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Here ya go, federal budget she is fixd. Now we just need to overthrow democracy to be able to implement it.
They're Stealing Your Money
Apr. 16th, 2004 04:55 pmThere's a bill in the Massachusetts legislature to create a state-wide single-payer medical insurance system. This is idiocy rampant. You want to know why? We've got a great example of the single-payer system right here in America. Half our health care spending is under a single-payer system, called Medicare.
The Medicare trustees have recently announced that they're going to go bankrupt in 2019 (that's in fifteen years for those of you keeping score at home). More importantly, due to the mostly mythical nature of the trust funds, they're going to start paying out more than they collect as soon as this year. The present value of the unfunded liabilities for Medicare is $27.7 trillion. That's approximately equal to the total value of all publicly traded companies in the world. 2.5x our GDP. That's the money we would have to dump in Right Now so that after investment growth there would be just barely enough to pay for the medical benefits we've promised people. Medicare is $280 billion per year right now (over $1000 for every man, woman, and child in the country), and rising fast. That's without paying for prescription medication.
Raising the retirement age won't fix this; health care costs are heavily loaded towards the end of your life.
Cutting benefits is a terrible plan, and no one would ever go for it. We'd have people dying while sitting on waiting lists for necessary procedures.
Part of the problem is the drug benefit Congress passed last year. Helpfully, the Democrats actually wanted a more expensive version.
Most of the problem is hospital costs. A staggering proportion of spending is on patients in the final six to nine months of their lives.
More fundamentally, the people making the decisions about what kind of care to receive (or provide) or where to get it have no clue what anything costs, or at least have no incentive to care. The doctors seem to think money is filthy and profane (up until they get their paycheck). They don't want to allow questions of cost to affect their Higher Calling. Well, get a grip. Cost-benefit trade-offs are being made whether you like it or not. The question is whether you're going to make them based on sensible criteria or not. How does it make sense that we've been paying for massively expensive procedures of dubious benefit, like cardiac bypass surgery, but until recently there wasn't a dime for cholesterol-lowering medications that cost pennies on the dollar? Why isn't there a way someone could decide to provide funding for smoking cessation programs, or exercise and diet regimens? Why is catastrophic health care insurance illegal? Why aren't more people aware of Medical Savings Accounts?
If you watch TV without a TiVo, you already know that there are thousands of commercials for diabetes testing supplies. That's because diabetics with Medicare get that stuff for free, and the providers bill Medicare directly. Why are there so many commercials for the diabetic supplies and none for other stuff Medicare also pays for? Because Medicare's prices set for the diabetes stuff are way too high -- lots of people are piling into that business because the profits are artificially enormous. If you live in Massachusetts you've seen the same thing for auto glass. The state-mandated auto glass insurance costs next to nothing to the consumer, and overpays the glass replacement companies, so they conduct a massive advertising blitz to try to grab as much of your grossly subsidized business as they can.
One tired argument that constantly gets advanced for single-p;ayer systems is that administrative costs for HMOs eat up 30% or more of the spending on health care, while Medicare spends less than 2% on administrative costs. Well, sure, Medicare saves on administrative costs. That's what you get if you don't bother to make more than a cursory effort to detect, prevent, or prosecute fraud. Fraudulent Medicare billing is attaining some really staggering numbers. Pretty soon billing Medicare for fictional procedures is likely to become a bigger industry than piddling stuff like making cars or growing food.
I admit that the masses of pointless paperwork associated with health care are terribly wasteful. But that would all change if the insurance companies were subjected to a legitimate competitive arena. If one HMO had fluid, painless referrals and a coherent, non-psychotic billing procedure, right now it wouldn't do them much good. HMOs are competing to be selected by employers, who really don't care how well they provide their services.
Speaking of which, corporations shouldn't be in the business of providing health insurance. Or pensions. Those aren't areas of expertise for them, and linking health care and pensions to employment just perpetuates the problem of the millions of uninsured and indigent in our society. But that's a topic for another day.
Old people need reasons to care about how much their medical care costs. There need to be good reasons for them to consider private insurance options, and the insurance carriers need to be allowed the flexibility to offer a wide variety of different forms of coverage, instead of the cookie-cutter one-size-fits-all package they're currently permitted to offer.
The Medicare trustees have recently announced that they're going to go bankrupt in 2019 (that's in fifteen years for those of you keeping score at home). More importantly, due to the mostly mythical nature of the trust funds, they're going to start paying out more than they collect as soon as this year. The present value of the unfunded liabilities for Medicare is $27.7 trillion. That's approximately equal to the total value of all publicly traded companies in the world. 2.5x our GDP. That's the money we would have to dump in Right Now so that after investment growth there would be just barely enough to pay for the medical benefits we've promised people. Medicare is $280 billion per year right now (over $1000 for every man, woman, and child in the country), and rising fast. That's without paying for prescription medication.
Raising the retirement age won't fix this; health care costs are heavily loaded towards the end of your life.
Cutting benefits is a terrible plan, and no one would ever go for it. We'd have people dying while sitting on waiting lists for necessary procedures.
Part of the problem is the drug benefit Congress passed last year. Helpfully, the Democrats actually wanted a more expensive version.
Most of the problem is hospital costs. A staggering proportion of spending is on patients in the final six to nine months of their lives.
More fundamentally, the people making the decisions about what kind of care to receive (or provide) or where to get it have no clue what anything costs, or at least have no incentive to care. The doctors seem to think money is filthy and profane (up until they get their paycheck). They don't want to allow questions of cost to affect their Higher Calling. Well, get a grip. Cost-benefit trade-offs are being made whether you like it or not. The question is whether you're going to make them based on sensible criteria or not. How does it make sense that we've been paying for massively expensive procedures of dubious benefit, like cardiac bypass surgery, but until recently there wasn't a dime for cholesterol-lowering medications that cost pennies on the dollar? Why isn't there a way someone could decide to provide funding for smoking cessation programs, or exercise and diet regimens? Why is catastrophic health care insurance illegal? Why aren't more people aware of Medical Savings Accounts?
If you watch TV without a TiVo, you already know that there are thousands of commercials for diabetes testing supplies. That's because diabetics with Medicare get that stuff for free, and the providers bill Medicare directly. Why are there so many commercials for the diabetic supplies and none for other stuff Medicare also pays for? Because Medicare's prices set for the diabetes stuff are way too high -- lots of people are piling into that business because the profits are artificially enormous. If you live in Massachusetts you've seen the same thing for auto glass. The state-mandated auto glass insurance costs next to nothing to the consumer, and overpays the glass replacement companies, so they conduct a massive advertising blitz to try to grab as much of your grossly subsidized business as they can.
One tired argument that constantly gets advanced for single-p;ayer systems is that administrative costs for HMOs eat up 30% or more of the spending on health care, while Medicare spends less than 2% on administrative costs. Well, sure, Medicare saves on administrative costs. That's what you get if you don't bother to make more than a cursory effort to detect, prevent, or prosecute fraud. Fraudulent Medicare billing is attaining some really staggering numbers. Pretty soon billing Medicare for fictional procedures is likely to become a bigger industry than piddling stuff like making cars or growing food.
I admit that the masses of pointless paperwork associated with health care are terribly wasteful. But that would all change if the insurance companies were subjected to a legitimate competitive arena. If one HMO had fluid, painless referrals and a coherent, non-psychotic billing procedure, right now it wouldn't do them much good. HMOs are competing to be selected by employers, who really don't care how well they provide their services.
Speaking of which, corporations shouldn't be in the business of providing health insurance. Or pensions. Those aren't areas of expertise for them, and linking health care and pensions to employment just perpetuates the problem of the millions of uninsured and indigent in our society. But that's a topic for another day.
Old people need reasons to care about how much their medical care costs. There need to be good reasons for them to consider private insurance options, and the insurance carriers need to be allowed the flexibility to offer a wide variety of different forms of coverage, instead of the cookie-cutter one-size-fits-all package they're currently permitted to offer.
