Bruce Bartlett gives you a different way of looking at the mess your political leaders, over a number of generations, have gotten us into and what it will cost, at a minimum, to fulfill the promises they’ve made over the decades.
To summarize, we see that taxpayers are on the hook for Social Security and Medicare by these amounts: Social Security, 1.3% of GDP; Medicare part A, 2.8% of GDP; Medicare part B, 2.8% of GDP; and Medicare part D, 1.2% of GDP. This adds up to 8.1% of GDP. Thus federal income taxes for every taxpayer would have to rise by roughly 81% to pay all of the benefits promised by these programs under current law over and above the payroll tax.
Since many taxpayers have just paid their income taxes for 2008 they may have their federal returns close at hand. They all should look up the total amount they paid and multiply that figure by 1.81 to find out what they should be paying right now to finance Social Security and Medicare.
To put it another way, the total unfunded indebtedness of Social Security and Medicare comes to $106.4 trillion. That is how much larger the nation’s capital stock would have to be today, all of it owned by the Social Security and Medicare trust funds, to generate enough income to pay all the benefits that have been promised over and above future payroll taxes. But the nation’s total private net worth is only $51.5 trillion, according to the Federal Reserve. In effect, we have promised the elderly benefits equal to more than twice the nation’s total wealth on top of the payroll tax.
We again have a new crop of political leaders making similar promises about a range of things, from energy to the environment to health care. Look at what they’ve done with the portion of health care they were given previously?
Someone – anyone – tell me how, given the performance of government to this point with Medicare and Medicaid, it is going to provide lower cost health care when it is obvious that it has been instrumental in doing just the opposite?
For some reason, I just can’t get past that negative and inconvenient truth enough to suspend disbelief and decide that once government is running the whole show, everything will fall in line and we’ll have world-class health care at a much lower price – all managed by government.
And one other point Bartlett makes – this mess was made by politicians and, as our laws are written, can only be fixed by politicians. But politicians rarely, if ever like to make decisions which will be unpopular and cause them to have to find new employment. No one likes to be the bad guy. So don’t expect much in the way of “fixing” this mess. You’re more likely to see the whole house of cards collapse because it is unsustainable and the administration in charge at the time blame the previous one (kind of like what you’re seeing now on just about everything else) than to see any political leader actually make the hard decisions necessary (and then win over the Congress) to actually take care of these looming problems.
Enjoy your Sunday.
My latest Examiner column about the usual – the law of unintended consequences.
The Congress described as the “most ethical and open Congress” in history by its Speaker is busy writing massive and costly health care legislation in secret. Even Democrats aren’t happy about this process:
Forty-five House Democrats in the party’s moderate-to-conservative wing have protested the secretive process by which party leaders in their chamber are developing legislation to remake the health care system.
The lawmakers, members of the fiscally conservative Blue Dog Coalition, said they were “increasingly troubled” by their exclusion from the bill-writing process.
They expressed their concerns in a letter delivered Monday to three House committee chairmen writing the bill, which House leaders hope to pass this summer.
Representative Mike Ross, an Arkansas Democrat who is chairman of the coalition’s health task force, said: “We don’t need a select group of members of Congress or staff members writing this legislation. We don’t want a briefing on the bill after it’s written. We want to help write it.”
Of course the Blue Dogs are Democrats elected in mostly conservative districts and thus hold seats which have traditionally been Republican. Meanwhile the chairmen of the three committees in question all hold safe Democratic seats.
The committee chairmen writing the House bill are Representatives Henry A. Waxman and George Miller, both of California, and Charles B. Rangel of New York.
Asked about the letter, Karen Lightfoot, a spokeswoman for Mr. Waxman, said he had met with some members of the Blue Dog Coalition and welcomed their suggestions. When she was asked why, then, they were complaining, she said, “That’s more of a question for the Blue Dogs than for us.”
Very similar to the Obama outreach to Republicans on the budget and stimulus. He ‘welcomed their suggestions’, but they certainly had no chair at the table when the legislation was formulated.
Your future health care is being decided behind closed doors by the liberal wing of the Democratic party. Apparently input from the “center” and right are not welcome. I’m not surprised in the least, but I’m sure there are some out there that are.
[HT: Mary R]
Today’s “Health Care Reform” day.
One of the myths Democrats are going to try to continue to promote is that 95% of Americans are getting a tax cut. Of course that means they’re politically prohibited from raising income taxes. But that certainly doesn’t mean that they must refrain from other taxes and fees which will impact 100% of Americans and, by the way, if they’re like the following, will be highly regressive:
The Center for Science in the Public Interest, a Washington-based watchdog group that pressures food companies to make healthier products, plans to propose a federal excise tax on soda, certain fruit drinks, energy drinks, sports drinks and ready-to-drink teas. It would not include most diet beverages. Excise taxes are levied on goods and manufacturers typically pass them on to consumers.
The proposal is also being touted as something which will help pay for “health care reform”:
The Congressional Budget Office, which is providing lawmakers with cost estimates for each potential change in the health overhaul, included the option in a broad report on health-system financing in December. The office estimated that adding a tax of three cents per 12-ounce serving to these types of sweetened drinks would generate $24 billion over the next four years.
Of course the article goes on to state that lawmakers aren’t considering the tax at present, but then the vast majority of our legislators don’t write or read the legislation they pass so saying they’re not considering it doesn’t mean it isn’t being considered by those who will write it (like the CSPI) or won’t be in legislation.
This sort of tax is also seen as a means of modifying behavior because a certain group considers the product it wants taxed as “unhealthy”.
Proponents of the tax cite research showing that consuming sugar-sweetened drinks can lead to obesity, diabetes and other ailments. They say the tax would lower consumption, reduce health problems and save medical costs. At least a dozen states already have some type of taxes on sugary beverages, said Michael Jacobson, executive director of the Center for Science in the Public Interest.
“Soda is clearly one of the most harmful products in the food supply, and it’s something government should discourage the consumption of,” Mr. Jacobson said.
Given that government is now seeking entry into the health care arena in a much bigger way than at present, and its stated goal is to make health care less costly, this fits supports the goal and gives the argument credibility that it wouldn’t otherwise enjoy. Note the phrase I’ve put in bold – it should send shivers down your spine. What sort of precedent would that set? And, what would be next?
Well, here you go:
Health advocates are floating other so-called sin tax proposals and food regulations as part of the government’s health-care overhaul. Mr. Jacobson also plans to propose Tuesday that the government sharply raise taxes on alcohol, move to largely eliminate artificial trans fat from food and move to reduce the sodium content in packaged and restaurant food.
And that’s the proverbial tip of the iceberg. The premise that it is the job of government to modify behavior through taxation (especially if it saves money) has obviously been swallowed whole.
Back to the original point about the myth of the tax cuts for 95% of Americans:
The beverage tax is just one of hundreds of ideas that lawmakers are weighing to finance the health-care plans. They’re expected to narrow the list in coming weeks.
But you can bet that the list won’t be too narrow – someone has got to pay for this. And, with mommy government deciding what you can and can’t eat, you might actually lose some weight. Not because you are necessarily eating healthy food, but because you can’t afford as much anymore. That’s because the one thing you can count on is your wallet will definitely lose weight as this “health care reform” abomination moves forward.
From a Washington Post editorial commenting on the health care industry proposal yesterday to try to save 2 trillion dollars over 10 years:
But it is important to note what wasn’t included yesterday. None of the interest groups signed up for a specific number; no one is saying who will sacrifice what, or how much. All are promising to “do our part,” but the actual share of the $2 trillion that would fall on each pair of shoulders was not laid out. What would make up the substance of the plan? That remains to be seen. How would the private sector be held accountable for this promise to reduce costs? That, too, remains to be seen.
Of course, Barack Obama’s promises to save money through the usual nebulous “waste, fraud, and abuse” rhetoric are no more specific than those proposed by the “interest groups” yesterday:
Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.
As is obvious, the assumptions in this sentence are legion and that includes the savings.
The White House has emphasized repeatedly that health-care reform is entitlement reform — that is, an answer to the nation’s long-term fiscal challenge. Yet, so far, it is backing a plan to expand coverage that would cost taxpayers between $1 trillion and $1.5 trillion over 10 years, while it has proposed health-care savings of only $309 billion.
Calling it an entitlement reform and “an answer to the nation’s long term fiscal challenge” effectively lumps all health care under government auspices. An entity which has managed to mismanage the portion it has assumed over the years into a “fiscal challenge’ now wants the rest of the industry under its effective control with an initial price tag of 1.5 trillion (anyone who has ever monitored government estimates of cost know they are always low ball estimates which end up costing many more times the initial estimate).
I’d like to see the WaPo challenge that estimate and this:
Financing Health Care Reform. The reserve fund is financed by a combination of rebalancing the tax code so that the wealthiest pay more as well as specific health care savings in three areas: promoting efficiency and accountability, aligning incentives towards quality and better care, and encouraging shared responsibility. Taken together, the health care savings would total $316 billion over 10 years while improving the quality and efficiency of health care, without negatively affecting the care Americans receive.
You can read the specifics of the administration’s plan below the cited paragraph, but in essence it consists of curbing waste, fraud and abuse (as if that’s actually measurable in terms of savings) and increasing “quality” of care (an “efficiency” that assumes the present “quality” isn’t good enough), stressing preventive care (and assuming everyone will take advantage of that) and reducing drug prices (a form of cost control).
How anyone assumes even $316 billion in savings based on those assumptions is beyond me. But what one can fairly claim, given experience with government proposals and estimates, is that 1.5 trillion as a “cost” figure is probably well below its eventual or real cost. If anyone actually believes the government will be more efficient in the delivery of health care than a market based system (something we don’t have, even now, as government’s intrusion has distorted that market) will gladly buy into the claims being made. Those of us who have seen these sorts of grand programs and estimates before (check into the promised cost of Medicare and its eventual real cost) know that we’re being led down the primrose path to ruin by a bunch of smooth talking politicians who really haven’t a clue … again.
As you may or may not know, I just sent the last week touring the houses of Thomas Jefferson, James Madison and James Monroe – three of this nation’s founding fathers. So when I glanced through the following interview with Barack Obama I tried to picture any of these three men ever contemplating this question or a role for government in the context of the question and frankly, it’s unimaginable.
The only vision I could even begin to imagine is the three of them looking on sadly and shaking their heads “no” in unison as they tried to grasp the size of government and the depth of its intrusion into the lives of citizens the questions and answers indicated. I’m sure they’d also be trying to figure out where it all went wrong. The questions have to do with “end of life care”:
Q:…where it’s $20,000 for an extra week of life.
THE PRESIDENT: Exactly. And I just recently went through this. I mean, I’ve told this story, maybe not publicly, but when my grandmother got very ill during the campaign, she got cancer; it was determined to be terminal. And about two or three weeks after her diagnosis she fell, broke her hip. It was determined that she might have had a mild stroke, which is what had precipitated the fall.
So now she’s in the hospital, and the doctor says, Look, you’ve got about — maybe you have three months, maybe you have six months, maybe you have nine months to live. Because of the weakness of your heart, if you have an operation on your hip there are certain risks that — you know, your heart can’t take it. On the other hand, if you just sit there with your hip like this, you’re just going to waste away and your quality of life will be terrible.
And she elected to get the hip replacement and was fine for about two weeks after the hip replacement, and then suddenly just — you know, things fell apart.
I don’t know how much that hip replacement cost. I would have paid out of pocket for that hip replacement just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model, is a very difficult question. If somebody told me that my grandmother couldn’t have a hip replacement and she had to lie there in misery in the waning days of her life — that would be pretty upsetting.
“…society making those decisions to give my grandmother … a hip replacment?” Above that he points to a doctor giving who that choice?
Below that who is Obama talking about making that decision or having that choice? Well it isn’t his grandmother. And although he uses the term ‘society’, he means government. Note he says that if someone had told him no he’d be upset, but he’s setting up the table to be ‘upset’. This is an old Obama trick – acknowledge the downside in a very personal way while still pushing for that downside.
Q: And it’s going to be hard for people who don’t have the option of paying for it.
THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
Anyone who hasn’t quite figured out the rationing model Obama is talking about with his answers to these two questions needs to take a remedial reading course. Anyone – where does he see the opportunity to “cut costs” in the medical field?
And, how will he do it. Unless you’re still hungover from celebrating Guinesses’ 250th birthday, he is talking about denial of service especially to the elderly. Government will determine whether or not you’re worth that $20,000 operation. And the “moral issue” he’s talking about is all wrapped up in egalitarianism. What he’s implying may be “immoral” is allowing those who can pay access to the service while those who can’t pay (and for whom government won’t pay) are denied it.
Again, contemplate the model Obama talks about – reducing the cost of health care – and tell me which way that “moral issue” would be decided? Got the money? Too bad – it would be “immoral” to let you buy the service others are denied.
Q: So how do you — how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
What a question. The assumption is swallowed whole. Where was the question “what if ‘we’ don’t want others making those decisions?”
And apparently you guys in fly-over country are too emotionally involved to make that sort of a decision through “normal political channels” so government have some unelected outside group develop the “guidance.” Only the elite can answer these questions properly.
Three questions, stunning in their implications. Three answers which should make the skin of all lovers of liberty crawl. I’m again left imagining Jefferson, Madison and Monroe listening in on this with unbelieving looks of horror on their faces. The irony is, their opposition to this incredible power grab by government would again leave them in the category of “radical”.
Not to talk down the seriousness of the situation with the “swine flu,” but 13,000 people have died from seasonal influenza since January:
An outbreak of swine flu that is suspected in more than 150 deaths in Mexico and has sickened dozens of people in the United States and elsewhere has grabbed the attention of a nervous public and of medical officials worried the strain will continue to mutate and spread.
Experts are nervous that, as a new strain, the swine flu will be harder to stop because there aren’t any vaccines to fight it.
But even if there are swine-flu deaths outside Mexico — and medical experts say there very well may be — the virus would have a long way to go to match the roughly 36,000 deaths that seasonal influenza causes in the United States each year.
Since January, more than 13,000 people have died of complications from seasonal flu, according to the Centers for Disease Control and Prevention’s weekly report on the causes of death in the nation.
No fewer than 800 flu-related deaths were reported in any week between January 1 and April 18, the most recent week for which figures were available.
Let’s put things into perspective for a moment. The swine flu scare is something to be concerned about, but it’s not a reason to cook up asinine conspiracy theories or use the public’s fear to advance your big government agenda.
GOP Know-Nothings Fought Pandemic Preparedness
posted by John Nichols on 04/27/2009 @ 08:00am
When House Appropriations Committee chairman David Obey, the Wisconsin Democrat who has long championed investment in pandemic preparation, included roughly $900 million for that purpose in this year’s emergency stimulus bill, he was ridiculed by conservative operatives and congressional Republicans.
Obey and other advocates for the spending argued, correctly, that a pandemic hitting in the midst of an economic downturn could turn a recession into something far worse — with workers ordered to remain in their homes, workplaces shuttered to avoid the spread of disease, transportation systems grinding to a halt and demand for emergency services and public health interventions skyrocketing. Indeed, they suggested, pandemic preparation was essential to any responsible plan for renewing the U.S. economy.
But former White House political czar Karl Rove and key congressional Republicans — led by Maine Senator Susan Collins — aggressively attacked the notion that there was a connection between pandemic preparation and economic recovery.
Now, as the World Health Organization says a deadly swine flu outbreak that apparently began in Mexico but has spread to the United States has the potential to develop into a pandemic, Obey’s attempt to secure the money seems eerily prescient.
And his partisan attacks on his efforts seem not just creepy, but dangerous.
According to this theory, if not for GOP opposition to one particular line item in the stimulus bill, everything would be perfectly hunky-dory right now. The leftosphere, having received their marching orders, responded dutifully:
Christy Hardin Smith: “Pandemic preparedness? Another GOP casualty. Dude, where’s my planning?”
Washington Monthly: GREAT MOMENTS IN POLITICAL INSIGHT (“On Feb. 5, the same as Collins unfortunate remarks, Karl Rove had an op-ed in the Wall Street Journal complaining about stimulus package, in part because it included money for ‘pandemic flu preparations.’
Sometimes, these folks just don’t think ahead.”)
It’s hard to know where to begin with this sort of nonsense. Competing for most ridiculous premise is the idea that a couple of remarks from Susan Collins and Karl Rove (who does not vote in Congress) were able to back off the entire Democratic Party. You know, the ones who control the House and Senate? I mean, how spineless do you have to be if you control the House, the Senate, and the White House, but you can’t stand up to one little old lady from Maine and a former politico? Pretty wimpy I’d say.
We’re also apparently expected to believe that pandemic flu was a big issue during the days of stimulus debate, instead of the impending financial collapse unless Congress did something (anything!). My recollection of those heady days in January and February conjures up much back-and-forth about whether the bill would save jobs, but nothing about whether we should do more to prevent a flu pandemic. Come to think of it, isn’t that why it was called the “stimulus bill” in the first place, as in to stimulate the economy? And wasn’t there a bunch of hullabaloo about so much pork being in the bill? Yes, I’m sure I read about that somewhere. Indeed, even Chuck Schumer was calling appropriations for pandemic preparations “porky”:
He [Chuck Schumer] said the compromise hammered out between Senate Democrats and moderate Republicans – which has enough support to get it past any threat of a filibuster – was far better than that passed by the House on Jan. 29.
“All those little porky things that the House put in, the money for the [National] Mall or the sexually transmitted diseases or the flu pandemic, they’re all out,” Schumer said.
Clearly, beefing up the federal government’s response to a flu outbreak was not the priority during the stimulus debate.
The “GOP did it” analysis also seems to suffer from that problem of time beginning on the day Obama was elected. It’s further complicated by the fact that, even if Obey’s appropriation had been included in the stimulus bill, it wouldn’t have the government in any better of a position than it is now (a fact which the legislators seem to understand since they had exempted Obey’s provision from the requirements that the money appropriated be used within 30 to 90 days (i.e. section 1103)). Regardless, the idea that the money appropriated less than two months ago would save our bacon today is unrealistic at best.
But doesn’t that just beg the question: what preparations have been made for a flu pandemic? Seeing as it’s so frightfully important that we are ready and eager to blame an entire political party for potential ill health, why is it that we’re only hearing about it now? What took Congress so long? Well, nothing actually:
What’s scarier in Washington, the prospect of a flu virus that could kill millions or the possibility that voters will toss out any politician who fails to prepare the nation for such a disaster? A pandemic could be a true global catastrophe, of course. But along the Potomac the second threat is also very real. That’s a big reason why both the White House and Congress are rushing to boost America’s capacity to produce vaccines and drugs against flu and other diseases.
On Oct. 18 the Senate Health, Education, Labor & Pensions Committee hurriedly passed a bill that would offer vaccine makers new liability protections and incentives for research. And the Administration is about to issue a flu pandemic plan expected to be extremely aggressive. “There is a sense of urgency on both sides of Pennsylvania Avenue,” says Senate Budget Committee Chairman Judd Gregg (R-N.H.).
That would be an article from October 2005 when the “White House” referred to President Bush, and “Congress” referred to the Republican controlled body. Seems like the Republicans were worried about a flu outbreak after all. How worried? Enough to spend gobs of money on it which, although comparatively paltry in these post-bailout days, completely dwarfs the proposal from Rep. Obey:
In 2004, Congress approved Project BioShield, a plan that would spend $5.6 billion over 10 years to jump-start production of vaccines and drugs to counter bioterror threats.
Again, that would be a GOP-controlled Congress. Of course, the GOP hasn’t always been in control. Many will recall that the Democrats swept into power in 2006. This was heralded as the harbinger of great change, and the first wave of the Democratic majority. What fun! Seeing as how important legislating against a flu pandemic is to the Democrats, surely they did something to improve upon the meager sum approved under the reign of the hated Republicans:
The fiscal 2008 Consolidated Appropriations Act working its way through Congress this week allocates only $76 million for pandemic influenza preparedness funding for the Health and Human Services Department, though the Bush administration requested a budget of $870 million for it.
The bill also chopped in half requested funding for the HHS office managing efforts to develop a national electronic health record system.
While House and Senate appropriations committees said they continue to support HHS pandemic flu preparation efforts, they indicated in the bill that they decided to cut the 2008 pandemic preparation budget because approximately $1.2 billion remains available from funds provided in previous appropriations.
Oops … I wonder how much of that $76 million is still left? It kinda makes you think that preventing and/or preparing for a flu pandemic wasn’t really such a big priority for the Dems, now doesn’t it? Yet somehow, in the heat of the debate over whether it was a good idea to mortgage the future of a few generations of Americans, it’s Susan Collins’ and the GOP’s fault that a swine flu outbreak has occurred, and the federal government may not be prepared for it. Yeah, that makes sense.
Well, I guess we should just chalk it all up to another crisis that Rahm doesn’t want to go to waste. Nothing like the good ole game of playing politics with people’s fears of becoming deathly ill. Not that any of the leftosphere would ever approve of such tactics, seeing as how moral and sanctimonious they seem to get. [/eyeroll]
MORE: I wonder which would be more effective in dealing with the swine flu outbreak — appropriating hundreds of millions more dollars on pandemic preparations, or staffing the HHS that would be in charge of actually spending the money? I know how John Nichols and the Nation (and, therefore, the leftosphere) would answer. For them, this must just be an inconvenient distraction:
The Obama administration declared a “public health emergency” Sunday to confront the swine flu — but is heading into its first medical outbreak without a secretary of Health and Human Services or appointees in any of the department’s 19 key posts.
President Barack Obama has not yet chosen a surgeon general or the head of the Centers for Disease Control and Prevention. His choice to run the Food and Drug Administration awaits confirmation.
Smoothest transition EVAH!
EVEN MORE: I’m guessing that the fact-checkers at the Nation have been sacked:
(1) It’s a good point to make that Collins somehow thought pandemic preparation money was not an economic issue deserving of inclusion in the stimulus package. But Collins was for the money being included in some other form. Now, I think her reasoning is stupid — pandemic prevention is part of a recovery plan. But it’s not like she was against the very idea of it.
In fact she has voted for a number of bills that included pandemic prevention in the past, including the war funding bill of 2007. This undermines her point about which basket the funding is in, but also proves that she’s not against the idea of it.
(2) Relatedly, this money is actually the tail end of money ($7.1 billion worth) that President George W. Bush pushed for in 2005. So this is actually Bush money! To pin all this on the GOP is, thus, a little silly.
(4) Importantly, the vast majority of the pandemic prevention money was passed in March’s omnibus bill, which passed the Senate by (uncounted) voice vote.
And that’s from a Kosmonaut [via: MM].
This story typifies, at least to me, the problem we can expect in the health care field if government becomes even more involved than it is now:
Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.
The trend for years has been away from general practice and toward specialties. Part of that stems from the fact that specialists are paid more than generalists.
Most of us understand that most of our medical care will take place in our latter years with the obvious exception of certain genetic and chronic diseases which afflict a portion of the younger population. So Medicare, which kicks in at 65 whether you want it or not, is a major payer (and player) to family practice doctors who care for older Americans that make up the bulk of their practice.
With that being the case, we’re seeing fewer and fewer medical students option to become family practitioners, preferring the more lucrative pay specialists earn. The consequent result of low pay, huge patient loads and little recourse for changing that has seen family practice numbers in medical universities drop alarmingly. Why spend all that time and money learning a particular craft when the rewards aren’t as great as you want?
So here we have the market for family practitioners reacting to a distortion in the market created by the government refusing to pay at what the doctors feel is an adequate rate for the treatment of the majority of their patients. The market’s feedback mechanism sends the signal to the potential doctor to look at areas which would be more lucrative than family practice to receive adequate compensation. That area is specialization.
The reason I bring this particular example up is the competing proposals. One say, “hey, if you want more family practitioners, pay them more – that provide the incentive to become a generalist”. On the other hand, there’s a proposal to do that, but to accomplish that increase at the expense of specialists who take medicare.
How do you suppose specialists will react? Well if they do as two of mine have, they’ll simply say, “sorry, we don’t treat Medicare patients”.
And how do you suppose such a decision would effect the number of family practitioners. Well, that would depend on how much they’re willing to increase payments to them.
In the era of massive budget cuts and the promise by government to “decrease” the costs of health care, any increase in my estimation, would by minimal and not enough to change the tide concerning family practice. But taking that increase out of what is paid specialists certainly might be the tipping point for many of them to declare they’ll no longer treat Medicare patients.
Certainly our old friend the Law of Unintended Consequences again at work.
Ramesh Ponnuru writes one of the better op/eds discussing the push for “universal health care” I’ve seen.
The practical case is that uninsured people raise premiums for everyone else. But such cost shifting raises premiums by 1.7 percent at most, according to a 2008 study published in the journal Health Affairs. Reforms that increase the number of people with health insurance, while stopping short of universal coverage, would presumably make that small percentage even smaller.
The obvious way to take care of that is to directly insure that relatively small group instead of messing with the entire system.
What about portability and pre-existing conditions? As we’ve been saying here, for literally years, remove it from being employer based and you’ve taken care of both as long as a person keeps their payments current. And, to make it more affordable, remove state mandates. Ponnuru says precisely the same thing:
An alternative approach would be to make it easier for people to buy insurance that isn’t tied to their employment. The existing tax break for employer-provided insurance could be replaced with a tax credit that applies to insurance purchased either inside or outside the workplace. At the same time, state mandates that require insurers to cover certain conditions, which make it expensive to offer individual policies, could be removed.
More importantly, it is a free-market approach. As Ponnuru says:
These two reforms would address most people’s anxieties about the health care system. Insurance would be more affordable, especially for people who cannot get it through an employer, so the number of people with insurance would rise. Indeed, this would enable more than 20 million more Americans to get insurance, according to a model created by Steve Parente, a health economist at the University of Minnesota.
More important, people would own their insurance policies and thus be able to take them from job to job. They would no longer need to worry about losing their job and their insurance at the same time, or feel they need to stay with a job they dislike because they need the benefits.
There it is, the same solution we’ve been pushing at QandO pretty much since QandO has existed. It is a common sense solution which actually reduces government’s role, gives people choices and makes coverage more affordable for a larger number of people, portable and negates the concern for “pre-existing” conditions.
Which is precisely why government will reject such a remedy.