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Let's at the outset establish something about entitlements: Medicare, Medicaid and Social Security are not the same program, don't have the same financing, don't have the same problems and don't have the same solutions. That's important, because it's easy to start talking about one and slip into talking about another. The complexities of individual state-supported Medicaid won't be covered today at all, and for the purposes of today's discussion, let's just get Social Security off the table, just like Congress ought to do.

Social Security

Social Security income and outgo, from federal government data

Social Security is not responsible for the deficit. It has its own funding mechanism, and while there is an issue in a few years, there are easy solutions to adjust revenue to match or nearly match expenditure (link is to ssa.gov.)

By the way, if you're wondering why the green income line is so spikey (it looks like an EKG), it's seasonally dependent.  

• Tax income reaches a peak in the second calendar quarter when many self-employed people pay their taxes with their income tax returns. After the second quarter, tax income falls as earnings of more and more people reach the taxable maximum for Social Security.

• Interest on special-issue securities is paid on June 30 and December 31. While relatively small amounts of interest are paid in every month when securities are redeemed, interest income is always largest in the second and fourth quarters.

You can see from the graph that there are some recent quarters where outgo is more than income and the green line falls below the blue. In fact, Social Security is  projected have enough funds for full benefits until 2037 2038.

We need a fix for 25 years from now, and it'll be cheaper and easier to fix it now. As it happens, Dylan Matthews had a nice post last year showing what can be done to fix the problem:

Dylan Matthews, July 2010
Currently, wages over a certain yearly total ($106,800 this year) are exempted from Social Security payroll taxes. Medicare's payroll tax has no such cap...

While all proposals put a dent in the shortfall, completely eliminating the cap without increasing benefits actually creates a long-term surplus, and eliminating the cap while increasing benefits comes close. The nature of Social Security as a social insurance, rather than welfare, program suggests that the latter proposal may be more palatable, as it retains the connection between what wage-earners pay into Social Security and what they get out of it.

So from now on, whenever you hear Social Security is on the table, our answer should be fine, so long as we are talking about keeping the benefits and raising the cap. Are we resistant to changes in Social Security? Do we refuse to consider any changes whatsoever? Of course not. See above.

Well, that was easy.  Now we can talk about health costs.

Medicare

One note about language before we get started:

"...when we're talking about cuts in things like health care and elderly support programs," [former Treasury Department official Eugene] Steuerle says, "we're basically talking about cuts in a rate of growth."

Health care, in other words, is always growing. If it's going to grow by $100 billion next year but is trimmed to grow only by $80 billion, that's still called "a cut."

"So the language can be very misleading," Steuerle says. A rate of sustainable growth is the real goal of any sensible Medicare reform proposal, he says.

And there we have a problem, not so easily solved: the current rate of growth is not sustainable. In fact, it's getting out of control because baby boomers are aging (story from 12/30/2010):
Starting on Saturday, Baby Boomers begin turning 65 and qualifying for Medicare — one every eight seconds. A record 2.8 million will qualify in 2011, rising to 4.2 million a year by 2030, projections show.

In all, the government expects 76 million Boomers will age on to Medicare. Even factoring in deaths over that period, the program will grow from 47 million today to 80 million in 2030.

That is going to significantly add to Medicare costs over the next several decades. As boomers age, they/we will flood the system, and that's not fully addressed by our current health reform law:
The federal health law, which will expand coverage to 30 million currently uninsured Americans, will have little effect on the nation's rising health spending in the next decade, a government report said today.

The report by the Medicare Office of the Actuary estimated that health spending will grow by an average of 5.8 percent a year through 2020, compared to 5.7 percent without the health overhaul. With that growth,  the nation is expected to spend $4.6 trillion on health care in 2020, nearly double the $2.6 trillion spent last year.

Health law critics said the report confirmed their concerns. "Most of us understood the health reform law was about expanding coverage not cutting costs," said Joseph Antos, a health policy expert at the conservative-leaning American Enterprise Institute.

But White House Deputy Chief of Staff Nancy-Ann DeParle said the report showed Americans were getting a good deal. "The bottom line from the report is clear: more Americans will get coverage and save money and health expenditure growth will remain virtually the same," she said on the White House blog.

The new health care law will keep the growth of costs under control (a good thing!) while insuring more people—a lot more people—in various ways, including through the expansion of Community Health Centers (there was $2 billion appropriated for federally qualified health centers in the 2009 stimulus package and another $28 million provided by HHS just last week.) Insuring more people and getting them access to health care is a good thing, even if it is not single payer (which I support, which is not what passed Congress, and which is a debate I will not rehash here.) But regardless of how efficient the new health care law proves to be, adding many more people to the system from the aging boomer population will cost more. This is from a recent article in the New England Journal of Medicine (my bolded):
On paper, the ACA significantly reduces the fiscal burden associated with Medicare: the Centers for Medicare and Medicaid Services estimates that it will slow per-beneficiary spending growth to about the rate of GDP growth, largely by reducing payments to providers and health plans. The ACA also establishes pilot mechanisms for transforming fee-for-service Medicare into a bundled-payment system with broader integration of care, which could promote cost containment by enabling providers to better capture practice efficiencies. Nevertheless, Medicare spending would still consume a growing share of the GDP because of increasing numbers of beneficiaries. Thus, even if the ACA achieves its ambitious goals, Medicare would still need extra resources to solve this demographic problem. Although some additional resources could come from reducing waste in the system, no industrialized country has ever achieved sustained growth rates of health care spending below that of the GDP, so it seems unlikely that Medicare's growth could be reduced below the projected ACA trajectory.
ACA, the health care act, does hold down costs by curtailing payments to providers and organizations and promoting efficiencies like electronic medical records (see Health Care Reform and Cost Controlby Peter Orszag and Ezekial Emanuel) but since they are not yet implemented, that's still on paper.

So, what about Medicare and Medicaid, now?

USA Today
Medicare and Medicaid spending rose 10% in the second quarter from a year earlier to a combined annual rate of almost $992 billion, according to new data from the Bureau of Economic Analysis (BEA). The two programs are on track to rise $90 billion in 2011 and crack the $1 trillion milestone for the first time.

The jump in health care spending is the biggest since the Medicare prescription drug benefit was added five years ago and ends a brief lull in the spending increases that occurred during the economic downturn.

The debt limit and spending package approved by Congress and Obama don't restrict costs of Medicare, Medicaid and other entitlement programs. The rapidly escalating costs of the health care programs will challenge lawmakers seeking to rein in federal spending in the future, especially in 2014, when coverage expands to people who are uninsured now.

As people age, they use more services. As people lose their jobs and lose health insurance, they use more government services.
The latest spending surge in federal health care is driven by more people getting more treatment, not by price increases. Health care inflation is at its lowest level in more than a decade — a 1.7% annual rate — but the aging population and the weak economy are sending more patients to government-financed care.
Now, another part of the equation is that average payouts for Medicare are three times what the average person pays in. When you pay a Medicare tax, you're paying for your parent's Medicare and your kids will pay for yours. And, ultimately, that's not sustainable.
There's a reason system current system is unsustainable, says Eugene Steuerle, a former Treasury Department official and senior fellow at Washington's Urban Institute. He boils it down to two simple numbers.

"An average couple retiring today has paid just a little over $100,000 in Medicare taxes" over the course of their working lives, Steuerle tells Guy Raz, host of weekends on All Things Considered.

And what do they receive?

"About $300,000 in benefits" — even after adjusting for inflation...

The result is a Medicare system that only pays for one third of itself. The shortfall is made up — in part — from other sources of revenue.

"It's also borrowing from China and Germany and a lot of other countries," Steuerle says.  

We know that by a different name: "deficit".

From the New England Journal of Medicine comes a graph illustrating how Medicare is paid for, and note the growing part that is made up of general revenues (click the graph for a bigger, more readable version):

The public financing of Medicare has particular implications for the economy. Specifically, raising taxes to pay for public insurance exerts a structural drag on the economy even if the revenue is spent on care; the same is not true of unsubsidized, privately purchased care or insurance. The net size and timing of the economic consequences depend on how the taxes are raised and how the revenue is spent. Deficit spending on health care also carries an economic cost: taxes are required to pay back any borrowed money (with interest), and rising debt-to-GDP ratios may have calamitous effects on the country's future ability to borrow. Moreover, increased spending on health care is not necessarily good for the economy even if it increases health care employment: spending on low-value health care diverts resources from other uses that could do more to boost the GDP and create jobs.
The program changes that would reduce costs include some contained in the Affordable Health Care Act when fully implemented, as well as some included in these excellent suggestions by economist Austin Frakt.  Certainly providers have to do their share in controlling costs. Health care costs themselves are unsustainable, and Medicare is just part of that big picture. And for more on what can be done about health care costs, I highly recommend Medicare, Our Deficit and Honesty by Dr. Chris Lillis and [my friend] Dr. Christopher Hughes, published at Doctors for America.:
Dr. Robert Levine wrote this piece a few years ago, and estimates that about a trillion dollars is wasted every year in our health care system between unnecessary care, administrative waste and fraud (not all in the Medicare system, but a substantial portion).  Find it hard to believe?  Then you have not read enough.   Physicians are part of the problem in ordering and performing unnecessary tests, procedures and surgeries, as outlined here by Dr. Rita Redberg.

Of course, one way to control costs is simply not to cover people so they don't get health care.

The Medicare actuaries acknowledged that they were off on one of their estimates last year. At that time, they predicted that national spending in 2009 would grow by 5.8 percent, instead of the 4 percent growth that the report said actually occurred. Keehan said one of the factors helping push that prediction off the mark was that fewer people than expected joined COBRA plans after losing their jobs and that resulted in fewer people with health coverage and less spending.

The office also predicted last year about 375,000 people would sign up for new Pre-existing Condition Insurance Plans by 2013. But since the plans began a year ago under the health law, only about 20,000 people have signed up.

I certainly don't advocate saving money by not covering people. The idea is to get folks the care they need, not deny it to save money. Then again, I don't work for an insurance company. In any case, the actuaries figure that as people become more aware of their options, including the ones mentioned above, costs will eventually go up.

For now, just note that because of that projected shortfall in Medicare hospital insurance, and the need to supplement with general revenue to make up the difference, Medicare will be on the table for discussion even when Social Security is not.

Here's what the federal trustees conclude:

Projected long-run program costs for both Medicare and Social Security are not sustainable under currently scheduled financing, and will require legislative corrections if disruptive consequences for beneficiaries and taxpayers are to be avoided.

The financial challenges facing Social Security and Medicare should be addressed soon. If action is taken sooner rather than later, more options and more time will be available to phase in changes so that those affected can adequately prepare.

And don't forget, it's not all about cuts, it's also about funding. We might start by cutting our military costs (wars are expensive) and applying those funds for needed programs at home. We might even tax the wealthy and corporations at a fair rate.  But even if we do, there will be lots of demands on that money, and in any case, health care costs (and slowing their rate of growth) are still going to have to be managed in a way that does the most good for the most people.

In reviewing both Social Security and Medicare financing, the Center on Budget and Policy Priorities comes to the same conclusion: "Social Security’s funding shortfall is relatively small and manageable", but "Medicare’s financial problems are much more challenging."

The bottom line is that there will have to be adjustments made to Medicare (and easier, but necessary, adjustments made to Social Security.) That's simply not debatable. Therefore, the political question isn't why Medicare and Social Security are on the table, it's whom do we trust to do it in a way that preserves the programs and protects the elderly?

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Comment Preferences

  •  there are, at times, commentsd along the lines of (82+ / 0-)

    "don't touch anything". Not possible.

    OTOH, I saw a comment the other day suggesting the problem with medicare is that health costs in generalare too high. That's true. But it doesn't account for the extra burden of the demographic time bomb of aging boomers.

    We need to control costs (what Washington calls a cut, or bending the curve to decrease rate of growth.) The best way, IMHO, is single payer, but short of that (it can't pass) we have to work with what we have. Implementing ACA and making it work will help, which is why I don;t oppose it.

    But ultimatelyy I think we need to let states like VT try single payer, then adopt it.

    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

    by Greg Dworkin on Sun Aug 14, 2011 at 06:10:22 AM PDT

    •  and with a bit more coffee (21+ / 0-)

      maybe i can improve my typing.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:11:04 AM PDT

      [ Parent ]

    •  Thank you for exlaining this clearly (14+ / 0-)

      Single layer would help greatly, but it will take time.  Clearly that isn't possible in this political climate, so other options are being proposed, including entitlement reform.  It is unfortunate that our priorities aremwhat they are, but I think you are exactly right.  We need to fight for dems and progressives at all levels.  The fewer republicans elected, the better this will turn out.

      •  complex topic (8+ / 0-)

        hope it made some sense.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Aug 14, 2011 at 06:43:26 AM PDT

        [ Parent ]

        •  Medicare and Medicaid (4+ / 0-)

          should be taken out of the budget altogether and a new government corporation stood up similar to the TVA.  A progressive health care tax should be instituted on everyone.
          Private health care companies would cease to exist because they offer no value to society.

          As it stands now, millionaires and billionaires hope onto Medicares as soon as they can.  

          Other financing support could come from sin taxes and lotteries.  

          •  yes, but (12+ / 0-)

            The problem is not one of revenue--it is expense.  We pay around 18% of gdp on health expenses--no other country is above 11% of a lower gdp.  Doctors, PHARMA, and hospitals all expect/charge too much.  Government clinics with paid physicians would be a giant step forward.  A law mandating the wholesale price of drugs to be the same throughout the industrialized world--right now, Americans are charged more than Canadians and Brits for drugs discovered and manufactured in the US.

            The elephant in the room is elder care.  MY mom passed away last year--at age 99--and ran up huge medicare/medicaid bills for unnecessary diagnosis and treatment.  I protested to her doctors who then called everything an emergency, sending her to the er--running up huge bills.  Finally, the hospital's social worker called me and basically said the doctors were told to stop.  Mom was a meal ticket for so many physicians--no longer a patient--the bastards.

            Apres Bush, le deluge.

            by melvynny on Sun Aug 14, 2011 at 07:48:07 AM PDT

            [ Parent ]

            •  Exactly! No matter how noble the cause, this rate (6+ / 0-)

              of growth is unsustainable.  The idea that we spend 18% of GDP on healthcare (and achieve such mediocre outcomes comparatively) is a travesty.

              "Because I am a river to my people."

              by lordcopper on Sun Aug 14, 2011 at 08:27:43 AM PDT

              [ Parent ]

            •  This is the real elephant in the room (4+ / 0-)

              end of life care.

              Other countries do it much better. Mostly because it's not the income driver that it is here, and partly because other countries don't feel that everything should always be done, no matter what, even when it won't do much good and may do harm.

              Other countries have guidelines for care, which can be a very good thing.

              •  but in this country (0+ / 0-)

                those guidelines for care are interpreted in this country as "death panels."

                In those countries certain levels of care are just simply not provided. Dialysis is not provided for non-functional people above a certain age; here there are no restrictions. Certain drugs are not approved on the basis of cost to benefit analysis.

                How do we deal with that here? We don't, or we cave to the screamers.

                Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                by stitchmd on Sun Aug 14, 2011 at 02:45:04 PM PDT

                [ Parent ]

                •  Ah, but we DO have those guidelines (2+ / 0-)
                  Recommended by:
                  missississy, trashablanca

                  Insurance companies do it all the time. ALL the time.

                  They make people be released when they should probably stay (and their doctor wants them to stay) because they won't pay if they stay longer.

                  They require test A before test B, even when the doctor doesn't really want test A, just test B.

                  They won't cover certain meds, they require larger copays for others, they force you to take generics because they won't pay for the brand name.

                  They do this ALL THE TIME.

                  Let the insurance companies put together a set of guidelines for end of life care. They probably have them already. People wouldn't say squat.

                  They don't now. If an insurance company says it, they just take it. If the GOVERNMENT gives guidelines, they're 'death panels'.

                  People can be really, really stupid at times.

            •  Doctors charge too much? Not primary care docs. (8+ / 0-)

              You wrote: "Doctors, PHARMA, and hospitals all expect/charge too much."

              I don't know the data about PHARMA and hospitals.

              But primary care docs I know, including my own -- the bedrock of medical care -- are poorly reimbursed by insurance companies AND by Medicare.

              My own doc -- an old fashioned 2-doc practice -- says he is just barely hanging on, re: reimbursement. I am also a doc, so we talk about this every year at flu-shot or physical-exam time.

              In 2001, my doc diagnosed the first NJ postal worker with anthrax -- with a lesion my doc described as "either the worst staph infection I've ever seen, or something completely different" -- and spent hours (unreimbursed) trying to reach the CDC to say he thought he had a case of anthrax similar to that of the first patient in North (?) Carolina.

              I'm talking about a very good, solid, busy, passionate family practitioner, who doesn't know from year to year if he can keep his practice open, given the low reimbursement rates from insurance and Medicare.

              •  okay (2+ / 0-)
                Recommended by:
                SingleVoter, trashablanca

                How about doctors joining us against insurers?  Maybe they should form a union.  Seriously, try to go to a doctor not covered by your insurance--my wife was charged $450 to see a gynecologist--yey only saw a PE.  $450 for 3 minutes with a physicians assistant is too much.

                Apres Bush, le deluge.

                by melvynny on Sun Aug 14, 2011 at 11:29:49 AM PDT

                [ Parent ]

                •  physicians are prohibited from unionizing (1+ / 0-)
                  Recommended by:
                  trashablanca

                  not an option.

                  There are physicians who have set up micropractices and charge lower rates, but it's still expensive.

                  Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                  by stitchmd on Sun Aug 14, 2011 at 02:41:00 PM PDT

                  [ Parent ]

                •  Sorry -- insurers ARE "us" (1+ / 0-)
                  Recommended by:
                  ozsea1

                  *  "We" demand employer-based health coverage.

                  *  Our employers push for lower insurance rates.

                  *  "We" complain when employers ask "us" to pay more of the cost of insurance.

                  *  "We" demand coverage for everything under the sun (and "we" will make this same demand from national health insurance).

                  It is, indeed, "us" and the insurers AGAINST the poorly-reimbursed primary care docs.

                  None of "us" want to understand this. We just want to blame the insurers.

                  In fairness, I concede that insurers take a bite -- sometimes a large bite (they have to make some profit in order to exist -- but how much?).

                  The only way around this is national health insurance. Like DemFromCt, I favor Single Payer, but it's not on the table now.

              •  Providers: We're great! (0+ / 0-)

                Payers: We can't continue to pay existing rates.

                Guess which argument must win.

              •  medicare is great payer c/w medicaid (1+ / 0-)
                Recommended by:
                melvynny

                Here in Florida the medicare fee schedule for a routine office visit, 99213 pays about $80.  The same service provided to a poor child on Medicaid pays less than $30.  And you wonder why doctors don't take Medicaid.  You have to see about 3 times as many patients to break even with the Medicare rate, not to mention the private insurance rate.

        •  We need to also remember that this (0+ / 0-)

          baby boomer demographic problem is also a temporary one, albeit a lengthy one.

          Once the baby boom passes away, the strain on the Medicare system will lessen.

          The most violent element in society is ignorance.

          by Mr MadAsHell on Sun Aug 14, 2011 at 11:07:22 AM PDT

          [ Parent ]

          •  but it's actually a double whammy (0+ / 0-)

            the demographic issues are one part but the cost of care is escalating as well - and it's becoming a problem in other countries, not just this one.

            Frankly, we just have to be more realistic about what the medical system can and cannot do, and deal with the fact that, indeed, we are all going to die someday and stop trying to pursue immortality at any cost.

            Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

            by stitchmd on Sun Aug 14, 2011 at 02:47:24 PM PDT

            [ Parent ]

      •  I agree that "single layer" (2+ / 0-)
        Recommended by:
        oneshot, lordcopper

        will cut costs, if by that you mean either that (a) couples will be restricted to one sex act, precluding having more than one child; and/or (b) only single people can have sex, resulting in zero population growth except for occasional out of wedlock births.

        Great idea -- clearly thinking outside of the box.

        The GOP: "You can always go to the Emergency Room."

        by Upper West on Sun Aug 14, 2011 at 07:25:48 AM PDT

        [ Parent ]

    •  In the meantime, when was the last time that the (10+ / 0-)

      amount withheld for MediCare was adjusted?  While private insurance has been going up dramatically for some time, has the MediCare "premium" been adjusted to reflect the increased cost of health care?

      Or, has it been allowed to stagnate, so that we will all learn the lesson that "MediCare doesn't work"?

      •  welcome to ACA (25+ / 0-)

        http://money.cnn.com/...

        High-income households will be paying more into Medicare as a result of the new health reform law.

        For starters, the Medicare payroll tax is going up for individuals making more than $200,000 in wages, and couples making more than $250,000.

        Currently, the Medicare payroll tax is 2.9% on all wages -- with the worker and his employer each paying 1.45%.

        Under the new law, starting in 2013, high-income individuals will pay another 0.9 percentage points -- so their share will total 2.35% of their wages.

        A single person making $250,000 will pay an additional $450 a year into Medicare relative to what he pays today, according to calculations by Deloitte.

        If he made $1 million, he will pay an additional $7,200.

        Couples making $500,000 in wages will pay an additional $2,250. If they made $1 million, they would pay an additional $6,750.

        In addition, high-income households would also be subject to a new 3.8% Medicare tax on investment income starting in 2013.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Aug 14, 2011 at 06:42:57 AM PDT

        [ Parent ]

        •  From where the surging costs (5+ / 0-)

          What I would really like to know is why the cost of treatment is soaring.

          I saw this little snippet:

          estimates that about a trillion dollars is wasted every year in our health care system between unnecessary care, administrative waste and fraud

          But hasn't waste, unnecessary care and fraud always existed and been a part of healthcare?  Is waste, unnecessary care and fraud responsible for the cost of health care surging year after year or is the surging cost reflective of some aspect of the process of providing health care?  Or is it just inflation?

          What aspect of healthcare itself, whether prescriptions, equipment, labor, insurance....or profit, is playing the primary role in increasing healthcare costs....or is it just simply fraud, waste and unnecessary care?

          There must be something somewhere in healthcare that underlies the year after year after year increases in healthcare costs.  The cost of healthcare is heading for the moon.  Why?  

          Sure government healthcare costs will go up as the baby boomers become elgible for government healthcare programs but private industry is having the same problems.  

          Some aspect of healthcare cost is out of control and affecting the costs of healthcare for both government and private healthcare.  Why can't we pin down what those costs are or do we already know?

          •  expensive new technology (3+ / 0-)
            Recommended by:
            skohayes, lordcopper, joedemocrat

            think Lasik, more expensive ways of capping teeth, cardiac caths at the time of heart attacks (rather than losing weight and quitting smoking), bariatric surgery, etc...

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Aug 14, 2011 at 07:29:46 AM PDT

            [ Parent ]

            •  Too many specialists (7+ / 0-)

              Even out here in the back of beyond, you can't just go to one doctor for a simple problem.
              I suffer from back problems due to old injuries, spinal stenosis and arthritis. In one year,  I went to my regular doctor, then on to an orthopedic, then to a neurologist and finally a pain management specialist. I had X-rays and two MRIs.
              The solution is pain killers and muscle relaxers. For that, my insurance company and I spent almost $30,000.

              You will never know what it’s like to work on a farm until your hands are raw, just so people can have fresh marijuana. Jack Handey

              by skohayes on Sun Aug 14, 2011 at 07:41:38 AM PDT

              [ Parent ]

              •  Exactly. This has been my belly ache. Treating (1+ / 0-)
                Recommended by:
                stitchmd

                stuff because of statistics not actual medical need is another one. They call it prevention but I see medications for non existent and potential (by stats) as  wrong because there are not only financial costs to those treatments but health costs. I am especially aware of that cost because I can not take many medications for longer then a month before I start reacting.

                And tests ... man they can pile that one up without making a significant dent in an individuals health. Geesh I don't expect a Dr to help me live forever ... I just want one to help me with what I want taken care of. I am tired of the lifestyle lectures because I know the costs of those choices and being lectured on them by someone like I am an idiot makes me not show up for years. I make my choices not based on trying to live to be 90 instead of 80 but on what will make it worth living to 80.

                Its a whole mindset that has caused me to fire a lot of Drs for imposing thier values on me and denying me the right to make my own value choices.

                Fear is the Mind Killer

                by boophus on Sun Aug 14, 2011 at 09:07:12 AM PDT

                [ Parent ]

                •  well, keeping your cholesterol down (2+ / 0-)
                  Recommended by:
                  joedemocrat, skohayes

                  so you don't heat a heart attack is a good thing and sensible.

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Sun Aug 14, 2011 at 09:18:47 AM PDT

                  [ Parent ]

                  •  yabbut (1+ / 0-)
                    Recommended by:
                    DemFromCT

                    we keep looking at these cholesterol numbers as if they are written in stone, rather than looking at the individuals affected.

                    I've had any of a number of patients who come in and have been put on statins to "get their cholesterol down," and they have mild to moderate side effects or they just simply don't want to take meds. So I've started doing Framingham calculations with them and discussing with them their risk profile, and discussing with them what their risk tolerance is. Just one example.

                    In medical school I was taught to "treat the patient, not the number."

                    This is, however, one of my biggest frustrations with "outcomes data measurement," because the measurements are of the low-hanging fruit, i.e., cold hard numbers especially in silos. They don't deal with the complexities that real human patients present to providers.

                    Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                    by stitchmd on Sun Aug 14, 2011 at 03:00:16 PM PDT

                    [ Parent ]

                •  get copies of any test results... (1+ / 0-)
                  Recommended by:
                  stitchmd

                  and share them with any of your other doctors to cut down on lab costs. lot of times things are being duplicated between doctors.  usually a CBC panel.  for me there is the added lipid panel regularly done for my cardiologist.  i share those results with my general physician so save myself an expense and lately, trying to be more cost conscious for the sake of Medicare.

                  I'm a blue drop in a red bucket.

                  by blue drop on Sun Aug 14, 2011 at 04:17:07 PM PDT

                  [ Parent ]

              •  The Specialist Game is a way to delay (0+ / 0-)

                treatment until you hopefully run out of money and become Medicaids problem.

                That's how Blue Cross murdered my mom.

                Mayan culture was strong enough to save the Mayan people from Mayan civilization.

                by JesseCW on Sun Aug 14, 2011 at 09:24:33 AM PDT

                [ Parent ]

            •  Hey, don't forget profits. Profits don't heal (1+ / 0-)
              Recommended by:
              sja

              anybody.  Why do we pay 20+% of our GDP on healthcare and the Canadians 11.4%?  Their cost of technology has gone up as fast as ours.

              Their drugs are controlled cost.  They don't have Sentara and other private providers making PROFIT for their shareholders.

              "Don't dream it, be it" - Brad, Janet and Frank

              by captainlaser on Sun Aug 14, 2011 at 10:19:52 AM PDT

              [ Parent ]

              •  their cost of technology has not gone up (0+ / 0-)

                asas fast; they don't pay, for example, $30K for a stent. And they significantly restrict who can get the stents, unlike what happens in this country.

                The Canadian system is a fee for service system, and drug manufacturers and device manufacturers are for-profit systems in Canada. It's a different level of expectation of level of profit.

                Diversity may be the hardest thing for a society to live with, and perhaps the most dangerous thing for a society to be without - W S Coffin

                by stitchmd on Sun Aug 14, 2011 at 03:02:47 PM PDT

                [ Parent ]

          •  One man's waste is another man's profit. (0+ / 0-)

            "Because I am a river to my people."

            by lordcopper on Sun Aug 14, 2011 at 08:31:23 AM PDT

            [ Parent ]

          •  The level of waste (5+ / 0-)

            and administrative cost is the real kicker.

            My husband is retired military, we have Tricare. He gets his eyes examined - that generates a statement (or many) from Tricare, as the optometrist submits his bill to them.

            He has to send it to them first, they have to see if we've reached our deductible, and adjust to the approved charges. This takes at least 2 mos. At least. Usually more. Then we get a bill from the optometrist for what Tricare has said we owe. Which we pay immediately.

            However, because of all the damned stupid paperwork, and how long it takes, the optometrist has waited anywhere from 3-7 mos (at least) to get his money. There have been times it's been a YEAR before we finally get the bill, especially if it's for any kind of emergency care.

            What business do you know that can wait that long to get paid? Of COURSE they pad the bills. How could they manage if they didn't?

        •  Thank you for the info (7+ / 0-)

          I didn't know that the ACA raised the medicare tax on the wealthy - no wonder the Republicans want to overturn it.

          I do wish that the president and all Dems would refrain from using  the term cuts and start using adjustments when referring to entitlement reform

        •  Thanks, I was aware of that. That is why I didn't (0+ / 0-)

          ask the question for which you kindly provided the answer.

          Do you have any information on the question that I did ask?

          •  to quote Steve Martin (5+ / 0-)

            well, excuuuuuuse me.    ;-)

            The answer appears to be: 2011.

            In 2011, if you file your taxes as “married, filing jointly” and your MAGI is greater than $170,000, you will pay higher premiums for your Part B and Medicare prescription drug coverage. If you filed your taxes using a different status and your MAGI is greater than $85,000, you also will pay higher premiums. (See the chart on pages 8-9 for an idea of what you can expect to pay.)

            http://www.ssa.gov/...

            it affects about 5% of medicare recipients. Hope that answers your question.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Aug 14, 2011 at 08:15:19 AM PDT

            [ Parent ]

        •  However, this source of revenue only hits "wages", (0+ / 0-)

          and does not touch other sources of "income".  Is that correct?

          "Because I am a river to my people."

          by lordcopper on Sun Aug 14, 2011 at 08:30:25 AM PDT

          [ Parent ]

        •  Re: higher-income people (4+ / 0-)
          Recommended by:
          DemFromCT, snackdoodle, SoCalSal, CrissieP

          As a higher-income person who understands that Medicare needs to be funded, I support the new and proposed taxes.

          I would also like people to know that higher-income people who become eligible for Medicare pay much higher Medicare premiums than lower-income people.

          My self-employed husband and I have been buying our own insurance for years, so we know what it costs.

          When hubby turned 65, we were shocked (but not disapproving) to learn that his costs would go UP, not down, as he signed up for Medicare. Nothing in the media had prepared us for this, and all our "average" income friends were  disbelieving, or thought we had made some kind of mistake.

          I approve of higher-income people paying more. But I would like to rebut some of the statements that "millionaires" can't wait to jump onto Medicare. Guess what: If you make a lot of money, Medicare actually costs MORE than your previous private insurance, at least in some cases.

          But -- never mind. Well-off people, even those who approve of paying more in, can't get no respect...

      •  Under Clinton, we blew the cap off of Medicare. (0+ / 0-)

        It used to have the same cap as SS, now it has none.

        Mayan culture was strong enough to save the Mayan people from Mayan civilization.

        by JesseCW on Sun Aug 14, 2011 at 09:22:57 AM PDT

        [ Parent ]

    •  Single payer can't pass with the current (5+ / 0-)

      "leadership."

      We need to address that tiny problem: bought and paid for government.

      Not that there's anything new about that. And not that these crooks are going away any time soon. Your idea about states trying single payer - I'd be willing to bet that the Wall Street administration will challenge that in court. But it's the best way to set out on that path, I agree.

      We don't need a third party. We need a second party.

      by obiterdictum on Sun Aug 14, 2011 at 06:46:42 AM PDT

      [ Parent ]

      •  Can't pass without a "gun" (an acknowledgement (0+ / 0-)

        that we can't afford the current system) to the head of the electorate.  Even then, there's no guarantee that the will to change exists in the country.

        "Because I am a river to my people."

        by lordcopper on Sun Aug 14, 2011 at 08:35:59 AM PDT

        [ Parent ]

    •  The very mention of "Medicare Reform" (18+ / 0-)

      sets off a hysteria that's just not rational around here. "Reform" should no more be a dirty word to progressives than "entitlements" is a dirty word to conservatives.

      Thank you. Your diary is much appreciated.

      As a Medicare recipient I can see from my own experience, a number of ways that costs could be cut and the system made more efficient for recipients, the most obvious of course being negotiated RX prices for Medicare and Medicaid patients.

      "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

      by Sybil Liberty on Sun Aug 14, 2011 at 06:49:41 AM PDT

      [ Parent ]

      •  The Problem with Reform (4+ / 0-)
        Recommended by:
        We Won, skohayes, lilchas, stitchmd

        Is that politicians tend to go after things with a hatchet rather than a scalpel.  And the flesh that is cut out depends on who is doing the cutting.  We need Portia :-)

        And as we have seen over time, conservatives don't give a damn about those in need, and dems have been either reluctant, timid or hog-tied in some way and don't get the job done.

        I agree that this is a complex problem and separating SS from the heath care programs is important.

        •  Then too, we have to ask ourselves if we've truly (3+ / 0-)
          Recommended by:
          lordcopper, snackdoodle, KayCeSF

          shoved our Dem reps as hard as we can, collectively speaking. We have an inclination all too often towards more talking, less doing.

          Lest we forget, FDR's New Deal was ALL about reform. Maybe we should try to own that word, rather than spontaneously combusting whenever we hear it.

          "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

          by Sybil Liberty on Sun Aug 14, 2011 at 07:23:59 AM PDT

          [ Parent ]

        •  How (4+ / 0-)

          Soon can newly eligible Medicare recipients be required to enroll in a managed care program vs just going randomly to physicians in private Practice?  Here in MN, Medicare patients that go with Mayo Clonic cost Medicare only half as much as many places in Texas and Florida where patients see physicians in private practice. I'm not against private practice but blue cross blue shield monitors them and only reimburses their preferred providers.  

          •  The Mayo clinic (8+ / 0-)

            is one of the most efficient health care systems in the US. More attention should be paid to how they accomplish this.

            You will never know what it’s like to work on a farm until your hands are raw, just so people can have fresh marijuana. Jack Handey

            by skohayes on Sun Aug 14, 2011 at 07:37:54 AM PDT

            [ Parent ]

            •  Pretty straightforward (5+ / 0-)

              they trust each other.

              If one doctor at the Mayo Clinic orders a test, the other doctors believe the results. They don't order the same test again in 2 wks, unless it's something that changes drastically in that amount of time.

              Most things don't.

              It would also help if a doctor could order test A, get the results, and if test B is indicated, order it IMMEDIATELY, rather than having to wait however long the insurer says they have to. Or if they could jump to test b and NOT have to go through test A - which is often what the problem is.

              It's not always the doctor that determines what gets ordered - it's the insurer.

            •  Mayo is fattening and high in cholesterol. (0+ / 0-)

              They should change their name to the Mustard Clinic. It's much more nutritious.

          •  I have no idea, but I think it's a good one. (3+ / 0-)

            I agree, I belong to a huge HMO on the left coast. They're pretty efficient and I've watched them improve quality of care over the past several decades. They have always negotiated drug prices for all of their patients, but I'm convinced that they could do even better on RX prices for seniors if the Dem mandate-clause (which was stricken in the final hour from the initial Medicare Part D before it was passed under bush) was restored today.

            "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

            by Sybil Liberty on Sun Aug 14, 2011 at 07:42:09 AM PDT

            [ Parent ]

          •  HMO's are for well people (3+ / 0-)
            Recommended by:
            Nada Lemming, mmacdDE, snackdoodle

            more so than ill people.  I have recent experience with this.

            My mom is on Medicare and has Tufts Advantage rather than straight medicare.  

            During a recent hospitalization she was released to rehab.  All worked fine until the insurance company said she was finished rehab (because her oxygen was ok when she took a certain number of steps on a flat surface).  They do not take into consideration climbing stairs, which caused her O2 to drop to 80.  even just 2 steps did this.

            In talking to the nurses at the rehab, they were furious with Tufts for shoving her out the door, and advised me to get her changed off of Tufts and back to regular Medicare.

            I was specifically told by more than one nurse that HMO's are for younger people and for healthy people...not particularly good for someone with poor health or chronic illness.

            •  "HMO's are for well people" (2+ / 0-)
              Recommended by:
              mmacdDE, ratcityreprobate

              I haven't had that experience with my HMO, altho granted, they do invest heavily in preventive care but I see that as a plus. My husband received excellent care during and after his two open-heart surgeries.

              I am truly sorry to hear that your mom had a bad experience with Tufts. This sort of experience is all too common I think, HMO or otherwise.

              "Show up. Pay attention. Tell the truth. And don't be attached to the results." -- Angeles Arrien

              by Sybil Liberty on Sun Aug 14, 2011 at 08:05:48 AM PDT

              [ Parent ]

            •  I (1+ / 0-)
              Recommended by:
              Sybil Liberty

              Am not familiar with hmo's, only mayo and the blue cross blue shield insurer. Mayo has insurance programs for businesses and many Medicare seniors just choose mayo for their provider.

            •  A change in residence (0+ / 0-)

              seems to be indicated.

              Alternately, I've known some old folks who decide to live on one floor.

              An episode of Brideshead Revisited comes to mind.

      •  "Negotiated Rx prices for Medicare"-too bad noone (3+ / 0-)
        Recommended by:
        david78209, lilchas, JesseCW

        Tried during that the health care reform debate. -Sen. Dorgan-

        / end snark

      •  If conservatives hate the Federal Government (0+ / 0-)

        so much, too much intrusions into their lives, etc, how about just ending Medicare altogether and let each state decide how they are going to pay for health care for the elderly and the poor?  

        Maybe the reptilian conservatives would feel the heat of the voters then, right now they seem almost isolated from reality.

        •  mitch daniels (2+ / 0-)
          Recommended by:
          worldlotus, jennylind

          well if medicare is ended and the states are left to "decide" then every senior citizen in indiana who can't afford private health care insurance can just go sit out on the curb and hope they die from the indiana summer heat  and humidity pretty quickly.

          with old mitch in charge of the state, it comes down to die and get out of the way or a rainy day fund................

          do you think any state would take on that program willingly?  they can barely afford their own state medicaid, welfare, food stamps, and unemployment insurance now.

          God forbid they raise the state income tax a 1/4 of a percent....or the rate of tax corporations pay towards unemployment insurance........while counties are taxing everything from the number of wheels on your vehicle to your motel room.  

      •  "Reform" Should Mean Increasing Of Benefits... (3+ / 0-)
        Recommended by:
        JesseCW, jennylind, Timothy J

        ...not cutting them.
         Obama administration has it ass backwards.

        The American fascist would prefer not to use violence. His method is to poison the channels of public information. ---Henry A Wallace VP 1941-45.

        by frandor55 on Sun Aug 14, 2011 at 08:30:43 AM PDT

        [ Parent ]

      •  Ditto with "spending cuts." (5+ / 0-)

        Since when do liberals oppose cuts to the military, to agricultural subsidies, or to corporate welfare?

        And yet, instead of pushing for liberal spending cuts that would eliminate upward redistribution, the party line around here has been to oppose spending cuts as if they were the enemy, instead of pushing for our cuts.

        Art is the handmaid of human good.

        by joe from Lowell on Sun Aug 14, 2011 at 08:32:42 AM PDT

        [ Parent ]

        •  When the cuts hit their district or state. (2+ / 0-)
          Recommended by:
          joe from Lowell, Sybil Liberty

          "Because I am a river to my people."

          by lordcopper on Sun Aug 14, 2011 at 08:46:54 AM PDT

          [ Parent ]

        •  Overall cuts during a recession are idiotic. (4+ / 0-)
          Recommended by:
          snackdoodle, priceman, Shmink, Timothy J

          Period.

          What's more, we don't agree with the basic right-wing premise that our Government is too big.  Compared to countries that work, it's simply not.

          You'll find a much different conversation happens if you talk about shifting spending from the the military to education or health care.

          Mayan culture was strong enough to save the Mayan people from Mayan civilization.

          by JesseCW on Sun Aug 14, 2011 at 09:27:21 AM PDT

          [ Parent ]

          •  But it's a ten-year timeframe. Back load them. (0+ / 0-)

            Yet another progressive argument - basic Keynesianism, really - that our side could have been making but didn't.

            Anyway, the Department of Agriculture and the IRS wouldn't get any smaller if we eliminated a bunch of ag subsidies and corporate welfare.  They'd just send out checks in smaller amounts.

            Art is the handmaid of human good.

            by joe from Lowell on Sun Aug 14, 2011 at 09:33:42 AM PDT

            [ Parent ]

          •  So is raising taxes, but you demanded that last yr (3+ / 0-)
            Recommended by:
            Sybil Liberty, snackdoodle, SoCalSal

            Perhaps Obama is just a better Keynesian than you, with his support for back-loaded spending cuts, back-loading tax hikes, and balancing the budget over the course of the economic cycle by jacking up deficits during the recession and then dialing them back once we're out of it.

            Funny how the people around here who do the most shouting about Keynesian economic theory never seem to remember that second part.

            Art is the handmaid of human good.

            by joe from Lowell on Sun Aug 14, 2011 at 09:38:54 AM PDT

            [ Parent ]

            •  No, it's not. The wealthy horde their cash (2+ / 0-)
              Recommended by:
              priceman, Timothy J

              and do not use it in any way that helps us out of this hole.

              If we tax the shit out of them, and spend that money productively, we help ourselves out of this hole.

              Mayan culture was strong enough to save the Mayan people from Mayan civilization.

              by JesseCW on Sun Aug 14, 2011 at 10:21:20 AM PDT

              [ Parent ]

              •  The majority of the taxes didn't go to the rich. (4+ / 0-)

                It's actually on the order of 70% of the dollar value of the Bush tax cuts that go to middle class families and below.

                And yet you were furious that Obama didn't allow their taxes to rise by letting the entirety of the cuts lapse, rather than extending them all.

                And for what?  So that some spending in the middle of a recession wouldn't be borrowed?

                Art is the handmaid of human good.

                by joe from Lowell on Sun Aug 14, 2011 at 10:28:35 AM PDT

                [ Parent ]

                •  Wrong (5+ / 0-)
                  http://www.washingtonpost.com/...

                  1. Extending the tax cuts would be a good way to stimulate the economy.

                  As a stimulus measure, a one- or two-year extension has one thing going for it -- it would be a big intervention and would provide at least some boost to the economy. But a good stimulus policy can't just be big; it should also offer a lot of bang for the buck. That is, each dollar of government spending or tax cuts should have the largest possible effect on the economy. According to the Congressional Budget Office and other authorities, extending all of the Bush tax cuts would have a small bang for the buck, the equivalent of a 10- to 40-cent increase in GDP for every dollar spent.

                  Why? As the CBO notes, most Bush tax cut dollars go to higher-income households, and these top earners don't spend as much of their income as lower earners. In fact, of 11 potential stimulus policies the CBO recently examined, an extension of all of the Bush tax cuts ties for lowest bang for the buck. (The CBO did not examine the high-income tax cuts separately, but the logic it used suggests that extending those cuts alone would have even less value.) The government could more effectively stimulate the economy by letting the high-income tax cuts expire and using the money for aid to the states, extensions of unemployment insurance benefits and tax credits favoring job creation. Dollar for dollar, each of these measures would have about three times the impact on GDP as continuing the Bush tax cuts.

                  How many more RW myths are we going to hear spouted by kossacks today on the front page or in the comments?

                  Pro Life??? Conservatives want live babies so they can raise them to be dead soldiers!- George Carlin

                  by priceman on Sun Aug 14, 2011 at 03:29:14 PM PDT

                  [ Parent ]

            •  Um, no (1+ / 0-)
              Recommended by:
              Timothy J

              Obama has not jacked up the deficits enough to cover the 2.5 demand gap and all he talks about is the deficit. Backloaded cuts after failing to reach this threshold is a failure to understand Keynesian economics.

              Failing to reach this threshold in a jobless recovery where population growth is ignored as a metric, does not make Obama a Keynesian.

              funny how people who ignorantly talk about keynes never talk about demand, just assumed economic growth, like RW neoclassical economists. There is no equilibrium. Unemployment can stay high indefinitely and it will unless real stimulative fiscal policy is actually tried.

              It's funny you don't realize or know that.

              Pro Life??? Conservatives want live babies so they can raise them to be dead soldiers!- George Carlin

              by priceman on Sun Aug 14, 2011 at 03:22:53 PM PDT

              [ Parent ]

    •  Even single payer systems (3+ / 0-)
      Recommended by:
      joe from Lowell, worldlotus, SoCalSal

      can find that they have to cut some benefits.  My sister lives in Canada and they have made some cuts to their health care system.  For example, they have now limited check-ups to one a year.

    •  thanks for this antidote to the hysteria (10+ / 0-)

      that passes for comment here most of the time.

    •  Your article is why I still come here... (8+ / 0-)

      Real data, real thought, real analysis.

      So much better than the " my plan/man for ponies is better than your plan/man for ponies" drivel and invective that seems to infect this place way too often....

    •  Medicare for everyone would help because more (3+ / 0-)
      Recommended by:
      snackdoodle, Uberbah, SoCalSal

      money would be paid in over the lifetime of any recipient. Since Medicare doesn't have to suck up profits it would cheaper then we are paying now.

      But ACA is a start in the battle with those who want to pull excessive profits before a dime is spent on care. But then there is a whole mindset amongst Drs about how a patient should be managed. I don't go to the Dr unless i have a problem and have battled for years about tests and meds that Drs want to make my insurance pay for when all that they base that on is my age.

      I don't see my lung Dr any more since he bought a lung testing machine... He wants to do this test yearly and it costs me about $800. Yet I have a little O2 sat device that tells me nearly as much... My O2 sats are improving according to it so why test if things are getting better. When they finally after years of problems discovered that I had pulmonary hypertension the Docs did over 20K tests when what really showed the true problem was me taping a O2 meter that recorded readings overnight to my finger. I do drive Docs crazy.

      Fear is the Mind Killer

      by boophus on Sun Aug 14, 2011 at 08:54:16 AM PDT

      [ Parent ]

    •  On the side of Social Security, however ... (4+ / 0-)

      ... it certainly does make sense to not touch anything when talking about a fiction such as the balance of the system over 25 years from now. And the US economy has never yet gone through any fifty year period without experiencing a massive change in our economic system, so the notion that the SI projections in the 25yr to 50yr range are meaningful is a bedtime fable.

      Which implies that the only part of the Social Security system that needs fixing is the Disability Insurance fund. Without raiding the Social Insurance fund, that is hitting a shortfall of benefits due and benefits payable inside the decade, and the US economy has been stable across enough individual decades for that projection to be taken as substantially meaningful.

      And of course, "raise the cap while keeping benefits in place" is not raising the cap, its imposing a levy, since the present "benefits in place" do not have any "cap" independent of the income that social security income tax is paid on.

      Saying in the confines of Daily Kos that its just "raising the cap while keeping the benefits" is a fine subterfuge, but it will last less than one news cycle in today's radical reactionary infested mess media.

      So better be prepared to make the case for a levy. There is a case to be made ~ the higher your income is, the more it tends to benefit from the broader income stability provided by the Social Security system ~ but the need to make the case cannot be ducked by clever wordplay.

      Eliminating the cap on Disability Insurance alone would not change the Disability Benefit, which is tied to PIA and hence tied to the Social Insurance tax cap.

      And of course, it would be a much smaller impact than elimnating the cap on Social Insurance right now, which would be likely to result in substantial slowing down of the economy to resolve problems that appear in projections so far into the future as to be primarily fictions.

      Indeed, since under the projection, the result of the fund balance running out is to 75 cents on the dollar, projected to be a higher standard of living than 100 cents on the dollar today, slowing the economy down now to fix the problem of the future is Reverse Robin Hood ~ robbing from the poorer to pay the richer.

      Support Lesbian Creative Works with Yuri anime and manga from ALC Publishing

      by BruceMcF on Sun Aug 14, 2011 at 09:15:27 AM PDT

      [ Parent ]

    •  SS does not have an issue in a few years. (6+ / 0-)

      It may have issues in a few decades if our economy stays fucked.

      I know that you're on the rightward fringe of our Party economically, but I still believe you have the freedom to try to advance your center right agenda.

      Just try to be somewhat honest about the simple facts of the debate at hand.  That used to be the difference between the Right-Wingers in our own Party and the Republicans.

      Mayan culture was strong enough to save the Mayan people from Mayan civilization.

      by JesseCW on Sun Aug 14, 2011 at 09:22:14 AM PDT

      [ Parent ]

      •  ha (6+ / 0-)

        yeah, I am as right wing as they come.

        Nice try.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Aug 14, 2011 at 09:37:42 AM PDT

        [ Parent ]

        •  Nice dodge. (3+ / 0-)
          Recommended by:
          priceman, joanneleon, gooderservice

          But that's what's nice about the Overton Window - you can be more conservative than Republicans from 20 years ago, yet still be "liberal".

          He's got a (D) next to his name. How many Ds and how many Rs next to his policies? - Jim P

          by Uberbah on Sun Aug 14, 2011 at 11:39:39 AM PDT

          [ Parent ]

          •  "one can" I suppose (5+ / 0-)

            though that has little to do with me.

            Any facts and substantiation to these comments? I thought not.

            let's see:  

            I support single payer, Democratic candidates, rational protection of Social Security (see post)< Medicare and Medicaid (not in this post) SCHIP and the social net, and that makes me mopre conservative than a mythical Republican form 20 years ago (we're talking Bob Dole).

            Really. You'll have to do a lot better to make it stick.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Aug 14, 2011 at 11:44:08 AM PDT

            [ Parent ]

            •  So does Larry O'Donnell. (5+ / 0-)

              He's also known for defending right wing framing and conservative policy from conservative Democrats.  Larry's support for the party platform is a mile wide.

              And an inch deep.

              Any facts and substantiation to these comments? I thought not.

              Facts, substance?  You left them entirely out of the storyline on Social Security.  The whole reason for the "trust fund" is to pay for the Boomers.  Where will the Boomers be in 25 years?  Mostly dead, as the youngest Boomers will be 75.  Especially if Medicare is cut.  The "shortfall" comes from extremely pessimistic economic forecasts, and you don't see these same Concerns for what ever-expanding DOD budget will be like in 25 years.

              And finally, before the "trust fund" was established by an increase in payroll taxes, SS was a paygo system.  It's literally impossible for it to become insolvent.  As long as Americans are working and payroll taxes are being collected, Social Security checks will be sent out.

              Oh, and you mentioned Bob Dole?  One of the Senators who led the payroll tax increase to pay for the Boomers?  The Bob Dole that called out Carter for proposing what Obama just did - paying into SS from the general fund as that's the first step in turning it into welfare?

              This Bob Dole right here?

              He's got a (D) next to his name. How many Ds and how many Rs next to his policies? - Jim P

              by Uberbah on Sun Aug 14, 2011 at 12:16:49 PM PDT

              [ Parent ]

              •  That's gonna (1+ / 0-)
                Recommended by:
                Uberbah

                leave a mark.  No facts, eh?  

                I so wish you were right, but sorry, clapping louder doesnt do anything in real life except confuse my dog. -dark daze

                by Nada Lemming on Sun Aug 14, 2011 at 06:58:51 PM PDT

                [ Parent ]

                •  no facts (1+ / 0-)
                  Recommended by:
                  joedemocrat

                  just lots of hot air. Hot air doesn't leave a mark.

                  "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                  by Greg Dworkin on Mon Aug 15, 2011 at 03:31:00 PM PDT

                  [ Parent ]

                  •  I read the articles. (0+ / 0-)

                    I found them very interesting. The New England Journal Of Medicine article claiming about 30% of health care spending is on unnecessary care. That's $830 billion a year - enough to cover the uninsured.

                    The New York Times article also listed a lot of examples...

                    The articles aren't naive - they realize it would be politically very hard to take on the medical establishments that do benefit from overuse..

                    Thanks again.

                    Some people are working every day on concrete issues of jobs, wealth, power and justice. And some people are discussing Osama bin Laden's civil rights or who is "deracinated" - Citizen K

                    by joedemocrat on Mon Aug 15, 2011 at 04:21:09 PM PDT

                    [ Parent ]

                  •  Just because you ignored the half dozen facts... (0+ / 0-)

                    ...in my post, doesn't mean they weren't there.  No rebuttal, just hand waving.

                    Must have left a mark after all.

                    He's got a (D) next to his name. How many Ds and how many Rs next to his policies? - Jim P

                    by Uberbah on Tue Aug 16, 2011 at 04:44:20 PM PDT

                    [ Parent ]

                    •  the half dozen facts (0+ / 0-)

                      1. Larry O'Donnell is a non-sequiter.

                      2. " The "shortfall" comes from extremely pessimistic economic forecasts

                      [that's actually false... the pessimistic forecasts simply make the year sooner, 2030, instead of 2038, but the projections are not based on economic forecast. Your fact is, in fact, not a fact.]

                      3. and you don't see these same Concerns for what ever-expanding DOD budget will be like in 25 years.

                      [funny, because a) that's not what this post was about and 2) I specifically said "We might start by cutting our military costs (wars are expensive) and applying those funds for needed programs at home" regardless.]

                      4. It's literally impossible for it to become insolvent.  As long as Americans are working and payroll taxes are being collected, Social Security checks will be sent out.

                      [the system won't have enough to pay for everything so it won't be insolvent, it will simply pay out 75% of what's owed. If you are scoring at home, another point for me.]

                      5. Bob Dole in your incomprehensible rant, is apparently being compared to something you think Obama said, not what I said (I said raise the cap).

                      6. I don't think there is a 6. Then again, I don't think there's a 1-5.

                      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                      by Greg Dworkin on Tue Aug 16, 2011 at 06:07:02 PM PDT

                      [ Parent ]

        •  Thank you for this diary. (1+ / 0-)
          Recommended by:
          Christin

          I agree with the poster who said you are one of the reasons they come here. I've always found your diaries very informational - no bullshit, pure facts, something a person can learn from.

          And how anyone conclude this is beyond me

          I know that you're on the rightward fringe of our Party economically, but I still believe you have the freedom to try to advance your center right agenda.

          That's one of the problems - personal attacks are easy but respectful, factual debate is much harder work.

          That said, I do support removing the payroll tax cap on social security. You do some polling work - is that popular or unpopular with the public?

          Some people are working every day on concrete issues of jobs, wealth, power and justice. And some people are discussing Osama bin Laden's civil rights or who is "deracinated" - Citizen K

          by joedemocrat on Sun Aug 14, 2011 at 12:54:25 PM PDT

          [ Parent ]

          •  well, consider the source (1+ / 0-)
            Recommended by:
            joedemocrat

            of the quote Joe.
            i mean really.

            "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Mom ♥ 12.25.2007 ------- A true sportsman is a hunter lost in the woods and out of ammo. ~Robert Brault

            by Christin on Sun Aug 14, 2011 at 07:59:25 PM PDT

            [ Parent ]

            •  I know but I'm just surprised (0+ / 0-)

              anyone would attack DemFromCT who does his research and knows his stuff...

              Finding Medicare cost savings isn't automatically a terrible thing...there are no doubt savings. and it could allow us to use the $$ for other things. I want to let people over age 50 who are long term unemployed into Medicare.

              Of course, he may saw then we aren't fully addressing the demographic trend. I don't know what he'd say.

              Some people are working every day on concrete issues of jobs, wealth, power and justice. And some people are discussing Osama bin Laden's civil rights or who is "deracinated" - Citizen K

              by joedemocrat on Sun Aug 14, 2011 at 08:17:47 PM PDT

              [ Parent ]

    •  and when I've suggest this (0+ / 0-)
      "don't touch anything". Not possible.

      I was told I'm either a disgusting human being or in denial because I'm ok with cuts to the safety net.

      But we want to get to the same place. We just disagree on the how. --mmacdDE

      by glynis on Sun Aug 14, 2011 at 10:37:08 AM PDT

      [ Parent ]

  •  When you talk about Social Security... (18+ / 0-)

    running out of money in 2037, you should add that this projection assumes that the U.S. economy will grow more slowly until then than it has ever grown in the past 100 years, including during the Great Depression.  If the economy grows faster than this, which is most likely, then Social Security has no deficit at all and is solvent forever, without raising the cap on taxed income.  What we should be doing now is carrying out measures to make sure that the economy grows at a reasonable rate, like a good jobs program.  But please don't feed the misconception that Social Security is in trouble.  It isn't, unless something very terrible happens to the economy.  

    "There have been tyrants and murderers and for a time they seem invincible but in the end they always fail. Always." -Gandhi

    by Grandma Susie on Sun Aug 14, 2011 at 06:14:32 AM PDT

    •  actually (13+ / 0-)

      I am simply laying out the facts. Nothing needs to be implemented during the recession. But if and when a fix is needed, we need not talk about raising retirement age or other inappropriate fixes. We know what to do, we can always debate when to do it.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:21:38 AM PDT

      [ Parent ]

      •  I think (11+ / 0-)

        We must do something - under a Democratic president, who recognizes the long-term problems, especially with Medicare.

        Give Obama credit for realizing that if kicked down the road a bit, a Republican president, and there will be one, will certainly just eliminate Medicare or make it a voucher system.

        This is a well-written diary, but will all those who are bashing Obama for his stance on fixing Medicare, now realize that Medicare, SS, and the Supreme Court are reason enough to GOTV in 2012?

        I happen to be one of the boomers who hopes to retire from 42 years of teaching this June. Now I am worried. If a Perry or Bachmann or Romney or any other crazy get into office, will I have to work till I drop?

        And by making other boomers unsure about Medicare, raises another question: if people like me don't retire, how will the younger generations find jobs?

        •  And what about productivity? (7+ / 0-)

          I'm still working, and now I'm thinking I might have to work until I drop as well. But I know I'm not able to keep up the level of work that I managed when I was in my forties and fifties.  I also work with others who are hanging on to their jobs but really need to go, for the good of the realm.  

        •  A Hobson's choice (1+ / 0-)
          Recommended by:
          lilchas

          If you don't reform now, as you say, you risk slashing from Perry, Romney et al. in 2013.

          If you do reform now, you risk an onslaught from the hyenas like last year's "Dems cut $500B from Medicare" successful (though lying) ad campaign.

          Even this year, the hyenas are revving up to attack based solely on "Obama put SS and Medicare on the Table!"

          I say defer action until re-election and a better Congress in 2013.

          The GOP: "You can always go to the Emergency Room."

          by Upper West on Sun Aug 14, 2011 at 07:30:26 AM PDT

          [ Parent ]

        •  Reason how? (0+ / 0-)
          This is a well-written diary, but will all those who are bashing Obama for his stance on fixing Medicare, now realize that Medicare, SS, and the Supreme Court are reason enough to GOTV in 2012?

          Will all those waving pom poms for Obama realize that he's as committed to cutting entitlements as any Republican - see the Catfood Commission, which he stacked with entitlement gutters.

          It took Nixon to go to China, and it takes a right wing Democrat to cut the crown jewels of the Democratic Party.  

          As for SCOTUS, what makes you so sure Obama wont go right ahead and appoint another Scalito to the court?  He's already in agreement with them on military, economic, corporate policy and the value of the Bill of Rights.  Yeah, he appointed Sotomayor and Kagan - who just ruled that the cops can avoid those quaint things we used to call "warrants" if they say they think they might be hearing you "destroying evidence" - with 59 Democrats in the Senate.

          McConnell would already be Majority Leader if it weren't for hacks like Sharon Angle, Christine O'Donnell and Linda McMahon handing seats to Democratic candidates.  Baring a gift from god, like oh, say, the House budget committee chairman proposing to devastate Medicare and SS - he will be ML next year if only because Dems are playing much more defense.

          He's got a (D) next to his name. How many Ds and how many Rs next to his policies? - Jim P

          by Uberbah on Sun Aug 14, 2011 at 11:48:25 AM PDT

          [ Parent ]

      •  But the facts should include... (5+ / 0-)

        that Social Security only runs out of money if the economy is truly terrible.

        "There have been tyrants and murderers and for a time they seem invincible but in the end they always fail. Always." -Gandhi

        by Grandma Susie on Sun Aug 14, 2011 at 06:51:55 AM PDT

        [ Parent ]

        •  economic recovery is a guess (5+ / 0-)

          and the projections were made well before the recession. I don't think your scenario is the correct one. it was designed to take us thru 2041 (iirc) and revision downward brings us to 2037, so the difference is a handful of years only. It still has to be addressed.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 07:07:58 AM PDT

          [ Parent ]

          •  Not much of a guess, it's not happening (2+ / 0-)
            Recommended by:
            DemFromCT, CrissieP

            There is actually nothing to indicate that we will have a meaningful economic recovery, or are even considering a reasonable path to an economic recovery.

            Not from Obama, Not from the Dems in congress, and most certainly not from the Republicans.

            And given that we are at Peak resources, especially oil, I sincerely doubt that we will ever see anything like the economic growth of the past.  Which means your estimated shortfalls are extremely optimistic.

            Thanks for taking on this issue.  If we don't start looking at some of these issues in the realistic approach you have taken, the left will be laughed at just as the irrational approach to many issues from the Tea Party are laughed at.  We can't afford not to understand the issues clearly and propose realistic solutions.

          •  It's (not) the Economy, Stupid... (0+ / 0-)

            (With respects to the Clinton campaign)

            Social Security is not pay-as-you-go, it is over-pay-as-you-go.  The still solvent-for-decades Social Security Trust Fund (despite the worst recession in over 70 years) is being held hostage to extract unrelated concessions.  We need to take Social Security completely off the table before someone trades it away to the hostage takers.  Yet the only thing anyone can say is "higher taxes now"?  Good grief!

            If Social Security is in such trouble why did Obama and Congress cut its revenue stream (a 33 % cut in most individual contributions)?  And why does Obama want to extend those lower rates?  The answer is that Social Security is SO OVERFUNDED that politicians feel secure using it to stimulate the overall economy!

            If Social Security was close to depleting its pre-paid reserves (it isn't) then we could talk about all of these sensible solutions we could employ to "fix it."  But to even offer the possibility of S.S. cuts/tax increases at any time in the near future is to deal yourself a losing hand.

            Medicare has problems (see other threads) but Social Security does not.  Leave it alone.  

        •  I agree the framing is problematic. (0+ / 0-)
        •  Not actually true (1+ / 0-)
          Recommended by:
          lordcopper

          Social Security won't run out of money, but benefits will have to be cut by 25% by 2037 if nothing is done. This isn't from the poor economy (as DemFromCT noted above), but from the large population of baby boomers that are starting to retire.
          The poor economy now has caused the SSA to revise that 2037 back to 2035 and to 2030 if the economy doesn't improve significantly.

          You will never know what it’s like to work on a farm until your hands are raw, just so people can have fresh marijuana. Jack Handey

          by skohayes on Sun Aug 14, 2011 at 07:48:47 AM PDT

          [ Parent ]

      •  If it ain't broke... (8+ / 0-)

        You are both inconsistent and fundamentally wrong when you say:
        "In fact, Social Security is  projected have enough funds for full benefits until 2037.
        We need a fix for 25 years from now, and it'll be cheaper and easier to fix it now."
        If we need a fix 25 years from now it is not cheaper to "fix" it now. Why would you prepay for a meal, or a mortgage -- or anything -- 25 years in advance?
        You are playing right into the hands of the anti-government radicals.  No other federal program has the kind of surplus that Social Security has been running since the last time we listened to the "fix it now" chorus.  The surplus should be payed back (at least most of it) before ANY other options are considered.  
        The truth is that both liberals and conservatives oppose paying out Social Security's surplus -- because they've been spending it on everything from war to farm subsidies for two decades.  Liberals fear having to cut other domestic spending while conservatives simply want to destroy social security.  
        While all pundits agree that defaulting on loans to China is unthinkable they blithely accept technical default on loans to Social Security.  And that's precisely what it should be called if we do ANYTHING other than pay back the surplus.

        •  You know, you're right (6+ / 0-)

          Saving for college and retirement is ridiculous.  Why, I'll just cancel my life insurance, cash out my 401(k)'s, and go out and buy a yacht and a BMW tomorrow!

          Give me your tired, your poor, Your huddled masses yearning to breathe free
          ¡Boycott Arizona!

          by litho on Sun Aug 14, 2011 at 07:21:00 AM PDT

          [ Parent ]

        •  Of course it's cheaper now (3+ / 0-)
          Recommended by:
          Hawkjt, joe from Lowell, CrissieP

          The rate of inflation alone says fixing it now will be cheaper than in the future.

          You will never know what it’s like to work on a farm until your hands are raw, just so people can have fresh marijuana. Jack Handey

          by skohayes on Sun Aug 14, 2011 at 07:52:12 AM PDT

          [ Parent ]

        •  Would you rather make one car payment a month... (3+ / 0-)
          Recommended by:
          CrissieP, worldlotus, snackdoodle

          for the next five years, or shell out the full cost of the car in five years?

          How do you know if you'll have that kind of money in five years?

          We need to make a small change now instead of a huge, wrenching one later.

          Art is the handmaid of human good.

          by joe from Lowell on Sun Aug 14, 2011 at 08:36:04 AM PDT

          [ Parent ]

          •  Why would you trust them this time around? (0+ / 0-)

            Very few car loans involve a $2.6 trillion trust fund.  And then still make you pay more -- and get back less.

            "Small change" is precisely what we will be paid when we retire if you trust the same types who promised they had "fixed it" for 75 years last time.

        •  So you never pay for anything ahead? (1+ / 0-)
          Recommended by:
          snackdoodle

          Never buy a concert ticket for something that's not today? Never buy a plane ticket for next month because the price WILL go up if you wait until the last minute?

          You never save, you pay cash for everything, including your HOME (because you ARE paying ahead when you pay your mortgage), you never buy insurance, because god forbid you should plan for something to go wrong.

          Must be nice to have billions...

          •  It ain't broke but politics is (0+ / 0-)

            I say that once you have saved enough to pay for the next 25 years of monthly payments you should start directing your money toward better investments that will actually make the economy grow.

          •  Tomorrow or 2038. What's the difference? (0+ / 0-)

            Big difference between a concert next week and one 25 years in the future.  We've overpaid into the system and we should start getting our money back (at least who currently qualify) before we start talking about "fixing" anything.

    •  I'll worry about (12+ / 0-)

      social security "running out of money" when the level of loss approaches 10% of the annual military budget.

    •  I'm skeptical that simply raising the cap... (4+ / 0-)
      Recommended by:
      JesseCW, snackdoodle, OplusO, Shmink

      will work. All the extra funds collected will once again go into the special SS bonds. As we have already seen, the powers that be will spend it whether on wars or tax cuts for the rich and then scream like stuck pigs when the time comes to redeem all those additional bonds.

      I think we're better off leaving SS alone for now and focus on Medicare. I think it would be fair to extend the Medicare tax to all income including interest, dividend and capital gains for a start. And have it progressive so that higher incomes pay a greater percentage. Let Medicare negotiate drug prices as well.

      For general revenues, we need a financial transactions levy that will raise significant sums of money and also discourage the sorts of wild speculative trading that does no good and indeed may actually harm our economy.

      Just another faggity fag socialist fuckstick homosinner!

      by Ian S on Sun Aug 14, 2011 at 08:23:25 AM PDT

      [ Parent ]

      •  Look, there are only 3 options with regard to SS (1+ / 0-)
        Recommended by:
        snackdoodle

        surplus funds

        1.  Lend the surplus to U.S. Govt (with interest)
        2. Invest surplus in corporate securities (risky)
        3. Hold surplus balances in cash

        I think you would agree that the "special SS bonds" represents the best option.

        "Because I am a river to my people."

        by lordcopper on Sun Aug 14, 2011 at 08:55:47 AM PDT

        [ Parent ]

        •  The best option is to limit the lending... (0+ / 0-)

          period. As events over the past decade have shown, there are a significant number of folks in positions of power who don't think SS should be paid back the money it lent to the government. I'm not sure it's a good idea to lend MORE money to a government controlled by those sorts of people. I say wait for fifteen years and see where we are then in terms of SS solvency.

          Just another faggity fag socialist fuckstick homosinner!

          by Ian S on Sun Aug 14, 2011 at 09:49:53 AM PDT

          [ Parent ]

          •  If that's were true, then SS has to be disbanded, (1+ / 0-)
            Recommended by:
            snackdoodle

            because without "compound interest" (investment) payments to  SS would represent a much larger percentage of GDP.  There is no advantage to holding SS contributions (payroll deductions) in cash.

            "Because I am a river to my people."

            by lordcopper on Sun Aug 14, 2011 at 10:28:41 AM PDT

            [ Parent ]

            •  I'm not arguing to hold contributions in cash... (0+ / 0-)

              I'm arguing that we should continue as we are doing now until/if it becomes clear that the shortfall is certain. By that time we will already be well into drawing down the trust fund. Then we can institute increases in the SS tax that will have the effect of slowing the rate of depletion of the trust fund such that we can continue to make the promised payouts once the fund is depleted and we baby boomers have all gone to our reward. Then it reverts to the pay-as-you-go system it's supposed to be.

              Just another faggity fag socialist fuckstick homosinner!

              by Ian S on Sun Aug 14, 2011 at 11:13:44 AM PDT

              [ Parent ]

              •  We know the every class of beneficiaries receives (1+ / 0-)
                Recommended by:
                SoCalSal

                more than they put in (COLAs and life expectancy).  The later we wait to address this issue, the more drastic the adjustment will have to be.  Furthermore, there's the issue of generational fairness to consider.  The later we wait to address the issue, the greater the likelihood that contributors are paying more for a declining benefit structure.  There is a limit as to what a society "can" pay for SS benefits, without forgoing current day investment opportunities important to society.  Remember, there is no imminent solution to the long term issues surrounding Medicare.  It's irresponsible to procrastinate in resolving these issues.

                "Because I am a river to my people."

                by lordcopper on Sun Aug 14, 2011 at 11:29:59 AM PDT

                [ Parent ]

        •  4th option? (1+ / 0-)
          Recommended by:
          SingleVoter

          In an ideal world we could invest the excess in economy enhancing ways -- education, infrastructure, scientific advances -- but, then, we don't live in an ideal world.  The Social Security subsidy to federal programs has been indiscriminate and largely wasted.

        •  There are possibilities (0+ / 0-)

          of investing it in foreign government securities (Spain or Germany) and in state general obligation debt.

  •  RE: funding mechanisms (6+ / 0-)

    I've always wondered if applying the Social Security and Medicare taxes to unearned income would be possible. But I suppose then they wouldn't be payroll taxes.

    At least taxing earned and unearned income the same would help the general fund side.

    •  Technically, yes. (3+ / 0-)
      Recommended by:
      ezdidit, caul, supercereal

      Politically, no.  That would require an honest statement about the fact that they are, in fact, income taxes.  Locking them to "earned" income, having no deductions apply to them at all, and capping them to boot, is a giant load of horseshit.

      Imagine the "payroll" taxes being applied to long term capital gains.  From 15%, they would go to 15.2% (7.6% x 2) + whatever the "income tax" rate is.  A 50% tax rate on the financial speculators?  Sounds good to me.  (Cue hysterical screaming from the mouthpieces for the ultrarich).

      P.S. I do think there should be an adjustment for inflation, and averaging over the number of years involved, but that's all irrelevant as long as the rate is different from standard income tax rates.

      I am become Man, the destroyer of worlds

      by tle on Sun Aug 14, 2011 at 06:43:44 AM PDT

      [ Parent ]

  •  Just pay less (6+ / 0-)

    The cost of health care isn't fixed and immovable. Pay half of what medicare rates are today and make licensure for providers dependent on accepting all and any medicare patients. Large hospitals and expensive specialists would need to live within our means.

    When I can go to Thailand and get much better care for a fraction of the cost something is broken.

    Or socialize medicine. Everyone gets a decent salary and benefits from the government. All hospitals are operated by the government. All insurances is via the govt.

    Single provider now!

    Voila.

    "Don't fall or we both go." Derek Hersey 1957-1993

    by ban nock on Sun Aug 14, 2011 at 06:17:14 AM PDT

    •  no viola (16+ / 0-)

      besides the fact that you can't implement it with a wave of your hand, you can't take care of people for nothing.

      You are right that decreasing costs in general is the way to go (how to do that turns out to be exceedingly hard but not impossible). But please see my very first comment about the demographic issue of adding beneficiaries.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:24:19 AM PDT

      [ Parent ]

      •  But European countries... (9+ / 0-)

        and all other first world countries have half the per capital health costs that we have and they have better health outcomes.  We can no longer afford the subsidies to the health insurance industry that keep our health costs unsustainably high.

        "There have been tyrants and murderers and for a time they seem invincible but in the end they always fail. Always." -Gandhi

        by Grandma Susie on Sun Aug 14, 2011 at 06:53:49 AM PDT

        [ Parent ]

        •  absolutely (3+ / 0-)
          Recommended by:
          skohayes, lordcopper, SoCalSal

          but don't confuse what you want with what we can do.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 07:08:55 AM PDT

          [ Parent ]

          •  If single payer were actually on the table (3+ / 0-)

            then we could honestly have that discussion about reducing per capita costs.

            The decision to stick with employer-based private health insurance locks in our ridiculously high health care costs, and limits our ability to advocate for the sweeping changes that could moot the entire Medicare problem.

            Give me your tired, your poor, Your huddled masses yearning to breathe free
            ¡Boycott Arizona!

            by litho on Sun Aug 14, 2011 at 07:23:42 AM PDT

            [ Parent ]

            •  agreed (2+ / 0-)
              Recommended by:
              lordcopper, SoCalSal

              now do something about it. You have until Tuesday.   ;-P

              Honestly, if it were easy to implement, we'd have done so.

              Yes, we need to keep fighting for it. In the meantime....

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Aug 14, 2011 at 07:33:02 AM PDT

              [ Parent ]

            •  Yes, IF ... but single-payer isn't right now. (0+ / 0-)

              It becomes more thinkable if Scotus kills the mandate (I'm not sure it will) and we get a Democratic House in 2012 (ditto). Then at least we can have a good dialog on it. But now?

              How many doctors do you know who will voluntarily reduce her or his take below what it is today? And to require that all doctors take Medicare? That much intrusion in this mixed-bag American political system alone would likely elect a bigger House GOP majority in 2012.

              I don't see how a significant portion of our medical care community would accept "Just pay less." It's not the real world.

              Obama and strong Democratic majorities in 2012!

              by TRPChicago on Sun Aug 14, 2011 at 07:40:17 AM PDT

              [ Parent ]

              •  But (0+ / 0-)

                isn't the other side of this a decrease in expenditures by health care providers? In effect savings on both ends.

                Depressions may bring people closer to the church but so do funerals - Clarence Darrow

                by nomorerepukes on Sun Aug 14, 2011 at 08:12:58 AM PDT

                [ Parent ]

              •  I don't know that it would (1+ / 0-)
                Recommended by:
                snackdoodle

                And I don't know that the doctors would make less, all things considered.

                They'd SAVE a ton in administrative costs, and my bet is their malpractice insurance would drop as well.

                Why? Well, a large chunk of malpractice cases are to cover future medical costs. Take that out of the mix, and people might be less likely to sue, and awards would be less as well.

                The administrative costs would be the big one. And more timely payment would help as well.

                If doctors and hospitals got paid in 90 days, and for EVERYBODY, they wouldn't have to tack on huge charges to cover the uninsured and to compensate for the months, sometimes YEARS, it takes them to get paid.

                That alone would make a huge difference.

                •  OK, but on malpractice claims, for example ... (0+ / 0-)

                  ... what system covers the patients who have been victims of too much anesthesia, or negligent surgery, or miscommunication in the OR, or a patently screwed up diagnosis, for examples.

                  I'm all for ways to decrease the involvement of lawyers in claims of all kinds, including "med mal", but the alternatives need more thought than I'm hearing from the advocates of tort reform.

                  Is it realistic to expect medical professionals to confess error and volunteer to pay the costs of a serious health problem, or death? Will boards of their peers award compensation, when there seems to be little punishment now for doctors who err in less significant ways?

                  And if a "system" paid the future medical costs of malpractice, how do you propose to hold the doctor or other medical professional responsible?

                  As for your points about timely payment, no concerns over insurance claims, less paperwork (other admin costs might help fill this vacuum), etc., I agree, though there are a lot of people in and out of the medical and political profession who don't.

                  Obama and strong Democratic majorities in 2012!

                  by TRPChicago on Sun Aug 14, 2011 at 10:24:54 AM PDT

                  [ Parent ]

                  •  You're not understanding universal health care (0+ / 0-)

                    It means you get the care you need, REGARDLESS of cause, and you get it when you need it, regardless of COST.

                    Whether you can work (or do) or not, no matter your age, no matter your condition - you get care you need.

                    Doctors don't know everything, and they do make mistakes. They should be held accountable for them. That's the job of medical boards, and in some cases, lawyers.

                    But in this country, too many times it goes to lawyers just so the patients can be compensated not just for lost wages or the impact on their futures, but because they have to pay for medical care and will NEVER be able to get health insurance.

                    That would never happen in other countries. NEVER. It's not even an issue.

                    Other countries don't have NEARLY the amount of malpractice suits we do. Nor do doctors there pay nearly what ours do for malpractice insurance.

                    It's not because their doctors are perfect - it's because if they do make a MINOR mistake, the patients will be cared for regardless of the cause.

                    It also would serve to make it easier for doctors to admit mistakes - they pretty much CAN'T now, even if they want to just to help others learn, because it opens them to a lawsuit.

        •  Blaming it on insurance is a bright shiny object (0+ / 0-)

          Eliminating insurers entirely wouldn't bring costs down to anywhere near what other countries pay.

          We have people making huge fortunes off charging us a ton of money to get healthcare, insurers are only the middle men.

          As long as some one can make a profit off charging me as much as they can, they will.

          If I'm dying and another guy is dying and the other guy has insurance that will pay five times what mine does the provider is going to figure out a way to forget about me. They'll have the front desk turn me away.

          That's just how our system works now.

          "Don't fall or we both go." Derek Hersey 1957-1993

          by ban nock on Sun Aug 14, 2011 at 07:18:03 AM PDT

          [ Parent ]

      •  I didn't say take care of people for nothing (0+ / 0-)

        just half.

        I'd think half as much would still be one of the highest rates in the world.

        Certainly no one ever has a problem cutting the rate I'm compensated at. I have no problem if hospital groups and providers are paid less, they can buy one less yacht.

        I just can't afford to support the lifestyles of providers any longer.

        Single provider today.

        Voila!

        "Don't fall or we both go." Derek Hersey 1957-1993

        by ban nock on Sun Aug 14, 2011 at 07:13:47 AM PDT

        [ Parent ]

        •  "Just half" (4+ / 0-)
          Recommended by:
          DemFromCT, boophus, mmacdDE, denise b

          is really an unrealistic suggestion. When I was practicing pathology, Medicare allowables were so low that we lost money on most clinical lab tests for Medicare patients; cutting those fees in half would have destroyed us. I know that many primary care offices lose money on each Medicare patient (and cutting fees in half would destroy them, too); however, plenty of surgeons and procedure-oriented specialists rake in big bucks on Medicare (I'm looking at you, ophthalmologists!).

          But, yes: single-payer now. With capitated rates, proper incentives, evidence-based-medicine, and so on.

          Joe

          Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

          by CitizenJoe on Sun Aug 14, 2011 at 07:44:38 AM PDT

          [ Parent ]

          •  Not single payer, single provider. (0+ / 0-)

            I simply don't believe the bit about losing money. If someone said they don't make as much as they'd like, ok, I'd believe it. I can't believe we are such horrid business people that the whole world can provide medical care at a fraction of our cost.

            I just never see any clinics or doctors offices with going out of business signs.

            "losing money" nah.

            "Don't fall or we both go." Derek Hersey 1957-1993

            by ban nock on Sun Aug 14, 2011 at 09:26:14 AM PDT

            [ Parent ]

            •  Sorry you don't believe my experience; (0+ / 0-)

              it was real, and I lived it. We had about a 2% "profit" margin overall on clinical lab testing--so we lost money on Medicare, made money on the rest. Back in about 1984, Medicare changed lab billing from Part B to Part A, and the Part B people stopped paying us, but the Part A people took about six months to start paying us, and we nearly went bankrupt (because we were such lousy business people that we went right on performing the lab tests for sick people, and still had to pay technologists, buy reagents, pay off loans for instruments, etc....). When Medicare started paying again, we survived, but we still lost money on nearly every Medicare test.

              As far as your not seeing clinics/docs' offices with going out of business signs: well, you are unlikely to see signs--there is hardly any inventory to have for a 40% Off! sale. But I know quite a few primary-care physicians who have closed their offices because of poor income. And if you look at primary-care physicians in the U.S., their income is quite comparable to international rates; they are not the problem, and cutting everybody across the board by half is merely ax-wielding, when we need a scalpel.

              Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

              by CitizenJoe on Sun Aug 14, 2011 at 10:19:40 AM PDT

              [ Parent ]

  •  A very important clarification (24+ / 0-)

    It's absolutely essential that people understand that a substantial proportion of health care spending -- not just Medicare but all health care spending -- in the U.S. is wasteful. In civilized countries such as the UK, there are agencies that evaluate treatments and determine which are effective under what circumstances. They won't pay for drugs or treatments which are licensed, but are not considered useful, or the best option, under particular circumstances. We don't do that, and in fact the ACA contains language that the comparative effectiveness research it will sponsor cannot be used by CMS to decide on what to pay for! This is an outrageous concession to drug and medical device industry interests, and medical specialists, who want to continue to be free to rip us off. Examples include inappropriate use of cardiac revascularization, back surgery, overprescription of psych meds, etc.

    A further step is cost effectiveness -- deciding that we won't pay $250,000 to give a terminal cancer patient one more month of desperately ill existence, for example. Other countries also do this, but we can't even talk about it. At some point we will have to.

    More is not always better in medicine. We're often better off doing less. But as soon as someone tries to have that conversation, the wingnuts start screaming about Death Panels.

    Are we all going to die? Yes. It's time we got used to it.

    •  agree completely and reiterate this from the post (13+ / 0-)
      Certainly providers have to do their share in controlling costs. Health care costs themselves are unsustainable, and Medicare is just part of that big picture. And for more on what can be done about health care costs, I highly recommend Medicare, Our Deficit and Honesty by Dr. Chris Lillis and [my friend] Dr. Christopher Hughes, published at Doctors for America.:
         Dr. Robert Levine wrote this piece a few years ago, and estimates that about a trillion dollars is wasted every year in our health care system between unnecessary care, administrative waste and fraud (not all in the Medicare system, but a substantial portion).  Find it hard to believe?  Then you have not read enough.   Physicians are part of the problem in ordering and performing unnecessary tests, procedures and surgeries, as outlined here by Dr. Rita Redberg.
      The key there is deciding what's "unnecessary". For example, from your own comment, which I completely agree with,
      deciding that we won't pay $250,000 to give a terminal cancer patient one more month of desperately ill existence, for example.
      would likely not meet unanimous agreement. ;-P

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:28:23 AM PDT

      [ Parent ]

    •  You talkin' death panels here? (1+ / 0-)
      Recommended by:
      lordcopper

      Getting between me and my doctor, deciding what care I can receive?  I can hear it now.  Oh, wait, we've heard it already, ad nauseam.

      If we don't fight hard enough for the things we stand for, at some point we have to recognize that we don't really stand for them. Paul Wellstone

      by Alice Olson on Sun Aug 14, 2011 at 06:42:30 AM PDT

      [ Parent ]

      •  End of life decisions.................... (5+ / 0-)

        .............When my mother was very ill the medical community placed the entire burden on me. I asked them, would this treatment make any difference? Most of the time they made me feel that it would. And not for financial reasons, but because they are human beings too. Man it's such a tough position to be in. I'm trying to decide how I would have felt if I was in a situation in which there was no choice, though. Are we going to be bankrupting our children anyway because they will feel obliged to pay out of their own pockets to keep us alive? Anyway, just food for thought.

      •  I'm sad they didn't push back harder on that lie. (2+ / 0-)
        Recommended by:
        lordcopper, mmacdDE

        The so-called "death panel" proposal wouldn't have reduced patients' control over their care, but increased it, by making their wishes more explicit.  The only treatments that don't get done with clearer, patient-centered end-of-life instruction are treatments that the patient has decided they don't want.

        Art is the handmaid of human good.

        by joe from Lowell on Sun Aug 14, 2011 at 08:39:33 AM PDT

        [ Parent ]

    •  Remember too (0+ / 0-)

      not providing a certain treatment doesn't mean not providing ANY treatment.

      Even a terminal patient will be given pain meds, made comfortable, have nursing care as needed, and as much as needed.

      They might not be in a hospital. They might be at home, or in a long term care facility, or at a family member's home. They WILL get nursing care, and the family will get counseling.

      But those things are much cheaper than a month of intensive care in a hospital when it's pretty obvious that the person is not going to get better, no matter what you do.

  •  I think before we get into structural of the (6+ / 0-)
    Recommended by:
    DemFromCT, DRo, caul, TFinSF, dizzydean, SingleVoter

    program itself, we should actually get into the general costs of the health care system as a whole:

    Why does, for instance, an MRI cost different amounts depending on the hospital, insurance company, or whether or not you're insured?

    Why can't it be more uniform?

    Why are there such things as $10 aspirin?

    And so on.

    Single payer can solve this (mostly), but as we don't have a single payer system, this does need to be addressed.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity." --M. L. King "You can't fix stupid" --Ron White

    by zenbassoon on Sun Aug 14, 2011 at 06:17:51 AM PDT

    •  The single most difficult question for any (10+ / 0-)

      provider is, "how much does it cost".

      Next time you go to the doctor try that one out at the front desk.

      I can walk into any hospital in Thailand and the receptionist can answer that question in under one minute and will gladly do so.

      "Don't fall or we both go." Derek Hersey 1957-1993

      by ban nock on Sun Aug 14, 2011 at 06:20:19 AM PDT

      [ Parent ]

      •  actually (7+ / 0-)

        it's easy. Now, you may not like the answer, but my office (I am a pediatrician) tells pts that whenever they ask, which is frequently.

        Not so easy is getting numbers from hospitals for acute care (who knows how long you'll be here?) , but for elective procedures you can get a good estimate.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Aug 14, 2011 at 06:47:06 AM PDT

        [ Parent ]

        •  when I walk up to the front desk your receptionist (2+ / 0-)
          Recommended by:
          DemFromCT, triv33

          would tell me you don't accept patients like my kids.

          "Don't fall or we both go." Derek Hersey 1957-1993

          by ban nock on Sun Aug 14, 2011 at 07:19:50 AM PDT

          [ Parent ]

          •  Are you suggesting (0+ / 0-)

            he engages in discriminatory practices?

            What is it about your kids that would make him refuse to treat them?

            Give me your tired, your poor, Your huddled masses yearning to breathe free
            ¡Boycott Arizona!

            by litho on Sun Aug 14, 2011 at 07:27:53 AM PDT

            [ Parent ]

            •  My kids are on CHIP, no pediatrician accepts (1+ / 0-)
              Recommended by:
              SingleVoter

              new Chip patients.

              I've no idea of the legality, I'm a parent not a lawyer.

              "Don't fall or we both go." Derek Hersey 1957-1993

              by ban nock on Sun Aug 14, 2011 at 07:39:18 AM PDT

              [ Parent ]

              •  see comment below (0+ / 0-)

                in CT it's called Husky, and there are multiple choices for parents to take their kids (like at least half a dozen).

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Sun Aug 14, 2011 at 08:04:32 AM PDT

                [ Parent ]

                •  I didn't mean to pick on you personally (1+ / 0-)
                  Recommended by:
                  DemFromCT

                  I knew about pediatricians from experience. It is what it is. When I can walk into an office and get care I know this country is headed in the right direction. Until then I'll work for affordable health care for all.

                  Connecticut is a big state, six places to take your kids isn't so great.

                  "Don't fall or we both go." Derek Hersey 1957-1993

                  by ban nock on Sun Aug 14, 2011 at 09:21:46 AM PDT

                  [ Parent ]

                  •  hey, it's not either-or (1+ / 0-)
                    Recommended by:
                    ban nock

                    CT does a pretty good job with the kids, I don't know every state and how they do things there.

                    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                    by Greg Dworkin on Sun Aug 14, 2011 at 09:39:10 AM PDT

                    [ Parent ]

          •  heh (0+ / 0-)

            only after the first visit. ;-)

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Sun Aug 14, 2011 at 07:34:50 AM PDT

            [ Parent ]

            •  Do you take new medicaid patients? (0+ / 0-)

              Because not one pediatrician in the N Denver metro region would, I called every one.

              "Don't fall or we both go." Derek Hersey 1957-1993

              by ban nock on Sun Aug 14, 2011 at 07:42:27 AM PDT

              [ Parent ]

              •  I'm a specialist (0+ / 0-)

                and most in my area take new medicaid patients but only in our defined catchment area. Medicaid is everyone's responsibility so we divvy it up throughout CT (pediatricians and specialists) each taking form their own geographic area. No out of state insurance esxcept by arrangement (exception for military families).

                We also have three separate clinic practices in town, including one medicaid only and two FQHC (community health centers) and an Americares clinic for adults.

                We all see it as our responsibility to do something even though none of us can do everything.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Sun Aug 14, 2011 at 08:03:15 AM PDT

                [ Parent ]

              •  my suggestions (0+ / 0-)

                1. local department of public health
                2. FQHC hotline

                http://findahealthcenter.hrsa.gov/...

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Sun Aug 14, 2011 at 08:06:31 AM PDT

                [ Parent ]

                •  Thanks I've used that search engine before (0+ / 0-)

                  my kids go to the clinic that comes out at the top of the list, but we have no pediatrician, or regular family doctor. No one will take new patients here, all poor people go to the clinic or the emergency room for faster care.

                  "Don't fall or we both go." Derek Hersey 1957-1993

                  by ban nock on Sun Aug 14, 2011 at 09:14:29 AM PDT

                  [ Parent ]

                  •  if that didn't work (0+ / 0-)

                    like I said, we have two FQHC that see kids), I suggest your local DPH, local hospital peds dept.  or even the state American Academy of Pediatrics for other choices.

                    "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                    by Greg Dworkin on Sun Aug 14, 2011 at 09:22:46 AM PDT

                    [ Parent ]

                    •  We go to La Clinica Campesina or something, it's (0+ / 0-)

                      where people like us go, because no pediatrician just takes people who arrive at the front desk, or call, or email. We have the wrong insurance.

                      "Don't fall or we both go." Derek Hersey 1957-1993

                      by ban nock on Sun Aug 14, 2011 at 09:40:18 AM PDT

                      [ Parent ]

                      •  no doc takes walk ins around us (1+ / 0-)
                        Recommended by:
                        ban nock

                        even for same day visits but we do take Husky (many of us do.)

                        I am sorry the system is as bad as it is, which is why I have always been for reform, incremental or otherwise.

                        Real people, real issues.

                        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                        by Greg Dworkin on Sun Aug 14, 2011 at 09:48:04 AM PDT

                        [ Parent ]

        •  There is the cash price, then there (1+ / 0-)
          Recommended by:
          ban nock

          is much lower negotiated rate that insurance companies pay. Am I right?

    •  absolutey has to be part of the picture (2+ / 0-)
      Recommended by:
      zenbassoon, caul

      ACA addresses it somewhat, and I call your attention to these links for other fixes:

      http://theincidentaleconomist.com/...

      http://www.drsforamerica.org/...

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:30:01 AM PDT

      [ Parent ]

    •  Hospitals charge $10 for aspirin because they ... (0+ / 0-)

      ... allocate costs of their building(s), their otherwise non-allocable costs, etc., I think. It's a system devised by bean-counters. And you can bet the "internal-rate-of-turn" built into the institution's "requirements" is pretty high.

      A hospital visit is an invitation to "pile on", an inescapable opportunity to make another $10 off an aspirin.

      Obama and strong Democratic majorities in 2012!

      by TRPChicago on Sun Aug 14, 2011 at 07:50:49 AM PDT

      [ Parent ]

      •  what do they do with the $10? (1+ / 0-)
        Recommended by:
        CrissieP

        in some cases, fund the money-losing pediatrics department, run a medicaid clinic or revitalize facilities so moms can have single rooms for newborns.

        Just sayin' ;-)

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Aug 14, 2011 at 08:29:26 AM PDT

        [ Parent ]

        •  Yes, Doc, I give you that. You make a good point. (1+ / 0-)
          Recommended by:
          DemFromCT

          But you must see how the typical in- or out-patient charges look to those of us used to seeing bills for things, even complicated things.

          A friend - faced with an insurance company that has now turned tail on the claim - got bills from the hospital and her doctor for relatively brief out-patient surgery (which did involve anesthesia), totalling more than $7000. Her insurance company has decided, after the fact, that the surgery was "cosmetic."

          If medical bills are itemized (as they used to be), we patients are baffled by the number of ways to count things provided to us. If they're not, they look like the lawyer's bills of old, that read simply, "For services rendered." Neither is very acceptable; both make us resentful.

          I'm aware that doctors and hospitals take a lot of patients who are not remunerative. You should be very proud of your profession for that. And I know costs have to covered. Thinking on those things, we agree.

          Obama and strong Democratic majorities in 2012!

          by TRPChicago on Sun Aug 14, 2011 at 10:11:00 AM PDT

          [ Parent ]

  •  Fix Medicare D by negotiating Rx prices like the (10+ / 0-)

    military does.  It was my understanding that Obama made a deal with former Senator Billy Touzen (R-LA) not to negotiate with Big Pharma while doing the health care reform.  Why don't we have a bill in Congress to fix Medicare D negotiation for lower prices?  It would have fixed the outflow of money a long time ago.

    It was another part of the GOP policy "raise the debt, pay for nothing, til we cause such financial crisis that we can cut entitlements and get rid of them."  The end of the New Deal.

    Bush allowed Senator Touzen to make the deal with Big Pharma to forbid the government negotiating power and buy the meds at the highest price.  After Touzen got Medicare D through he quit Congress and became the head of Big Pharma with a $1M+ salary. I think he got an "Ethics waiver" from Bush....yes the Bush administration actually gave out "ethics waivers."

    •  I would like to see a link to your understanding. (0+ / 0-)

      As I distinctly recall the president saying that Medicare reforms should be related to provider payments and negotiating for lower drug costs.  This was part of his grand bargain proposal I believe.

      •  HA! (2+ / 0-)
        Recommended by:
        pot, marty marty

        "Grand bargain".  Yeah, right.  I'll believe it when it actually happens, not before then.  The Big Pharma Subsidy Act has remained, unchanged, since the late-night shenanigans that led to its passage.

        I am become Man, the destroyer of worlds

        by tle on Sun Aug 14, 2011 at 06:52:17 AM PDT

        [ Parent ]

      •  Are you kidding?! Greenwald and many others have (2+ / 0-)
        Recommended by:
        Shmink, denise b

        Written about this extensively - Dorgan pushed hard for negotiated Rx prices as part of health insurance reform, and was completely undermined by the Admin.  Messina and others have basically admitted as much.

        Sorry, pretending otherwise will not make it so.  

        •  Not only that (3+ / 0-)
          Recommended by:
          marty marty, Shmink, Timothy J

          but they lied to Congress about the projected cost of the program, and threatened to fire the Medicare actuary if he revealed the true projections.

          The GOP: "You can always go to the Emergency Room."

          by Upper West on Sun Aug 14, 2011 at 07:34:39 AM PDT

          [ Parent ]

        •  Looking for a link to the part about the (0+ / 0-)

          administration undermining the proposal.

          •  The first give up to pharma was at the outset ... (2+ / 0-)
            Recommended by:
            marty marty, Timothy J

            ... of health care reform, before negotiations began. It was done to take Pharma out of the debate from minus Day One. The White House did not "alert the media" needless to say, but DC knew that was the deal from the Get Go.

            Obama and strong Democratic majorities in 2012!

            by TRPChicago on Sun Aug 14, 2011 at 07:58:23 AM PDT

            [ Parent ]

            •  DC knew that was the deal? (2+ / 0-)
              Recommended by:
              worldlotus, edwardssl

              That is not my idea of substantive evidence.  Who is it exactly that provided this insight?  I posted a link to a bloomburg article where the Obama administration was pushing drug purchasing reform.  I understand that administrations will say one thing and do another, but I won't just assume the worst about the first Dem president in the decade because someone claims to have inside knowledge.  

              The accusation that Obama has been bought off by Big Pharma, and will decrease benefits for seniors while continuing to funnel taxpayer money to pharmaceutical companies is a pretty horrendous claim.  It would be a deal breaker for me and I think for most Democratic voters.  

              For an accusation that serious, I would need far more that someone's claim that DC knew that was the deal.  That could just as easily be a rumor planted by the GOP.  

              •  Yup. (1+ / 0-)
                Recommended by:
                Timothy J

                From Huff Post, March 29, 2010:

                As Obama's health care drive began last year, drugmakers agreed with Senate Finance Committee Chairman Max Baucus, D-Mont., and White House officials to support the effort. In exchange, the companies volunteered $80 billion in 10-year savings for the health care changes, and backed it up with an expensive TV ad campaign pushing Obama's proposal.

                Moreover, your comment wrongs me. You wrote, "The accusation that Obama has been bought off by Big Pharma ..." That is not what I said. Repeat: I made no such accusation - and I would not - about President Obama. What I wrote was the reverse: "... a giveup to pharma ... at the outset." As Alan Fram at Huff Post and a number of others reported, Pharma was deliberately removed from the game as the WH and others strategized how to play out the health care reform debate and votes. Did they get something for it? Yup, but I think you have the transaction and the motivation backwards.

                While I don't blame you for wanting citations to sources, oneshot, please know that I do not like being mis-stated. Know, too, that I resent your linking me with "rumor(s) planted by the GOP." Find an instance where I've done that.

                And when you write that you "... would need far more that someone's claim that DC knew that was the deal," I ask you: Were you there?

                Obama and strong Democratic majorities in 2012!

                by TRPChicago on Sun Aug 14, 2011 at 09:57:25 AM PDT

                [ Parent ]

                •  I don't have any idea what you are saying. (0+ / 0-)

                  I apologize if I misquoted you, but I don't understand your point.  You put out a quote saying that big pharmacy supported health care reform, and agreed to give up 80 billion in the negotiations.  Where does it say that the admistration gave up anything?  Why would they give up anything?   And for someone who is so concerned about being misquoted, you certainly misrepresented what I said.  I never linked you with anything.  What I said was that rumors in dc can be placed by a variety of people for a variety of reasons.  Without a source, anyone could be responsible for the rumor.  

                  Lastly, no I wasn't there.  I don't see how my need for a source or a link leads to that conclusion.  I want a link to the allegation that there was a deal between the administration and big pharmacy, that there would be no negotiating for prices.  I still don't have a link or source to document that there was such an agreement.  Evidence is important.  

                  •  We are talking past each other. (1+ / 0-)
                    Recommended by:
                    Timothy J

                    The quote I gave you was in response to your challenge to find a source. That's a reasonably reliable source. A Google search will produce similar reports.

                    As for the deal: what Pharma got was to not be a part of health care reform; what the Administration and Baucus got (if you believe Huff Post) was Pharma either neutral or lobbying for rather than against reform. In other words, a major player who could logically have been included in a health care reform package bill came out unscathed.

                    As for my misrepresenting you, it was your response to me that suggested "people" (was there anyone else nearby on this thread?) could be swallowing a GOP line ... and I wanted to be clear that I don't.

                    Now as for evidence, whose word would you accept? As for "documentation", it may be written somewhere, but it isn't exactly the kind of deal the parties memorialize for the world, is it? As for a link to a source, it was Huff Post who had the story; there's a "link to the allegation".

                    Obama and strong Democratic majorities in 2012!

                    by TRPChicago on Sun Aug 14, 2011 at 05:00:16 PM PDT

                    [ Parent ]

                    •  You say that pharma was unscathed (0+ / 0-)

                      But the quote you posted said that they were committing 80 billion for healthcare reform.  That isn't exactly unscathed.
                      As for the source, huff post is fine, but there really isn't anything in the quote which documents what the deal was, who made it, and what the terms of this deal were.  I don't see anything in the quote that would indicate that the administration, in the future, could not seek to pay lower rates for drugs under Medicare part d.    That was the claim that I originally wanted a link to.  

                      Healthcare reform is not the same as Medicare part d. Two different programs , allow for two different negotiations.

        •  Sorry, don't trust Greenwald an unnamed "others." (0+ / 0-)

          Do you have any evidence at all to back up your claim?

          I just keep seeing it asserted over and over.

          Art is the handmaid of human good.

          by joe from Lowell on Sun Aug 14, 2011 at 08:41:40 AM PDT

          [ Parent ]

        •  Because Obama made a behind the scene deal (2+ / 0-)
          Recommended by:
          Shmink, Timothy J

          with Big Pharma!

      •  Last year Obama cut 21% on the medical (0+ / 0-)

        providers -- MY DOCTORS!  He is cutting Medicare from the back door so my doctors will say they can't afford to take me.  That's an actual fact!  Now he wants to do more cutting to medical providers.  Obviously, 21% was not enough?

        •  Obama did not cut your doctors payments (1+ / 0-)
          Recommended by:
          edwardssl

          By 21%.  Honestly, do you people just take anything bad that happens and attribute it to Obama?  If you bothered to do any research you would see that the 21  % provider cut  was scheduled in a law from 1997.  It was a budgeting gimmick that was designed to make the budgets look better.  Congress passed laws three times to prevent the cuts from happening.  In 2010, the house passed a bill that would have prevented the cuts from occurring, but due to the filibuster, the bill was unable to get through the senate.  However much the congress wanted the cuts prevented, the bill to make sure doctors were paid enough was very unpopular with the middle class for obvious reasons.

          •  problems with the automatic cut to docs (0+ / 0-)

            go back many years and have to do with the cost of running an office not being included.  You can't arbitrarily set prices for medicare and ignore inflation and the rise in salaries and benefits, office supplies, medical equipment, etc.

            "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

            by Greg Dworkin on Mon Aug 15, 2011 at 04:38:11 AM PDT

            [ Parent ]

            •  I am not arguing for any cuts to medicare (1+ / 0-)
              Recommended by:
              DemFromCT

              Was just pointing out to th poster who claimed that Obama had cut the pay to his doctors by 21%.  These cuts were written into law in 1997 to automatically take effect.  Obama didn't create them, and in fact he supported a bill to prevent them.  For so many here now, the facts don't even matter, if they can use something to make Obama look and, they just go ahead with it.  Reality is irrelevant for some here.

    •  For more info see bloom burg article (1+ / 0-)
      Recommended by:
      worldlotus

      http://www.bloomberg.com/...

      It is entitled "Obama singles out drug companies for savings in debt talks"

    •  Great comment (0+ / 0-)

      (one nit -- it's "Tauzin,"  not that a crook like him deserves to have his name spelled right.)

      The GOP: "You can always go to the Emergency Room."

      by Upper West on Sun Aug 14, 2011 at 07:36:57 AM PDT

      [ Parent ]

  •  Thanks, DemFromCT, for a calm, rational, (18+ / 0-)

    factual explanation of Medicare's cost issues.  I think a lot of the rage and hysteria surrounding this issue stems from our certain knowledge that the GOP means to cripple these programs with the goal of eventually eliminating them.  When they talk about "protecting" Medicare for future seniors, we know that they are lying.  

    This leads us to believe that when the President uses the same language of "protecting" or "making changes" to Medicare, that he has those same goals.  (I, for one, do not believe his goal is join with Republicans to destroy the New Deal, as many here claim).  This fear and mistrust leads to our inability to talk rationally about the actual fiscal problems that Medicare faces.  You have spelled out the problems, and offered a few common-sense solutions (cut the military budget, increase tax revenues) that should be on Democrats' lips every single day.

    Thank you.

    Sometimes I wonder whether the world is being run by smart people who are putting us on or by imbeciles who really mean it. --Mark Twain

    by SottoVoce on Sun Aug 14, 2011 at 06:20:02 AM PDT

  •  Remove the cap on eligible income, (1+ / 0-)
    Recommended by:
    DRo

    and we would never have a problem for eternity.

    Question for Mitt, If corporations are people, why don't they have to pay SS taxes?

    •  that's SS (2+ / 0-)
      Recommended by:
      aisling, Hawkjt

      no such fix exists for mediare, the bigger problem.

      But as a commenter above notes, there's no unanimous agreement as to when to lift the cap.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:49:19 AM PDT

      [ Parent ]

  •  There's crap in here that makes no sense (21+ / 0-)

    This nonsensical statement you quote has the appearance of right wing anti-government ideology.

    The public financing of Medicare has particular implications for the economy. Specifically, raising taxes to pay for public insurance exerts a structural drag on the economy even if the revenue is spent on care; the same is not true of unsubsidized, privately purchased care or insurance.

    I would argue that privately funded health care spending has a bigger drag because it is such an inefficient use of resources. Medicare has far lower overhead costs that private insurance.

    If you compare the U.S. health care system to those of other developed nations the U.S. comes out on the bottom for cost efficiency of delivery.

    look for my eSci diary series Thursday evening. "It's the planet, stupid."

    by FishOutofWater on Sun Aug 14, 2011 at 06:21:46 AM PDT

    •  Precisely. Taxes can be progressive, hence... (2+ / 0-)
      Recommended by:
      Timothy J, FishOutofWater

      impose virtually no negative 'drag' on the economy because they're coming out of surplus income from the wealthy that otherwise will go into a hedge fund or foreign investments. Private insurance premiums instead consume resources that otherwise would go right into working class pockets and be spent purchasing goods and services.

    •  No one ever points that out (2+ / 0-)
      Recommended by:
      tle, FishOutofWater

      Taxes                     Corporate health care expenditures

      XXXX                      XXXXXXXXXXXXXXXXX

      Taxes                    State run health care expenditures

      XXXXX                    XXXXXXX

    •  Yes, I don't understand that conclusion (6+ / 0-)

      We start with an assumption  that single payer is better, and then out of the blue comes this assertion about it causing a structural drag on the economy that private insurance does not.  

      Perhaps because single payer covers everyone, and private insurance is paid only by all who can afford it funds a necessarily smaller health care system?  The structural drag being eliminated by throwing those who cannot afford private insurance out in the street? under the bus? Back on a smaller public health care system?

      Planning a vacation or convention in Arizona? Come to Palm Springs instead! Same desert weather, none of the bigotry.

      by grey skies turning to blue on Sun Aug 14, 2011 at 06:42:05 AM PDT

      [ Parent ]

      •  The profits and administrative costs... (3+ / 0-)
        Recommended by:
        Timothy J, marty marty, mmacdDE

        of the private insurers are enough to cover everyone under a single payer system without spending another dime.  Further savings come from negotiating drug prices with big pharma, and covering preventive health care to avoid more expensive procedures later.  There are many other second order savings possible at every level and they are important, but these are the biggies.

        "There have been tyrants and murderers and for a time they seem invincible but in the end they always fail. Always." -Gandhi

        by Grandma Susie on Sun Aug 14, 2011 at 06:58:03 AM PDT

        [ Parent ]

        •  And remember too (0+ / 0-)

          that the govt covers the cost of the old, the disabled, and the military.

          That's a large chunk of the cost of medical care, because those are the largest users of medical care.

          The govt pays the bills of those that cost the most. It would be a relatively minimal increase for them to cover EVERYBODY.

    •  I lean toward your POV on that (5+ / 0-)

      citing the NEJM and economists has its risks and rewards. ;-)

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:51:13 AM PDT

      [ Parent ]

      •  The wording "structural drag on the economy" (0+ / 0-)

        is very worrisome.  I wonder how the NEMJ and economists justified that conclusion.  Did you find that?  

        If it is a valid complaint, wouldn't it be easier to decouple Medicare and health care costs from the general fund with a separate revenue stream, like Social Security?  Then it becomes comparable to insurance premiums, no?

        Planning a vacation or convention in Arizona? Come to Palm Springs instead! Same desert weather, none of the smog, traffic and bigotry.

        by grey skies turning to blue on Sun Aug 14, 2011 at 04:33:18 PM PDT

        [ Parent ]

        •  please read the entire article (0+ / 0-)

          the NEJM link was attached to the original argument.

          in a recession any tax increase particularly one large enough to cover  Medeicare needs, would be a drag on the economy.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 05:18:07 PM PDT

          [ Parent ]

          •  Actually, I did read the entire article (1+ / 0-)
            Recommended by:
            DemFromCT

            I slogged through the whole thing because I wanted some facts about the Medicare problem, and because you had spent some time writing it.  But occasionally I may lose my train of thought in what is, for me, the middle of the night.  Please accept my apologies, and please don't make unflattering assumptions about your reader -- me.  I'm just trying to figure things out so I will know what to say back to Republican arguments.

             

            Planning a vacation or convention in Arizona? Come to Palm Springs instead! Same desert weather, none of the smog, traffic and bigotry.

            by grey skies turning to blue on Mon Aug 15, 2011 at 11:56:24 PM PDT

            [ Parent ]

            •  ;-) (0+ / 0-)

              I appreciate that you read it... I meant read the entire NEJM article because it puts what they meant about a drag on the economy in perspective...

              they really talk about huge escalations in taxes if the medicare fix is only tax increases.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Tue Aug 16, 2011 at 04:22:10 AM PDT

              [ Parent ]

    •  Exactly right, FishOutofWater. (3+ / 0-)
      Recommended by:
      pot, Timothy J, Jagger

      This is basically an apologia diary for the WH.

      I work with B2B PAC, and all views and opinions in this account are my own.

      by slinkerwink on Sun Aug 14, 2011 at 07:07:53 AM PDT

      [ Parent ]

    •  Agree. And another question... (1+ / 0-)
      Recommended by:
      marty marty

      If I put in $100,000 over my lifetime - after 50+ years that $100K is worth more than $100K.  It should be more than the $300K that I may need in care.  

      How do you calculate the actual worth of someone's contributions over many decades of time?

    •  The "note about Language" is also a right-wing (0+ / 0-)

      framing of the issue.

      Reductions in rates of growth are cuts. Claiming they aren't cuts because the amount in year X+1 is greater than in year X ignores a lot of other context (e.g. inflation).
      It's an argument identical to claiming that "revenue doubled under Reagan's tax cuts:" technically, in unadjusted dollars, the claim is correct, but when adjusted for inflation, tax revenue grew at a slower rate overall during his administration than the previous several.

      In politics, context matters a lot, so it's worth noting that "reductions in growth aren't cuts" is also an argument that, e.g., Rush Limbaugh has used for years, especially when railing against the social safety net.

      •  Bull (0+ / 0-)

        If I reduce the growth of my expenses, I've SAVED MONEY. Doesn't matter how you look at it - if I'm spending less on utilities because I put in new windows and insulation, I have more money to spend on other things.

        What do you have against saving money?

      •  Reducing the rate of growth does not (0+ / 0-)

        necessarily require cuts in care.  e.g. not paying for unnecessary repeated testing.  Or reducing the burdensome payments to insurance companies that operate Medicare Advantage plans.

        Planning a vacation or convention in Arizona? Come to Palm Springs instead! Same desert weather, none of the smog, traffic and bigotry.

        by grey skies turning to blue on Sun Aug 14, 2011 at 05:11:09 PM PDT

        [ Parent ]

    •  Is this true? (1+ / 0-)
      Recommended by:
      worldlotus
      If you compare the U.S. health care system to those of other developed nations the U.S. comes out on the bottom for cost efficiency of delivery.

      I saw results of a study recently in which the U.S. was 17th, but ahead of Switzerland and Portugal (in one parameter).

       However, another study of overall efficiency tends to confirm what you assert: we suck.

      Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

      by CitizenJoe on Sun Aug 14, 2011 at 08:21:20 AM PDT

      [ Parent ]

  •  On the table because it is humane and sane and (1+ / 0-)
    Recommended by:
    hooper

    those are two qualities that the right wing feels need to be stomped into the grit and grime of the 19th century world they are trying to drive us into. The logic of their thinking leads to questions like; "why should we try to help the starving children of Somalia, after all it they haven't figured out how to get food why should we worry whether or not they eat?".

    Interestingly Pawlenty just dropped out of the race to be top race baiter and while he was on the clown bus he was tied for most likely mental health admissions client to be allowed to go to the campus store to buy cigarette rolling material without the accompaniment of a staff member. Next up for dropping out should be Huntsman and then we will have a 100% loathsome group of nasty, dog kicking cretins to deal with in 2012.  

  •  The heart of it is fair and palatable rationing. (21+ / 0-)

    This will never be popular or easy, but the heart and soul of this issue comes down to rationing. No one likes to use that word; it's political poison. But as I've written before, in America we're already rationing health care brutally, by the most execrable method possible: ability to pay. If you're very well insured or wealthy, the sky's the limit. You can be days from death due to terminal cancer, or brain dead on a ventilator, and you'll still get absurdly expensive and utterly pointless kidney dialysis if it'll keep you going even one more day. If you have no money and no insurance, you can die for lack of basic immunizations or $30 worth of antibiotics to treat a pneumonia.

    After 25 years in medical practice, I'm convinced that the great majority of patients understand and accept the reality of some kind of rationing. It's obviously stupid, even cruel, to apply extremely aggressive and expensive technologies to (slightly) extend the suffering of terminally ill patients. Yet we do this every day in America, to thousands of people, simply because of the way care is organized. It's generally run by hospital-based subspecialists who have irresistible biases toward therapeutic maximalism. Primary care docs who tend to have a firmer grasp of the futility of extremist end of life care are generally marginalized, or simply unavailable as our numbers fall due to retirement and death while most new grads go into specialties.

    Then there's the issue of payment source. Medicare is at least rational and (nominally) accountable in its current form. Payment denials are (believe it or not) generally sensible. Private/commercial insurers on the other hand are neither rational nor accountable. Their denials tend to be financially driven, arbitrary, and self-serving. "Sorry, that's not a covered benefit. Check page 127, column B, of your second benefits contract."

    John Kitzhaber, at the time Governor of Oregon, tried to make rationing at least fair and explicit, by prioritizing services based on cost-effectiveness and proven efficacy for Medicaid patients, then covering all services down to a point on the list determined by State resources (and hence taxpayers' willingness to pay). In return for this explicit rationing, a much larger number of patients were included in coverage. Overall it was much fairer and more effective than 100% coverage above an arbitrary financial line, and 0% coverage for families earning $1 more per year.

    The biggest problem is simply that rationing is totally vulnerable to demagoguery. It's a difficult and subtle argument to make, and slagging it (You're killing grandma!) even as you expand brutal "backdoor rationing" by excluding patients from any access is as easy as clubbing baby seals. And given the mean, vicious nature of today's Republican party, and our craven corporate media, it's an insoluble problem

    •  great comment (3+ / 0-)

      even allowing for your understandable bias against subspecialists ;-)

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:53:38 AM PDT

      [ Parent ]

      •  Sorry; gotta learn to rein that in. (1+ / 0-)
        Recommended by:
        DemFromCT

        I've just come off a long stretch of extreme frustration with the 'medical Mecca' university hospital 50 miles up the road that's our tertiary care center. In recent months they have come to stonewall on basically every transfer that might cost them on the DRG, claiming they have "no beds". They have refused a half dozen consecutive attempts at transfering frail elderly patients with problems exceeding our rural hospital's skill set. "Sorry, we're still 'code red' in the ER; we just have no beds at all". This in the middle of summer, no flu season in sight.

        Funny thing, though. They still accept coronary patients for a 'drive by stent' at the speed of light. Lots of money in that. I'm sure it's just a coincidence.

         I love this month's Consumer Reports article on the subject; it quite rightly slags organized medicine for its money-driven obsession with stents over diligent lifestyle and risk factor modification.

  •  I am completely math challenged (0+ / 0-)

    but looking at your Medicare graph with projections out to 2076 -- is there a consideration given to the fact that all of us boomers will be dead at that point?  Is that why the sort of leveling off occurs around 2036?

    Vi er alle norske " My faith in the Constitution is whole; it is complete; it is total." Barbara Jordan, 1974

    by gchaucer2 on Sun Aug 14, 2011 at 06:23:47 AM PDT

    •  afaik, baby boom ends (1+ / 0-)
      Recommended by:
      gchaucer2

      and we aren't flooding the system with new seniors.

      Death is already taken into account in the projections.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 06:54:50 AM PDT

      [ Parent ]

  •  How are these programs "different" (0+ / 0-)

    than corporations? A group of people pooling their resources to better their lot in life?

  •  Beautiful, sane diary! Thanks, DemFromCT. (1+ / 0-)
    Recommended by:
    joe from Lowell
  •  exhaustive report (3+ / 0-)
    Recommended by:
    FishOutofWater, Jagger, mmacdDE

    *competitive bidding by all suppliers to the Medicare/aid system: pharms,  various supplies  and testing services (CAT etc).  How much is saved if all suppliers to the system bid competitively, like any business would require?

    I  am looking at the billing documents for an ER visit by the MIL.   Spouse is an RN.  Prices quoted are absurdly higher than she sees on billing for her rural clinic.  Billing document is impossible to understand.

    don't always believe what you think...

    by claude on Sun Aug 14, 2011 at 06:35:09 AM PDT

  •  One unanswered question about Medicare (5+ / 0-)

    If Medicare was opened up to everyone, regardless of age, how would that impact its financial solvency?

    IMHO, raising the age from 65 to 67 would be a less efficient way to address the financial problems of Medicare, than increasing the pool of eligibility by opening it up to younger participants.  Logic would dictate that if you have a larger pool with more younger and healthier members paying into the system, the financial stability of the system would be improved.

    Is there any study that attempts to quantify the financial aspects of opening up Medicare to younger people?

    The United States is not just losing its capacity to do great things. It's losing its soul.--Bob Herbert. gulfgal98's corollary- Our soul is gone.

    by gulfgal98 on Sun Aug 14, 2011 at 06:35:53 AM PDT

  •  Excellent summary. When all is said and done.... (6+ / 0-)

    ...after all the waste in the system and the wasteful insurance system are subtracted, the fact really is that health care costs are rising well ahead of general inflation because of our aging and longer-living population, and because medical technology keeps advancing.

    For example, I am getting fairly regular treatments for a vision condition. It's an age-related condition. The treatments have so far prevented me from being blind. Six years ago, the miracle drug simply did not exist. I would have lost most of my vision. The treatments cost over $20'000/year. I am fortunate to have good health benefits from my job. In a few years these costs will be picked up by Medicare instead.

    Six years ago, this biotech miracle would not have been costing the system anything. Now it's costing a lot. (It's a very popular condition.)

    We do need to come to grips with how we pay for this, because changing how we raise money and pay for health care alone will not address the fact that costs are also rising for legitimate reasons.

    "So, am I right or what?"

    by itzik shpitzik on Sun Aug 14, 2011 at 06:37:05 AM PDT

  •  Probably because it is a very large chunk of our (0+ / 0-)

    non-discretionary spending.  I could be wrong, though.

    Anyone who is making something new has to break something else - Taylor Goldsmith

    by SpamNunn on Sun Aug 14, 2011 at 06:37:07 AM PDT

  •  Private Insurance Drags on Economy (11+ / 0-)

    You quote Katherine Baicker, Ph.D., and Michael E. Chernew, Ph.D. in the NEJM:

    Specifically, raising taxes to pay for public insurance [Medicare] exerts a structural drag on the economy even if the revenue is spent on care; the same is not true of unsubsidized, privately purchased care or insurance.

    How is that not true of private care and insurance? Since private care and insurance spend on substantial profits that are not as stimulative of the US economy as Federal spending, private medical expenses seem a larger drag on the economy. And profits are only one diversion: direct medical expenses (not through insurance) are more likely to be wasteful (lower quality care), since the patients are less likely to be informed and organized enough to protect themselves from the widespread fraud and incompetence that drives up medical costs, than if the payer was a government office with experts, collective buying power, and rules for withholding payment.

    Maybe Baicker and Chernew (and you by quoting them without challenge) are right. But there's no substantiation offered for that assertion. Though they do say later in their article:

    Its pooling of risk is crucial to the functioning of insurance markets. If sicker people are disproportionately likely to obtain insurance, premiums will increase, even fewer people will enroll, and insurance markets may eventually collapse.

    In other words, if insurance markets weren't relieved of sicker people (the purpose of health insurance), their prices would rise, they'd leave more people uninsured, and might eventually collapse. Baicker and Chernew admit that only by a foundation of government subsidy do US medical insurance markets function at all. It sounds like private insurance is the structural drag on the economy, that just socializes the losses to privatize the profits, just like every other financial industry in modern America.

    Which is why discussing Medicare is the perfect place to discuss single payer. Though you say:

    Insuring more people and getting them access to health care is a good thing, even if it is not single payer (which I support, which is not what passed Congress, and which is a debate I will not rehash here.)

    We have to "rehash" that debate, or rather have it (not the "death panels" fake debate we had instead). Indeed, your story here is missing the critical comparison: to the private insurance versions of the public ones that our government (and its corporate sponsors) have forced onto the butcher's block. Of course Social Security's competing private pension systems, 401k/IRA or some corporate "person's" empty promise in a decades old contract always first up for reneging during inevitable periodic manufactured crises, have proven worthlessly unreliable more than twice a generation. Which is why we invented Social Security generations ago. But here we're discussing Medicare, and the private competition must answer the question: how much do the private insured pay per dollar of benefits, net across their lifetimes, compared to the Medicare insured. And that answer must be scaled by how much more the Medicare insured must consume, since the more expensive patients are hustled off private insurers onto it by careful design lest the private insurance industry fail.

    If we don't have that actual debate in those actual terms, of course Medicare will fail. If we debate Medicare only within the terms rigged by the medical/insurance/Congressional complex, we will remain sick, poor and wrong. "Don't get sick, and if you do die quickly" will replace Medicare as younger/healthier (for a while) Americans refuse to invest in Medicare for All the way all our foreign competitors do, and instead squander our medical budgets on private insurers and the dysfunctional medical billing system they enable.

    BTW, you started that paragraph with "From the New England Journal of Medicine comes a graph illustrating how Medicaid is paid for", but you meant to write "Medicare".

    "When the going gets weird, the weird turn pro." - HST

    by DocGonzo on Sun Aug 14, 2011 at 06:39:10 AM PDT

    •  DemfromCT needs to respond to this (1+ / 0-)
      Recommended by:
      Heart of the Rockies

      I agree completely. It develops the point I made briefly above.

      look for my eSci diary series Thursday evening. "It's the planet, stupid."

      by FishOutofWater on Sun Aug 14, 2011 at 06:58:26 AM PDT

      [ Parent ]

      •  I favor single payer as I have stated (1+ / 0-)
        Recommended by:
        edwardssl

        I don't really see the debating point as central to the discussion I presented in the diary. I was already going on too long.

        OTOH, I am happy to rehash it in comments and in other diaries. But any such discussion has to start with "the votes were and are not there".

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun Aug 14, 2011 at 07:15:18 AM PDT

        [ Parent ]

        •  Private Insurance Drags on Economy (1+ / 0-)
          Recommended by:
          FishOutofWater

          OK, I didn't expect you would debate single payer (or its Medicare for All version), as you said. I understand the editorial nature of choosing your battles in a post about a large subject like public insurance and pensions. But I did want to point out that particular debate is necessary, even if you won't address it in this diary.

          But you can't also ignore a debate over the central premise of this story you posted called "Medicare: Why is it on the table?". You quoted Baicker and Chernew asserting without supporting

          Specifically, raising taxes to pay for public insurance [Medicare] exerts a structural drag on the economy even if the revenue is spent on care; the same is not true of unsubsidized, privately purchased care or insurance.

           How is private health care/insurance not a drag on the economy that taxpaid Medicare a drag on the economy assertedly is? That is the debate I offered in my post. Is there are reason you don't get into that essential debate either? Because it is central to the scope of your story that Medicare is a drag on the economy while its private counterpart is not. And I don't even see any basis offered for  that assertion.

          "When the going gets weird, the weird turn pro." - HST

          by DocGonzo on Sun Aug 14, 2011 at 07:53:02 AM PDT

          [ Parent ]

      •  No Response So Far (0+ / 0-)

        Their response to your post doesn't address the point you made supporting mine, it only responds to my point that a debate over single payer is necessary, on the same terms (plus the essential parts missing) offered in this diary. By dismissing that debate, as warned in the original story.

        Their response doesn't address their quoting an unsupported assertion that Medicare drags the economy while private insurance/care payments do not. Neither here nor in your other comment you mentioned, nor in their throwaway response to it:

        I lean toward your POV on that [...]

        citing the NEJM and economists has its risks and rewards. ;-)

        They've had their chance to address their fundamental omission, and both misdirected from it and laughed at it. Without supporting that assertion, they tacitly admit it's unsupportable. Without that support, all discussion of changing Medicare collapses as make believe. Which does often get enough votes to pass the Congresses and White House we've got.

        "When the going gets weird, the weird turn pro." - HST

        by DocGonzo on Sun Aug 14, 2011 at 08:02:57 AM PDT

        [ Parent ]

        •  forgive me if I spend a little time responding to (1+ / 0-)
          Recommended by:
          edwardssl

          the other two hundred comments first.

          I don't necessarily agree with the cited point from the NEJM... that is, I accept that taxes on any kind can be a drag on the economy, albeit a necessary one (who likes taxes?).

          I wanted to quote from the article that produced the graph and I didn't want to cherry pick the quote.

          You may consider that a major point worth discussing. That's your right. Me, because i don't agree with it, I don't find it particularly interesting or important. Sorry.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 08:45:36 AM PDT

          [ Parent ]

          •  Forgiven, But Not Necessarily (1+ / 0-)
            Recommended by:
            FishOutofWater

            You did respond to my comment, and the other comment elsewhere. But not to the actual point, as I described in my followup.

            What's weird is that you just said that you don't agree with the point you cited to the NEJM. Though you said "don't necessarily agree", which nullifies whatever you're saying about it. It's weird that you say you didn't want to cherrypick, but that is what you're doing: cherrypicking a rootless point from the NEJM.

            That point is certainly a major point worth discussing. The point of your story is that Medicare is on the table because people like those two writers in the NEJM say it's worse for the economy than its private counterpart. Yet they also say that its private counterpart can't exist without it. If that's not interesting or important, then what is, in discussing why Medicare is the target for cuts?

            "When the going gets weird, the weird turn pro." - HST

            by DocGonzo on Sun Aug 14, 2011 at 09:02:37 AM PDT

            [ Parent ]

            •  I wanted to quote the piece accurately (0+ / 0-)

              please discuss it if you find that interesting.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Aug 14, 2011 at 09:26:08 AM PDT

              [ Parent ]

              •  should read (0+ / 0-)

                "if you find it that interesting"

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Sun Aug 14, 2011 at 09:52:48 AM PDT

                [ Parent ]

              •  I Am (0+ / 0-)

                You're not. Though what you are discussing requires you do, for consistency.

                The quality of this one-sided discussion is a big reason I stopped posting here last year after years of full engagement. The site is a vanity hobby horse for centrist Democrats and the people who want to waste time posting at them.

                I'm going back to doing the other stuff I do that has an actual effect on what Democratic politics has failed to effect for generations. Enjoy your potemkin politics.

                "When the going gets weird, the weird turn pro." - HST

                by DocGonzo on Sun Aug 14, 2011 at 01:29:44 PM PDT

                [ Parent ]

  •  Medicare is on the table for the same reason (1+ / 0-)
    Recommended by:
    singe

    Social Security and Medicaid are: Obama's handlers want to turn all that taxpayer money over to Wall Street to play with. The Wall Street establishment has bought all the necessary politicians and privatized all the easy stuff; and we're down to education and social services. Very, very simple. Criminal, but simple.

    We don't need a third party. We need a second party.

    by obiterdictum on Sun Aug 14, 2011 at 06:42:55 AM PDT

  •  ("WHO" do we trust--not "WHOM.") (0+ / 0-)

    It's in the last line of an extraordinarily good exposition of the issues. Thanks!!

    (You might have said, "To whom do we entrust the policy planning..." But 'Whom do we trust' is just so wrong.)

  •  Let's at the outset establish something: (4+ / 0-)

    let's quit calling these programs 'entitlements'--at least for the ones that are funded by user contributions over their life.

    The banks have a stranglehold on the political process. Mike Whitney

    by dfarrah on Sun Aug 14, 2011 at 06:44:09 AM PDT

    •  hah (4+ / 0-)

      let's at the outset establish that someone will take issue with something somewhere, without fail, under all circumstances. ;-)

      I am not a fan of redefining language.  

      An entitlement is a guarantee of access to benefits based on established rights or by legislation.

      it is fair usage.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:18:37 AM PDT

      [ Parent ]

      •  The term has been abused and denigrated by the (1+ / 0-)
        Recommended by:
        Brooke In Seattle

        Right, along with "liberal".

        It's said with a sneer and to them "entitlement = welfare".

        THAT'S what needs to be teased out and highlighted.

        It's not like welfare.

        Republicans HATE America. Deal with it. / It's the PLUTONOMY, Stupid!

        by xxdr zombiexx on Sun Aug 14, 2011 at 07:21:16 AM PDT

        [ Parent ]

        •  will you stop using liberal? (1+ / 0-)
          Recommended by:
          joe from Lowell

          I will not stop using the correct term, entitlement.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 07:57:17 AM PDT

          [ Parent ]

          •  No no no no... Im not saying stop using it (4+ / 0-)

            just saying that MOST people ASSUME it means what he RW says it does, so that Social Security is equated with Welfare.

            That's all Im saying.

            Republicans HATE America. Deal with it. / It's the PLUTONOMY, Stupid!

            by xxdr zombiexx on Sun Aug 14, 2011 at 07:59:52 AM PDT

            [ Parent ]

            •  ah, got it (0+ / 0-)

              thanks!

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Sun Aug 14, 2011 at 08:46:41 AM PDT

              [ Parent ]

            •  You're absolutely right. Dems should argue that. (3+ / 0-)
              Recommended by:
              Arnie, worldlotus, schnecke21

              Something like, "When we say something is an entitlement, it means you are entitled to it, like your pay check.  People who worked for and paid into Medicare have a right to the benefits they paid for.  Saying something is an entitlement is saying that it's not just a program that Congress can decide it's a good idea to give to people, or not, like highway spending.  You don't have a right to have a highway expanded near your town.  The government didn't make a deal that they'll add those lanes for you to use if you pay income taxes.  But with Medicare and Social Security and other entitlements, they did.  You have a right to those benefits, because you paid specific taxes in exchange for a defined benefit.  It's no different than the right you have to your pay check."

              Art is the handmaid of human good.

              by joe from Lowell on Sun Aug 14, 2011 at 08:54:59 AM PDT

              [ Parent ]

    •  Why? It's not a dirty word. (0+ / 0-)

      An entitlement is something you're entitled to.  It expressed the thought that you have earned this, that you deserve it, that it's not just a program that Congress or somebody else can decide is a good idea, or not, and nobody else has an individual right to those benefits outside of the question of whether Congress thinks it's good policy.

      I don't think we should run away from "entitlements" like we ran away from "liberal."

      Art is the handmaid of human good.

      by joe from Lowell on Sun Aug 14, 2011 at 08:50:23 AM PDT

      [ Parent ]

    •  Entitlement (1+ / 0-)
      Recommended by:
      Brooke In Seattle

      is a term coined by the courts. It is a term of art. It does recognize the contribution factor. Once one has made the requisite contributions and reached a certain age as required by law, one becomes entitled to receive Social Security benefits.

      Depressions may bring people closer to the church but so do funerals - Clarence Darrow

      by nomorerepukes on Sun Aug 14, 2011 at 09:32:00 AM PDT

      [ Parent ]

  •  I think more should be done to promote (3+ / 0-)

    tobacco smoking, alcohol consumption, gun ownership, high-fat diets and that exercise and physical fitness, health foods and attempts at health maintenance and longevity be criminalized.

    I've finally seen the light. I am unsure how I could have been so short-sighted. Better late then never, though, eh?

    I will end my work to get marijuana relegalized and put my energy into discouraging it's use. I will encourage tobacco and alcohol use as legal and good.

    Marijuana does NOTHING to discourage longevity and is just not the disease-causing substance we need Americans using and the current marijuana prohibition laws are a fine model for prohibiting health-focused lifestyles.

    And that's how marijuana use is also to blame for our economic woes.

    Republicans HATE America. Deal with it. / It's the PLUTONOMY, Stupid!

    by xxdr zombiexx on Sun Aug 14, 2011 at 06:47:12 AM PDT

    •  eh (0+ / 0-)

      just tax the crap out of pot and let's balance the CA budget.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:19:33 AM PDT

      [ Parent ]

    •  btw (0+ / 0-)

      Phillip Morris was in an NPR story last week about getting into trouble in the UK for promoting 'studies' that showed dying saved money.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:21:17 AM PDT

      [ Parent ]

  •  Why I am resistant to putting SS on the table: (2+ / 0-)
    Recommended by:
    tardis10, Jagger

           With the make-up of the "sooper committee" as it is, Six die hard republicans and Baucus, the only thing that will be discussed is a cut in benefits not raising the cap.  I'm not psychic but I smell a rat. If I'm wrong I'll apologize "to anyone who may take offense at what I've said".  If I'm correct tens of millions of Americans will have benefits under a program that is solvent for decades ahead in order to save tax breaks for the most affluent as part of a so-called austerity program that will even further damage those same  tens of millions.

    For every complex problem there is an answer that is clear, simple, and wrong. H. L. Mencken

    by irate on Sun Aug 14, 2011 at 06:50:28 AM PDT

    •  Actually, Kerry and Clyburn are the rats (1+ / 0-)
      Recommended by:
      David PA

      Baucus will probably not role over to the GOP.

      •  Why do you say that, fwdpost? (0+ / 0-)
        •  Baucus was burnt in negotiations (1+ / 0-)
          Recommended by:
          David PA

          on healthcare and may not want to embarass himself again.

          Clyburn is co-chair of Third Way, which is pure Clinton DLC corporate neodem. http://www.thirdway.org/...
          and I think he will go with raising Medicare and SS ages, and I think I heard him say this.

          Kerry has endorsed Obama's prior Grand Bargain, which didn't work out. He also was involved in earlier days with Peterson and is financed by Blackstone, from FDL:

          Senator John Kerry – One of the richest members of the Senate, whose 4th largest contributor over the past 5 years has been none other than Blackstone Group. The juggernaut hedge fund headed by deep, deep pocketed Social Security jihadist (and friend of Barack Obama’s) Pete Peterson. Don’t worry though, I’m sure when the Republicans propose SS cuts, he’ll defy his corporate overlord and act like an actual Democrat.
    •  as Chico used to say about Harpo (1+ / 0-)
      Recommended by:
      irate

      "he's honest, but you gotta watch him a little."

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:22:12 AM PDT

      [ Parent ]

  •  There are several reasons for higher costs (7+ / 0-)

    including the boomers. The other really obvious ones are new technology, ultra-high drug costs, biological patents, and pharma and bio patent abuse.

    NEW TECHNOLOGY

    A lot of new technology is great, life-saving, important. A lot is abused. Doctors hide behind malpractice to justify high-reimbursement procedures. Not just that, but a lot of it gets abused to the patient's detriment. CT scans Instead of X-rays deliver a lot more radiation and aren't always necessary, especially for children. Robotic surgery is whizz-bang, but not any more effective. It just puts the doctor in a different room, and how is that good? It was invented for long-distance surgery, not to put then patient int next room. The list goes on forever, and we pay for it.

    Drugs. Do you have any idea how many drugs are no more effective than the old one, but cost factors of hundreds, sometimes thousands, as much? It gets better. The are Rx drugs that do the same thing as the old ones, so the old ones go OTC. Now they cost a lot less, but they cost the patient a lit more because it's not covered by insurance, while the $100 drug just has a $10 co-pay. Hundreds of expensive new drugs are only slightly better, and all the improve,met is on a very small population of patients with a side effect, but they all get the new one, often it's because the pharma rep that goes to the doctor's office is a hot former University of Kentucky cheerleader.

    Then list goes on forever, but the ugly little secret is that every major advance in medicine is a miraculous improvement for a very small percentage of patients, but issued on a very large percentage of them. The excuse is always malpractice. The reason is always profit. If you don't believe it, compare utilization in states with malpractice reform and those without. The worst hospital in the country for this sort of abide is one in Texas, and they had draconian malpractice reform.

    Add to all that the fact that we grossly overpay for pharmaceuticals because Medicare D isn't allowed to negotiate, and you have the picture of a medical system that isn't growing in necessary Costello because of boomers, but one that is growing in profit off of them.

    Done with politics for the night? Have a nice glass of wine with Palate Press: The online wine magazine.

    by dhonig on Sun Aug 14, 2011 at 06:53:09 AM PDT

  •  well done, Thanks for this n/t (1+ / 0-)
    Recommended by:
    DemFromCT
  •  looks like a very thorough and well written diary (1+ / 0-)
    Recommended by:
    DemFromCT

    I jumped ahead to the concluding paragraph which summarized what I already knew so I didn't take the time to read the whole thing. The politics are the part that make it extra challenging. Will the dems make needed changes and risk  being effectively attacked. The whole issue is too complex for voters and anyone who touches it will be a very easy target.

  •  Couple of nits. (3+ / 0-)
    Recommended by:
    Alice Olson, fwdpost, DemFromCT

    In the paragraph that begins: From the New England Journal of Medicine ...I think you mean Medicare not Medicaid. Also,the SS Actuary recently extended SS full solvency to 2038.
    Medicare does indeed need some fixing. We could start by negotiating drug costs. Depending on how it is done,we could further tweak the premiums on high earners. (but too much means testing will add to our HC system tiering further) Certainly lowering waste,fraud & abuse is needed. Although doubtful all that much will be realized there.  
    Education about end of life issues is also key to reducing costs. This has to happen across the spectrum,not at the hospital bedside during times of crisis. Understanding POA's,Living Wills,DNRs etc.can't stay in the closet.  
    Lastly it is possible that a strong IPAB board for care outside of Medicare (as contained within the ACA) will help drive lower costs across the entire healthcare system. That is why I am floored that Democrats in "The New Democrat Coalition" are joining with the GOP to scuttle it.  

    "George RR Martin is not your bitch" ~~ Neil Gaiman

    by tardis10 on Sun Aug 14, 2011 at 06:54:20 AM PDT

  •  Just great . . . (1+ / 0-)
    Recommended by:
    fwdpost

    Why don't we just propose a legalize euthanasia program at 65?  Seems better than the austerity proposals of the NWO nuts in power.

    Let's Build a Liberal Media Infrastructure!!!!!

    by lovingj on Sun Aug 14, 2011 at 07:00:07 AM PDT

  •  Why does everyone just roll over for them? (2+ / 0-)
    Recommended by:
    fwdpost, Brooke In Seattle

    I'm talking about the health-industrial complex. Everyone acts as though it's a law of the universe that they get to keep grabbing a larger and larger share of the economy forever. The whole debate is about how big each year's increase will be.

    I suggest reading innovation guru Clay Christensen's latest book, in which he tackles health care: The Innovator's Prescription. He explains why health care costs have been so intractable and what can be done about it. (Key point: innovation and competition have, up to now, tended to increase health care costs, not decrease them. But it doesn't have to be this way.)

    Keep in mind that other countries get by with half what we spend and have equal or better outcomes.

    What is valued is practiced. What is not valued is not practiced. -- Plato

    by RobLewis on Sun Aug 14, 2011 at 07:05:06 AM PDT

  •  Allow for drug price negotiating and (2+ / 0-)
    Recommended by:
    We Won, Brooke In Seattle

    work on controlling health care costs at hospitals, etc. Allow people to buy into Medicare so it becomes a Medicare for All program.

    I work with B2B PAC, and all views and opinions in this account are my own.

    by slinkerwink on Sun Aug 14, 2011 at 07:06:57 AM PDT

    •  the first two will control costs (0+ / 0-)

      and are excellent ideas.

      The third will not save money and will cost more. That's not a reason to avoid it, but it is not a suggestion like the first two, which combine savings with good practice.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 08:23:00 AM PDT

      [ Parent ]

    •  or at least I am unaware of (1+ / 0-)
      Recommended by:
      nickrud

      any estimate of savings (I am happy to be corrected). Please post a link if you have one.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 08:24:01 AM PDT

      [ Parent ]

  •  The first step towards lowering medicare costs (1+ / 0-)
    Recommended by:
    nickrud

    is simply to lower the increase in the rate of treatment with age.  And the way to lower that rate is for people to be healthier in the first place, which requires a greater emphasis preventative (primary) care.  Programs that keep people healthy in the first place are far less costly than ones in which they are allowed to develop chronic conditions that require perpetual cycles of hospitalization.

    Immunizations, adequate nutrition, exercise and healthy eating programs, disincentives towards unhealthy and addictive substances, and secondary screenings are all important steps in the control of the growth of health-related issues, and all programs that Republicans have worked strenuously to defund or simply end.  The obesity epidemic and other ongoing health issues are the whirlwind reaped from the destructive winds they have sown.

  •  Thank you, DfCt for braving the winds of howl. (5+ / 0-)
  •  From every dollar Americans spend on (3+ / 0-)

    health care, too large a slice is taken by middle-folk such as accountants, managers and profit plus waste & fraud leaving too little for actual care.

    Those who profit from this situation are fighting tooth and nail to prevent reform. Better than many go insured than the gravy train stop running.

    Also too, if Medicare is weakened, then there is less chance of the most sensible (IMHO) form of universal health care, expanding Medicare to cover all Americans

  •  A cowardly approach to healthcare (0+ / 0-)

    Amazing that other industrialized countries manage to provide healthcare coverage for entire populations without the whining of pundits about the cost.

    GE pays no taxes and old people eat catfood. Stuff your studies and get real about a plutocracy that has enabled the lowest real tax rates in the world for the rich, except Mexico.

    No, we can't allow the rich to pay 39% taxes on incomes over $250,00 to RAISE Social Security benefits and give everyone free healthcare. That would be so mean, and all the pundits and media geniuses are there to protect their rich friends.

    Sadly, the experts are like the lackeys in the courts of the lords and master of years ago. Yes, your highness, I love your clothes (what clothes?).

    •  nice rant (1+ / 0-)
      Recommended by:
      nickrud

      so what part of this paragraph that I wrote

      And don't forget, it's not all about cuts, it's also about funding. We might start by cutting our military costs (wars are expensive) and applying those funds for needed programs at home. We might even tax the wealthy and corporations at a fair rate.  But even if we do, there will be lots of demands on that money, and in any case, health care costs (and slowing their rate of growth) are still going to have to be managed in a way that does the most good for the most people.
      do you disagree with?

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:46:18 AM PDT

      [ Parent ]

      •  I disagree with this comment... (0+ / 0-)

        "And don't forget, it's not all about cuts"

        None of it should be about cuts. We should be raising taxes for corps and the rich, and negotiate with drug companies.

        In fact, univeral healthcare would probably save trillions each year.

        Eliminating overtime as much as possible, would create jobs.

        Enhancing our retirement system and lowering medicare eligibility age would induce more people to retire early and open up jobs for the younger workers.

        In short, we need policies for people, not accountants, and we need to recognize there is a class war between the 98% and the rest of us. We must also realize that part of the upper 2% includes people, disguised as corporations and vice versa.

        Does it make you ponder how Germany can manage 56% Social Security on prior wages, and we are at less than 40%, or that Germany mandates six weeks paid vacation for most workers, and months of sick paid leave for new mothers or fathers? And meanwhile, they are miles ahead of us in exports and production per capita? Plus, universal healthcare, education (including university) and nursing homes.

        Americans expect little but work until they die. Small expectations lead to small and miserable existance.

        And if you don't believe that, visit a nursing home and watch the half dozen Medicaid recipients crowded in a room, drugged, waiting for death, and compare that kind of cruelty to the progressive (and more expensive) publicly financed group homes and family assitance in most developed countries.

        •  everything you said can be true (0+ / 0-)

          and yet we may not be able to afford it, as currently structured. To insist we can misses the point, although elections we lose sometimes bring us back to that point. To afford it, we have to restructure. Yet the political will to do that is not there.

          That's where we are stuck. and to acknowledge reality doesn't make me rigth wing. Sorry.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 03:46:35 PM PDT

          [ Parent ]

  •  Daily Kos at its best (8+ / 0-)

    and as usual it's written by DemFromCT.  Incredibly informative and painfully honest analysis.  Unfortunately, it raises just as many questions as it answers.

    Give me your tired, your poor, Your huddled masses yearning to breathe free
    ¡Boycott Arizona!

    by litho on Sun Aug 14, 2011 at 07:14:42 AM PDT

  •  It's necessary for health care dollars to (2+ / 0-)
    Recommended by:
    DemFromCT, worldlotus

    pay for the new science and technology, although a lot of it isubsidized through separate funding.
    NASA spending, for instance has advanced the knowledge and technology.
    So some of these new technologies are expensive.
    However, soon, we may have some breakthroughs, such as those from stem cell research, that will be game-changers. In other words, some diseases like diabetes or cancers may be completely curable with relatively cheap applications of one time vaccines or treatments. These developments, even with the cost of R and D, could radically bring down costs.

  •  Social Secuity is not responsible for the deficit (0+ / 0-)

    however the accumulated social security surplus is a ripe plum that can be taken to avoid raising taxes to address the deficit

  •  Let's not forget: most of these problems would be (0+ / 0-)

    fairly easily fixable, if the super wealthy would settle for a slightly smaller second yacht, etc.

    If Gilligan's Island were updated, Gilligan, the Prof. and Mary Ann would probably eat the Howells.

  •  I have no expertise in this area, but these are (6+ / 0-)

    my observations as a long-time caregiver for my nonagenarian mom. My mom broke her hip in January of last year. I was out of the country. The surgeon put a lot of pressure on my sister to do a hip replacement on my mom. It was expensive and totally unsuccessful. It cost medicare a lot of money. My mom would have been much better off in a wheelchair. She was over-medicated twice in the hospital and subsequently fell and dislocated her shoulder. When I asked the docs about the success rate for rehabilitating nonagenarians, I could not get a straight answer. I know that folks will be screaming about death panels, but the first premise of medicine should be do no harm. We should not be paying for procedures that are likely to be unsuccessful.

    •  it's okay to say no (4+ / 0-)

      many families push the docs to 'do something', though.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:53:49 AM PDT

      [ Parent ]

    •  Hope your mom is doing better (4+ / 0-)

      What happened to her is the fear we all have.  Shoved into the system and run thru all the possibilities.  And how many of us have the knowledge to question what is happening?

      When my mom was dying one nurse was honest with me and my sister.  She said Mom had the heart of a woman 20 years younger and that was why she was still alive.  Mom was bedridden and miserable, but when her potassium levels began to fall her medical team wanted to add it to the drug cocktail.  That one nurse told us and we talked to Mom - she said no, just let nature take it's course.  She died peacefully a few days later.  I will always be grateful to that woman and hope that when I am at the end someone is as honest with me.

  •  If it comes down to trust ... (0+ / 0-)

    ... we may be in big trouble.

    It's attractive to make a clear political contrast between Dems and Rs by saying "Dems will protect Medicare. R's won't." That's what people want to hear.

    If we say instead "There will need to be changes made to Medicare, but trust the Dems rather than the Rs to do it", then that's a far less compelling argument. Because a great many Americans DO trust the Rs more than the Ds, if only because they feel like one of "them".

    This is such a complex, sensitive problem with such incredibly high stakes for every person and family in America. It's very troubling that it comes at a time when we as a people are incapable of solving any kind of problems. The problem is only peripherally our politicians. More cogently, it's the nature of our population - stupid, lazy, greedy and much more motivated by emotion than by good judgment.

    WE elect these people. WE created this government that can't solve problems.

  •  US healthcare is a monopoly protected from (0+ / 0-)

    international competition.

  •  Isn't Medicaire funded long-term with ~1% payroll (1+ / 0-)
    Recommended by:
    FishOutofWater

    tax increase?

    •  see graph (1+ / 0-)
      Recommended by:
      David PA

      helpful, but not enough

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:55:20 AM PDT

      [ Parent ]

      •  Doubling the 1.45% tax would almost offset (1+ / 0-)
        Recommended by:
        FishOutofWater

        the general revenue transfers. Even if it's not that large of an increase, the degree to which it is helpful is very large.

        I'd argue that politicians should say "Do you want lowered Medicare benefits or a slightly higher tax rate?"

        Means testing of Medicare too could reduce outlays and it could be done in a fair way.

  •  MYTH -- Savings from Electronic Medical Records (0+ / 0-)
    ACA, the health care act, does hold down costs by curtailing payments to providers and organizations and promoting efficiencies like electronic medical records (see Health Care Reform and Cost Controlby Peter Orszag and Ezekial Emanuel) but since they are not yet implemented, that's still on paper.

    I'm convinced those "efficiencies" from electronic medical records won't happen.  I think they're a pie-in-the-sky dream that vendors of overpriced electronic medical record systems sold to policy makers who were desperate enough to buy into any scheme that claimed it could save money, without examining the scheme critically.

    We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

    by david78209 on Sun Aug 14, 2011 at 07:44:33 AM PDT

    •  it's no panacea ( really hate using it) (5+ / 0-)

      but since I use it every day, I am equally convinced it's a huge help because many docs from different offices can read the record and not duplicate tests and services.

      You can get the record to another doc instantly, in time for this afternoon's visit with them.

      You can also search and study, say, asthma, and see if your patients are getting their flu shots, make adjustments and see if you increased the %  from year to year.

      Just a couple of examples.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 07:52:43 AM PDT

      [ Parent ]

      •  What system are you using? (2+ / 0-)
        Recommended by:
        dizzydean, FishOutofWater

        I'd bet they're all hard to learn and a pain to use, which makes me wish the government had promoted the system that VA and military hospitals have been using for a good while.  That system may not be better, but at least it's already familiar to a fair number of health care workers.

        I wish the government would 'open-source' that system, the way Linux is open-sourced.  That might encourage private business to write programs that make it more user-friendly without making it interoperable to users who have no or different add-on programs.  It might also bring the price down from the stratosphere ($45,000 per doctor is a figure I've seen) to something reasonable.

        My experience with electronic medical records is limited to disgust for the freebie electronic prescribing program I struggle with to meet the 'meaningful use' criteria for Medicare.   That system only recognizes about half the pharmacies in my area; apparently they want to charge the pharmacies a fee to be listed.  What's more, when I send a prescription over the system, it's likely to get lost in cyberspace.  In addition, I'm suspicious that it's being used to automate the process of spying on my prescribing habits, so that information can be sold to drug companies that want to measure how effective their promotions are.

        We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

        by david78209 on Sun Aug 14, 2011 at 08:25:04 AM PDT

        [ Parent ]

        •  The VA is in the process of (2+ / 0-)
          Recommended by:
          dizzydean, FishOutofWater

          releasing it as open source: lasted word I had is that they're still setting up the infrastructure for managing the source code and changes. A recent press release is here: http://www.blogs.va.gov/...

        •  the latter already happens (0+ / 0-)

          well, at least with EMR they can read my handwriting.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 08:50:06 AM PDT

          [ Parent ]

        •  I use allscripts (1+ / 0-)
          Recommended by:
          david78209

          but I also hear decent things about EPIC.

          I'm no expert, so don't take that as an endorsement. each has its major issues.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 08:51:23 AM PDT

          [ Parent ]

          •  I'm "using" allscripts, too (0+ / 0-)

            and I'm thoroughly unimpressed.  I think I've had more passwords than patients enrolled.

            Every now and then, on a quiet day, I'll tell a patient that Medicare wants me to use e-prescribing, and say, "Watch how well it works."  I then go through trying to enter the patient into the system.  Often there's a problem, and after piddling with the computer for three or four minutes I scratch out a paper prescription and tell the patient, "See how well that doesn't work?"  Sometimes the prescription does indeed go through (it usually works with Walgreen's) and I still give the patient a written prescription because the drugstores often don't get the one on the internet.

            Prescribing medicine should be about the easiest thing to computerize.  There are only a few thousand prescription medicines approved in the country; each one has no more than a handful of dosing regimens; and the bottle of medicine the patient walks out of the drugstore with ought to be interchangeable anywhere in the USA.  If the computer nerds can't get e-prescribing working smoothly, I don't trust them to mess with the whole medical record.

            I have paper charts in my office older than I am.  One patient's opening page is from 1947.  I have no trouble reading it.  How many electronic formats from 1987 are still easy to read?

            And how about privacy?  It wouldn't be very hard to steal a peek into the records of one of my patients, or a few, but stealing copies of them all would take hours or days at a copying machine.  If everything were electronic, one sly thief with a key drive that costs $8.99 (on sale today at Target; it holds 8GB) could steal everything in a few minutes.
            And how about security?  There are people who could forge a change in my paper charts that I couldn't detect, I think, but most of them work for the CIA.  A rank amateur could alter an electronic record and I wouldn't know it from how the 'chart' looked.

            We're all pretty strange one way or another; some of us just hide it better. "Normal" is a dryer setting.

            by david78209 on Sun Aug 14, 2011 at 12:09:55 PM PDT

            [ Parent ]

        •  I've been helping my wife chose a program (1+ / 0-)
          Recommended by:
          david78209

          they're all over-priced, especially for single practitioners and seem like they provide cookie-cutter solutions.  Still, it would be a big help for her in the long run if we find something that works, especially in terms of time saved.

          Our biggest drag is the damn insurance companies who should be forced to standardize their electronic submissions systems.

          The mediator between head and hands must be the heart. Epigram from Metropolis

          by dizzydean on Sun Aug 14, 2011 at 09:00:06 AM PDT

          [ Parent ]

    •  this is the same efficiencies (0+ / 0-)

      that firing nearly all the typists, filers, secretaries, draftsmen and similar labor intensive data handling workers and having the people they once worked for learn to type has created in the last 30 years. It's real, not an illusion. Not a panacea but over the next 30 years it can be a real cost cutter.

  •  It's like saying the car has a 1/4 tank left (0+ / 0-)

    So I might as well give it back to the dealer.

    "You can't run a country by a book of religion. Dumb all over, a little ugly on the side." Frank Zappa

    by Uosdwis on Sun Aug 14, 2011 at 07:46:04 AM PDT

  •  Medicare --- Medicaid (0+ / 0-)

    It is good that you fixed the typo in:
    "From the New England Journal of Medicine comes a graph illustrating how Medicaid is paid for, and note the growing part that is made up of general revenues (click the graph for a bigger, more readable version):"

    ...since it is in reference to Midicare. but the article doesn't do much to highlight the differences between the two. Which are major.

    •  I said in the beginning (0+ / 0-)

      that we just don't have time to get into the differences.

      Yeah, that was a major typo.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 08:52:16 AM PDT

      [ Parent ]

  •  Excellent article, but... (2+ / 0-)
    Recommended by:
    DemFromCT, joe from Lowell

    "It's also borrowing from China and Germany and a lot of other countries," Steuerle says.

    I am sick of people who should know better talking about the national debt as if we're only borrowing money from foreign countries. Americans own most of the debt. China owns about 9%; Germany even less.

    Obviously, I don't blame the diarist for this. I blame the quoted official. But far too many Americans abbreviate the debt debate as "money we owe China"--even Jon Stewart says it now and then, and he's one of the smarter guys--and it wouldn't have to be this way if the people who knew better had an honest, intelligent discussion with people about the issue.

    Ok, rant done. Carry on with your thoughtful health care discussion. I just needed to get that out.

    Shameless plug (for all readers): Check out my new fiction blog at http://watchyoureyes.blogspot.com/

    by angryreader18 on Sun Aug 14, 2011 at 07:57:10 AM PDT

    •  so noted n/t (0+ / 0-)

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 08:52:57 AM PDT

      [ Parent ]

    •  47% of US debt is foreign owned (0+ / 0-)

      The mediator between head and hands must be the heart. Epigram from Metropolis

      by dizzydean on Sun Aug 14, 2011 at 08:56:57 AM PDT

      [ Parent ]

      •  Leaving about 53% domestic owned, (0+ / 0-)

        If my math, and the article you site is correct.

        And China owns 9.8% of all debt, also according to this article.

        My qualms against the quoted official have not changed. Countries like China own a small fraction of our debt, and failing to specify this only fuels the rumors that they own almost all of it. I'm not trying to say we don't have foreign creditors, but we don't owe it all to China, or even most of it to China, as is commonly believed.

        Shameless plug (for all readers): Check out my new fiction blog at http://watchyoureyes.blogspot.com/

        by angryreader18 on Sun Aug 14, 2011 at 10:11:27 AM PDT

        [ Parent ]

  •  Great Diary (2+ / 0-)
    Recommended by:
    dizzydean, CrissieP

    The immediate problem is political.  The slightest hint of Dems changing SS or Medicare starts the Koch-brothers-funded wolves howling DEMS CUT MEDICARE. It worked perfectly in the 2010 elections, even though it was based on the lie that the drug and Medicare Advantage savings were cuts.

    They don't need truth -- any hint of cuts by Dems is pounced upon -- witness the recent memo after the debt ceiling deal that screamed "Obama put SS and Medicare on the table!"

    It is a horrible truth that any modification, no matter how thoughtful, of SS or Medicare by Dems is trumpeted as cuts and death panels, while the obvious intention of Republicans is to kill the programs completely.  When that intention is disclosed, e.g., by the Ryan Plan, voters react strongly.  

    What to do?  Essentially, nothing until 2013.

    1.  As you point out, SS is not in trouble. Nothing should be done until 2013 at the earliest.

    2.  Similarly, although Medicare is threatened by cost increases, any reforms are politically lethal and may negate the political advantages Dems received from the Ryan Plan.

    So even though Dems want to be "adults" and deal realistically with Medicare cost increases, they cannot afford to do so until 2013 at the earliest.

    The GOP: "You can always go to the Emergency Room."

    by Upper West on Sun Aug 14, 2011 at 07:57:10 AM PDT

  •  if social security is not responsible (0+ / 0-)

    for the deficit and has it's own funding, why would
    the president say he might not be able to send out
    the checks?

    •  That was in response (2+ / 0-)
      Recommended by:
      dizzydean, joe from Lowell

      to the debt ceiling increase.  The government sends out many checks each month and would have had to make a decision on who got paid.  For example do you pay the military and government workers or social security recipients?  There would not have been enough money to cover everything.

  •  I think the hysteria when it comes (0+ / 0-)

    is because of the specific solution.  Raising the age of Medicare eligibility is a hatcher and cruel.  Going after the cost of healthcare itself is more important - the ACA does not do it enough but it at least is trying.  Fixing SS is easy (and SS is not an imminent problem anyway - unless you really want to trust 30 year estimates), and is as simple as increasing the benefit and eliminating the income cap for instance.  A lot of the Grand Bargain solutions on SS though too easily give in to the Republican Zombie Lies about the program.

    Medicaid needs the most attention because it is the one the politicians are most anxious to throw under the bus - both at the state and federal levels.

  •  The reason the right wants to eliminate funding (0+ / 0-)

    for women's clinics is that those clinics artificially reduce the death rate for newborns which eventually will put additional strain on the system.  

  •  The One (2+ / 0-)
    Recommended by:
    DemFromCT, FishOutofWater

    issue I have with this discussion, as with all other discussions of the issue of health care, is that it focuses on the wrong thing.

    As thoughtful and well-reasoned as this post is, it continually talks about "covering" people for their health care.

    IMHO that's the wrong term, used to discuss the wrong issue, in such a manner that the whole debate is focused on keeping private corporations happy and profitable, rather than on the real issue, which is keeping Americans healthy.

    When someone uses the term "health coverage," I generally stop reading, no matter how sensible the opinions, or even if I generally agree.  The correct term is "health care."

    The problem is not, and should not, be defined as "coverage."  That is saying that the problem is ensuring that corporations can make enough profit in the health industry.

    If you want me to pay attention, talk about "health care."  Talk about providing care to those who need it, in a sector where the classically understood economics of supply and demand and choice do not work.

    Treat health care like education:  a networked social good that is only viable if available to all, regardless of ability to pay, at a basic level.  Then put in place a system like education is supposed to be and was when our country was viable.  Health care institutions paid for by taxes, where care is available to all.  If you are wealthy, and want to pretend you are buying care that is better than that available to the rabble, private institutions are available for a premium, but you still pay your taxes to support the general welfare.

    Lots to say to fill in that simple, basic idea, but we should stop talking as if the only option is a system that focuses on private profit as the only solution to all problems.

    "... there is no humane way to rule people against their will." Naomi Klein, The Shock Doctrine

    by Noziglia on Sun Aug 14, 2011 at 08:15:36 AM PDT

    •  This diary focused (0+ / 0-)

      primarily on Medicare,which has very little private component,outside of products such as medical equipment and pharma.

      Dismissing a balanced look at the medicare system due to the use of a word ''coverage'' ; in a context that does not include private insurance simply because you link it to insurance industry coverage for the general population seems silly to me.

      We get the point,you despise private insurance...now,what does that have to do with medicare, a public program that is essentially single payer?

    •  the rest of the world uses those terms (0+ / 0-)

      I provide health care every day. You won't see me with your kids most likely if you do not have coverage.

      That's a simple fact.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 08:55:29 AM PDT

      [ Parent ]

  •  An excellent, informed, non-demagogic piece. (3+ / 0-)
    Recommended by:
    Hawkjt, dizzydean, DemFromCT

    Thank you for this.  This is one of the best overviews I have read, and I hope it gets some discussion going that has a little more depth than that which has surrounded the issue of Medicare financing to date.

    Art is the handmaid of human good.

    by joe from Lowell on Sun Aug 14, 2011 at 08:28:38 AM PDT

  •  Well done, DemFromCT. (1+ / 0-)
    Recommended by:
    dizzydean

    Thank you for the explication and de-conflatation.
    (And, as was said above, for braving the winds of howl)

    Joe

    Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

    by CitizenJoe on Sun Aug 14, 2011 at 08:41:09 AM PDT

  •  Can we get one thing out of the way (3+ / 0-)

    Baby boomers, the largest and best educated working cohort in the history of the US are not the problem because they are now the largest cohort needing medical care in old age.  Over 50 years, beginning with our summer and part-time jobs in high school, we have paid taxes into the general revenue, FICA, and Medicare.

    If those revenues are too low, it is as much because of the suppression of wage and salary income since the early 1970s as it is about our numbers.

    We are frigging not the problem.

    And most of us are now in situations in which we cannot afford the deductibles and co-pays in the current Medicare rules.  So, even with Medicare, we are still forgoing needed health care and prescriptions.

    Let's start talking about the reality of Medicare instead of the image that it pays for everything and seniors have no costs at all.

    50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

    by TarheelDem on Sun Aug 14, 2011 at 08:46:29 AM PDT

    •  I 'm a boomer (0+ / 0-)

      don't take it personal but we are aging. ;-)

      That has consequences without blaming us for existing or existing in large numbers.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 09:11:31 AM PDT

      [ Parent ]

      •  We've understood those consequences (3+ / 0-)

        ...which is why the folks that created the programs built actuarial analysis into those programs.

        It was only in the 1960s that we had the illusion (or fear) that we wouldn't survive until our thirtieth birthday (1975 for the earliest of us) because of a general nuclear war.  (I guess that was the letdown that led to Reaganism.)

        50 states, 210 media market, 435 Congressional Districts, 3080 counties, 192,480 precincts

        by TarheelDem on Sun Aug 14, 2011 at 09:27:03 AM PDT

        [ Parent ]

    •  PS (0+ / 0-)

      excellent comment!!

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 09:11:52 AM PDT

      [ Parent ]

  •  What about means testing Medicare? (0+ / 0-)

    Perhaps through linking the Medicare premium to income?  (Yup, people on Medicare pay a premium just like people on private health insurance.  It's just a lot lower than what it would be if they were purchasing health insurance, or if Medicare beneficiaries were funding the program on their own).

    There has long been an aversion to doing this among liberals, for a very reasonable, political reason: because we're afraid that if the program is "welfare," that is something that benefits only poorer people, political support for it will dry up.

    However, there is a long, long way to go between the status quo and Medicare becoming a program for poor people.

    Art is the handmaid of human good.

    by joe from Lowell on Sun Aug 14, 2011 at 09:04:51 AM PDT

  •  $12,000.00 for a Chemo injection ... (1+ / 0-)
    Recommended by:
    SingleVoter

       that Medicare pays $600.00 for. If you don't have insurance, you can be sure you'll pay the full amount.
    Another example, but the other way: Medicare pays about $5000.00 for an electric wheel chair (Jazzy). Look on Craig's List and see what you can buy a new one for.
    A lot of the cost of medical care is phonus balonus.

  •  Thank you for a (1+ / 0-)
    Recommended by:
    DemFromCT

    reality-based diary.

    How refreshing compared to the hysteria we're been subjected to recently.

    As I've been saying over and over lately, changing the law so that the gov can negotiate prices with drug companies can save Medicare Part D $400 billion over 10 years.

    It was a proposal made during the health care bill debate that had to be dropped in order to get the initial ACA bill through, but that didn't mean the proposal couldn't be brought up again.  In fact, we're in a much stronger position to get it through now, since there's no other "greater bill" attached to the proposal we're trying to push that could be held hostage.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity" - MLK

    by edwardssl on Sun Aug 14, 2011 at 09:58:54 AM PDT

  •  I don't understand this (2+ / 0-)
    Recommended by:
    SingleVoter, joanneleon
    Specifically, raising taxes to pay for public insurance exerts a structural drag on the economy even if the revenue is spent on care; the same is not true of unsubsidized, privately purchased care or insurance.

    Why is the tax a larger drag than paying the same amount for private insurance?

    I would add personally that one of the biggest problems with private insurance today is not just that it is expensive but that it is unpredictably expensive - ie, it is increasing by 10% or more a year when income is not.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Sun Aug 14, 2011 at 10:03:03 AM PDT

    •  that's their view (0+ / 0-)

      not mine. Private insurance also arbitrarily limits care and jacks up admin fees and favors shareholders over patients. I'm guessing they are capitalists.

      I didn't truncate the quote because I was trying to be fair to the authors.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 10:11:03 AM PDT

      [ Parent ]

    •  one way to take it (0+ / 0-)

      (the way I originally took it when I posted) is that any raising of taxes for anything in the midst of a recession is a structural drag on the economy and leads to bigger deficits. Spending the same money on private insurance may provide less care, less efficient use of resources and less people covered but has a different effect on the economy as we measure it.

      I can write them and ask what they meant.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 10:15:38 AM PDT

      [ Parent ]

    •  oh, and from their piece (0+ / 0-)
      Although the economy can probably bear some tax increases to help finance Medicare, if recent rates of spending growth continue, taxes would have to increase precipitously. An analysis performed by the Congressional Budget Office (CBO) before the ACA was passed suggested that income tax rates would have to increase by more than 70% to finance health care spending that grew just 1 percentage point faster than the GDP — and by more than 160% to finance growth at the historical rate of 2.5 percentage points faster than GDP growth, increasing the income tax rate in the top bracket, for example, to 92% from 35%.

      Even with just 1 percentage point excess growth in health care spending, the CBO estimates that the tax increase would reduce the GDP by 3 to 16%.2

      Of course, such tax-financed spending may be worthwhile — the cost of raising the revenue must be weighed against the good done by the program, and Medicare has many costs and benefits beyond its effect on the GDP.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 10:24:37 AM PDT

      [ Parent ]

    •  Unpredictably expensive (0+ / 0-)

      in more ways than one.  Not only are the premiums unpredictable but the amount that they will pay for different things, whether or not they will pay for different things, their formulary list, and what seems like a hundred other ways, it is very difficult to know how much something is going to cost when you go to a doctor, a hospital, etc.  And if you have the luxury of time before needing care, it's nearly impossible to figure out what it is going to cost ahead of time.

      Every year there are new ways that you have to pay for something else or more than you paid last time for the same thing.

  •  Medicare trouble caused by health care "system" (2+ / 0-)
    Recommended by:
    DemFromCT, SingleVoter

    When you compare US medical costs with other countries, several things stand out glaringly.  Doctor charges and fees; the excessive capital costs of hospitals that speculatively build excessively luxurious new facilities in the name of "competition"; the perverse incentives of fees versus overall patient wellness; and the overhead of private medical insurance.  It's important to note that even with single-payer, the only one of these problems you would definitively solve is the insurance overhead.  Whether or not we get single-payer, the problems in our health care "system" are far broader and more entrenched than simply a public versus private thing.

    And even though Medicare stands out as being one of the world's most efficient health carriers in terms of administrative overhead, it still has to pay vendors for all these other dysfunctions — which is why an operation with tiny overhead is still busting its budget.  

    Further steps toward comprehensive health reform will make dramatic differences. Reversing the comprehensive health reform we already have will make health care unaffordable for the large majority of American individuals and businesses.

  •  Thanks, Dem. You've convinced me that removing (3+ / 0-)

    the contribution cap AND removing the benefit cap, will make medicare solvent to about 2100.   Good enough for me.

    I don't think removing the contribution cap and keeping a benefit cap is equitable.  Let the plan be fully progressive and have the amount that well-to-do people actually draw be limited by the fact that they are only one person with roughly the same medical costs as a poor person.

    "Don't dream it, be it" - Brad, Janet and Frank

    by captainlaser on Sun Aug 14, 2011 at 10:17:15 AM PDT

  •  Health care should help people not accountants (1+ / 0-)
    Recommended by:
    SingleVoter

    By emphasizing the incontestable fact that the more Americans who are given health care the better, the article gives the right message.  Of course, there will always be the problem of how to pay for the care, but any solution which cuts people off from care is totally unacceptable.  At present American health care is consuming some 18% of GNP while in the rest of the world which has mandatory universal health care the percentage of GNP devoted to health care does not exceed 11% and they have better health outcomes.  This proves that America can provide universal health care insurance at a more affordable price.

  •  Doesn't make sense to me to raise the (3+ / 0-)

    Medicare age from 65 to 67. If a 65/ 66-year-old needs catastrophic care and has no insurance or inadequate insurance, the bill will get passed along to our society by the caregivers anyway.

    Plus, we will lose two years of providing preventive care to the critically aged 65 and 66, who, I presume,  have chronic conditions in large numbers.

    In other words, I don't understand how we save money by increasing the benefit age.

    Medicare-buy-in please, please...

    "Lets show the rascals what Citizens United really means."

    by smiley7 on Sun Aug 14, 2011 at 10:45:47 AM PDT

  •  I HAVE always thought it was about the WHO! (0+ / 0-)

    that is why the repugs are pushing obama so hard. They can't achieve their dastardly deeds of killing medicare and privatizing SS without DEMOCRATIC SUPPORT. That is also, why, i am concerned about obama. he is too willing to compromis and far to willing to surrender the common good to repuglican skullduggery.

    An EGG is not a person, A corporation is not a person!

    by CarmanK on Sun Aug 14, 2011 at 12:15:23 PM PDT

  •  Thank you (0+ / 0-)

    this is one of the most comprehensive, balanced look at Medicare that I have seen. Thanks for your time to put this together.

  •  You shouldn't pay as much per person (0+ / 0-)

    if 20% more pill poppers are on Medicare Part D. By that time, about 50% more people around the world will have American level incomes. Cut the American per person prices/payouts by 30%, for a 10% net savings.

    Don't pay a hospital the same per patient rate if 20% more Medicare patients are there. Cut the rates by 15% because capital costs should have been fixed by 2011.

    Even if life expectancy rises, that doesn't mean each person is going to get that much more care.

    I may get cancer at 93 instead of 85 because of a less toxic environment made possible by government regulation.

    I will merely get cut, zapped, and chemotherapy eight years later in life.

  •  Regional variation: Dartmouth Atlas (1+ / 0-)
    Recommended by:
    DemFromCT

    See http://www.dartmouthatlas.org/

    One of the most striking aspects about Medicare expenditures and the impact physicians and hospitals have on costs is the dramatic regional variation. And variation that is largely NOT explained by differences in the patients and their condition but in the 'practice patterns' in those regions.

    Importantly, quality does not increase with increase in expenditures and at some point may decrease.

    In any effort to 'reform' Medicare and reduce the rate of growth, this will be one of the greatest challenges.

     

  •  The time to get cost containment by law (1+ / 0-)
    Recommended by:
    ravenwind

    is now.

    The politicians can point to the young healthy people who are going to loose much of their disposable income because of the PPACA and demand similar deep shared sacrifice from medical and insurance providers.

    1. CPI-based caps on premiums for exchange plans which should be based on well-defined 2009 coverage standards such as Maryland style comprehensive standard health benefit plan (CSHBP), minimum FEHBP basic required coverage, and Medicare Parts A and B

    2. loss ratio minimums as per HR 3200

    3. a federal agency with the power to control medical facility administrative compensation and costs

    4. a federal excessive drug expenditure rebate collection agency to ensure our drug costs don't exceed international per capita level benchmarks

    5. implemented hospital plans to at least break even on Medicare level rates by 2015

    6. no charge access to electronic health record standards

    7. a federal doctor importing, screening, test-based retraining, and licensing agency with the mission to provide access to doctors all across America at Medicare rates or less

  •  Tax the estates of dead doctors (0+ / 0-)

    and the doctor-funded large estates of former significant others.

  •  The tale of a doctor in Greece (0+ / 0-)

    who probably is making about $12,000/year at best.

    I'm living in Greece almost 15 years, and working like a pediatrician in one medium size town.

    The Greek Government, and its institutions, never pay ANYONE on time. It is usually "habit" for us to wait up to 2 years to be payed for our services. Despite the cost of the private visit, which is ( listen UK !) - 8E[~$11]. Yes, every visit on private doctor here is payed by the Greek Government- 8E ( 20E before tax - 12E goes on "taxes"!!!).

    ....in 2011 you must pay 7.000 E, par example, for the years 2000-2007, not because you have committed a tax fraud, or have some kind of tax errors. Simply because they vote for a such thing- 1000E for every year. And this- the socialist parasites call "justice", because according to them, all ( in our case) doctors are "cheaters", and must be punished. Nobody in Europe knows these "practices"... .
    Dishonest, disgrace, third world State... .

    In the small towns, there is not a single doctor exist, which are able to pay taxes, not because we do not want to do. Because we earn so little, than after deduction, almost 60-70% of us are on the month income level of 600-700E and bellow the official line
    ....
    In my small town, of 120.000, there is 80 taxi drivers ( pampered with good wages) and almost 90 cardiologists/ 120 pathologists on private practice
    .
    In 7 mln Greece, there is 4 or 5 Medical Universities, endlessly producing "doctors"....

    on the second page of comments:
    http://www.guardian.co.uk/...

    Half of current Medicare rates paid promptly would greatly appeal to this doctor and many others.

  •  We already paid for that, ShockDoctrineDemfromCT (1+ / 0-)
    Recommended by:
    priceman

    with the payroll tax increase back in the 80s.

    And there we have a problem, not so easily solved: the current rate of growth is not sustainable. In fact, it's getting out of control because baby boomers are aging (story from 12/30/2010):

    The problem is that health care costs have been growing in an out of control way because certain (specialist) doctors fees are out of control, hospitals are out of control, PhRMA is out of control, medical device companies and many other areas of the health field have no morals only greed.  

    The health care field and the greedmongers in it (not the workers -- the corrupt doctors and other profiteers) are out of control.

    But it does not surprise me at all that you would try to obscure that.  It's disgusting to see a front pager on a supposedly Democratic site enabling this administration as it destroys Medicare, destroys the party and destroys the country, ShockDoctrineDemfromCT.

    •  solutions are hard to come by (4+ / 0-)

      single payer would go a long way to righting the equation, which is why I support it.

      But the demographic time bomb is a hard fact. Alas. It is unfortunate that your comment contains so many insults and so few practical solutions.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun Aug 14, 2011 at 03:59:17 PM PDT

      [ Parent ]

      •  What is unfortunate (0+ / 0-)

        is to have a person writing on the front page here who so often carries water for the administration, but worse than that, tries to sell the right-wing claptrap about the need to cut Medicare to a progressive community.

        The "I support single payer" is a familiar game among people in Congress who are all for it until they actually have to vote for something that might pass.

        If you really are for single payer, for universal, health care for all, why are you not fighting like hell to keep Medicare from being cut and undermined?  Please answer me that. Why are you not fighting like hell against it?

        •  interesting (4+ / 0-)

          What's funny is that of the 400 some odd comments (most of them excellent and stimulative of discussion), yours is one of the very few who takes issue, not with the post, but with who is writing the post, and thinks it's somehow appropriate to berate me for all the ills of the world, real and imagined.

          Perhaps it's beyond you, but you might consider that it's you who has gotten it completely wrong.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 06:43:01 PM PDT

          [ Parent ]

          •  DemFromCT - can I send you something via mail? (3+ / 0-)
            Recommended by:
            joedemocrat, edwardssl, evergreen2

            the private messaging system on here.
              thanks.

            "Oh no...you changed your hair color? It's just so dark. You like it? And with your skin tone?" My Mom ♥ 12.25.2007 ------- A true sportsman is a hunter lost in the woods and out of ammo. ~Robert Brault

            by Christin on Sun Aug 14, 2011 at 07:39:12 PM PDT

            [ Parent ]

          •  Very specific (0+ / 0-)

            My complaints were very specific, having to do with Medicare and the rising costs of health care and did not

            berate me for all the ills of the world, real and imagined

            The other complaint is about having a front page writer here defending cutting Medicare.  Those were very specific complaints.  I see many others among the 400 with similar sentiments.

            And seriously, I had hoped that you would answer the one question that I asked in my earlier comment.  Why are you not fighting against these cuts?

            If you really are for single payer, for universal, health care for all, why are you not fighting like hell to keep Medicare from being cut and undermined?  Please answer me that. Why are you not fighting like hell against it?
            •  I see (0+ / 0-)

              that down below you did give an answer about why you are not fighting against the cuts.  Not sustainable.

              Do you believe that more funding is the answer?

              Also, what about the out of control costs of specialist doctors, hospitals, devices, testing and PhRMA?  Do you see that as a path to making Medicare sustainable?

              •  I believe that making medical care cheaper (1+ / 0-)
                Recommended by:
                evergreen2

                is the sustainable answer, one reason I support single payer AND failing that, ACA (the law of the land).

                As to your last paragraph, absolutely yes. But the costs are not as out of control equally divided. Hospitals need to be funded well enough to take care of all comers regardless of insurance, etc. and until the system is completely changed there's going to be cost shifting with hospitals and docs. Charge who can afford it and take care of those who cannot. PhRMA has no such excuse.

                Funny, except for medicine, that principle is generally applauded in progressive circles.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Mon Aug 15, 2011 at 04:33:26 AM PDT

                [ Parent ]

        •  as to your last question (3+ / 0-)
          Recommended by:
          joedemocrat, edwardssl, evergreen2

          I don't find emotional rants in the least bit instructive or helpful. I prefer to understand the factual basis behind claims, decisions and actions and act accordingly. The purpose of this diary is to do so.

          If Medicare does not get restructured (be it increased funding, decreased costs or some combo) it is unsustainable. That is a fact. Rail against it all you want, it's like complaining about the sun coming up.

          Single payer didn't have the votes to pass and we don't have it. See my very first comment... the first comment in the post. VT and state level implementation to show it works seems like the best way to get it done.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun Aug 14, 2011 at 06:47:51 PM PDT

          [ Parent ]

          •  Question... (1+ / 0-)
            Recommended by:
            evergreen2

            During the ACA debate, it was discussed how our fee for service system leads to overuse.

            However, with so many uninsured and underinsured, there are a lot of people who underuse.

            That's why it is hard for me to believe that as a society we overuse. You are a good researcher- any data?  

            Also, if we move from fee for service to something else if we spend less on health care then somebody earns less money whether it be doctors, hospitals, drug companies, medical equipment companies. So they will fight it tooth & nail..And spin it as impacting people.

            Also, this isn't meant to criticize you or attack you and not debate the issue. I'm generally support your posts and find them factual. I am just asking questions I've wonder about.

            Some people are working every day on concrete issues of jobs, wealth, power and justice. And some people are discussing Osama bin Laden's civil rights or who is "deracinated" - Citizen K

            by joedemocrat on Sun Aug 14, 2011 at 07:20:17 PM PDT

            [ Parent ]

            •  good questions! (2+ / 0-)
              Recommended by:
              joedemocrat, evergreen2

              plenty of overuse...plenty of data.

              See the two links above where I talked about Doctors For America:

              http://healthpolicyandreform.nejm.org/...

              http://www.nytimes.com/...

              and see the poster who talked about the Dartmouth Atlas.

              http://www.dailykos.com/...

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Mon Aug 15, 2011 at 04:23:26 AM PDT

              [ Parent ]

              •  Thank you for this reply and your messages!! (2+ / 0-)
                Recommended by:
                DemFromCT, evergreen2

                I skimmed the first one already, and it does appear there's plenty of overuse.

                I would support changing the health care delivery system to make that more efficient; this will free up dollars we can use to move towards universal care.

                This is why I come to Daily Kos - to learn. I've always felt you are somebody anyone can have a good, intelligent conversation with agree or disagree and come away and learn something new.

                I'll have plenty of good reading material later today when I have time

                Some people are working every day on concrete issues of jobs, wealth, power and justice. And some people are discussing Osama bin Laden's civil rights or who is "deracinated" - Citizen K

                by joedemocrat on Mon Aug 15, 2011 at 05:46:17 AM PDT

                [ Parent ]

          •  Also, while I agree w/ finding medicare (1+ / 0-)
            Recommended by:
            evergreen2

            cost savings the problem is I want to spend that money on expanding Medicare to more people..

            For example, there are so many long term unemployed age 50+. Some of these people are desperate for health care.

            How about letting these Americans into Medicare?  If you are age 50 or above and out of work you are eligible for Medicare?  And pay for this by increasing the payroll tax  on six figure incomes?  Or having a tax on corporate jobs sent overseas?  Yes, pay for it...

            Maybe that's not easible just like single payer isn't. But there's a lot of people out there age 50 or above who would support the idea.

            Some people are working every day on concrete issues of jobs, wealth, power and justice. And some people are discussing Osama bin Laden's civil rights or who is "deracinated" - Citizen K

            by joedemocrat on Sun Aug 14, 2011 at 07:41:34 PM PDT

            [ Parent ]

            •  yes it seems like a good idea, but.... (2+ / 0-)
              Recommended by:
              joedemocrat, evergreen2

              I have not seen data on cost, and given what we already know about adding the aging boomers, how is that a sustainable idea?

              Maybe it is and I am not aware of the data, but it is something we have to ask.

              "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

              by Greg Dworkin on Mon Aug 15, 2011 at 04:25:17 AM PDT

              [ Parent ]

              •  so a longer term solution has to be (2+ / 0-)
                Recommended by:
                joedemocrat, evergreen2

                make medical care cheaper.

                I agree that medicare is more efficient than private insurance, but someone (CBO, CBPP) has to run the numbers before we sign on.

                "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

                by Greg Dworkin on Mon Aug 15, 2011 at 04:26:54 AM PDT

                [ Parent ]

  •  Physician income! (1+ / 0-)
    Recommended by:
    evergreen2

    There is a recurring theme on this thread and elsewhere that a major driver of health care costs is physician income: it's those damned greed docs. I believe that some physicians' incomes are unreasonably high, but most primary care physicians enjoy a decent income for very hard work. Some subspecialists do make obscene incomes. But if you eliminated all physician income--docs work for free!--you get rid of 7.2% of health care costs. (661,000 docs@250K out of a 2.3 trillion dollar heath care economy).

    Joe

    Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

    by CitizenJoe on Mon Aug 15, 2011 at 08:00:49 AM PDT

    •  I should have added: (0+ / 0-)

      Physician behavior is a huge driver of costs. But physician income is far less significant.

      Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

      by CitizenJoe on Mon Aug 15, 2011 at 08:03:50 AM PDT

      [ Parent ]

      •  that is exactly right (0+ / 0-)

        and doc behavior can be incentivized to do the right thing.

        Provide best practice guidelines and evidence based care and under most circumstances, docs will follow the best practice rules.

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Mon Aug 15, 2011 at 06:50:18 PM PDT

        [ Parent ]

        •  Pretty radical notion. (0+ / 0-)

          Provide accurate information and incentives to do the right thing, and most people will do the right thing.
          I suppose we could try that........

          Joe

          Dear Ayn Rand fans: Please, would each of you just go all John Galt, immediately? Thank you.

          by CitizenJoe on Tue Aug 16, 2011 at 06:13:48 AM PDT

          [ Parent ]

  •  Great Diary! Lot's of information to digest. (0+ / 0-)
    The office also predicted last year about 375,000 people would sign up for new Pre-existing Condition Insurance Plans by 2013. But since the plans began a year ago under the health law, only about 20,000 people have signed up.

    CMS Chief Actuary Rick Foster attributed the lack of public awareness of the new insurance pools for the less-than-anticipated participation. He said his office took into account the low participation rates in making estimates for enrollment in Medicaid and insurance exchanges starting in 2014.

    I do find it a little incredible only 5% of those with pre-existing conditions would have been aware of the new law passed. They were probably the most aware group of what was going on in the HC debate. I suspect it's more a case that those folks simply can't afford this new insurance that they've been offered. It's been one of the sticking points for me in the whole debate and I think we'll see that problem exacerbated in 2014 when the general public is required to buy insurance from corporations. Not only will many not be able to afford it but many others that are healthy, and currently receiving employer sponsored insurance, refuse to pay for it.

    So, I do not think the ACA did much if anything to curb the rising healthcare costs, and that will result in rising costs for Medicare as well.

    Therefore, the political question isn't why Medicare and Social Security are on the table, it's whom do we trust to do it in a way that preserves the programs and protects the elderly?

    There was a time, not too long ago that that was an easy question to answer. Now? Not so much.

    "I will be happy to see the Republicans test whether or not I'm itching for a fight on a whole range of issues," President Obama - Liar

    by jec on Mon Aug 15, 2011 at 11:19:10 AM PDT

  •  Wow. Well done. (1+ / 0-)
    Recommended by:
    evergreen2

    I missed this diary before.  I will refer to this again and again.  Thanks.

    This is what diaries should be about.  Information, links and resources for people to verify their own facts.

    "The bottom line is, we've got to wake up. We can't allow our disappointment in Obama to lull us into allowing a truly dangerous strain of conservative philosophy to gain any more traction than it already has." --ObamOcala 4/5/11

    by smoothnmellow on Mon Aug 15, 2011 at 12:56:05 PM PDT

  •  Thx for this diary DemFromCT! (1+ / 0-)
    Recommended by:
    DemFromCT

    So informative, and great comments conversation--thx to you for staying in with it.

    My 84-yr-old dad died three years ago, my mom just turned 90, I'm about to turn 60, with long-term diabetes, and am buying my own insurance (self-employed), and my 24-yr-old daughter is on my plan.

    I'm still trying to figure out all this stuff, and your level-headed non-flamboyant patient description and comments are so helpful.  I feel more ready to have a deep conversation with my mom's absolutely wonderful pc physician.

    Namaste!

  •  Problematic Analysis (0+ / 0-)

    A dollar spent on health care is roughly the same as a dollar spent on donuts. There is no fiscal drag from the government taxing at the proper level to pay for the service as long as the money is going back into the economy (in the long term).

    The problem is the trajectory of health care spending in general. As Dean Baker constantly points out if we spent the same amount of GDP on health care as other advanced countries we would have surpluses as far as the eye can see.

    http://www.cepr.net/...

    It would take grown-ups in Congress about five minutes to extend the life of the Social Security Trust Fund forever, but the right wing ideology gets in the way. Tax up to 90% of earned income like the Reagan era Commission recommended.  Has anyone ever noticed what the Trust Fund is invested in? Low return government bonds because the "serious people" are afraid of social ownership of interests in publicly traded firms.

    •  the fiscal drag refers to ever rising taxes in the (1+ / 0-)
      Recommended by:
      splashoil

      midst of a recession. it isn't that all taxes under any circumstances are a drag, it's large tax increases to keep up with medicare would be in the midst of a depression, assuming current cost projections.

      The problem is the trajectory of health care spending in general. As Dean Baker constantly points out if we spent the same amount of GDP on health care as other advanced countries we would have surpluses as far as the eye can see.

      I completely agree.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Mon Aug 15, 2011 at 06:48:12 PM PDT

      [ Parent ]

  •  Canada Health Care Cost (1+ / 0-)
    Recommended by:
    DemFromCT

    Sorry I am late to the party!  I do feel that a key element has been left out of this discussion:  just what a terrible failure our health Insurance system is at controlling costs and providing affordable care.  Take a look!

    Just a little reminder of how bamboozled and screwed we are here.  I'm in Bellingham, WA 20 minutes from the border.  Across the line, prescription drugs cost 1/3 to 1/4 of Stateside prices.  Below are health care costs:

        My friend in British Columbia, CANADA!, pays 60/month.
        If you make nothing, you file a form and based on your pay, you get the help you need.

        http://www.health.gov.bc.ca/....
        “Effective January 1, 2011, monthly rates are $60.50 for one person, $109.00 for a family of two and $121.00 for a family of three or more.”

        http://www.health.gov.bc.ca/....
        1st Line = Adjusted Net Income
        2nd Line = Subsidy Level
        3rd Line = One Person
        4th Line = Family of Two
        5th Line = Family of Three or More

        $0 – $22,000
        100% premium assistance
        $0.00
        $0.00
        $0.00

        $22,001 – $24,000
        80% premium assistance
        $12.10
        $21.80
        $24.20

        $24,001 – $26,000
        60% premium assistance
        $24.20
        $43.60
        $48.40

        $26001 – $28,000
        40% premium assistance
        $36.30
        $65.40
        $72.60

        $28,001 – $30,000
        20% premium assistance
        $48.40
        $87.20
        $96.80

        Over $30,000
        Full Rate
        $60.50
        $109.00
        $121.00

        ——————-
        So if you make over 30k/year, then you pay the regular.
        The regular for
        1 person is 60.50
        2 people is 109
        3 or more is 121.

        SO A FING FAMILY OF 3 OR MORE PAYS 121 PER MONTH. OR $1452 PER YEAR!!!

    •  this was never meant to be a comprehensive (1+ / 0-)
      Recommended by:
      splashoil

      look at every aspect of American health care, hence a lot was left out (including solutions!) ;-)

      Thanks for the comment.  Never too late.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Tue Aug 16, 2011 at 05:56:38 PM PDT

      [ Parent ]

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