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Conventional wisdom offers us the following scenario:

“The Baby Boomers will soon age into Medicare.  These greedy geezers will not be gracious enough to die quickly.  Thus, the cost of caring from them in their dotage will soon bankrupt Medicare.  We need to cut benefits, raise the eligibility age, or increase co-pays and deductibles.  Maybe we should do all of them.  Or, we could privatize it. Now that's an idea.”

This is a relatively accurate representation of the current state of debate about Medicare, its future, and the Boomers’ role in that future.  However, before I dive into this debate, I need to distinguish between three things:  prices, costs, and expenditures.  Prices are what a health care provider wants you to pay for a good or service.  Costs represent the resources required to produce a good or service.  Expenditures are how much someone, in the end, pays for a good or service.  

We have a great example from recent times.  About 55 years ago, the FDA approved a drug, hydroxyprogesterone caproate or Delalutin, for use to halt an impending miscarriage. The manufacturer stopped producing Delalutin in 2000.  It was not effective, and there may have been manufacturing problems.  However, a study published in 2003 in the New England Journal of Medicine indicated that the compound reduced the likelihood of pre-term labor for some women who had a previous pre-term delivery.  Since then, many women have taken the medication, mixed by compounding pharmacies, to reduce the likelihood of pre-term labor.  The cost per weekly injection ranged from approximately $10-$25.  Total costs over the entire pregnancy would be somewhere between $200 and $500.

In 2011, the FDA approved this same compound under the name “Makena,” and gave KV Pharmaceuticals (KVPHP) the right to produce and market Makena.  KVPHP put a $1,500 price tag on each injection, which adds up to about $30,000 per pregnancy.  They also, bless their bleeding hearts, set up a subsidiary to help income-challenged women get the medication. Oh, and just as an aside, KVPHP stock jumped from about $3 per share to $13 in the weeks after this announcement.  Two months after their initial approval of Makena, the FDA indicated that it would NOT prosecute compounding pharmacies for producing the generic version of the compound, named 17P.  KVPHP then dropped its price to a mere $690 per dose.  

The “cost” of producing a unit of the compound was something under (being a generous sort of person) $25.  The initial “price” per unit was $1,500. Some analysts indicate that by June of this year over 100 provider and insurers were already paying the “reduced” price of $690.  Their expenditures (suckers!) for the compound were $690 per unit.  Please keep these distinctions and the example in mind as I return to the central issue here -- Boomers and Medicare.

The scenario that opens this diary is what happens when people take three facts and put them together.  

a. The percentage of the population who are elderly is increasing because of the Boomers.

b. Per capita health care costs increase with age.

c. The Medicare Trust Committee in 2009 predicted Medicare bankruptcy in 2017.

OR      (to be all pseudo-mathematical about it)

    c = a + b is the argument

It’s very simple; it’s very clear; it’s VERY wrong.  Don’t misunderstand.  Two of those statements (a and b) are true.  Statement “c” is arguably true (I will get to that later).  It is just that those three “facts” do NOT constitute a causal chain.  Statement “c” may be true, but it will not necessarily result from the conjunction of “a” and “b.”  That means c ≠ a + b.  (Note: My union would rip up my membership card if I wrote something about health care and did not have an equation or two sprinkled around in it.).

The National Committee to Preserve Social Security and Medicare ( has a very nice site that gives you great information on some of reasons why “a” and “b” don’t make “c.”  Below is a chart on that site that provides Congressional Budget Office projections from 2005 of Medicare expenditures as a portion of GDP.  What is interesting about the chart is that it decomposes the sources of the increase in expenditures.  As the chart indicates, the major factor driving expenditure increases are “excess cost growth ” (read that as prices for this discussion)
A few years back (2003), a group of very well respected economists (including Uwe Reinhardt of Princeton), published an article in HEALTH AFFAIRS, the premiere journal for health policy wonks.  The article’s title tells the tale ---“IT’S THE PRICES, STUPID.”  The conclusion of the article indicated that the USA spends much more on health care than any other country, but we utilize health care services at lower rates than countries that spend much less.  The authors then reach the reasonable conclusion echoed in the article’s title --- It’s the prices we pay, not the services we get, that make US health expenditures so high.  If they replicated these same analyses today, I have no doubt the conclusion would be the same.  I also have no doubt that the same economists that disputed the 2003 conclusion would do the same today, and they would be wrong again.

“Demography is not destiny,” even when it comes to heath care expenditures.  This should be even clearer when you recognize that we Boomers will completely be out of the health care equation ( read that as dead) by 2050.  Note how the total expenditure line in the chart continues its steady rise after 2050, with no interruption, out to 2080s.  

I am sure this news comes as a relief to our grandchildren.  The thoughtful ones were worried that they might have to figure out a way to evade prosecution for murdering us, so that they and their children might have a chance at a decent life (see my diary ALL BOATS SHOULD RISE ON THE GRAY TIDE for an in-depth discussion of this aspect of inter-generational strife).

All discussions of the bankruptcy of the Medicare Hospital Insurance Trust Fund remind me of Mark Twain’s line that went something like, “Rumors of my death have been greatly exaggerated.”   A 2009 Congressional Research Service report provides some interesting information about the insolvency of the Trust Fund.  In 1970, the Trustees projected insolvency in 1972; in 1980, their estimate was 1994; in 1990, their date for doom was 2003; in 2000, it went to 2025.  The 2010 report makes it 2029, up 12 years from the 2009 report.  The Medicare Hospital Insurance Trust Fund is a political ping-pong ball.  Its insolvency date is one of the better examples of the role played by smoke and mirrors in health policy and politics in this nation.  The Fund will go bankrupt when politicians decide to let it go bankrupt.

A blast from the past might help move this discussion along.  Before the Balanced Budget Act of 1997, Medicare home care was incredibly lucrative.  A number of health care corporations expanded their Medicare home care dramatically in the 1990s.  A colleague was an analyst for one of the groups that dived deeply into Medicare home care.   My colleague told the group that these payment levels were a spigot that was going to be turned off in a few years.  My colleague’s advice was that they should take care not to put themselves at too high a risk of financial problems when payments dropped.  The response was something like, “Yeah, but I will have made tons of money by then.  What happens after that doesn’t really matter to me.

As the example above (and the almost unending list of all the others like it) should convince you that all the rhetoric and reasoning behind Occupy Wall Street (OWS) applies to health care.  We have a rapacious medical-industrial complex (MIC) that has, to enhance the wealth of its members, declared war on the American public's pocketbooks and health.  They will try to sell a $25 medication (to reduce the likelihood of premmies, for God sake) for $1,500.  I am sure if you ask a KVPHP executive why they REALLY did that the answer would be “because we thought we could (and BTW, I made out like a freakin’ bandit on my stock options).”  

The corporatization of health care and the ability of the MIC to ride roughshod over the US citizenry has the same roots as the de-regulation of derivatives trading.  A boatload of money is out there, waiting to be gobbled up by a few -- at the expense of the many.  As an added bonus, the MIC gets to blame any resulting problems (minor issues like infant mortality or no access to health care for the working poor) on demography, technology, bad character, excessive government regulations, or whatever suits its corrupt fancy or fantasies.  You should read Vampire Cabbie’s diary GIVE ME HEALTH CARE OR GIVE ME DEATH for a very clear and deeply disturbing image of the human reality behind all these words.

What’s the remedy for this mixture of money and misery?  That is a very complex question that has a number of very complex answers (BTW, anyone who says they have the answer is just hyping their latest book.).  Of course, a first good step is a single-payer system, MEDICARE FOR ALL, which should go a reasonable distance in dealing with price inflation and get insurance companies out of the mix (it’s a twofer!).  But, it’s just a first step.  However, I am not an enemy of incremental reform, since I have no idea what the perfect answer is.  

If I were all-powerful, then I would have answers.  All physicians would be like my friend, Bob.  All nurses would be like my friend, Sarah.  All health care administrators would be like my friend, Jack.  All health policy analyst would be like my friend, Charlene.  All for-profit health care corporations would be like…. Wait a minute, there wouldn’t be any such thing as for-profit health care corporations.  

Originally posted to ATexican on Sun Dec 18, 2011 at 09:45 AM PST.

Also republished by Community Spotlight.

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Comment Preferences

  •  Tip Jar (41+ / 0-)

    The folly of mistaking a paradox for a discovery, a metaphor for a proof, a torrent of verbiage for a spring of capital truths, and oneself for an oracle is inborn in us." Paul Valery, French poet, essayist, philosopher, and curmudgeon, 1895

    by ATexican on Sun Dec 18, 2011 at 09:45:02 AM PST

  •  What so many of these calculations miss is how (8+ / 0-)

    many jobs those aging boomers are providing. And all those good paying jobs send revenues back to the government.

    I think we need to evaluate Medicare to find out who is manipulating and milking the system for unneccessary care or treatment or medications. We need the FDA to step up and do a better job evaluating the effectiveness as well as the hype to reduce costs of crap medications that are expensive placebos.  There are many areas to deal with this problem but they require a lot of hard work and reducing the profit taking off of lives and health.

    If they were to get rid of medicare many hospitals and nursing homes would simply close. There would be a reduction of Doctors because people would not be able to replace the money they paid the Feds ( to be given to the richest as tax cuts).

    The government should be on this possible way of improving the economy by servicing this huge market while at same time meeting the promises they made.

    Fear is the Mind Killer

    by boophus on Sun Dec 18, 2011 at 01:18:08 PM PST

    •  It is all about jobs (17+ / 0-)

      The only reason the corporations, the insurance companies, Wall Street, and the Republican Party hate Medicare is that the money doesn't flow through them on the way to the beneficiaries.  

      They would love to skim off ~35% of our money before it's spent on us.  As they do in private health insurance and Wall Street retirement funds.  

    •  Anybody have an idea of how many (7+ / 0-)

      jobs are created by Medicare?  Could you divide the total annual payout by the average annual salary of healthcare workers?

      •  All of these jobs are non value add (0+ / 0-)

        The more people you have employed in health care, generally, the worse your economy is. Same with police, fire, etc.

        (-5.50,-6.67): Left Libertarian
        Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

        by Sparhawk on Sun Dec 18, 2011 at 02:32:57 PM PST

        [ Parent ]

        •  Your data or is this just a libertarian screw (5+ / 0-)

          everyone, i love to watch em die info?

          Fear is the Mind Killer

          by boophus on Sun Dec 18, 2011 at 03:28:03 PM PST

          [ Parent ]

          •  How can people.... (0+ / 0-)

            ...whose only function is to stop stuff from being broken or stolen actually create any kind of wealth? It's like calling a janitor at Intel a chip maker.

            Economically speaking, these kinds of jobs are a necessary evil, nothing more! Only jobs that make, mine, or manufacture something of value drive the economy forward.

            (-5.50,-6.67): Left Libertarian
            Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

            by Sparhawk on Sun Dec 18, 2011 at 06:03:01 PM PST

            [ Parent ]

            •  As an economics instructor (2+ / 0-)
              Recommended by:
              gatorcog, Alice in Florida

              that's one of the dumbest statements I've ever read. Okay, suppose you mine a boatload of iron ore. What good is it?
                Suppose you manufacture computer chips? What good are they?
                For any mined or manufactured product to have any value, someone has to buy it. That means that you have to have people who require the product in order to use it for something else.
                Who do you rely on more, the computer chip maker or the barber?
                The fact is, 70% of the US economy is services. Things that are manufactured or mined have value only because people use them to provide services.

        •  So ridiculous on its face (3+ / 0-)
          Recommended by:
          JVolvo, radarlady, Alice in Florida

          I think I'll leave it for awhile and let the rest of our community bask in the lurid glow of your libertardian idiocy.

          Oh, and meanwhile, please, dear sparrowfart.....

          " people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

          by ozsea1 on Sun Dec 18, 2011 at 04:11:10 PM PST

          [ Parent ]

        •  PPPFffwwaaawww! (2+ / 0-)
          Recommended by:
          ozsea1, Calamity Jean

          More jobs=more prosperity=economic collapse. Huh?

          Unemployment= good times 4 all. And I am the Queen of Romania.

          Don't let millionaires steal Social Security.
          I said, "Don't let millionaires steal Social Security!"

          by Leo in NJ on Sun Dec 18, 2011 at 04:45:55 PM PST

          [ Parent ]

          •  More police and fire jobs don't (0+ / 0-)

            They don't make us more prosperous in general. They don't actually make anything at all. They just stop stuff from being broken or stolen.

            (-5.50,-6.67): Left Libertarian
            Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

            by Sparhawk on Sun Dec 18, 2011 at 05:58:55 PM PST

            [ Parent ]

        •  Complete nonsense. (5+ / 0-)
          Recommended by:
          ozsea1, radarlady, kareylou, gatorcog, bumbi

          Police, firemen and doctors are not value added? What on earth are you smoking? Would you even contemplate living in a place where these 3 are not available? Of course not.

          These 3 professions are about as necessary to the society as anything else. Right after food and clothing probably.

          Only a doctrinaire libertarian would think that a box set of 'Keeping up with the Kardashians' is value added, and health care is not.

          •  re (0+ / 0-)

            It's simple, really.

            They are not value add. They don't actually make anything, nor do they provide any service of positive value.

            All they do is stop stuff from being broken or stolen. That stuff is what you are really interested in. 'Making stuff' is value add. Providing services (as in, a restaurant or a shop) is value add. The more of this stuff in the world, the richer we all are.

            Police and fire are value subtract. More police and fire, all other things being equal, add zero to the wealth of the world. They just consume resources.

            (-5.50,-6.67): Left Libertarian
            Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

            by Sparhawk on Sun Dec 18, 2011 at 05:56:37 PM PST

            [ Parent ]

            •  "nor do they provide any service of positive value (4+ / 0-)
              Recommended by:
              Sparhawk, Calamity Jean, kareylou, bumbi

              How do you figure health care is not of positive value? How come people have to pay doctors & nurses to perform them then?

              If somebody is willing to pay money for something, it is by definition value added.

              You libertarians just have a doctrinaire religious belief that government cannot possibly be good for the economy. It's a religious belief.

              •  They'd rather not (1+ / 0-)
                Recommended by:

                Do you want to go see that new movie? Yes? Then it represents wealth. More movies means a higher living standard for all of us.

                Do you want to see the doctor because you broke your ankle? Yes? Ok, what if you just not break your ankle in the first place? That's a far preferably outcome. The ideal amount of health care is zero, because you don't need it, thought that ideal is never (of course) realized.

                That's why health care is a negative while movies are a positive. Health care just fixes broken stuff. It's always a loss. Always. (Advances in health tech are not a loss, but the act of dealing with sickness is a loss).

                (-5.50,-6.67): Left Libertarian
                Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

                by Sparhawk on Sun Dec 18, 2011 at 06:13:47 PM PST

                [ Parent ]

                •  By the way (0+ / 0-)

                  This also says nothing about my opinion about whether the government or the private sector is a better purveyor of health care or any other service, only that we recognize these services as the costs they are rather than deluding ourselves into thinking we can build an economy from them.

                  (-5.50,-6.67): Left Libertarian
                  Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

                  by Sparhawk on Sun Dec 18, 2011 at 06:15:23 PM PST

                  [ Parent ]

                  •  To paraphrase Jesus of Nazareth, "The economy (3+ / 0-)
                    Recommended by:
                    Onomastic, kareylou, Alice in Florida

                    was made for humans, and not humans for the economy."  Economic activity should provide for the well-being of the people engaged in it.  Health care is one component of a pleasant comforable life.  It can't be the only component, because everyone needs other things (goods and services) in addition, but without health it's difficult to enjoy the other things.  

                    Receiving appropriate health care allows people to be more productive in their work, and therefore contributes to the overall wealth of society.  

                    Renewable energy brings national global security.      -6.25, -6.05

                    by Calamity Jean on Mon Dec 19, 2011 at 12:14:37 AM PST

                    [ Parent ]

                •  OK in that case I don't particularly want to eat (2+ / 0-)
                  Recommended by:
                  ozsea1, kareylou

                  wholegrain cereals neither. It's just that at my age I have to be conscious of my health. That's why I eat fiber rich oatmeals and cereals every morning instead of bacon and eggs.

                  So I suppose according to your theory wholegrain cereals also don't add any value to the economy.

                  •  'Stuff' nearly always adds value (1+ / 0-)
                    Recommended by:

                    To a point, the more whole grain cereals exist in the world, the richer we all are.

                    The fact that you would rather eat bacon is irrelevant. You are wealthy (sort of) because you need whole grains and you have access to them. The grower, miller, etc all add value because they took something worth little and made it worth more.

                    Police never do this. They just stop stuff from being broken or stolen, a service that's a necessary evil at best.

                    This isn't a 'theory', it's simple common sense. In a world of limited resources, devoting resources to fire and police takes them from other priorities (education, research, hell, blowing the money just for fun would be a better use than buying more police and fire than you need). Think of police and fire like auto insurance, you need them to live your life, but in no way do you 'want' to pay for it.

                    (-5.50,-6.67): Left Libertarian
                    Leadership doesn't mean taking a straw poll and then just throwing up your hands. -Jyrinx

                    by Sparhawk on Sun Dec 18, 2011 at 07:22:47 PM PST

                    [ Parent ]

                    •  'buying more police than you need' (3+ / 0-)
                      Recommended by:
                      Calamity Jean, Onomastic, bumbi

                      is obviously a bad thing. Then again so is buying more flowers than you need.

                      You still have'nt made the case for why 'stuff' always add value, and services don't add value. Police stop stuffs from getting stolen. That sounds like a great value to me. In fact, so great is the value added that almost all the corporations around here hire extra private security in order to augment the police protection.

                      •  It's not all services, just the repair services (1+ / 0-)
                        Recommended by:

                        I don't think the original comment was unclear about this; making something more valuable out of something less valuable, whether that is transforming a chunk of rock into a bar of steel, or turning a chunk of raw meat into a goot meal, is adding value.

                        In an ideal world, we'd still want these sort of improvements. In the same ideal world, we would not have accidents, fires, crimes, etc. (by definition all of which reduce value), and thus wouldn't need police, fire, etc. to guard against them.

                        Police and fire departments add value in the sense that employing them is less expensive than allowing the destruction to proceed unabated, but clearly nobody is better off after the fire department has saved 1/2 of their house from burning down.

                        I think it was also clear that the original comment made no comment about the distinction between private security forces and government agencies, so the whole "ungrateful Libertarian scum" argument presumably doesn't apply in this case.

                        •  Is turning goot into good adding value?!? (1+ / 0-)
                          Recommended by:
                        •  Sounds like arbitrary distinctions to me (1+ / 0-)
                          Recommended by:

                          Is a hair cut a 'repair service' then? What about restoration of old cars? Is that just repair too?

                          As to value added- health care most definitely adds value. If a surgeon is able to do an appendectomy on you to save your life from certain death- guess what- you would borrow $50,000 to get that done if you were in that situation. That is the ultimate value-addedness- saving your life.

                          But if you listen to the gospel the libertarians preach- the guy cooking meth is adding more 'value' to the economy than the doctor who just saved your life.

                          The truth of the matter is anything that anyone will pay money for is value added.

                •  Don't firefighters buy fire trucks? (2+ / 0-)
                  Recommended by:
                  bumbi, ozsea1

                  Don't physicians require a host of ancillary personnel, medical equipment, Hospitals? Doesn't the police functionof govt require courst, lawyers, clerks, courthouse buildings, firearms, etc?
                    Ironically, you're using a Marxist idea of value, where the value of a good is added by the labor used to produce it.
                    As we understand value these days, value is what people are willing to pay for a good. Without these "value negative" uses, much of the product of mining and manufacturing would be worthless.

            •  "Right" Libertarianism inaction (3+ / 0-)

              Your thought processes leads to conflation of related but different concepts.

              Indirect vs direct value is the real starting point of this conversation.

              You know that already. So, you're trolling.

              " people (and the) political class..cannot be rich and do politics without us..They have no skills that we depend on; they have no control of anything except through paper. "To keep you is no benefit; to destroy you is no loss." Visceral

              by ozsea1 on Sun Dec 18, 2011 at 08:18:33 PM PST

              [ Parent ]

            •  rediculous (2+ / 0-)
              Recommended by:
              icemilkcoffee, ozsea1

              Since when is the prevention of loss not value added?  Ever hear of knock on effects, or multiplier effects?  I'll put it simply:
              If the fire department keeps my shit from burning up, I can sell it later for money.  The buyer then makes something out of it that's greater than what I put into it.  Value added, mmmkay?

              Well, I guess I don't know what you mean by "equal justice under the law." - Bushy McSpokesperson

              by gatorcog on Mon Dec 19, 2011 at 08:52:01 AM PST

              [ Parent ]

          •  NJ's GOP Governor Christie cut state funding (0+ / 0-)

            for state, regional and local police as part of his "reform"...As a result, violent crime in the cities is escalating  wildly...IIRC in Camden, rape and murder are up by over 40% since  before the cut. Mr. Christie's policies have also laid off teachers and health care workers along with state workers in general. It is noteworthy that New Jersey's state employees were instrumental in the state's recovery after the serious storms earlier in 2011.

            This is just typical GOP bullshit. I see NOT A SINGLE proposal anywhere to cut pay or perks for ELECTED government officials, although they are extremely highly paid and compensated, well beyond the average government worker or private sector worker. But , hey - they are IMPORTANT!!!!


            Retired AFSCME Steward and licensed gun carrying progressive veteran.

            by old mark on Mon Dec 19, 2011 at 06:21:06 AM PST

            [ Parent ]

      •  The problem with Medicare (7+ / 0-)
        Recommended by:
        Chi, JVolvo, ozsea1, radarlady, Matt Z, peachcreek, bumbi

        and government-run (socialistic!!) insurance is that it is very hard to steal enough money to gold-plate your yacht.

        Don't let millionaires steal Social Security.
        I said, "Don't let millionaires steal Social Security!"

        by Leo in NJ on Sun Dec 18, 2011 at 04:39:59 PM PST

        [ Parent ]

    •  Part of the Problem is (1+ / 0-)
      Recommended by:

      people who like to show medicare is run with only 3-5% overhead but somehow fail to mention that fraud running around 15% the last I looked. That of course is what we can see. It might be much higher.

      The Fact of the matter, it is all about price and fraud, and while it's a convenient argument around the left to blame the insurance companies, I am here to tell you that there is a reason an old College Buddy gets paid 5-10 Million a year as an executive VP at one of the smaller Big Pharmas while his boss is in the top 20 paid CEOs of all the S&P 500.

      While 5-10 Million a year may not seem much,  some of you 6 figure earners should see how many years of peak income you would have to work to come close to one year's pay. As for the rest of the 99% low to mid 5 earners, don't bother unless the Smith and Wesson 29 cent all inclusive health care plan is locked up in a gun safe.

      The tragedy is, that we have somehow come to the conclusion that all Health Providers should make "good Livings" Doctors like  Oncologists who are some of of the drug companies best direct salespeople when pushing drugs that cost 6 figures or more per year because "It's not only for you , it's for your family. Shouldn't you think of them when making important decisions like...WTF? don't have insurance?...JHC...wrong fucking file again...You eat shit n die you poor bastard. I have a golf session at 2:00pm ".

      Ok, I exaggerate a little, but we all should understand that the cost side of this picture doesn't solely belong to insurance companies. For more validation, compare the market valuations of the major insurance companies to the major providers.

      The big tragedy is that it's included as the only growing sector in our GDP. Yes that's right. Worthy of more investment for containment drugs and such, damn the cures. Cures never bring in repeat customers. It is somewhat ironic when one considers that even the beneficiaries of this 2.5 Trillion dollar annual expense er debit to GDP is growing at a compound rate of double digit percentages so much so that their own health care benefits are seen as a limiting factor while some of them provide none to some for their lower level workers.

      "Daddy, did you just run over the corpse of grandma?"

    •  A guy named Berwick might have helped with this (0+ / 0-)

      .... but we know what happened to him (and evidence based medicine) on the way to confirmation.

      The Elephant. The Rider. The Path. Figure those out and change will come.

      by Denver11 on Sun Dec 18, 2011 at 03:44:40 PM PST

      [ Parent ]

    •  I'm pretty old and I've never met a single person (5+ / 0-)

      who was willing to take unnecessary medications or get unnecessary medical treatments for any reason. On the other hand, I have met some people who believe that the appropriate amount of profit on a good or service is the maximum amount the (captive) market will bear. And, many, many people believe it's the fiduciary duty of a corporation to milk the system for as much as possible on behalf of the stockholders, many of which are pension programs. It's a truly vicious cycle in the name of capitalism.

      Men never do evil so completely and cheerfully as when they do it from a religious conviction. -- Blaise Pascal

      by RJDixon74135 on Sun Dec 18, 2011 at 07:05:42 PM PST

      [ Parent ]

  •  But costs for perks for Boehner et al might. (1+ / 0-)
    Recommended by:
    Liberal Granny
  •  Social Security and Medicare Boards of Trustees (2+ / 0-)
    Recommended by:
    Dburn, kareylou
    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.

    Timothy F. Geithner,
    Secretary of the Treasury,
    and Managing Trustee      

    Hilda L. Solis,
    Secretary of Labor,
    and Trustee

    Kathleen Sebelius,
    Secretary of Health
    and Human Services,
    and Trustee

    Michael J. Astrue,
    Commissioner of
    Social Security,
    and Trustee

    Charles P. Blahous III,

    Robert D. Reischauer,

    •  Legislative Changes being a single Payer system (2+ / 0-)
      Recommended by:
      ozsea1, radarlady

      of course that's not what we'll get. It will be somewhere close to Marty Feldman pushing a wooden wagon in mid-evil England exhorting people to "bring out your dead"

      Mel Brooks or Month Python. I can't remember because
      I 'm a boomer without health insurance who is watching all the "public options" being priced just out of my reach and I'm pretty sure I have CRS.  

  •  much like the debate about Social Security (5+ / 0-)

    ...the Republican disinformation machine has also convinved a sizeable number of people that Social Security's economic collapse is inevitable...and then play the fear card by telling young folks that they're going to put in but won't be getting anything back. Talk about cynicism.

    Why the Democrats enable them to get away with these lies is beyond me.

  •  of course it's all bullshit (4+ / 0-)
    Recommended by:
    ozsea1, Calamity Jean, radarlady, Matt Z

    do you think that conservatives ever tell the fucking truth?  They can't and will never deal with the truth.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Rianne Eisler

    by noofsh on Sun Dec 18, 2011 at 03:47:24 PM PST

  •  Bankrupt, yes. (4+ / 0-)
    Recommended by:
    joe wobblie, ozsea1, radarlady, Matt Z

    But by constantly escalating health care and drug costs.

    As with medicaid, SS, and other social programs any sort of abuse is not a major problem with being able to finance them.

    Most all of the criticism today is a variation of Reagan's "welfare queens" propaganda and is a red herring to distract from any problems, real or most often imagined or greatly exaggerated.

    99%er. 100% opposed to fundamentalist/neoconservative/neoliberal oligarchs.

    by blueoasis on Sun Dec 18, 2011 at 04:43:14 PM PST

  •  Government price regulation (5+ / 0-)

    The US is one of the few (perhaps the only) developed countries that does not regulate drug prices. This is one reason why many drugs are cheaper in Canada or Mexico (although some pharmacies there are also selling generics that are not allowed to be sold in the US due to patent protection).

    Allowing importation of drugs from foreign pharmacies is a backdoor way of also "importing" their price regulation policies, and might be more politically acceptable than the straightforward mechanism of having such policies ourselves. But right now even that is apparently not being considered, although some importation does occur anyway.

  •  Example of Medicare being ripped off (3+ / 0-)
    Recommended by:
    ozsea1, radarlady, bumbi

     Recently had a routine colonoscopy. My "prep" consisted of a solution that came in a  large box costing $85 if you had no insurance. In the box was a gallon plastic jug with a small amount of solution to which you added water. Drink it over the course of the day before to cleanse the system.  I was curious, so I looked at the ingredients.  It was all over the counter stuff like phosphate of soda with a little electrolyte replacement.  The ingredients could be ordered in bulk for about 15 cents.

    There is no reason why 99% of people couldn't use this very inexpensive prep rather than the expensive stuff my doctor prescribed.

  •  hidden costs of no health care (6+ / 0-)

    One thing that doesn't seem to come up in health care reform debates is the cost to us all of people not getting correct health care. If someone is being juiced by health insurance & providers to the extent that they lose their home or farm, that's a hidden cost to the economy. If someone can't get well and can't work or work up to their potential, that's a hidden cost in productivity to the economy & society at large. None of this happens in a vacuum.

  •  Facts are wrong, diarist beliefs unchanged (0+ / 0-)

    If you find yourself quoting data from 2005, you should probably ask yourself if there is something more recent.

    The CBO's current take on the respective roles of aging and excess cost growth in the overall growth of Medicare, Medicaid and Social Security are quite different from that graph in 2005 with much greater weight now given to aging.

    The revision dates to about 2009, and you can read about it here:

    CBO's 2011 version of its long-term budget outlook is here (the chart in question is Box 1-1.

    You should be aware that these charts describe total costs for Medicare and Medicaid, not just those for Medicare Part A (hospital insurance) which is the part of Medicare that is funded by payroll taxes and has a Trust Fund like Social Security. Medicare parts B and D (outpatient and physician's services and drug coverage) are funded by general revenue and premiums and as such can never "exhaust" in the way the Part A trust fund can.

    The dates of the HI trust funds insolvency change, not because of political whimsy but because Medicare policy changes frequently. The diarist quotes numerous projections but not what happen in the interim. To wit, he says:
    "The Medicare Trust Committee [sic] in 2009 predicted Medicare bankruptcy in 2017."

    First, it is the Medicare Board of Trustees. Second, this is a projection of the Part A trust fund, only. Aging and excess cost growth impact Medicare parts A (HI), B & D (SMI) as well as Medicaid. Aging impacts Social Security. Third, in 2009, congress passed the ACA which lowered Medicare's costs and increased it's revenues pushing the dates of Part A's exhaustion from 2017 to 2029. That was a bit overoptimistic as the next years calculation's showed. The effects of recession (primarily) brought the projection back to 2024.

    "The projected date of HI Trust Fund exhaustion is 2024, five years earlier than estimated in last year’s report, at which time dedicated revenues would be sufficient to pay 90 percent of HI costs. The share of HI expenditures that can be financed with HI dedicated revenues is projected to decline slowly to 75 percent in 2045, and then to rise slowly, reaching 88 percent in 2085. Over 75 years, HI’s actuarial imbalance is estimated to be equivalent to 21 percent of tax receipts or 17 percent of program outlays.

    The worsening of HI's projected finances is primarily due to lower HI real (inflation-adjusted) non-interest income caused by a slower assumed economic recovery, and by higher HI real costs caused by higher assumed near-term growth in real economy-wide average labor compensation. The resulting increases in HI real deficits are concentrated in the near term, which is why trust fund exhaustion occurs five years earlier than was projected last year despite a relatively modest increase in the 75-year actuarial deficit."

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