for the future of Medicare, much less Social Security (which, having its own funding source, is utterly secure for decades to come: so Serious People all know that we must act now to destroy it because otherwise it won’t be there! This makes sense to our Beltway Punditocracy.). The administration and, by and large, The Body Democrat will remain in their defensive crouch, trying not to “screw up” 2012 with a lot of progressive mumbo-jumbo, because, as any Serious Person can tell you, those dozens of Tea Partiers that showed up in DC the other day are the ones that run the country, now and forever, without any regard to election results, polling data, or the stated wishes of the American People at large. Those 100k that showed up in the tundra of Wisconsin? Just out of town Union thugs. No reason to pay attention to them at all. They’ll only win in 2012 if ACORN steals the election for them.

Welcome the Responsibility

Radical as this seems to Americans, the rest of the world has figured this out and gotten it right. We keep getting it wrong, and we’re paying for it.

Vermont Governor Peter Shumlin, talking to Ezra Klein about his plans to make Vermont the first all single payer healthcare state in the Union.
I eagerly await the “why this instance isn’t actually states’ rights” argument from the GOP.
Source: Washington Post

Defazio Bears Attention

TPM reports:

Rep. Peter Defazio (D-OR) proposes that people be allowed to opt out of the insurance mandate altogether – but if they do, they will not be allowed to free-ride on the new health care system.

Under his plan, a person opting out “must file an ‘affidavit of personal responsibility’ with the state exchange. Such a filing will waive their rights to: 1) Enroll in a health insurance exchange; 2) Enroll in Medicaid if otherwise made eligible; and 3) Discharge health care related debt under Chapter 7 bankruptcy law,” DeFazio wrote in a letter to colleagues Tuesday.

Under his plan, if a person wants back into the system, they’d need to buy insurance on their own, out of pocket, for five years. The idea here, and with other, similar plans, is to moot one of the constitutional complaints about the mandate – that it penalizes “inactivity.”

Exactly. No doubt the legions of “go die in the streets” conservatives who are morally wounded by the very concept of the individual mandate are lining up to cosponsor this. Right? Right?

Defazio Bears Attention

Some of my libertarian friends balk at what looks like an individual mandate. But remember, someone has to pay for the health care that must, by law, be provided: Either the individual pays or the taxpayers pay. A free ride on the government is not libertarian.

Mitt Romney (when governor of Massachusetts) saying the sort of thing that makes him unelectable in 2012. Sad but true.
But he gets at the real “fix” for the individual mandate: simply opt out of guaranteed care for some defined period and pay a fine to get back into it with no guarantee against taking yet another hit for any preexisting conditions. In other words: Go die in the streets; we won’t lift a finger. The GOP and their Tea Klan enablers can certainly get behind that, as it’s the basis for their entire worldview. I’m sure they’ll all be rushing to get in on that particular filing deadline…

And this is precisely why the Senate should have no other business until the debt ceiling vote. Alright, who wants to vote against the liver? Anyone against the liver? Next, the kidney. One or a pair? How about one lung, one kidney? Can we agree on that civilly?