Yet Another Healthcare Debate...Sorry

[Maia_s_Well]

I’m starting this thread as a spin-off from my pit thread: Insurance company poopyheads - The BBQ Pit - Straight Dope Message Board because some interesting points are being raised in that thread.

There is a lot that makes sense to me about having our government involved in/providing some kind of healthcare. This comes in part from my own experience, which I’ve detailed in the other thread, but I will recap here. In short, I have been disabled and covered by Medicare for 12 years. During that time, I had NO problems getting my medical bills paid, and was able to manage paying the balances of medical bills that Medicare covered. Last year, my husband got a job with insurance, and added me. This insurance company (we’re calling it “Untied”) has rejected most of the claims presented to them because of a recurring “oversight” or “computer error” or something that makes them believe Medicare is my primary insurance (it’s not). I have experienced a year’s worth of escalating medical bills, calls from providers, and extremely frustrating circular phone conversations with Untied reps, in which I am given either little information or conflicting information. I’ve been given some great suggestions in that thread to try to resolve my current situation, but I would like to take a look at the bigger picture here in Great Debates.

Here, then, are some of the impressions I’ve gotten. Please help me fight my ignorance by sharing facts and experiences that either support these impressions or correct me where I am wrong. If I may, I would like to ask if we try to stick to pragmatism and reality rather than big scary words and ethereal, moral absolutes. Not that there are not moral implications in the debate; I just can’t learn anything from too much yelling about how the other side is made up of morons.

Anyway, here’s my impressions. Have at them.

My experience has been that Medicare is run efficiently. Before I got private coverage, I paid less in co-pays, and I never had to call Medicare and fuss at them because my providers were calling and fussing at me. This experience makes me question the idea that government shouldn’t be involved in healthcare because government doesn’t manage anything well, which seems to be a common argument against government healthcare.

It seems to me that a lot of businesses find way to save or make money that are unethical. For example, after struggling to get my bills paid by my private insurance for over a year, my husband’s comment that the company is trying to get me to cancel my coverage with them because I’m expensive seems possible. If private insurance companies could find legal ways to get rid of the really expensive folks like me, what is to stop them from doing that? I think it’s human nature for some people to feel justified in getting what they can, whether through insurance shenanigans, deceptive mortgage practices marketed to less educated people, etc. So, how do we fix that? Or, do we fix that? Do we try more oversight and regulation, more laws, etc.? Or do we say, let’s let the government provide healthcare, since a government agency would not be trying to make a profit, and therefore would not be motivated to use deceptive practices?

And along the same lines, it seems to me that government healthcare would be cheaper, since there is no need to build in a profit.

It seems to me that we already pay for people who don’t have insurance. If someone is having a heart attack and they go to the ER, they can’t be turned away because they have no insurance and no money, right? So, the rest of us end up paying for that person’s care one way or another anyway, right? So, if we go ahead and make sure that person is covered by some kind of insurance, maybe we can pay for some doctor visits before the guy has a heart attack, and maybe we’ll end up spending less. Plus, maybe with preventative care, he won’t die early or become disabled (when we will have to pay for him then).

I know that freedom is important, and part of American freedom is the freedom to do stupid things. The idea of being forced, through paying taxes, to support the medical well-being of other people in our country, even if it makes better economic sense, is still losing a little bit of freedom. And while I know that some people believe we are entitled to healthcare, I’m not there yet. Words cannot express the gratitude that I feel for the healthcare I’ve been given. Even when I’m frustrated with my private insurance company, I never really forget how damn lucky I am to have the help I have. (I also feel this sense of gratitude every time we park in a handicapped space or I drive my chair up a ramp. I’m extrodinarily blessed to be disabled in this country, where I get so much help for free.)

And finally (not because I don’t have more impressions I want corrected but because I da tired and it’s da naptime), I wasn’t always disabled. There was a time in my younger days when I worked jobs with no insurance, because, hey, I was young and healthy. I mention this because asking for healthcare costs to be spread out more among all of us is asking some of these young, healthy folks to pay a little bit for insurance that they mebbe don’t need right now. And, in a perfect world, wouldn’t it be best if that was a choice they were asked to make rather than a law? I am getting more healthcare than I ever paid in premiums. At this point, I’m pretty sure more has been spent on my medical issues than I even earned my entire working life, and while I’m grateful for it, it’s really not “fair”. So I understand that there are people who don’t want to pay for me.

Looking forward to feedback. And, hey! Don’t be gentle with me just ‘cause I’m a crip. I have just as much right to be mocked as anyone else on this board!

[Chief_Pedant]

@Maia_s_Well

There is a lot that makes sense to me about having our government involved in/providing some kind of healthcare.

My experience has been that Medicare is run efficiently. Before I got private coverage, I paid less in co-pays, and I never had to call Medicare and fuss at them because my providers were calling and fussing at me. This experience makes me question the idea that government shouldn’t be involved in healthcare because government doesn’t manage anything well, which seems to be a common argument against government healthcare.

I’m not sure government has much of a chance to reduce healthcare costs in the current environment simply by becoming an alternate payor (or even the only payor).

Read this interesting article on “The Cost Conundrum” by Dr Atul Gawande which appeared in The New Yorker.

The Cost Conundrum

A snip from the article:

“In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”

Supposedly it’s making the White House rounds at the President’s request.

The article basically takes the position that, regardless of payor, when a system pays by procedure, and people want healthcare, and doctors not only are compensated for doing stuff but allowed to build businesses around medicine, all incentives are for healthcare costs to get out of control.

There are a lot of good points in the article, and in general it’s pretty hard on the medical profession. But neither does it take the position that simply making the Feds the single payor is going to solve much.

[Mama_Zappa]

@Chief_Pedant

…

“In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”…

I haven’t read the referenced article yet (though I will later), but I wonder about whether this isn’t a skewed figure.

Medicare consists entirely of people over 65, or with long-term health issues, right? Either of whom would be expected to have considerably higher medical expenses in general, than the average. I know for example that my insurance hasn’t paid anything like that money for me, based on the EOBs we get (and I’m including estimated drug costs as well). Does the article contrast Medicare reimbursements with the population in general?

The Pit thread that spawned this one details an insured person’s enormous struggles to get a private insurer to cover costs they’re contractually obligated to pay - but appear to be making every effort to avoid paying. Other anecdotes in that thread (and I know “anecdote != data”) tell about insurance companies having unwritten policies to deny everything at first.

My own contributions to that thread tell of labyrinthine reimbursements (which bear approximately ZERO resemblance to the amounts actually billed), consistent failures to reimburse, etc. I know of people who are “too rich” for assistance (Medicaid or whatever) but not rich enough to have jobs with insurance. I have one friend who has significant medical issues and receives Medicaid. She’d like to get a well-paying job, but the minute she goes above a certain income level she loses the Medicaid. As her medical expenses probably exceed that income, she can’t afford to work more, earn more, and contribute to the economy.

The US (I have read; will look up cites later) spends more per capita on health care than any other country - and people are going without care. Something’s broke(n). Very, very broke(n).

[Ruminator]

@Maia_s_Well

My experience has been that Medicare is run efficiently. Before I got private coverage, I paid less in co-pays, and I never had to call Medicare and fuss at them because my providers were calling and fussing at me. This experience makes me question the idea that government shouldn’t be involved in healthcare because government doesn’t manage anything well, which seems to be a common argument against government healthcare.

The problem with your analysis is that you’re only noticing one aspect of “government management.” You’ve only focused on the “customer service” portion. With that limited benchmark, you easily give the govt a grade A+ on the report card.

However, we have to look at Medicare in totality and not just the customer service you praised. Total analysis includes how the govt handles the funds (tax revenue) for Medicare and how it manages costs. If you add these factors in, Medicare is going bankrupt – the USA has doesn’t have the money to fund it without borrowing even more money.

People incorrectly analyze Social Security the same way. You can’t say SS is a “success” because “it’s kept people from poverty” — that objective is not the whole picture. The WHOLE PICTURE also includes how the govt manages the SS revenue the citizens have entrusted the govt to handle. So far, the govt has “redirected” SS revenue to pay for regular budget items that have nothing to do with SS! The govt has issued IOUs to SS. Therefore, the govt gets an F - a failing grade for not being a wise guardian with your taxes.

Think about it. That’s like saying Joe Blow is managing his household “competently” because you notice he’s been paying his water bill on time. But take a closer look at HOW he’s been paying his water bill: he’s been paying the utility bills with his credit-card and he’s about max out his credit limit. Then what? Since his situation wasn’t sustainable, eventually the water service gets disconnected.

You have to train your mind to look at the WHOLE financial picture.

[gonzomax]

As always, Insurance companies are in the business of denying coverage. A poster last week said she fought her company for weeks over a dispute. They finally agreed to cover it. Then they said most people wont fight that hard. That of course means they are not paying for things that are covered.
Medicare actually has an interest in prevention . The clinic I go to, offers help with dieting, nutrition, weight loss and will council about exercise programs. Your insurance company just wants you gone. They will fight and deny everything they can. If you are old or sick, they want you off their rolls. Even if you paid premiums for 40 years, the tables say you may become expensive.
I got a letter last month from medicare telling me what new preventative tests I qualify for. When did your insurance company send you a letter like that? Every letter is about raising premiums and cutting coverage. What a great system.

[Maia_s_Well]

@Mama_Zappa

I haven’t read the referenced article yet (though I will later), but I wonder about whether this isn’t a skewed figure.

Medicare consists entirely of people over 65, or with long-term health issues, right? Either of whom would be expected to have considerably higher medical expenses in general, than the average.

Does the article contrast Medicare reimbursements with the population in general?

The US (I have read; will look up cites later) spends more per capita on health care than any other country - and people are going without care. Something’s broke(n). Very, very broke(n).

I have to echo Mama Zappa in questioning that quote. What conclusion do we draw from comparing what Medicare pays average per person covered to what private insurance pays, when that’s sort of like comparing…well, not apples to oranges, but apples to all the fruit including apples? Of course payout per person is higher for Medicare, but that’s not because the government is inefficient (mebbe it is inefficent, but that’s not the explanation). It’s because Medicare is only available to, you know, old and sick people. (Sorry, I know 60 is the new 20 or whatever, and y’all aren’t old, and…well, you know.) Perhaps I’m misunderstanding the point you’re making with that quote, Cheif?

@Chief_Pedant

---

There are a lot of good points in the article, and in general it’s pretty hard on the medical profession. But neither does it take the position that simply making the Feds the single payor is going to solve much.

I maked da bold.

Having the Feds be the single payor would, even if possible (and I just don’t think us Americans are ready for that), certainly would create all kinds of new problems. What I’m getting from you is that, while government wouldn’t be motivated to find unethical ways to screw with folks to make more money, government also would not have a built-in motivation to save money, right? I mean, a business is (theoretically) motivated to discover the best business practices for saving and making money, so taking away the profit motive also mebbe takes away the motive to cut costs? Is that what you’re saying? Because that sounds like a valid concern to me.

I just heard a quote on TV from President Obama about a public option that will, in part, provide competition for private insurance. That also makes some sense to me, but it seems like it would be hard for private insurance to compete with a public option. In my experience, there has been no comparison between having Medicare and private insurance. Private insurance has been way more complicated, more expensive (both the premiums and co-pays, not to mention the bills I’ve simply paid myself rather than have to hassle the private insurance to pay), and the service more incompetent (at best). So I guess what I’m saying is that while a public option seems like a reasonable compromise (hey, you da rich and can buy better coverage with less wait times, good on you), it seems like more and more people would go to the public option until most of the private business go out of business. And then we end up with single payor or nearly that, anyway. Isn’t that part of what private insurance companies are afraid of? If they have to compete with a public option, they might not be able to continue the unethical practices that some of these companies engage in some of the time.

Thanks for the article; this is the kind of information that I’m looking for.

Mama Zappa, I think (as you suggested in the other thread), educating myself and then others and seeing how I can work towards change might indeed be something I can do!
You are right…something’s broke. I believe in us Americans, and I believe we can make things work better than this.

[athelas]

@Maia_s_Well

I mean, a business is (theoretically) motivated to discover the best business practices for saving and making money, so taking away the profit motive also mebbe takes away the motive to cut costs? Is that what you’re saying? Because that sounds like a valid concern to me.

I just heard a quote on TV from President Obama about a public option that will, in part, provide competition for private insurance. That also makes some sense to me, but it seems like it would be hard for private insurance to compete with a public option. In my experience, there has been no comparison between having Medicare and private insurance.

Thisarticle has a good overview of argument for and against the “public option.” The main question is, is this public option going to be heavily subsidized, as Medicare is, or will it simply function as another company?

If [the latter], the public plan would have to stand on its own financially, as private plans do, covering all expenses with premiums from those who signed up for it.

But if such a plan were desirable and feasible, nothing would stop someone from setting it up right now. In essence, a public plan without taxpayer support would be yet another nonprofit company offering health insurance. The fundamental viability of the enterprise does not depend on whether the employees are called “nonprofit administrators” or “civil servants.”

In practice, however, if a public option is available, it will probably enjoy taxpayer subsidies. Indeed, even if the initial legislation rejected them, such subsidies would be hard to avoid in the long run. Fannie Mae and Freddie Mac, the mortgage giants created by federal law, were once private companies. Yet many investors believed — correctly, as it turned out — that the federal government would stand behind Fannie’s and Freddie’s debts, and this perception gave these companies access to cheap credit. Similarly, a public health insurance plan would enjoy the presumption of a government backstop.

Such explicit or implicit subsidies would prevent a public plan from providing honest competition for private suppliers of health insurance. Instead, the public plan would likely undercut private firms and get an undue share of the market.

If the public plan gets subsidized, the subsidies will expand until it makes all private plans noncompetitive - in this sense a subsidized public plan is simply a backdoor to single-payer healthcare.

If the plan is not subsidized, then the question still remains: what will this “public company” be instructed to optimize - revenues, or the happiness of politically powerful groups? Given the structure of politics, politicians will have incentives to give more care than is optimal, at the expense of the taxpayers. This is a classic example of the “concentrate the benefits, spread the cost” tactic. And exactly who in our government will mimic the behavior of shareholders?

[athelas]

By the way, if you’re wondering what the alternative to fully nationalized healthcare is, hereit is, courtesy of Milton Friedman. It’s fairly long, but presents a point of view all too absent from today’s debates. Just one excerpt:

Two simple observations are key to explaining both the high level of spending on medical care and the dissatisfaction with that spending. The first is that most payments to physicians or hospitals or other caregivers for medical care are made not by the patient but by a third party—an insurance company or employer or governmental body. The second is that nobody spends somebody else’s money as wisely or as frugally as he spends his own…

Third-party payment has required the bureaucratization of medical care and, in the process, has changed the character of the relation between physicians (or other caregivers) and patients. A medical transaction is not simply between a caregiver and a patient; it has to be approved as “covered” by a bureaucrat and the appropriate payment authorized. The patient—the recipient of the medical care—has little or no incentive to be concerned about the cost since it’s somebody else’s money. The caregiver has become, in effect, an employee of the insurance company or, in the case of Medicare and Medicaid, of the government. The patient is no longer the one, and the only one, the caregiver has to serve. An inescapable result is that the interest of the patient is often in direct conflict with the interest of the caregiver’s ultimate employer. That has been manifest in public dissatisfaction with the increasingly impersonal character of medical care.

[sleeping]

@Ruminator

However, we have to look at Medicare in totality and not just the customer service you praised. Total analysis includes how the govt handles the funds (tax revenue) for Medicare and how it manages costs. If you add these factors in, Medicare is going bankrupt – the USA has doesn’t have the money to fund it without borrowing even more money.

Even if Medicare is going bankrupt, it doesn’t mean that it can’t be fixed with a modest tax increase on the wealthy. And, Medicare spends less per capita than private insurers:

In international perspective, the United States spends nearly six times as much per capita on health care administration as the average for Organization for Economic Cooperation and Development (OECD) nations. Nearly all of this discrepancy is due to the sales, marketing, and underwriting activities of our highly fragmented framework of private insurance, with its diverse billing and review practices.19 Indeed, according to research by the Commonwealth Fund, the United States could save up to $46 billion a year if it spent what other countries with mixed public-private insurance systems, such as Germany, spend on insurers’ administrative costs.20

People incorrectly analyze Social Security the same way. You can’t say SS is a “success” because “it’s kept people from poverty” — that objective is not the whole picture. The WHOLE PICTURE also includes how the govt manages the SS revenue the citizens have entrusted the govt to handle. So far, the govt has “redirected” SS revenue to pay for regular budget items that have nothing to do with SS! The govt has issued IOUs to SS. Therefore, the govt gets an F - a failing grade for not being a wise guardian with your taxes.

True. But that’s why we should fight for proper management of our money and control of our government–so that our money is directed toward the programs that produce societal benefits, instead of being dumped into a trough for banks and the arms industry.

[Maia_s_Well]

@Ruminator

The problem with your analysis is that you’re only noticing one aspect of “government management.” You’ve only focused on the “customer service” portion. With that limited benchmark, you easily give the govt a grade A+ on the report card.

I have not already made an analysis; I am here asking for more information so that I can begin a process of analysis. I am not only noticing only the one aspect, because I’m not foolish or closed-minded enough to base my entire political opinion solely on my own experience. I am not giving the entirity of Medicare or the Federal government any kind of grade on any report card, because I know I don’t have enough information yet. As I’ve said before, I’m here to fight my own ignorance.

@Ruminator

However, we have to look at Medicare in totality and not just the customer service you praised. Total analysis includes how the govt handles the funds (tax revenue) for Medicare and how it manages costs. If you add these factors in, Medicare is going bankrupt – the USA has doesn’t have the money to fund it without borrowing even more money.

It’s interesting you read what I said about my experience as “praising” Medicare. Yes, I’ve had good experiences with them and no real problems. I consider “praise” to have emotional connotations that I don’t feel and I’m not really interested in, so I don’t know what that means. It just doesn’t sound like what I did to me.
Do you have a cite about Medicare going bankrupt? I would appreciate being steered to some hard numbers.

@Ruminator

People incorrectly analyze Social Security the same way. You can’t say SS is a “success” because “it’s kept people from poverty” — that objective is not the whole picture. The WHOLE PICTURE also includes how the govt manages the SS revenue the citizens have entrusted the govt to handle. So far, the govt has “redirected” SS revenue to pay for regular budget items that have nothing to do with SS! The govt has issued IOUs to SS. Therefore, the govt gets an F - a failing grade for not being a wise guardian with your taxes.

Yes, I see what you’re getting at here, and I agree with you more than disagree. There are problems, and our current pattern of entitilement programs are simply unsustainable. We needa fix it. I think the only place we disagree is in the grading thing. I have a hard time calling the entire thing a failure, because even though “keeping people from poverty” is not the only factor or objective to weigh, at least that one objective has been partially met. Does it do enough for what it cost us and our children? No, not really, especially since it is unsustainable. So, I’m interested in answers about what I can do, what we can do as interested citizens, and what we can ask our government (on whatever level is appropriate) to do.

@Ruminator

Think about it. That’s like saying Joe Blow is managing his household “competently” because you notice he’s been paying his water bill on time. But take a closer look at HOW he’s been paying his water bill: he’s been paying the utility bills with his credit-card and he’s about max out his credit limit. Then what? Since his situation wasn’t sustainable, eventually the water service gets disconnected…

Again, the problem with this analogy is I am not saying Medicare is competent, I am sharing my experience and asking for facts and experiences from others so that I can EDUCATE myself. I am not at all the kind of person who would consider myself capable of judging Joe Blow’s household management at all, let alone based on a single piece of information. That’s just not how I…am.

However, if someone were to say to me (and some ones have, for example in my family), “The government screws up everything it touches, so giving the Feds control of our health will be terrible!” or something to that effect, I would of course reflect on my own experiences with various government agencies, from Medicare to the Postal Service to the county tax office to the DMV to gather data. That doesn’t mean I’m fool enough to think my experiences are adequate data to form any kind of solid “analysis”.

OK, now that I’ve broken past my intimidation and started really posting on these boards (only took a few years!), I look forward to starting a thread to debate the limited value of experience (yah, my experiences are anecdotal but that doesn’t make the data worthless, just not worth that much).

@Ruminator

You have to train your mind to look at the WHOLE financial picture.

OK, this last one? I’m going to take it like you meant the universal “you”, 'cause if I take it personally, it’s gonna tick me off. Also, my mind is about looking, as well as I can, at the WHOLE picture. Financial just being, you know, a part.

[Mama_Zappa]

@Mama_Zappa

I haven’t read the referenced article yet (though I will later)…

Fascinating article (as promised, I did read it). I had not realized from Chief Pedant’s posting that this was focused on a specific town and includes a larger percentage of the population in general than we’d expect to see most other places.

The article’s point that such trends are unsustainable is a good one. But who can force the medical culture to behave more like Grand Junction CO, than McAllen TX?

I’ve seen doctors practicing both ways - heck, even the same doctor! My doctor has never prescribed anything more invasive for me than a chest X-ray (a couple of times during an asthma flareup), while my husband wound up with a stress test, a repeat stress test with radioisotopes, and a gall-bladder ultrasound… for what turned out to be benign overexertion-based discomfort.

[gonzomax]

Medicare is an efficient organization. The cost of running it is minuscule. It is far more efficient than private corporations. Medicare is saddled with the people insurance companies do not want. The old and the long term ill. If Medicare could get paid to cover everybody, the cost would drop a ton. It would be so civilized.

[athelas]

@sleeping

In international perspective, the United States spends nearly six times as much per capita on health care administration as the average for Organization for Economic Cooperation and Development (OECD) nations.

Yes, this meme has been floating around for the left blogosphere recently. Yet:

2. Closely related to this point is the bizarre habit of taking about costs without mentioning benefits. The implicit argument appears to be that administrative costs are simply waste - this is the ancient cutting out the middleman fallacy. Administrative benefits, for example, reduce fraud and are a necessary consequence of making it easy for patients to get second and third opinions from different doctors.

3. Even if we could switch from a private to a public system and save administrative costs, the deadweight costs of taxation will far exceed any reasonable savings.

4. Any savings on administrative costs is a one-time level effect but the real issue with health care costs is growth as a share of GDP. (By the way, this same point explains why the debate over whether the public plan will discipline private monopolies is not especially important, monopoly–even if it is a problem–could at best explain a level effect not a growth effect which is where the action is.)

5. I’m not surprised that administrative costs under Medicare and under Canada’s system suggest some potential cost reductions from moving to a single-payer system–again, Ladadid save on marketing expenses–but it’s a complete blunder to use Medicare administrative costs as an argument in favor of a “public option.” The whole point of the public option, so we are told, is to compete on a level footing with private plans which means marketing expenses and all the rest.

From the same site:

There is also a broader point that I have always wondered when people cite the low administrative costs of Medicare. At least a portion of it has to come from the fact that they cover everything with little dispute. In addition, Medicare is also approaching fiscal insolvency. These are not two unrelated points, and therefore I wonder if perhaps Medicare might want to spend a little bit more on administrative costs?

As the OP’s experience suggests, government is highly incentivized to make people happy, and not highly incentivized to deny care to keep its own size down.

[Maia_s_Well]

@athelas

…If the public plan gets subsidized, the subsidies will expand until it makes all private plans noncompetitive - in this sense a subsidized public plan is simply a backdoor to single-payer healthcare.

Thanks for the link and spelling this out. This is kinda the vague thought I had, but well explained.

@athelas

If the plan is not subsidized, then the question still remains: what will this “public company” be instructed to optimize - revenues, or the happiness of politically powerful groups? Given the structure of politics, politicians will have incentives to give more care than is optimal, at the expense of the taxpayers. This is a classic example of the “concentrate the benefits, spread the cost” tactic. And exactly who in our government will mimic the behavior of shareholders?

Wait…what?

Oh. Here’s another one of my blindspots you’ve just helped me see.:smack: “The happiness of politically powerful groups”? See, I thought it would just be the government and us Amuricans. But there’s another kind of power out there, isn’t there? Your talking about lobbyists? Special interest groups? That kind of thing, right?

Jeez Louise this stuff is all so complicated.

[Ruminator]

@Maia_s_Well

Do you have a cite about Medicare going bankrupt? I would appreciate being steered to some hard numbers.

The government’s own trustees have already stated that Medicare is going bankrupt.

http://www.google.com/search?q=medicare+bankrupt+2019

The fact that Medicare is insolvent is not in dispute.

What people disagree about is how to fix it. Cut benefits or raise taxes. Or stay paralyzed and do nothing because that program is a scared cow – just borrow money to “pay” for it.

Raising taxes won’t work because Medicare is fundamentally flawed in its structure to spend more than the GDP growth of the country. You have to rewrite the laws so Medicare has a hard ceiling on what it can spend. If there is no cap, raising taxes isn’t going to solve it. Taxes come from economic activity – which is the GDP. But… no politician can do the RIGHT thing by pushing for cost caps because they’d get voted out of office. The typical voter isn’t going to understand the WHOLE PICTURE of Medicare and how its financially unsustainable – and they don’t care – they just want it to keep paying paying paying. You have no voter support to encourage the politicians to do the right thing. Therefore, you’re back to square one with an unsustainable system.

[Maia_s_Well]

@athelas

Yes, this meme has been floating around for the left blogosphere recently. Yet:From the same site:As the OP’s experience suggests, government is highly incentivized to make people happy, and not highly incentivized to deny care to keep its own size down.

I’m embarrassed to admit that I didn’t understand most of what you put in the quote. I have bookmarked the link and will read through the article with dictionary.com open in another window.

Like, what does “the deadweight costs of taxation” mean? That sounds like something that would be relevant in many government issues, so worth knowing.

[Maia_s_Well]

@Maia_s_Well

Like, what does “the deadweight costs of taxation” mean? That sounds like something that would be relevant in many government issues, so worth knowing.

Never mind. I looked it up and found out what it means.

[Maia_s_Well]

@Ruminator

The fact that Medicare is insolvent is not in dispute.

What people disagree about is how to fix it. Cut benefits or raise taxes. Or stay paralyzed and do nothing because that program is a scared cow – just borrow money to “pay” for it.

Thanks for the link.

OK, here’s a totally crazy idea. I know it won’t work, but I can’t help but ask.

What would happen if we opened Medicare up to anyone who wanted it? And President Obama or various activists groups specifically asked Americans to join? If there was a real grass-roots effort to persuade Americans, especially young, healthy Americans, to join? The there would be a lot more healthy people paying premiums into Medicare. Could that fix the problems with Medicare without robbing other government programs? Because I would be happy that it would be a choice.

I’m ok with it if y’all chuckle at my naivety.

[Antinor01]

@gonzomax

As always, Insurance companies are in the business of denying coverage. A poster last week said she fought her company for weeks over a dispute. They finally agreed to cover it. Then they said most people wont fight that hard. That of course means they are not paying for things that are covered.
Medicare actually has an interest in prevention . The clinic I go to, offers help with dieting, nutrition, weight loss and will council about exercise programs. Your insurance company just wants you gone. They will fight and deny everything they can. If you are old or sick, they want you off their rolls. Even if you paid premiums for 40 years, the tables say you may become expensive.
I got a letter last month from medicare telling me what new preventative tests I qualify for. When did your insurance company send you a letter like that? Every letter is about raising premiums and cutting coverage. What a great system.

Mine does. They also cover my preventative visits at no cost to me. I am also offered the same type of classes, most at no cost.

Not all insurance companies are the same.

[Voyager]

@Mama_Zappa

Fascinating article (as promised, I did read it). I had not realized from Chief Pedant’s posting that this was focused on a specific town and includes a larger percentage of the population in general than we’d expect to see most other places.

The article’s point that such trends are unsustainable is a good one. But who can force the medical culture to behave more like Grand Junction CO, than McAllen TX?

I’ve seen doctors practicing both ways - heck, even the same doctor! My doctor has never prescribed anything more invasive for me than a chest X-ray (a couple of times during an asthma flareup), while my husband wound up with a stress test, a repeat stress test with radioisotopes, and a gall-bladder ultrasound… for what turned out to be benign overexertion-based discomfort.

I think the point of the article is that the amount spent on healthcare is not a good indicator of outcomes. People against reforms moan and groan about rationing, but if we were able to ration McAllen to look like El Paso, we might have better health for a lot less money. As the article said, some of the extra costs were for invasive remedies when simpler, cheaper, ones did just as well.

As for the standard conservative attacks: do you demand extra tests of your doctor, and does she agree? The problem may not be us as patients but doctors who have a strong financial incentive to add tests - and who can usually medically justify it, at least to themselves. Often doctors don’t have a clue about the cost of treatments, which in some sense is good but in others may cause them to discount cost when recommending a treatment.

As another example, we all have car insurance, usually with a deductible, just like health insurance, these days. It pays the rest. Do we deliberately crash our cars because of this?

I have seen a study that shows that people do use more healthcare if it costs less - but the study did not indicate if this additional use was frivolous or useful.

In my case, a fluttery pulse was discovered one day when I was trying to donate blood. I had drunk a ton of Mountain Dew for lunch, and figured it was just the caffeine. However, having good insurance, I was able to go see my doctor at almost no cost. Funny story - it turned out I had arhythmia, and could have keeled over from a stroke at any time. Frivolous use of medical care, right? If I worked in a low paying job without coverage, and had to decide if I wanted to go to the doctor or eat, I might well be dead today.