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U.S. President Barack Obama delivers remarks alongside Human Services Secretary Kathleen Sebelius (R) and other Americans the White House says will benefit from the opening of health insurance marketplaces under the Affordable Care Act, in the Rose Garden
Health care spending as part of the overall economy shrunk slightly in 2012, the first time since the Clinton administration that health care spending actually shrank as a percentage of the economy. The big question for economists is why, exactly.
"There are two explanations," says David Cutler, a Harvard economist who served as a health care adviser in President Obama's 2008 campaign. "One is the recession was a big and drunken episode that has a very long hangover. The alternative view is that something big has actually changed."

The new data, published in the journal Health Affairs, showed health spending grew by a relatively slow 3.7 percent in 2012, about one percentage point slower than the rest of the economy. That meant health care shrunk as a percent of gross domestic product, falling from 17.3 percent in 2011 to 17.2 percent in 2012.

We have had a very long hangover from this recession, and it has created a lot of uninsured people. Any nonessential medical care is one of the things sacrificed in personal economies when times are bad. Additionally, patents for some major, highly used prescription drugs expired, making much cheaper generics available. These things are undoubtedly contributing to the shift. But it's also possible that the Affordable Care Act is actually bending the cost curve. Medicare spending in particular has slowed, still growing but at slower rate than pre-ACA. This is another data point that will be interesting to watch in the next few years as so many more people get access to health care from Obamacare.

Originally posted to Joan McCarter on Tue Jan 07, 2014 at 03:10 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (14+ / 0-)

    "The NSA’s capability at any time could be turned around on the American people, and no American would have any privacy left, such is the capability to monitor everything. [...] There would be no place to hide."--Frank Church

    by Joan McCarter on Tue Jan 07, 2014 at 03:10:31 PM PST

  •  It's ACA (1+ / 0-)
    Recommended by:

    Or more specifically, ACA's prescriptions on:
    1. Outcome-based payments e.g. for ACOs. Now doctors and hospitals get paid to fix the problem, as opposed to being paid to keep the patient coming back.
    2. Insurance companies being restricted to 80% "med loss ratio", i.e. only 10% of premiums can go to "admin" (read bonuses for CEOs) and profits. Rest has to be spent on claims, or else the remaining premiums have to he RETURNED.

    Shall we go? Yes, let's go.

    by whenwego on Tue Jan 07, 2014 at 03:34:18 PM PST

    •  A very small percentage of payments are now (1+ / 0-)
      Recommended by:

      outcomes based. We are headed in that direction but you need to be part of a large group or HMO to even have outcomes based pricing make sense. The overwhelming majority of medical payments are still fee for service. I doubt that outcomes based pricing has had much of an impact beyond the 30 day hospital re-admission rules for Medicare.

      "let's talk about that"

      by VClib on Tue Jan 07, 2014 at 03:53:15 PM PST

      [ Parent ]

    •  No evidence presented for this thesis. (0+ / 0-)

      That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

      by enhydra lutris on Tue Jan 07, 2014 at 04:01:09 PM PST

      [ Parent ]

      •  Agree evidence is scanty but (0+ / 0-)

        there's no evidence to the contrary, and if you look at the timelines, it's precisely when ACA was being debated that the downward trend started, IMHO.

        Shall we go? Yes, let's go.

        by whenwego on Tue Jan 07, 2014 at 04:20:31 PM PST

        [ Parent ]

        •  The classical fallacy (known since antiquity) (0+ / 0-)

          that you are using is called argumentum ad ignorantum. Just thought you'd like to know.

          BTW, if the trend started when ACA was being debated, then its provisions can't be the cause because the trend precedes them.

          That, in its essence, is fascism--ownership of government by an individual, by a group, or by any other controlling private power. -- Franklin D. Roosevelt --

          by enhydra lutris on Tue Jan 07, 2014 at 04:44:44 PM PST

          [ Parent ]

          •  Similar to saying love did not start (0+ / 0-)

            when you date someone, only when you married them. Wonder what THIS fallacy is called.

            Shall we go? Yes, let's go.

            by whenwego on Tue Jan 07, 2014 at 05:04:48 PM PST

            [ Parent ]

          •  hard evidence will take a decade (0+ / 0-)

            The ACA's detractors said healthcare costs would skyrocket.

            The ACA's supporters said it would bend the cost curve down and slow growth.

            The cost curve is bending, growth is slowing.

            But I guess the Republicans would be perfectly justified in repealing the ACA since there's no evidence that anything in the ACA is working.

            How about we let the history books bicker about what mechanism is responsible for this great trend. In the here-and-now, the designers and implementers of Obamacare should take a victory lap. What they said would happen is happening.

            •  I know with my expierience with MAYO (0+ / 0-)

              Raises costs to cover those that seek care who don't pay or pay less.  

              Example charging $80,000 for heart surgery. but after finding out my insurance at the time capped it at 49,000 Mayo reduced it to the insurance cap. so the next person coming in had to pay more to make up for my insurance refusing to pay what the surgery was actually worth.

              ^^^^ this is FACT it happened to me. And my insurance at time refused to cover the actual value of the surgery. Putting MAYO in the RED. on my surgery. MAYO had to recover it from someone who could pay more or had better insurance coverage. thus "raising the cost of care overall"

              As Long as we have for profit insurance companies involved in the healthcare system and refuse to fix the tax codes, and deal with inequality, and the bullying nature that we call Modern Capitalism, we will never have a working healthcare system. I am not against capitalism  I Have a problem with the modern version of it that is distorted so far from true capitalism.

              •  your story is the opposite of what you think it is (0+ / 0-)

                No insurer pays the full rate. That's because the rates hospitals and doctors charge are completely made up and often have little to do with the costs or complexity of the procedure.

                The Mayo Clinic doesn't need to take your insurance. They're not running a charity and their list prices are marked up far above break-even.

                They know what your insurance will pay and they accept your insurance and do the surgery because it's profitable to do so. Overall it sounds like a pretty good outcome for all parties involved.

        •  There is evidence to the contrary. (0+ / 0-)

          Not much, but some.

          Specifically, the ACA has only just taken something close to full effect.  It is hard to credit ACA with reductions in health care costs when it isn't doing anything.

          Provisions that took place earlier -- letting kids stay on til 26, requiring insurance plans to cover some preventive visits, etc, elimination of recission, would not reduce health care costs. More likely, they increased costs just a bit.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Sat Jan 11, 2014 at 07:34:52 PM PST

          [ Parent ]

          •  the limits on profit-taking by private insurance? (0+ / 0-)

            The fact that the federal gov't finally made regulating the incredibly inefficient private insurance industry a priority?

            It's funny how much better people behave when they think someone might be watching.

            •  Not totally, (0+ / 0-)

              my company just changed insurance companies because of a 21% increase from Blue Cross & Blue Shield. If what is in this article is true, and I have read the same in other articles, is Blue Cross just doing some profit taking?

              If you are not the lead dog, the view never changes.

              by RepresentUsPlease on Sat Jan 11, 2014 at 08:00:56 PM PST

              [ Parent ]

              •  Don't know, but the question is interesting as the (0+ / 0-)

                Blues are, strictly speaking, not-for-profit insurers.

                Not sure how much they act that way other than taking tax breaks.

                LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                by dinotrac on Sat Jan 11, 2014 at 08:17:40 PM PST

                [ Parent ]

            •  What limits? Are you talking about the limits (1+ / 0-)
              Recommended by:

              on administrative costs compared to services rendered?

              That would be 20% for smaller plans and 15% on bigger plans?

              Two problems there:

              1. You are confusing health care with health insurance. The cost of health care is driven by health care proficers, not by insurance companies.

              2. Some companies were already doing better than  that before the ACA.  Many were right around those ratios.  I know that I got a check back from my insurance company last year -- a little less than 1% of my insurance bill and a ton less than the 51% increase for the coming year's rate.

              And, actually, a third:

              3. That actually provides a disincentive for lower costs.  It effectively turns insurance companies into cost+plus utilities, meaning that the only way to increase profits is to increase costs.

              LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

              by dinotrac on Sat Jan 11, 2014 at 08:14:57 PM PST

              [ Parent ]

              •  they go hand in hand (0+ / 0-)

                I responded to another post where I gave personal example of how they go hand in hand

                regarding heart surgery cost of said surgery and the limit insurance put on said heart surgery and how MAYO raised cost to recover loss from my surgery because insurance refused to pay the value of the actual surgery.

                •  I went back and read that. (0+ / 0-)

                  First, if MAYO is the Mayo Clinic -- good for you.  Hard to find better care by doctors practicing medicine instead of merely maintaining a practice.

                  But -- also, look at your example.  They reduced the cost of your procedure so that insurance would cover it.  The difference had to be made up somewhere, but, overall, the costs would be the same.  Some people would pay more than others -- maybe that $80,000 proceudre would cost only $60,000 per person if everybody had insurance, but the total costs across the population of patients wouldn't change.

                  LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                  by dinotrac on Sun Jan 12, 2014 at 12:29:24 PM PST

                  [ Parent ]

            •  Who's watching those limits? (0+ / 0-)

              Government bureaucrats are looking over insurance company books to see exactly what their profits are, and how much they're spending on service?

              ha ha

              I have several fully-loaded bridges over the Mississippi River to sell you, if you believe that horseshit...the CEO of any health care network provider is going to allow the evil gubmint to AUDIT them? Their entire company? How many years will THAT take?

              Keep fluffing those Obamabots, people. There must be money in it, because there is certainly no credibility. I don't care WHAT the ACA law says, or what YOU say it says: Nobody is going to pay the least amount of attention to that. And when they get CAUGHT, what will happen to them? A fucking Jamie Dimon-style 'penalty'...

              "I feel a lot safer already."--Emil Sitka

              by DaddyO on Sat Jan 11, 2014 at 09:50:41 PM PST

              [ Parent ]

              •  Or...maybe... (0+ / 0-)

                ...maybe the law allows the insurance companies to...self-report? Even better, to self-regulate?

                ha ha

                Sure it does. Dr. Coburn gave Obama his personal guarantee that they would! He's his GOOD FRIEND, after all...he'd never lie about a thing like that, would he?

                "I feel a lot safer already."--Emil Sitka

                by DaddyO on Sat Jan 11, 2014 at 09:58:54 PM PST

                [ Parent ]

                •  Think you hit it on the head with self reporting (0+ / 0-)

                  This is called "down sizing the government" and "shifting responsibility to the private sector" to "run the government".  With no real oversight. because any real oversight would expand size of government,  thus the right would have the house, pull its funding so the oversight could never actually be implemented. example de-funding the EPA and the USDA and FDA.

                  I would not be surprised if the law did have "self reporting" written in, considering who was actually involved with writing the ACA from the start, being a  "heritage foundation" bill a front for Koch brothers.  Bush Administration and an industries who have/had conflict of interest.

                  ACA of today is a modified version of the Heritage foundation bill That had better chance of passing than either the original ACA or a one payer system, or a universal healthcare system.  The modified ACA had the best chance of surviving the FAR right-wing filibuster process.

                  Even though the modified ACA is not the best option going forward,  It was necessary because our medical system is on the verge of collapse and needed to be fixed ASAP. Because we did not fix problems as they arose. we Just patched it so the unpopular fix would have to be done sometime in the future and those in power would not lose their votes by doing an unpopular move that was necessary. Due to too many bad people in control of certain infrastructures.

  •  My Bet Is on the ACA (1+ / 0-)
    Recommended by:

    The recession might have something to do with this but then again other parts of the economy have also been hit so they would also slow at the same time as the medical field.  So that would appear to be an unlikely explanation

    I think that it is pretty clear that a lot of this is the ACA.  A variety of measures have been built into it to bend the cost curve and they clearly seem to be taking effect.  

    If you want to convince yourself of this look at the response of many doctors and others in the medical field.  You would think that overall demand would drive up costs and generate even greater profits for this sector of the economy and as such they would unequivocally support this legislation since you would expect the ACA to generate massive windfall profits for them.  Instead many individuals in the healthcare industry despise the ACA since they are now being subjected to these various new regulations and rules which are beginning to bend the cost curve.  What truer indicator can you get that this is actually working than the reaction of actual individuals in the medical field who are finally starting to have their excessive salaries and the profits which they have been able to generate in this industry constrained by these new regulations and rules controlling the medical field.  

    •  In other words "lower costs" for us (0+ / 0-)

      translate as "lower income" for providers and manufacturers in the medical-industrial complex.

      That makes sense, and it will be interesting to see whether they are able to push back successfully. I'm guessing that many people have realized that you can't have one sector of the economy keep expanding at the rate it was, without eating everything up.

    •  So, how, exactly, has the ACA lowered costs? (2+ / 0-)
      Recommended by:
      nextstep, wsexson

      You want it to be so, but it would be more credible if you could come up with a mechanism, expecially considering that most of the laws provisions had not yet hit in 2012.

      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

      by dinotrac on Sat Jan 11, 2014 at 07:37:01 PM PST

      [ Parent ]

      •  most of the law affecting health providers (0+ / 0-)

        and insurers took effect immediately on passage. Most of the law's provisions dealing with buying insurance hadn't taken effect in 2012.

        But those parts aren't the parts that were supposed to bend the curve.

        •  Not the pre-existing condition restrictions, and (1+ / 0-)
          Recommended by:

          not the individual mandates.  It's easy not to see the individual mandates as not affecting insurers except that the individual mandates require us to buy insurance that meets the laws requirements for coverage in order to avoid paying a penalty, and that, in turn, has resulted in a change to the insurance policies made available.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Sat Jan 11, 2014 at 08:20:20 PM PST

          [ Parent ]

  •  Cleveland Clinic Downsizing (1+ / 0-)
    Recommended by:

    Oh, by the way the Cleveland Clinic is also downsizing a few thousand people in an attempt to increase their efficiency in large response to these cost saving measures being implemented in the ACA.

    •  Hospitals have been doing this for years (1+ / 0-)
      Recommended by:

      squeezing costs and productivity (e.g. fewer nurses per floor), to increase their profits and their CEO salaries. I'm not convinced it's the ACA. I'd want to see what the "downsizing" consists of.

      •  Cleveland Clinic Downsizing (1+ / 0-)
        Recommended by:

        I'm actually from Cleveland and this was big news there.  The Cleveland Clinic specifically said that the $330 million in budget reductions that the Cleveland Clinic was going to undergo was largely caused by the ACA.  Please find two associated links from last September relative to these budget reductions.  

        The article also states that they had not made overall layoffs at the Cleveland Clinic in 11 years and my sister who worked as a nurse on the cardiovascular and transplant floors for the Cleveland Clinic for 35 years said they rarely if ever had layoffs there.  I also believe that I have seen other articles that indicated that some other hospitals may also be doing the same thing.  

      •  I understand what you 're saying and you might (1+ / 0-)
        Recommended by:

        be correct, but I am don't like the "well so and so has been doing this for years....." argument every time an issue comes up.  

        The ACA is supposed to be better.  Not status quo or worse but better....much, much better, actually.

         Some of us will be paying more for our insurance now, some of us a lot more, and I don't mind it if that happens to me or my family so others can also have insurance but I don't want the same system we had before and then pay more for it.  I want better, much better and getting better everyday.   So the "but whatever has happened in the past for years and years...." arguments just don't fly with me.

        If something comes up like layoffs, or shortages or hikes in premiums or whatever....we need to be diligent in making it better ASAP...not just say "well, it was like that before." That argument is simply not acceptable.

      •  I also want to say that if you meant it has been (0+ / 0-)

        happening for years and so the ACA is not involved at all, rather than it is acceptable that it is happening regardless of the ACA....then I understand that and agree with you.

  •  There are less uninsured people (0+ / 0-)

    but there are more people getting expensive E.R. care too.

    •  No-no-no. (0+ / 0-)

      ER is the last resort, least effective, worst outcomes form of medical treatment. People are too late in disease cycles when they get there.

      Early treatment is where this is going, plus getting treatment through General Practitioners and the growing numbers of Community Health Centers.

  •  Seriously? ACA bending the cost curve in 2012? (1+ / 0-)
    Recommended by:

    There is only one way for that to have happened, and the pressure would be in an upwards, not downwards direction.

    The ACA does little or nothing to reduce the cost of health care.  It redistributes responsibility for payments.  Some individuals will find their cost of insurance is lower because of the laws requirements, but...the overall cost of care? Not much there.

    LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

    by dinotrac on Sat Jan 11, 2014 at 07:31:49 PM PST

    •  No-no-no. (1+ / 0-)
      Recommended by:

      The Patient Protection sections of PPACA address the phenomenon known as referrals fraud. This is just now getting rolling -- discouraging combined medical practices from exploiting chronic care patients by running them around from office to office to office.

      Referrals fraud has been the single largest factor driving cost increases.

      •  I don't know how much of that is fraud and how (0+ / 0-)

        much is just terrible medical practice, but my wife almost went under the knife for fear of cancer (while I desperately sought somebody to be sane and rational).  Fortunately the head of the practice whose doctor did a biopsy took it on himself to do a mamogram that showed convincingly  that the reason the biopsy found nothing but healthy cells was because there were nothing buy healthy cells to find.

        He had her immediately sent back to prep to get dressed and I would love to have been in on the call where he "convinced" the surgeon to cancel the surgery.

        I remain highly disappointed that a country needing health care refrom has to settle for a sort of Rube Goldberg health insurance reform.

        Still, better than nothing, I'm sure.

        LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

        by dinotrac on Sun Jan 12, 2014 at 12:25:54 PM PST

        [ Parent ]

    •  Not necessarily proof...but at least a data point. (0+ / 0-)

      My recollection of events during the Clinton healthcare debate of the early-to-mid 1990s includes a period (1-2 years?) of much slower health care/insurance cost inflation.  At the time, it was attributed (at least a good piece of it) to insurance companies and providers "playing nice" in an attempt to encourage public pressure on Congress to "go easier" on insurance companies and providers, or at least not pressure Congress to "get tough".

      The explanation works for me; after all, if you'd just received a (say) 25% increase in your premiums and a healthy boost for your deductibles and/or out-of-pocket expenses, which way do you think you'd lobby your Senator or Congresscritter?  If those industries had arrogantly doubled premiums during the debate, we'd probably have single-payer today!

      "Push the button, Max!" Jack Lemmon as Professor Fate, The Great Race

      by bartcopfan on Mon Jan 13, 2014 at 09:59:51 AM PST

      [ Parent ]

  •  Patent law and health care (0+ / 0-)

    Now I am not sure exactly my own personal opinions are on the matter.

    But one idea ive been tossing around is the healthcare costs may be in for a little headwind (decreasing overall costs) due to patent expiration of many major medical discoveries.

    Now I have next to no exposure to the medical field, other than friends and family, but in my entierly non expert world view, many of the major blockbuster drugs we have now n days, come from discoveries in the 80's and 90's

    The 2000's do not seem to have had many major new drugs; this most recent era of drug research seems to have been more theoretical with the payoff yet to come.

    As such with many blockbuster drugs having their patents expiring over the next two decades, there seems likely there will be major cost savings over this time period.

  •  if costs were rising who would blame the ACA? (1+ / 0-)
    Recommended by:

    You know the usual suspects at Fox and the WSJ would (and Morning Joe). In fact, I'd bet a good number of the pundits currently equivocating about whether the ACA is actually bending the curve would be piling on to declare how terrible it was.

    •  My costs have done NOTHING BUT RISE (0+ / 0-)

      And they continue to do so unabated.

      The ACA is a miserable failure. It was passed by the wrong people. If it had been passed by, in kos's own words, "more and BETTER DEMOCRATS", it would be a public option.

      It saves the government money, and insurance companies profit by all the millions of extra customers. Me? Nada. Not a goddamned thing.

      I've been poor all my life. That's okay. I can handle it. But I cannot handle Democrats whitewashing a corporatist Republican idea that does nothing for the most important citizens of this nation, the middle class. NOTHING has improved in THEIR health care. The costs for their premiums or the costs of their share of out-of-pocket expenses has only gone up since the ACA was implemented.

      I don't like to be lied to by Republicans; by Democrats? It makes me write TOO MANY DAMN POSTS...

      "I feel a lot safer already."--Emil Sitka

      by DaddyO on Sat Jan 11, 2014 at 09:56:44 PM PST

      [ Parent ]

  •  Maybe it's all the Tea Party faithful who are (1+ / 0-)
    Recommended by:

    refusing to get medical care because of Obama Derangement Syndrome. :)

    “The future depends entirely on what each of us does every day.” Gloria Steinem

    by ahumbleopinion on Sat Jan 11, 2014 at 07:44:20 PM PST

  •  Not MY spending! (0+ / 0-)

    It goes up, every year, the little things AND the big.

    Sure. It's only one anecdote. My little experience. My wife's public school health care plan. My heart attack. My watching co-pays triple and more in the last six years. The price for GENERICS has quadrupled past 'affordable' into 'eat or medicate?' Why?

    Because the insurance companies knew this day was coming. I laughed out loud when I read ON THESE PAGES the very idea that insurance companies were LOWERING their rates in the heady days before the ACA was fully implemented, anticipating the 'competition' and appealing to their insured.

    ha ha

    They've been ramping up prices every since the Medicare Part D law was put into place. They've been acting exactly as a MONOPOLY would--charging as much as possible, their only reluctance being they might draw BLOOD instead of shearing wool...

    You people make me laugh, trying to burnish a turd like the ACA, when everyone here in the real world knows better. The ACA saves THE GOVERNMENT money, and only in the long run...but not me, and not the middle class. Obama has FAILED, and that is the only version of history worth telling anyone interested in reality...

    "I feel a lot safer already."--Emil Sitka

    by DaddyO on Sat Jan 11, 2014 at 09:45:43 PM PST

  •  Way to go from 17% to OECD average -- 9% of GDP (2+ / 0-)
    Recommended by:
    waterstreet2013, nextstep

    Singapore has 4% and Finland 10% with much better outcomes than in the US. There still is a huge amount of free-ridership built into the US system.

  •  Sorry, "Harvard economist" is losing its cachet (0+ / 0-)

    I don't know anything about David Cutler, but given recent history, being a Harvard economist is no longer a guarantee that mere mortals will genuflect before you.

    Harvard's economics department has been pretty thoroughly exposed as a conservative propaganda mill.

    Perhaps I'm being unfair, but it doesn't hurt to remain skeptical.

    What is valued is practiced. What is not valued is not practiced. -- Plato

    by RobLewis on Sun Jan 12, 2014 at 07:51:12 AM PST

  •  here is 1 personal piece of the puzzle (0+ / 0-)

    It has to do with how the states and federal government processes eligibility for people using the safetynet programs as a whole medicaid/ medicare, snaps, QMB, etc.   Also using that same eligibility as a means of controlling the spending of the states/fed without fixing the broken tax codes and without holding the people actually responsible for the financial calamity we find our nation/world in..  

    This is very personal to me because I am being held accountable for problems created by other people in leadership roles, and the puppet-masters pulling their strings (I place Koch brothers, Waltans, etc here) in this group. And I am paying with my health and life because that is all I have left that anyone will accept. They won't accept my services because they believe I am inferior to a person who has no health issues.

    First I Personally stopped going in for care despite having "Some coverage" based on eligibility out of fear of falling in a loophole/ catch 22, where I have to foot a good chunk of the medical bill, I know I can't pay period.

    As a result the local medical institution saw almost a 100% drop in business from me as a result. All because of the screwing around with the eligibility of disabled as a means of not paying for services that should be paid. Because by not paying now, only causes that person to become even sicker, that will require even more expensive treatment, costing more than the accumulative cost, if it been paying all along. Example caught early stage cancer vs untreated mid/late stage cancer. (I don't have cancer I was using it as example most people can relate too and understand)

    Loss of medical business from me is all done by manipulating the income/asset limits we are allowed to have  in order to use these services(that keeps the medical economy functioning)
    In my case The SSA cost of living adjustment is so many% points each year, while the State income limit increases and at a "SMALLER"%  eventually pushing disabled off the programs, after they used it so many years. Usually the longer a person been disabled with little to no resources, the more their health suffers due to the war on the disabled and the belief they can no longer contribute and become freeloaders, when that is just not the case.

    So want to fix the medical economy? stop making the most vulnerable pay the price of someone else wrong doing.

    Fix the tax codes. Example close the tax evasion loophole called "online purchases" by requiring all companies to collect the sales tax and send it to the relevant states so the purchase would be just like going to a brick and mortar store like best buy. This is NO new tax  Its tax evasion.  the tax code still requires to pay the tax but it was written before the internet was around.  so it did not give specific mechanisms on how to collect and send the tax to the relevant states.

    In our state if you make $500 purchases in the year or more online.  Your required to follow the honor system and pay the state your sales tax, how many people actually do that?  The IRS only follows the big items like 100,000$ cars due to lack of man power for over sight.

    The fix tax codes to adjust for the disparity of wealth redistribution.  When the more wealth is accumulated by the few and taken from the many there is less tax money to be collected under old codes, thus all services suffer. Like roads, parks, manciple, building inspections, EPA, human rights watchdogs, USDA, etc.

    Stop Spending on unnecessary falsified wars, iraq Afghanistan, we did not go there for the reasons bush claimed. WE WERE WRONG. We are wrong about Iran as well, Its a power play so we get what we want at expense of the rest of the world.

    Stop financially bailing big institutions out, that cause large scale calamity. The people responsible for it should be an have been permanently barred from ever holding such a position in any organization in the entire world, These particular people are not worthy of redemption because in their eyes they never did any wrong.  A person has to know and feel they did wrong before they are capable of redemption for the wrongdoing. If they feel they did no wrong, and seek no retribution, then they will continue to cause large scale calamity

  •  Big Pharma... (0+ / 0-)

    ...has still not been reined in.

    The copay for my prescription was $30 a month last year. The drug is now eligible for generic which apparently means the maker can charge twice as much for their generic now. I've been told that the price will not come down until other manufacturers start producing it.

    Market forces...

    We have it within our power to make the world over again ~ Thomas Paine

    by occupystephanie on Sun Jan 12, 2014 at 12:02:00 PM PST

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