Medicare

Cain–Gingrich Debate–November 5, 2011

by asmwizard

Herman Cain and Newt Gingrich met for a special debate on November 5.  It was held in Texas and televised on C-SPAN.  Billed as a Lincoln-Douglas style debate, it lasted about an hour and a half and concentrated on entitlement reform.  An relatively small in-house audience of two or three hundred (my estimate) was present.

Supposedly, there would be no moderator, only a timekeeper.  Actually, there was a moderator plus another questioner, but they only asked questions.  The debate met the objectives of allowing the candidates to speak at length to answer a question thoroughly.  Cain and Gingrich were very friendly and uncritical toward each other, with no “gotcha” style remarks.  Both men came across as very likeable.  However, last night there wasn’t a debate in the true sense – there was no argument back and forth – no criticism of the other’s position.  The two men just took turns giving their perspectives on a question.

Herman Cain surprised me with the depth of his knowledge and his ability to relate entitlement reform to his business experience.  I no longer consider him a flyweight as a potential president.  He tends to favor most features of the Paul Ryan reforms to Social Security and Medicare.  He also mentions the reforms made in Chile, and I had thought he was talking about health care reform there, and had been a bit critical of that.  Last night, he mentioned Chile in relation to Social Security reform, citing the fact that people have personal retirement accounts in Chile as part of the government plan.  

Newt Gingrich probably impressed viewers as having considerably greater knowledge and understanding of issues.  He favors allowing people to choose from options rather than outright mandate from government.  I had heard him say he isn’t in favor of advancing the retirement age, and doesn’t advocate means testing for Social Security and Medicare, and I had wondered why.  It turns out that he doesn’t want to limit choice.  He’s in favor of premium-defined plans  with flexibility rather than one-price government-defined benefit packages, and wants them structured so that wealthier people will choose to self-insure.   He emphasized the use of computer systems to greatly reduce fraud in the entitlements, would form a consortium of IBM and the credit card companies to administer the entitlements with an emphasis of catching crooks trying to defraud the system.  

Both men favor block granting Medicaid to the states, while giving them fewer federal guidelines to follow.  I had thought this was a cop-out from a very difficult problem, but it does make sense.  The risk I see is that some states may be less competent than others in delivering health care.

I would like this format used between two men who disagree with each other, and don’t like each other so much.  Gingrich–Obama or Cain–Obama debates in this style would produce some real fireworks, in my opinion.

Rebuttal–Paul Krugman, “Medicare works better than private insurance”

by asmwizard

I subscribe to and read the Kansas City Star, where Paul Krugman’s column frequently appears.  Krugman may be the most liberal columnist since Karl Marx.  Needless to say I rarely agree with even a single sentence in his columns.  His version of the truth is so different from my own that I want to argue against him – but the Star doesn’t allow it – a letter to the editor is restricted to 200 words or less, and you can’t say much of anything in 200 words.  Of course, if you could properly respond, they wouldn’t print it anyway.  The Star has a Liberal bias, and they print more Liberal than Conservative letters.  I’ve learned it’s best not even to try.

There is a column by Krugman in today’s Star (July 27, 2011) that riles me.  My opinion is that his stupidity is matched only by his ignorance.  Unfortunately, it is not on his website today, so I’ll have to paraphrase.  It will likely appear on his website in a few days.  Krugman’s website

The title of is column and the main idea is that “Medicare works better than private insurance.”  This statement may be true for the Democrat Party – which loves to support and promote entitlements — but in general it’s the reverse of the truth. 

The article is primarily designed to bash Republicans, but Obama comes in for a share as well, although his bashing is more subtle. 

He begins by stating that “what the president offered to the GOP, especially on Medicare, was a very bad deal.  Specifically, according to many reports, the president offered both means-testing of Medicare recipients and a rise in the age of medicare eligibility.”    Krugman goes on to say, “The first would be bad policy; the second would be terrible policy.”  My view: means testing is one of the few areas where cuts should be made in Medicare.   Should millionaires receive it?  I don’t think so.  I’d begin reducing benefits at net levels of around $50,000 of net taxable income for single persons, and $75,000 for married couples, and cut them off completely above $100,000 and $150,000, respectively.  That would cut the medicare enrollment significantly.  Paul Krugman, no doubt a wealthy man, will have to take out his own insurance if I have my way.  I think the Medicare age should be the same as the Social Security retirement age.

He goes on: “And throwing Americans in their mid-60’s off Medicare . . .”  My response: No plan I’ve seen envisions making any change whatever in eligibility to those currently receiving Medicare (except possibly Obamacare – which purports to cut 800 billion dollars out of it, somehow, in 10 years.) 

He goes on: “Medicare, with all it’s flaws, works better than private insurance . . . It has been more successful in controlling costs.”  Where to begin?  Medicare is to doctors as pro bono work is to lawyers.  The government controls how much a doctor is paid for each procedure or test.   Doctors have to write off the difference.
Some rebel – they stop taking Medicare patients.  Future plans, especially those propounded by Democrats, propose to reduce pay even further.  Private insurance pays a percentage of the doctor’s usual charges.  Since Medicare shortchanges doctors, they respond by raising their usual rates.  This increases health care costs for everyone.

Krugman:  “Also, did I mention that Republicans are doing all they can to undermine health care reform – they even tried to undermine it as part of the debt negotiations – and may eventually succeed?  If they do, many of those losing Medicare coverage would find themselves unable to replace it.”  This is nothing but the most despicable demagoguery.  The determination to revoke Obamacare  doesn’t mean Republicans want to undermine health care.  Here Krugman reveals how immensely biased he is.  Republicans have suggested many ideas to reform health care, and all are intended to reduce the cost without losing effectiveness.  Democrats didn’t accept a single Republican amendment to Obamacare, which they had to pass without a single Republican vote.

Krugman’s article is largely directed at the Ryan plan, although he doesn’t mention it specifically.  I could go on about this ridiculous column, but that’s enough for now.

 

 

What’s wrong with American health care?

by asmwizard


What was wrong with health care before Obamacare? Plenty. There are many processes that drive up health care costs : Some we can’t control are:

  • ever-improving technology (which requires expensive new equipment);

  • the aging and expanding population, and consequent increase of chronic disease;

  • the continuing development of new prescription drugs. There are others – see the two links which immediately follow.

A good reference on health care costs: http://www.kaiseredu.org/Issue-Modules/US-Health-Care-Costs/Background-Brief.aspx

And another by Doctor Lundberg: http://www.kevinmd.com/blog/2010/08/8-reasons-healthcare-costs-rising.html

There are other processes we can possibly change:

  • Medicare/Medicaid. These programs drive up medical costs by creating a game between the federal government and the health care providers. The government will allow the minimum possible fee for medical services. To make what they think is a fair profit, the providers charge more, trying to raise the basis on which the government sets fees. The hospitals and doctors also bill for every charge they can conceivably think of. Patients don’t protest, because the government – a 3rd party – adjudicates and pays, except for moderate costs to the patient. Taxpayers are on the hook for it all.

  • Free care of necessity: America may be the only country in the world where very few are ever turned away from a hospital due to inability to pay. Doctors and hospitals (in effect) give a lot of free care away, and customers pay much more to support it. The hospitals and doctors try to collect later, but write off large sums as uncollectable.

  • Malpractice litigation and insurance costs. Juries award huge sums to patients. Doctors have to buy increasing amounts of insurance to protect themselves, and most order expensive and possibly unneeded tests to document that they’ve covered all the bases.

  • Federal laws that prohibit health insurance companies from crossing state lines restrict competition.

  • The long-term decline of the dollar. Inflation is a big contributor to rising costs.

Now, some points made by Doctor Lundberg (see 2nd link above) – from his list of factors that drive up costs:

–Patients with insurance who consider medical care a “freebie” with no cost consequences.

– Physicians who neither practice evidence-based medicine nor include costs in their decisions. Decisions are often driven by the pervasive mystique of “defensive medicine,” which now dictates hugely expensive (and lucrative) “defensive practice standards.”

– Hospitals want to fill beds, especially ICU beds, and aggressively market the newest and most expensive technology, beautifully performing tests, and treatments that patients often do not need.

– Drug companies successfully push use of their most expensive drugs. (TV broadcasts are now swamped with drug commercials.)

A new health care plan would need to address as many of these points as possible. The two extremes of howthe federal government could deal with it:

  • Don’t deal with it. This was the approach for most of our nation’s history.

  • A pay-all federal system, funded by taxpayers. That’s tough, because one estimate of average lifetime health care costs is $316,600.00 (higher for women than men because women live longer – women $361,200, men $268,700.) Much of that is due to aging and chronic illnesses. These may not be valid estimates, but who knows? The breakdown: a third of that in middle age, half of it as a senior, and only a sixth before middle age, seems right. These are staggering costs. How can the taxpayers come up with enough money to pay for 313 million Americans? The answer is, they can’t, because 313,000,000 * 316,200 is approximately 99 trillion dollars. That number might even impress politicians.

If sustained by the Supreme Court as constitutional, or repealed before going into effect, Obamacare intends to reduce federal costs by making everyone buy insurance, either private or federal. It will be very expensive, for the reasons given above.