Medicare crisis

Part of the new federal  health care plan will be funded by cuts to Medicare, the existing government program that pays for health care for the elderly.  Already, though, an increasing number of doctors are  refusing to take on Medicare patients because the payments are too low.  And starting on January 1 those payments are scheduled to be cut  a whopping 25%.   From The Washington Post:

Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you’re a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he’ll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District’s Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

“It’s not easy. But you realize you either do this or you don’t stay in business,” she said.

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that’s not even taking into account a long-postponed rate-setting method that is on track to slash Medicare’s payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate (SGR) and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy’s overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors’ pay rates in 2002, Congress has chosen to put off the increasingly steep cuts called for by the formula ever since.

This month, the Senate passed its fourth stopgap fix this year – a one-month postponement that expires Jan. 1. The House is likely to follow suit when it reconvenes next week, and physicians have been running print ads, passing out fliers to patients and flooding Capitol Hill with phone calls to persuade Congress to suspend the 25 percent rate cut that the SGR method will require next year.

via Doctors say Medicare cuts forcing them to shift away from elderly.

Does anyone have a solution for this?

About Gene Veith

Professor of Literature at Patrick Henry College, the Director of the Cranach Institute at Concordia Theological Seminary, a columnist for World Magazine and TableTalk, and the author of 18 books on different facets of Christianity & Culture.

  • Pete

    Fee for service. Can it be any more obvious that the government’s ever getting involved in health insurance was (as many warned it would be) the road to bankruptcy being paved with good intentions?

  • Pete

    Fee for service. Can it be any more obvious that the government’s ever getting involved in health insurance was (as many warned it would be) the road to bankruptcy being paved with good intentions?

  • WebMonk

    I would absolutely hate to be a politician having to unravel this mess because Medicare is so gargantuan and has tentacles in almost everything – changes have unintended consequences (not necessarily all bad) which cannot all be seen ahead of time. Any changes a legislator may want to do will have adverse consequences all over the board, which will be opposed strenuously. Those adverse consequences are sometimes necessary, but it doesn’t stop those who are being affect from opposing the changes.

    Basically, my view is that Medicare will eventually be either mostly useless or scrapped entirely. I vote and write legislators for the scrapped option, but I suspect it will continue on with a plenitude of tweaks which turn it mostly useless and much more costly in another decade or two. It will eventually get folded into some healthcare legislation and live on out of sight (mostly) causing a constant drain and headache for decades beyond, should the current healthcare system last that long.

    Aren’t I a bundle of cheer this morning?!

  • WebMonk

    I would absolutely hate to be a politician having to unravel this mess because Medicare is so gargantuan and has tentacles in almost everything – changes have unintended consequences (not necessarily all bad) which cannot all be seen ahead of time. Any changes a legislator may want to do will have adverse consequences all over the board, which will be opposed strenuously. Those adverse consequences are sometimes necessary, but it doesn’t stop those who are being affect from opposing the changes.

    Basically, my view is that Medicare will eventually be either mostly useless or scrapped entirely. I vote and write legislators for the scrapped option, but I suspect it will continue on with a plenitude of tweaks which turn it mostly useless and much more costly in another decade or two. It will eventually get folded into some healthcare legislation and live on out of sight (mostly) causing a constant drain and headache for decades beyond, should the current healthcare system last that long.

    Aren’t I a bundle of cheer this morning?!

  • DonS

    Pete’s got it right. There are two sectors of the economy that the government intervened in in an extraordinary way, beginning in the 1960′s. Those two? Health care and higher education. Government essentially chose to destroy the health care market, at least for the elderly, in favor of a single payer system, when Medicare was passed in 1965. Similarly, government chose to prop up higher education, and make it policy that practically everyone is entitled to a college education, by instituting a plethora of federal student grant and loan programs.

    As a result, since 1970 health care inflation in the U.S. has averaged 11.6%, 2.9% per annum greater than our GDP growth rate http://findarticles.com/p/articles/mi_m0795/is_nSUPP_v13/ai_12206797/

    In higher education, during roughly the same period of time, college tuition inflation has averaged 1 and 1/2 to 2 times the general inflation rate, which is no surprise to any of us http://www.finaid.org/savings/tuition-inflation.phtml

    So, the government is 0 for 2. While many folks inexplicably argue that this means the government needs to do more (!), logic dictates that these sectors of the economy need more market pressure, not less. The only way to restore market forces is to re-connect the patient to the cost of health care, in the case of Medicare. This doesn’t mean government money needs to leave the system, but it does mean that it needs to be managed differently in order to bring down costs. Insurance is intended to cover catastrophic losses, with a person’s own resources being used to cover everyday costs, just as in other areas of the economy, such as food and shelter. How did we ever get to the place where patients pay nothing for healthcare? It’s stupid, and needlessly raises demand for a scarce resource. We need, even for seniors, high deductive catastrophic coverage, supplemented with tax advantaged health spending accounts for the payment of everyday expenses and deductibles. The government can partially or fully fund these HSA’s for low income people, but allow those people to manage the funds and pay for their own care out of those accounts.

    It would work wonders for the market, reduce insurance paperwork by 80% or more, and allow medical providers to get paid right away, rather than having to wait months for the processing of paperwork. It’s so logical that it’ll probably never happen.

  • DonS

    Pete’s got it right. There are two sectors of the economy that the government intervened in in an extraordinary way, beginning in the 1960′s. Those two? Health care and higher education. Government essentially chose to destroy the health care market, at least for the elderly, in favor of a single payer system, when Medicare was passed in 1965. Similarly, government chose to prop up higher education, and make it policy that practically everyone is entitled to a college education, by instituting a plethora of federal student grant and loan programs.

    As a result, since 1970 health care inflation in the U.S. has averaged 11.6%, 2.9% per annum greater than our GDP growth rate http://findarticles.com/p/articles/mi_m0795/is_nSUPP_v13/ai_12206797/

    In higher education, during roughly the same period of time, college tuition inflation has averaged 1 and 1/2 to 2 times the general inflation rate, which is no surprise to any of us http://www.finaid.org/savings/tuition-inflation.phtml

    So, the government is 0 for 2. While many folks inexplicably argue that this means the government needs to do more (!), logic dictates that these sectors of the economy need more market pressure, not less. The only way to restore market forces is to re-connect the patient to the cost of health care, in the case of Medicare. This doesn’t mean government money needs to leave the system, but it does mean that it needs to be managed differently in order to bring down costs. Insurance is intended to cover catastrophic losses, with a person’s own resources being used to cover everyday costs, just as in other areas of the economy, such as food and shelter. How did we ever get to the place where patients pay nothing for healthcare? It’s stupid, and needlessly raises demand for a scarce resource. We need, even for seniors, high deductive catastrophic coverage, supplemented with tax advantaged health spending accounts for the payment of everyday expenses and deductibles. The government can partially or fully fund these HSA’s for low income people, but allow those people to manage the funds and pay for their own care out of those accounts.

    It would work wonders for the market, reduce insurance paperwork by 80% or more, and allow medical providers to get paid right away, rather than having to wait months for the processing of paperwork. It’s so logical that it’ll probably never happen.

  • DonS

    In my last post, “high deductive” should, of course, be “high deductible”.

  • DonS

    In my last post, “high deductive” should, of course, be “high deductible”.

  • http://www.toddstadler.com/ tODD

    But isn’t what the article describes essentially a good thing for “conservatives”? After all, it’s a move in the direction of less government care for the elderly. And if Medicare patients have fewer options for service, and are being seen less frequently, then isn’t the government paying less for their services? If more and more doctors refuse to take Medicare, wouldn’t that be a good thing for those who complain about entitlement spending? While the article notes that doctors “complain” that “they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress,” isn’t that the stated goal of “conservatives”?

    I also like how Republicans passed the Sustainable Growth Rate under Clinton, and then completely failed to enforce it when it meant anything under Bush. That says something, doesn’t it? Oh, and look, the Republicans in control of the House now are “likely to [pass a stopgap "fix" once more] when it reconvenes next week”. What a surprise!

    DonS (@3), I’d love to hear how the government keeping the elderly out of private health care has caused private health care costs to go up. If we dumped all those people, with all their ailments, doctor visits, and pills, back into private health care plans, my premiums would go down? Do tell.

  • http://www.toddstadler.com/ tODD

    But isn’t what the article describes essentially a good thing for “conservatives”? After all, it’s a move in the direction of less government care for the elderly. And if Medicare patients have fewer options for service, and are being seen less frequently, then isn’t the government paying less for their services? If more and more doctors refuse to take Medicare, wouldn’t that be a good thing for those who complain about entitlement spending? While the article notes that doctors “complain” that “they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress,” isn’t that the stated goal of “conservatives”?

    I also like how Republicans passed the Sustainable Growth Rate under Clinton, and then completely failed to enforce it when it meant anything under Bush. That says something, doesn’t it? Oh, and look, the Republicans in control of the House now are “likely to [pass a stopgap "fix" once more] when it reconvenes next week”. What a surprise!

    DonS (@3), I’d love to hear how the government keeping the elderly out of private health care has caused private health care costs to go up. If we dumped all those people, with all their ailments, doctor visits, and pills, back into private health care plans, my premiums would go down? Do tell.

  • DonS

    tODD @ 5: Hmmm, you’ve assembled a very nice collection of caricatures in one succinct post ;-) . Very nice job.

    So, in your mind, what conservatives want is “less government care for the elderly”? Nice. Um, but wrong. How about better care at less cost? How about not having to wait six or eight weeks or six months for an appointment? How about not forcing a “geriatric specialist” to only see his geriatric patients twice a year?

    Where in my post did I advocate putting elderly patients in private health care? Did you read it, or even attempt to understand what I was saying? Or did you just go straight for the stereotype that conservatives are mean and selfish? How about this statement “This doesn’t mean government money needs to leave the system, but it does mean that it needs to be managed differently in order to bring down costs”? Does that sound like moving patients to private care? Sheesh.

    There is no way, especially given the tentacles Medicare has established in our society, and the amount of money each of us has poured down the rathole, that the elderly can be moved to private care. Old people get sick. They die. They have limited incomes. Their health care costs are too high to be absorbed by the private health care system as it has evolved because of the institution of Medicare, and the costs it has imposed on our system. But we can work to change the way we administer Medicare’s funding, no doubt reduce costs substantially, as well as the rate of health care inflation, and afford our seniors far better care than they get now. Empower the people. Deleverage the bureaucrats. Free the healthcare providers from endless paperwork and months of payment delays with every patient visit. It’s a win-win-win.

    It’s certainly worth a try, compared to the disaster we have now.

  • DonS

    tODD @ 5: Hmmm, you’ve assembled a very nice collection of caricatures in one succinct post ;-) . Very nice job.

    So, in your mind, what conservatives want is “less government care for the elderly”? Nice. Um, but wrong. How about better care at less cost? How about not having to wait six or eight weeks or six months for an appointment? How about not forcing a “geriatric specialist” to only see his geriatric patients twice a year?

    Where in my post did I advocate putting elderly patients in private health care? Did you read it, or even attempt to understand what I was saying? Or did you just go straight for the stereotype that conservatives are mean and selfish? How about this statement “This doesn’t mean government money needs to leave the system, but it does mean that it needs to be managed differently in order to bring down costs”? Does that sound like moving patients to private care? Sheesh.

    There is no way, especially given the tentacles Medicare has established in our society, and the amount of money each of us has poured down the rathole, that the elderly can be moved to private care. Old people get sick. They die. They have limited incomes. Their health care costs are too high to be absorbed by the private health care system as it has evolved because of the institution of Medicare, and the costs it has imposed on our system. But we can work to change the way we administer Medicare’s funding, no doubt reduce costs substantially, as well as the rate of health care inflation, and afford our seniors far better care than they get now. Empower the people. Deleverage the bureaucrats. Free the healthcare providers from endless paperwork and months of payment delays with every patient visit. It’s a win-win-win.

    It’s certainly worth a try, compared to the disaster we have now.

  • DonS

    OK, now I’ve got four comments in moderation. No “S” word, no links, no suspicious words that I can see.

    Short and sweet is the ticket. tODD @ 5, you will be blizzarded with responses later (sorry about that), but please re-read my post. I specifically state that I am NOT advocating removing government money from the system. So I am not sure why you are going on about dumping seniors in private care.

  • DonS

    OK, now I’ve got four comments in moderation. No “S” word, no links, no suspicious words that I can see.

    Short and sweet is the ticket. tODD @ 5, you will be blizzarded with responses later (sorry about that), but please re-read my post. I specifically state that I am NOT advocating removing government money from the system. So I am not sure why you are going on about dumping seniors in private care.

  • cattail

    What’s going to happen, the way things are going ( I was a senior accountant for a large HMO for 11 years, so I do have some expertise here):

    Thanks to the big cuts coming to the Medicare Advantage program, it will die (my premiums go up 15% next year and my co-pays go up 20 to 50%). A number of HMOs (not mine yet) have already discontinued this program, which unlike standard Medicare focuses on wellness, preventive care and coordinated care for the seriously ill. Private physicians will not accept new Medicare patients, such as those of us ditched by the HMOs, with such a low reimbursement rate. Costs for Medicare supplemental insurance will skyrocket to the point that many of us can’t afford it. I fully expect that in a couple of years the only way I’ll be able to get medical care is to sit in the ER along with the illegal immigrants. At least I’ll be able to practice my Spanish! Of course the ER is by far the most expensive way to provide care, and the cost falls on private hospital patients!

    By the way, it isn’t just us old folks who will get the shaft, but also our military services. The system for military dependents, Tricare, uses the same payment schedules as Medicare. The dependents of those who fight and die for our country will be sitting in the ER along with us older folks and the undocumented!

  • cattail

    What’s going to happen, the way things are going ( I was a senior accountant for a large HMO for 11 years, so I do have some expertise here):

    Thanks to the big cuts coming to the Medicare Advantage program, it will die (my premiums go up 15% next year and my co-pays go up 20 to 50%). A number of HMOs (not mine yet) have already discontinued this program, which unlike standard Medicare focuses on wellness, preventive care and coordinated care for the seriously ill. Private physicians will not accept new Medicare patients, such as those of us ditched by the HMOs, with such a low reimbursement rate. Costs for Medicare supplemental insurance will skyrocket to the point that many of us can’t afford it. I fully expect that in a couple of years the only way I’ll be able to get medical care is to sit in the ER along with the illegal immigrants. At least I’ll be able to practice my Spanish! Of course the ER is by far the most expensive way to provide care, and the cost falls on private hospital patients!

    By the way, it isn’t just us old folks who will get the shaft, but also our military services. The system for military dependents, Tricare, uses the same payment schedules as Medicare. The dependents of those who fight and die for our country will be sitting in the ER along with us older folks and the undocumented!

  • http://www.toddstadler.com/ tODD

    I think I’ve finally cracked the spam queue problem, for what it’s worth. It was Don’s now-approved comment (@6) that helped me figure it out. Wanna know what word caused that comment to go into moderation, Don? I’m 95% certain it was … “specialist”.

    Why? Well, ask yourself this: what word (or, perhaps, what brand name) appears embedded in the word “specialist” — as well as “socialism” and “socialist” — that is a common spam topic?

    Memo to all commenters: avoid words that, while themselves innocuous, contain drug names embedded in them.

  • http://www.toddstadler.com/ tODD

    I think I’ve finally cracked the spam queue problem, for what it’s worth. It was Don’s now-approved comment (@6) that helped me figure it out. Wanna know what word caused that comment to go into moderation, Don? I’m 95% certain it was … “specialist”.

    Why? Well, ask yourself this: what word (or, perhaps, what brand name) appears embedded in the word “specialist” — as well as “socialism” and “socialist” — that is a common spam topic?

    Memo to all commenters: avoid words that, while themselves innocuous, contain drug names embedded in them.

  • Pete

    Strong detective work, tODD!

  • Pete

    Strong detective work, tODD!

  • DonS

    tODD @ 9: That’s impressive sleuthing. How did you ever think of that? You’re almost certainly correct, because I think I used that word in each of my four attempts (the other three — all similar– haven’t been released — hopefully Dr. Veith deleted them). But then again, your comment didn’t go into moderation, so it’s a pretty inconsistent spam filter. And highly ridiculous.

  • DonS

    tODD @ 9: That’s impressive sleuthing. How did you ever think of that? You’re almost certainly correct, because I think I used that word in each of my four attempts (the other three — all similar– haven’t been released — hopefully Dr. Veith deleted them). But then again, your comment didn’t go into moderation, so it’s a pretty inconsistent spam filter. And highly ridiculous.

  • http://www.toddstadler.com/ tODD

    DonS (@6), look, I’m going off of two lines of thinking from you.

    The first is your claim (@3) that government involvement in the “health care market, at least for the elderly” has been the main (or only?) cause for health care costs vastly outpacing GDP. This claim of yours is as of yet unsubstantiated in any way, and I still would like to hear you support that argument. However, it necessarily follows from your argument that, had the government not gotten involved in the “health care market, at least for the elderly”, overall health care costs wouldn’t have gone up so much. I think this argument makes no sense, as I’ve already said, but you’re the one making it. Isn’t the obvious implication that metastasizing health care costs is bad and that the government should get out of the “health care market, at least for the elderly”?

    Furthermore, I have read not a few posts from you decrying entitlement spending and how it will bankrupt our country. And yet now you are saying (@6) that we can fix things with just a few tweaks? Just make everything more efficient? Forgive me, but that’s the sort of vague nonsense that routinely gets mocked here, especially when a Democrat is saying it. “I will decrease our deficit by trimming the budget and through vast increases in efficiency!” Please.

    If Medicare spending is our country’s main problem (and you have done quite a good job convincing me that it is, at least along with the other major entitlement programs), then no amount of “changing the way we administer Medicare’s funding” or “reduce costs” or “deleveraging the bureaucrats” is going to truly change things. It’s, as people are fond of saying, rearranging the deck chairs on the Titanic. If you believe that Medicare is the problem, come out and say it. There’s no getting around that solving that problem is going to involve vast amounts of pain, especially for seniors who have not otherwise saved money for their own health care costs.

    But now you sound like you are an advocate of Medicare, if perhaps resignedly. If you are, okay, but then I don’t really believe everything you used to say about the problems of entitlement spending.

    Either it’s a good thing that our government help out the old people that use a vastly disproportionate amount of our health care resources, or it’s a bad thing. If, as you now seem to argue, that it’s something we need to do, then vague assertions about trimming the fat really won’t do. We need to talk about funding such a program, and that means more taxes.

    In short, I think you’re being inconsistent. Or your views have changed.

  • http://www.toddstadler.com/ tODD

    DonS (@6), look, I’m going off of two lines of thinking from you.

    The first is your claim (@3) that government involvement in the “health care market, at least for the elderly” has been the main (or only?) cause for health care costs vastly outpacing GDP. This claim of yours is as of yet unsubstantiated in any way, and I still would like to hear you support that argument. However, it necessarily follows from your argument that, had the government not gotten involved in the “health care market, at least for the elderly”, overall health care costs wouldn’t have gone up so much. I think this argument makes no sense, as I’ve already said, but you’re the one making it. Isn’t the obvious implication that metastasizing health care costs is bad and that the government should get out of the “health care market, at least for the elderly”?

    Furthermore, I have read not a few posts from you decrying entitlement spending and how it will bankrupt our country. And yet now you are saying (@6) that we can fix things with just a few tweaks? Just make everything more efficient? Forgive me, but that’s the sort of vague nonsense that routinely gets mocked here, especially when a Democrat is saying it. “I will decrease our deficit by trimming the budget and through vast increases in efficiency!” Please.

    If Medicare spending is our country’s main problem (and you have done quite a good job convincing me that it is, at least along with the other major entitlement programs), then no amount of “changing the way we administer Medicare’s funding” or “reduce costs” or “deleveraging the bureaucrats” is going to truly change things. It’s, as people are fond of saying, rearranging the deck chairs on the Titanic. If you believe that Medicare is the problem, come out and say it. There’s no getting around that solving that problem is going to involve vast amounts of pain, especially for seniors who have not otherwise saved money for their own health care costs.

    But now you sound like you are an advocate of Medicare, if perhaps resignedly. If you are, okay, but then I don’t really believe everything you used to say about the problems of entitlement spending.

    Either it’s a good thing that our government help out the old people that use a vastly disproportionate amount of our health care resources, or it’s a bad thing. If, as you now seem to argue, that it’s something we need to do, then vague assertions about trimming the fat really won’t do. We need to talk about funding such a program, and that means more taxes.

    In short, I think you’re being inconsistent. Or your views have changed.

  • http://www.toddstadler.com/ tODD

    Actually, DonS (@11), my comment did go into moderation! Which is embarrassing, because I forgot to obey my own suggestions! But it was released fairly quickly, so you might not have noticed the delay.

  • http://www.toddstadler.com/ tODD

    Actually, DonS (@11), my comment did go into moderation! Which is embarrassing, because I forgot to obey my own suggestions! But it was released fairly quickly, so you might not have noticed the delay.

  • DonS

    tODD @ 13: OK, that makes sense. So now we know, no drug names either standing alone or embedded in words. This could get tricky.

  • DonS

    tODD @ 13: OK, that makes sense. So now we know, no drug names either standing alone or embedded in words. This could get tricky.

  • DonS

    tODD @ 12:

    “The first is your claim (@3) that government involvement in the “health care market, at least for the elderly” has been the main (or only?) cause for health care costs vastly outpacing GDP.” — well, I didn’t actually make that claim, although it is certainly implied. I did provide evidence, namely that the influx of vast amounts of government funding into health care and higher education, which in each case serves to isolate consumers from the real cost of services and thus drive up demand, has coincided with extreme inflation in those same two sectors. Causation or coincidence? I can’t prove causation definitively, but basic economic theory dictates that if you increase the number of dollars chasing a relatively fixed supply of services, the increased demand will result in higher prices. Couple this with the structure of our health care system, which tends to offer first dollar coverage of many medical services, and you drive patients to seek those services more often than they otherwise would. Sure, there are other factors leading to the increase in cost of health care, such as skyrocketing medical malpractice claims and resultant defensive medicine, as well as the increased usage of expensive technology. But, in my view, these are secondary to the fact that consumers don’t know or care about cost of services, because they seldom have to pay the bill. That’s not a good economic situation.

    “Isn’t the obvious implication that metastasizing health care costs is bad and that the government should get out of the “health care market, at least for the elderly”?” Well, no. Because I don’t leave it to implication. I offer a specific remedy which involves continued government involvement in the market, and explain why I think this is necessary.

    “And yet now you are saying (@6) that we can fix things with just a few tweaks? Just make everything more efficient?” — well, no. If you examined my proposal, it’s a heck of a lot more than a few tweaks, or making everything more efficient. It turns the system upside down, by converting Medicare from comprehensive to catastrophic, high deductible, insurance. It assumes that seniors should pay out of pocket for routine medical care, just as they do for food and shelter, rather than claiming every office visit and drug purchase through their insurance plan. It then institutes HSA-type plans so that seniors can use tax advantaged money, to fund those routine health care costs and deductibles. For those who are poor, the accounts would be funded, wholly or partially, by the government. But the patient would always, until catastrophic insurance kicked in, pay for the cost of care, so they knew what was going on.

    Regarding my inconsistency as to entitlements, my problem with them isn’t their existence. It is that benefits at specified levels are guaranteed in budget out-years. I believe that benefit levels and eligibility criteria should be established in each budget year based on available revenues, and that we should not be obligating future taxpayers without their consent. But, strictly speaking, Medicare and Social Security are social insurance programs, a different type of entitlement, where you do have to establish benefit and eligibility criteria up front, though you do need to have the capability to adjust those levels as time goes by. The key for these kinds of programs, long-term, is to pre-fund them, in the same way that local government and private pension plans are supposed to be pre-funded. We’re not there though, so in the real world, though I don’t like the situation, I am trying to deal with it creatively and realistically, with an underlying desire to see health care for seniors improve in a way that is cost effective for the nation.

  • DonS

    tODD @ 12:

    “The first is your claim (@3) that government involvement in the “health care market, at least for the elderly” has been the main (or only?) cause for health care costs vastly outpacing GDP.” — well, I didn’t actually make that claim, although it is certainly implied. I did provide evidence, namely that the influx of vast amounts of government funding into health care and higher education, which in each case serves to isolate consumers from the real cost of services and thus drive up demand, has coincided with extreme inflation in those same two sectors. Causation or coincidence? I can’t prove causation definitively, but basic economic theory dictates that if you increase the number of dollars chasing a relatively fixed supply of services, the increased demand will result in higher prices. Couple this with the structure of our health care system, which tends to offer first dollar coverage of many medical services, and you drive patients to seek those services more often than they otherwise would. Sure, there are other factors leading to the increase in cost of health care, such as skyrocketing medical malpractice claims and resultant defensive medicine, as well as the increased usage of expensive technology. But, in my view, these are secondary to the fact that consumers don’t know or care about cost of services, because they seldom have to pay the bill. That’s not a good economic situation.

    “Isn’t the obvious implication that metastasizing health care costs is bad and that the government should get out of the “health care market, at least for the elderly”?” Well, no. Because I don’t leave it to implication. I offer a specific remedy which involves continued government involvement in the market, and explain why I think this is necessary.

    “And yet now you are saying (@6) that we can fix things with just a few tweaks? Just make everything more efficient?” — well, no. If you examined my proposal, it’s a heck of a lot more than a few tweaks, or making everything more efficient. It turns the system upside down, by converting Medicare from comprehensive to catastrophic, high deductible, insurance. It assumes that seniors should pay out of pocket for routine medical care, just as they do for food and shelter, rather than claiming every office visit and drug purchase through their insurance plan. It then institutes HSA-type plans so that seniors can use tax advantaged money, to fund those routine health care costs and deductibles. For those who are poor, the accounts would be funded, wholly or partially, by the government. But the patient would always, until catastrophic insurance kicked in, pay for the cost of care, so they knew what was going on.

    Regarding my inconsistency as to entitlements, my problem with them isn’t their existence. It is that benefits at specified levels are guaranteed in budget out-years. I believe that benefit levels and eligibility criteria should be established in each budget year based on available revenues, and that we should not be obligating future taxpayers without their consent. But, strictly speaking, Medicare and Social Security are social insurance programs, a different type of entitlement, where you do have to establish benefit and eligibility criteria up front, though you do need to have the capability to adjust those levels as time goes by. The key for these kinds of programs, long-term, is to pre-fund them, in the same way that local government and private pension plans are supposed to be pre-funded. We’re not there though, so in the real world, though I don’t like the situation, I am trying to deal with it creatively and realistically, with an underlying desire to see health care for seniors improve in a way that is cost effective for the nation.

  • Dan Kempin

    tODD, #9,

    Brilliant. Alli need to nicotrol the moderation is toradol the words carefully . . . unless they are viagral to the conversation.

  • Dan Kempin

    tODD, #9,

    Brilliant. Alli need to nicotrol the moderation is toradol the words carefully . . . unless they are viagral to the conversation.

  • Dan Kempin

    Ha! Good one, tODD!

  • Dan Kempin

    Ha! Good one, tODD!

  • Dan Keflex

    Meet my new Cranach identity!

  • Dan Keflex

    Meet my new Cranach identity!

  • http://www.toddstadler.com/ tODD

    DonS (@15), you say you “didn’t actually make that claim”, but go back and read your own comment (@3), specifically the part where you say “As a result”! You are making an explicit case for causation, and not coincidence. Based on your subsequent arguments, I have to assume that you erred in using that phrase.

  • http://www.toddstadler.com/ tODD

    DonS (@15), you say you “didn’t actually make that claim”, but go back and read your own comment (@3), specifically the part where you say “As a result”! You are making an explicit case for causation, and not coincidence. Based on your subsequent arguments, I have to assume that you erred in using that phrase.

  • http://www.toddstadler.com/ tODD

    And DonS (@15), you seem to chastise me, saying, “If you examined my proposal, it’s a heck of a lot more than a few tweaks, or making everything more efficient”, but let’s look at your “proposal” (@6) together:

    We can work to change the way we administer Medicare’s funding, no doubt reduce costs substantially, as well as the rate of health care inflation, and afford our seniors far better care than they get now. Empower the people. Deleverage the bureaucrats. Free the healthcare providers from endless paperwork and months of payment delays with every patient visit.

    This is what we’ve been discussing, and, well, it’s hardly a proposal. It’s incredibly vague.

    You apparently expected me to remember some other proposal, one you had made elsewhere in the past, in spite of the fact that I thought you were changing your stance with this reply. It’s hardly fair for you to complain that I didn’t “examine your proposal” when we were clearly discussing your comment on this thread (@6), which, again, is nothing but a wish list of results. If you’d like to refer me to a past comment in which you lay out an actual proposal, and tell me that you still agree with that comment, that’s fine, but my memory is only semi-infinite. ;)

    Going off of what you’ve revealed in this thread (@15), your system would effectively end Medicare in all but name, it would seem.

    And while you earlier protested (@6), “Where in my post did I advocate putting elderly patients in private health care?” I see you saying here that “seniors should pay out of pocket for routine medical care”. In what way could that be called “Medicare” or not be called “private care”? They would be on their own for everything until catastrophic government insurance kicked in.

    And what I never hear in proposals like yours is what would be done for the transition. Let’s say your proposal goes into effect 2011. You now have a vast number of seniors who have zero dollars in their “HSA-type plans” that are now facing paying for the first NN-thousand dollars of medical care. What happens to them? How do you implement your plan without causing any disruption for the elderly or those otherwise unable to confront their new health costs? How are “catastrophic” levels determined — is it an across-the-board flat cutoff or is it based on your income?

    But, in the end, wouldn’t that transition look a lot like what the article describes, with fewer and fewer people having Medicare cover their costs, and having to pay out of pocket for their care?

  • http://www.toddstadler.com/ tODD

    And DonS (@15), you seem to chastise me, saying, “If you examined my proposal, it’s a heck of a lot more than a few tweaks, or making everything more efficient”, but let’s look at your “proposal” (@6) together:

    We can work to change the way we administer Medicare’s funding, no doubt reduce costs substantially, as well as the rate of health care inflation, and afford our seniors far better care than they get now. Empower the people. Deleverage the bureaucrats. Free the healthcare providers from endless paperwork and months of payment delays with every patient visit.

    This is what we’ve been discussing, and, well, it’s hardly a proposal. It’s incredibly vague.

    You apparently expected me to remember some other proposal, one you had made elsewhere in the past, in spite of the fact that I thought you were changing your stance with this reply. It’s hardly fair for you to complain that I didn’t “examine your proposal” when we were clearly discussing your comment on this thread (@6), which, again, is nothing but a wish list of results. If you’d like to refer me to a past comment in which you lay out an actual proposal, and tell me that you still agree with that comment, that’s fine, but my memory is only semi-infinite. ;)

    Going off of what you’ve revealed in this thread (@15), your system would effectively end Medicare in all but name, it would seem.

    And while you earlier protested (@6), “Where in my post did I advocate putting elderly patients in private health care?” I see you saying here that “seniors should pay out of pocket for routine medical care”. In what way could that be called “Medicare” or not be called “private care”? They would be on their own for everything until catastrophic government insurance kicked in.

    And what I never hear in proposals like yours is what would be done for the transition. Let’s say your proposal goes into effect 2011. You now have a vast number of seniors who have zero dollars in their “HSA-type plans” that are now facing paying for the first NN-thousand dollars of medical care. What happens to them? How do you implement your plan without causing any disruption for the elderly or those otherwise unable to confront their new health costs? How are “catastrophic” levels determined — is it an across-the-board flat cutoff or is it based on your income?

    But, in the end, wouldn’t that transition look a lot like what the article describes, with fewer and fewer people having Medicare cover their costs, and having to pay out of pocket for their care?

  • Jimmy Veith

    I agree that we should increase the rate of pay for doctors who treat medicare patients by a modest amount. It should be paid for by allowing the tax rate for persons making more than $250,000.00 return to the levels they were in the Clinton era.

    Having said that, I believe there are a few “inconvenient truths” that need to be mentioned which have been ignored thus far in these comments.

    First: American doctors are compensated at a rate far greater than in any other country in the world. General practioners should be paid more (so we will have more of them), but specialists need to lower their expectations of what they should be making. If there are not enough specialists that can’t live on $500,000 per year, then we need to increase the supply of doctors by increasing enrollment in medical schools.

    Second: The basic economic rules of a supply and demand economy do not work when it comes to medical services. The fair price of goods or services is supposed to be established by what a willing buyer and a willing seller would be willing to pay when neither is under any compulsion to buy or sell. If I have a medical procedure, I do so because I might die if I don’t have it done, and I will pay any price to have it done. (Remember the Jack Benny skit where he is confronted with a robber who demands his money or his life, and Jack Benny replies after hesitating, “I’m thinking about it!”)

    Third: There is is a non-economic incentive that acts as a disincentive to overuse medical services, which is the pain and discomfort associated with the medical proceedure.

    Fourth: Making people pay for a deductible for preventive care actually costs more money in the long run. If I don’t have a colonoscopy because I can’t afford an $800.00 deductible, it will cost more in the long run if I get colon cancer. This is why the new health care law will eventually eliminate all deductions for preventive care.

    I know this comment may offend the laissez faire capitalist ideologues, but I have a question for you. Did Adam Smith’s, The Wealth of Nations, (written in 1776) have a chapter on health care economics? What kind of health care was available in 1776?

  • Jimmy Veith

    I agree that we should increase the rate of pay for doctors who treat medicare patients by a modest amount. It should be paid for by allowing the tax rate for persons making more than $250,000.00 return to the levels they were in the Clinton era.

    Having said that, I believe there are a few “inconvenient truths” that need to be mentioned which have been ignored thus far in these comments.

    First: American doctors are compensated at a rate far greater than in any other country in the world. General practioners should be paid more (so we will have more of them), but specialists need to lower their expectations of what they should be making. If there are not enough specialists that can’t live on $500,000 per year, then we need to increase the supply of doctors by increasing enrollment in medical schools.

    Second: The basic economic rules of a supply and demand economy do not work when it comes to medical services. The fair price of goods or services is supposed to be established by what a willing buyer and a willing seller would be willing to pay when neither is under any compulsion to buy or sell. If I have a medical procedure, I do so because I might die if I don’t have it done, and I will pay any price to have it done. (Remember the Jack Benny skit where he is confronted with a robber who demands his money or his life, and Jack Benny replies after hesitating, “I’m thinking about it!”)

    Third: There is is a non-economic incentive that acts as a disincentive to overuse medical services, which is the pain and discomfort associated with the medical proceedure.

    Fourth: Making people pay for a deductible for preventive care actually costs more money in the long run. If I don’t have a colonoscopy because I can’t afford an $800.00 deductible, it will cost more in the long run if I get colon cancer. This is why the new health care law will eventually eliminate all deductions for preventive care.

    I know this comment may offend the laissez faire capitalist ideologues, but I have a question for you. Did Adam Smith’s, The Wealth of Nations, (written in 1776) have a chapter on health care economics? What kind of health care was available in 1776?

  • http://www.geneveith.com Gene Veith

    Jimmy (my brother), the kind of health care available in 1776 was bleeding! They bled you! Just like today, the government and doctors and everybody trying to bleed you dry, except it was literal then. (I actually went to the doctor today, and he took my blood!)

    I actually agree with much of what you say. You bring up a good laissez faire market solution. It’s Reaganesque supply side economics, actually. Increase the number of doctors.

    The monopoly of the American medical establishment and its control over medical schools keeps the number of doctors artificially low, keeping the prices they can command artifically high. There are actually many more people who could make good doctors than are allowed into medical schools. If we had more medical schools, we could turn out many, many more doctors, which would have the double effect of bringing down prices and increasing the amount of medical care.

    P.S.: Your comment got spam filtered because you use the word “specialist,” which has the same male enhancement brand name embedded as “socialist”!

  • http://www.geneveith.com Gene Veith

    Jimmy (my brother), the kind of health care available in 1776 was bleeding! They bled you! Just like today, the government and doctors and everybody trying to bleed you dry, except it was literal then. (I actually went to the doctor today, and he took my blood!)

    I actually agree with much of what you say. You bring up a good laissez faire market solution. It’s Reaganesque supply side economics, actually. Increase the number of doctors.

    The monopoly of the American medical establishment and its control over medical schools keeps the number of doctors artificially low, keeping the prices they can command artifically high. There are actually many more people who could make good doctors than are allowed into medical schools. If we had more medical schools, we could turn out many, many more doctors, which would have the double effect of bringing down prices and increasing the amount of medical care.

    P.S.: Your comment got spam filtered because you use the word “specialist,” which has the same male enhancement brand name embedded as “socialist”!

  • DonS

    tODD @ 19: Touche. I don’t think it changes anything, because I acknowledged in 15 that I implied it, but you are right that I said “as a result”, which is more than an implication.

  • DonS

    tODD @ 19: Touche. I don’t think it changes anything, because I acknowledged in 15 that I implied it, but you are right that I said “as a result”, which is more than an implication.

  • DonS

    tODD @ 3: My proposal is actually laid out in comment #3.

  • DonS

    tODD @ 3: My proposal is actually laid out in comment #3.

  • DonS

    tODD @ 20: I should have read further before I posted. “I see you saying here that “seniors should pay out of pocket for routine medical care”. In what way could that be called “Medicare” or not be called “private care”?

    Well, Medicare doesn’t pay for everything. There is the famous “doughnut hole” for prescription drugs, which weren’t covered at all until Bush’s plan came into effect. There are also substantial copayments for most service, until a certain maximum is reached. So the term “Medicare” doesn’t mean “completely paid for by the government”.

    As for transition, I’m sure the only way to possibly implement something like this, politically, would be to phase it in over many years. You certainly couldn’t make such a dramatic change for any existing beneficiaries, and probably not for those less than 10 years away from eligibility. I could foresee establishing it as a mandatory change for those under a particular age (say 45), and making it an optional change for those over that age. I am over that age, but I would opt in in a heartbeat. But others like the security of a more comprehensive plan. For those on the new plan, they would get to start their HSA right away. I could even see the government putting a certain amount of money in their HSA’s to account for contributions they had made into the system over the years, at the time of conversion, to jump start the thing.

    Of course, the objective is to lower Medicare costs to something that can be sustained in the long term. But I’m not talking about a really radical change in current funding levels, we are more talking about reducing future increases. Part of the advantage of this kind of system is to reduce health care costs and inflation, by sharply reducing the endless paperwork of insurance claims processing and improving physician cash flow by allowing them to be paid immediately upon rendering services. As I indicated earlier, people presently paying cash can routinely negotiate prices that meet or are lower than negotiated insurance prices, so I think you could easily realize a 10-20% cost reduction by eliminating routine insurance claims. I would put a lot of the rest of the money into people’s HSA’s. When they save money, allow them to roll it over to future years. Eventually, after specified amounts are exceeded, allow it to be used for non-healthcare purposes upon payment of applicable taxes, as is the case with ordinary HSA’s or IRA’s. Incentives are a wonderful thing.

  • DonS

    tODD @ 20: I should have read further before I posted. “I see you saying here that “seniors should pay out of pocket for routine medical care”. In what way could that be called “Medicare” or not be called “private care”?

    Well, Medicare doesn’t pay for everything. There is the famous “doughnut hole” for prescription drugs, which weren’t covered at all until Bush’s plan came into effect. There are also substantial copayments for most service, until a certain maximum is reached. So the term “Medicare” doesn’t mean “completely paid for by the government”.

    As for transition, I’m sure the only way to possibly implement something like this, politically, would be to phase it in over many years. You certainly couldn’t make such a dramatic change for any existing beneficiaries, and probably not for those less than 10 years away from eligibility. I could foresee establishing it as a mandatory change for those under a particular age (say 45), and making it an optional change for those over that age. I am over that age, but I would opt in in a heartbeat. But others like the security of a more comprehensive plan. For those on the new plan, they would get to start their HSA right away. I could even see the government putting a certain amount of money in their HSA’s to account for contributions they had made into the system over the years, at the time of conversion, to jump start the thing.

    Of course, the objective is to lower Medicare costs to something that can be sustained in the long term. But I’m not talking about a really radical change in current funding levels, we are more talking about reducing future increases. Part of the advantage of this kind of system is to reduce health care costs and inflation, by sharply reducing the endless paperwork of insurance claims processing and improving physician cash flow by allowing them to be paid immediately upon rendering services. As I indicated earlier, people presently paying cash can routinely negotiate prices that meet or are lower than negotiated insurance prices, so I think you could easily realize a 10-20% cost reduction by eliminating routine insurance claims. I would put a lot of the rest of the money into people’s HSA’s. When they save money, allow them to roll it over to future years. Eventually, after specified amounts are exceeded, allow it to be used for non-healthcare purposes upon payment of applicable taxes, as is the case with ordinary HSA’s or IRA’s. Incentives are a wonderful thing.

  • DonS

    Jimmy, welcome to the discussion!

    Dr. Veith, I think you make a good point about the supply of doctors. However, it’s not nearly as hard to get into medical school today as it was 30 years ago when I was in college. The process of becoming a doctor is arduous and expensive, causing medical students and residents to essentially have to put their lives on hold until their early 30′s. Their number of earning years are substantially reduced compared to the rest of us, and they come out of school with large debts. Then, they get into practice facing all of the costs of starting up a medical practice and paying for insurance. To boot, from the first day they are under a payment schedule imposed upon them by Medicare, Medicaid, or a huge insurance company and requiring them to fill out and submit claim paperwork for each patient they see. They then wait for several weeks to receive payment. Medical practice is not that rewarding today, not enough to justify all of the initial start-up costs for many would-be doctors. Jimmy, to your first point, in a typical big city, where most speci@lists can be found, $500,000 isn’t that much money for a person who probably didn’t start earning a decent living until they were 35, is extraordinarily trained, and each day bears the responsibility for treating and maintaining sick or grievously injured human beings. Moreover, I’m not sure how many speci@lists make nearly that amount anymore. I know general practitioners often barely make six figures. Under some government health plans, such as Medicaid, they get paid under $20 to see a patient, which is ridiculous. You pay more than that to get your nails done.

    As to your second point, supply and demand definitely doesn’t work for acute medical procedures or emergencies. That’s where catastrophic medical insurance comes into play. But I think it can work for the more routine matters. I don’t understand why we think a routine practitioner visit should be completely paid for. What other service do we receive for nothing out of pocket? Maybe we should have haircut insurance, because I really don’t like having to lay out $22 for a haircut every six weeks :-) (yeah, I know, I live in CA). Those people I know who are uninsured and pay cash for medical services certainly pay attention to the cost of those services, and make sure to negotiate appropriately. If more of us did that, it would help. I think it would help a lot.

    I’ve got no argument with your third point. I avoid the doctor at all costs. However, I know a lot of people who go to the doctor with every sniffle, largely because it’s free. Make ‘em pay $65 to go, and they’ll figure out that an antihistamine will help their sniffle and that antibiotics really don’t help when you have a virus.

    I heartily disagree with your fourth point. Many experts disagree as well, including the head of the Congressional Budget Office http://blogs.abcnews.com/politicalpunch/2009/08/congressional-budget-expert-says-preventive-care-will-raise-not-cut-costs.html Modern preventive care is more than just seeing your doctor once a year and getting your blood pressure checked. It’s scans, colonoscopies, mammograms, blood work, etc. For those 45 and older, all of the recommended annual or biannual tests can run hundreds to thousands of dollars per year. When you make that all free, you are adding a tremendous fixed annual cost to the system. And, ultimately, everyone gets sick and dies anyway. I’m not meaning that to be morbid, but logically, it’s impossible to see how free preventive care for everyone SAVES money. It just can’t. You’re taking on all of the annual preventive care, plus the end of life care, for each person. It’s unsustainable.

    I’m not saying that we as individuals don’t benefit from preventive medical care. Some of the recommended tests and procedures are a good idea, some are overkill (no pun intended, but, really, avoid excessive scans). But if such prevention is important to us, we should each be fully capable of prioritizing some of our own resources to pay for it, in the same way we manage to come up with money to pay for our food and gas each day.

  • DonS

    Jimmy, welcome to the discussion!

    Dr. Veith, I think you make a good point about the supply of doctors. However, it’s not nearly as hard to get into medical school today as it was 30 years ago when I was in college. The process of becoming a doctor is arduous and expensive, causing medical students and residents to essentially have to put their lives on hold until their early 30′s. Their number of earning years are substantially reduced compared to the rest of us, and they come out of school with large debts. Then, they get into practice facing all of the costs of starting up a medical practice and paying for insurance. To boot, from the first day they are under a payment schedule imposed upon them by Medicare, Medicaid, or a huge insurance company and requiring them to fill out and submit claim paperwork for each patient they see. They then wait for several weeks to receive payment. Medical practice is not that rewarding today, not enough to justify all of the initial start-up costs for many would-be doctors. Jimmy, to your first point, in a typical big city, where most speci@lists can be found, $500,000 isn’t that much money for a person who probably didn’t start earning a decent living until they were 35, is extraordinarily trained, and each day bears the responsibility for treating and maintaining sick or grievously injured human beings. Moreover, I’m not sure how many speci@lists make nearly that amount anymore. I know general practitioners often barely make six figures. Under some government health plans, such as Medicaid, they get paid under $20 to see a patient, which is ridiculous. You pay more than that to get your nails done.

    As to your second point, supply and demand definitely doesn’t work for acute medical procedures or emergencies. That’s where catastrophic medical insurance comes into play. But I think it can work for the more routine matters. I don’t understand why we think a routine practitioner visit should be completely paid for. What other service do we receive for nothing out of pocket? Maybe we should have haircut insurance, because I really don’t like having to lay out $22 for a haircut every six weeks :-) (yeah, I know, I live in CA). Those people I know who are uninsured and pay cash for medical services certainly pay attention to the cost of those services, and make sure to negotiate appropriately. If more of us did that, it would help. I think it would help a lot.

    I’ve got no argument with your third point. I avoid the doctor at all costs. However, I know a lot of people who go to the doctor with every sniffle, largely because it’s free. Make ‘em pay $65 to go, and they’ll figure out that an antihistamine will help their sniffle and that antibiotics really don’t help when you have a virus.

    I heartily disagree with your fourth point. Many experts disagree as well, including the head of the Congressional Budget Office http://blogs.abcnews.com/politicalpunch/2009/08/congressional-budget-expert-says-preventive-care-will-raise-not-cut-costs.html Modern preventive care is more than just seeing your doctor once a year and getting your blood pressure checked. It’s scans, colonoscopies, mammograms, blood work, etc. For those 45 and older, all of the recommended annual or biannual tests can run hundreds to thousands of dollars per year. When you make that all free, you are adding a tremendous fixed annual cost to the system. And, ultimately, everyone gets sick and dies anyway. I’m not meaning that to be morbid, but logically, it’s impossible to see how free preventive care for everyone SAVES money. It just can’t. You’re taking on all of the annual preventive care, plus the end of life care, for each person. It’s unsustainable.

    I’m not saying that we as individuals don’t benefit from preventive medical care. Some of the recommended tests and procedures are a good idea, some are overkill (no pun intended, but, really, avoid excessive scans). But if such prevention is important to us, we should each be fully capable of prioritizing some of our own resources to pay for it, in the same way we manage to come up with money to pay for our food and gas each day.

  • DonS

    Darn. Dr. Veith, you can just delete my comment in the spam filter. I forgot about “speci@list” again.

    Thanks.

  • DonS

    Darn. Dr. Veith, you can just delete my comment in the spam filter. I forgot about “speci@list” again.

    Thanks.

  • http://www.toddstadler.com/ tODD

    DonS (@25), I get that “Medicare doesn’t pay for everything”. Heck, my employer’s plan doesn’t pay for everything, either.

    I just don’t understand your specific objection to my referring to your proposal as putting the elderly on private health care (“Where in my post did I advocate putting elderly patients in private health care?” @6, and “So I am not sure why you are going on about dumping seniors in private care” @7).

    But your proposal would apparently require seniors to pay all of their health care costs up to some level (and, I always wonder, what sort of level do you have in mind? — you didn’t answer my questions about that earlier as to fixed or proportional). To whom would they pay? In what sense could you argue that the government was involved whatsoever, in your proposal, before the catastrophic insurance kicked in? Wouldn’t people, including the elderly, be forced off government insurance, to work exclusively with private health care companies?

  • http://www.toddstadler.com/ tODD

    DonS (@25), I get that “Medicare doesn’t pay for everything”. Heck, my employer’s plan doesn’t pay for everything, either.

    I just don’t understand your specific objection to my referring to your proposal as putting the elderly on private health care (“Where in my post did I advocate putting elderly patients in private health care?” @6, and “So I am not sure why you are going on about dumping seniors in private care” @7).

    But your proposal would apparently require seniors to pay all of their health care costs up to some level (and, I always wonder, what sort of level do you have in mind? — you didn’t answer my questions about that earlier as to fixed or proportional). To whom would they pay? In what sense could you argue that the government was involved whatsoever, in your proposal, before the catastrophic insurance kicked in? Wouldn’t people, including the elderly, be forced off government insurance, to work exclusively with private health care companies?

  • DonS

    tODD @ 28: Quite simply, if Medicare is your insurance plan, and you have no private supplemental insurance, then you are not covered by a private health care plan. I guess if you mean by “private health care” that a patient has to pay for some things himself, then sure. But that’s not the conventional definition of the term in this context. Moreover, my proposal would provide that a lot of the out of pocket expenses, particularly for lower income people, would be paid for out of HSA accounts at least partially funded with government money.

    I haven’t thought through the level for the deductible. In regular HSA plans, it is typically somewhere between $1500 and 3000. Such a thing would be designed by actuaries, and might vary depending upon the resources of the insured.

    “Wouldn’t people, including the elderly, be forced off government insurance, to work exclusively with private health care companies?”

    No, not if you mean private health insurers. Though I guess it is possible that such insurers might come into the market to offer supplements for covering all or part of the deductible. Why would the elderly be forced off government insurance? I don’t understand.

  • DonS

    tODD @ 28: Quite simply, if Medicare is your insurance plan, and you have no private supplemental insurance, then you are not covered by a private health care plan. I guess if you mean by “private health care” that a patient has to pay for some things himself, then sure. But that’s not the conventional definition of the term in this context. Moreover, my proposal would provide that a lot of the out of pocket expenses, particularly for lower income people, would be paid for out of HSA accounts at least partially funded with government money.

    I haven’t thought through the level for the deductible. In regular HSA plans, it is typically somewhere between $1500 and 3000. Such a thing would be designed by actuaries, and might vary depending upon the resources of the insured.

    “Wouldn’t people, including the elderly, be forced off government insurance, to work exclusively with private health care companies?”

    No, not if you mean private health insurers. Though I guess it is possible that such insurers might come into the market to offer supplements for covering all or part of the deductible. Why would the elderly be forced off government insurance? I don’t understand.

  • http://theobservationtree.blogspot.com Louis

    Further comment on Jimmy’s point: Many Canadian doctors end up in the US because of the problem – low supply, high pay. Thus Canada has a shortage – especially the “climatically & urban challenged” provinces like Saskatchewan. Result: Upwards of 30% of doctors in Saskatchewan is South African – because the pay is good and (this one is more important) the environment is safe. (I get asked – Are you a Doctor? – often, as soon as people hear I am South African!)

    What happens in South Africa, then? The SA government has been importing….

    Cuban doctors.

    Thus – the American medical establishment are merely continuing the squeeze on Cuba.. :)

  • http://theobservationtree.blogspot.com Louis

    Further comment on Jimmy’s point: Many Canadian doctors end up in the US because of the problem – low supply, high pay. Thus Canada has a shortage – especially the “climatically & urban challenged” provinces like Saskatchewan. Result: Upwards of 30% of doctors in Saskatchewan is South African – because the pay is good and (this one is more important) the environment is safe. (I get asked – Are you a Doctor? – often, as soon as people hear I am South African!)

    What happens in South Africa, then? The SA government has been importing….

    Cuban doctors.

    Thus – the American medical establishment are merely continuing the squeeze on Cuba.. :)


CLOSE | X

HIDE | X