American politics
Health reform
There’s gambling in this gin joint?
Sep 9th 2010, 15:52 by V.V.V. | NEW YORK
A NEW study just released by the Centres for Medicaid and Medicare Services, a government agency, suggests that the sweeping set of health reforms passed by Congress in March will not do much to cut costs over the next decade. In February, before passage of the reforms, those same boffins estimated that health costs would rise an average of 6.1% per year over the next decade. The new study, which takes the new laws into account, says the increase will be about 6.3% per year over that period.
This news has already sent pundits and politicians into a frenzy. Conservatives are gleefully proclaiming this study as validation for their view that ObamaCare was always going to add a mountain of red tape and subsidies that will make the health system more expensive. They point to a separate study released this week suggesting that health insurers are planning to raise premiums 1% to 9%, in response to the new regulations imposed by the reforms, as proof that this effort will only hurt the ordinary man.
For their part, Democrats are rushing to defend the law’s magical cost-cutting powers that they claim the new study ignores, pointing to theoretical savings to come from a more efficient health system. Pointing to recent scandals involving Anthem Blue Cross in California and other insurers who used bogus actuarial techniques to try to justify massive rate hikes rates, they vow to use the power of state insurance regulators and new federal powers to demand justifications for those proposed rate increases.
Who’s right? Both—and neither. Both are right in the following sense. Political claims made by the boosters of reform aside, ObamaCare was always chiefly about extending coverage, not tackling the demons driving cost. After all, it was modelled on the Massachusetts universal-care health reforms pushed through (then renounced) by then-governor Mitt Romney, a Republican presidential hopeful in 2012. The Bay State’s reformers explicitly went for coverage even though they knew it would increase costs. Given that the new federal reform will spend hundreds of billions of dollars on new subsidies to help the uninsured get coverage, and given that it imposes new coverage requirements on insurers (such as the ban on discrimination against people with “pre-existing conditions”), it was always going to raise overall health costs.
Democrats may also be right, though only time will tell. It is possible that the enormous waste and inefficiency in the American health system can be checked by reforms. On this view, savings will eventually come from greater investments in preventive care, comparative effectiveness studies, realignment of incentives away from “fee for service” medicine and the elimination of the use of emergency rooms by the uninsured for routine care. Both because such savings may take more than a decade to materialise and because the Congressional Budget Office’s influential scoring methodology does not account for such savings, it is probably fair to say that most official studies do not give sufficient weight to such possible cost savings.
However, both sides of this argument are wrong too—or at least disingenuous. To claim that the new study is in any way shocking, be that to praise it or to bury it, is simply ridiculous. ObamaCare focused on expanding coverage, not controlling costs, as most independent analysts argued all along. Indeed, Andrea Sisko, the lead author of this new study, acknowledged as much this week: “The overall net impact is moderate… the underlying impacts on coverage and financing are more pronounced.”
And of course this is something that readers of The Economist knew all along. The week that ObamaCare passed Congress in March, they were informed that “the reforms will expand coverage dramatically, but at a heavy cost to the taxpayer. They will also do far too little to rein in the underlying drivers of America’s roaring health inflation. Analysis by RAND, an independent think-tank, suggests that the reforms will actually increase America’s overall health spending—public plus private—by about 2% by 2020, in comparison with a scenario of no reform.”
That is why it is ridiculous to claim, from left or right, that the new report is shocking. It’s not. However, it is the silly season before the mid-term elections when ridiculous claims are all too common. Punters are therefore advised to take any outraged statements made by politicians or political commentators with a heavy dose of salt.
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Why is the patient paying cash?
Yup. It is OK with gambling so long as it is future generation money for another unfunded budgetary spending.
I wonder what the true point of this article is? If we shouldn't be shocked (which we are not) then what should we be?
Is this just a "we told you so article"?
gzuckier wrote: Sep 11th 2010 3:01 GMT ".@Lexhumana
Consider this another puzzled request regarding where in the world do you get the ideas you post?"
If you bothered to actually read my posts, you would plainly see the link to the World Health Organization and their comprehensive health rankings of all nations.
http://www.who.int/whosis/whostat/2010/en/index.html
In contrast, I see that you cited to some website about a fellow named Photius Coutsoukis. Other than having his own webpage, I do not see anything that renders him to be an authoritative source on much of anything. Unlike you, I will stick with citing to authorities that both the left and right have at least heard of, like the WHO.
BogMeadow says, "The truly poor in the US get excellent care at no cost to themselves. They can walk into any emergency room and demand care, that's the law."
It is commonly claimed that the poor in the US already have universal health care because they can waltz into an emergency room and get free health care.
Several problems with this argument:
1) Contrary to what many people seem to think, EMERGENCY ROOM CARE IS NOT FREE HEALTH CARE.
If you do not have insurance you WILL receive a bill. If cannot pay, many hospitals have taken to suing poor people. There are people who work in walmart making minimum wage who have had 1/3 of their wages garnished for going to a hospital. If you work at a Walmart you don't have any extra money in your paycheck.
2) Emergency room care is mainly good for patching up broken bones and dealing with acute illnesses - true emergencies. If you have cancer, showing up in an emergency room isn't going to do you much good.
3) 'Excellent' hardly describes the care you get in an emergency room. Someone I know showed up in an emergency room with a fever and an acute infection and waited 14 hours for treatment. He spent the entire night sitting in a hard-back chair. When you do get seen it is generally by an overburdened medical resident, not a primary care doctor.
4) Hospitals do not post their prices so they can bill you for whatever they like. If you do not have insurance they typically charge you 3-4 times as much. In other words, charging the most to the people who can least afford to pay.
Some people say that people who don't have health insurance should just go out and buy it. Unfortunately it is not that simple. With PER MONTH costs of $1200-$1300 to insure a family, no one who is lower-income can afford something like that.
I understand that many conservatives believe that people working in lower-wage jobs do not deserve to have health care. But for those that do, there are better and much cheaper ways of providing it then encouraging people to go to an expensive emergency room.
What a mind-boggling dichotomy! On the one hand the US claims to be 'the' Super-Power Par Excellance: the richest, most powerful country, this side of the Milky Way! And on the flip side, America has one of the worst/poorest public health care systems in the developed & possibly developing world!!
And to all those cold, heartless, selfish, self-absorbed, greedy, inhumane & filthy-rich sub-humans who detract, deride & dennigrate Universal Health Care, may you be cursed with some incurable & dreadful disease, that all your hideous wealth cannot find a cure for.
Maybe then you'll learn to empathise & understand the pathetic plight of the poor, downtrodden millions, who have no insurance cover or the resources.
The ironic thing about all this:
The bill that passed IS the watered-down compromise that takes Republican concerns into account.
The current health reform package is a free-market based system almost identical to the republican health care proposals put forth by Dole congress in 1994.
There isn't much radical about it at all. So, they liked their plan then, but they hate it now?
The Bible sayeth "The Rich shall be richer, and the poor shall have what they have taken away from them".
In the United States, it appears that the Rich shall also live healthier, and the poor shall have what health they have taken away from them...
On election night we at the Rio in Las Vegas where all the Democratic Obama faithful had gathered to follow the voting returns. When the big screen in the banquet room flashed his victory I found my self aflood with tears, as many others in the space were similarly affected. WHAT A MOMENT!
Let's see. When was it that the disenchantment with President Obama took me over? Not a word from him on the single-payer option when the debate raged. Silence.
Support of the telecom companies release from potential prosecution for violating our 4th Amendment protections? Nah! This eavesdropping on the citizenry is a presidential power prerogative that -as I began referring to him- Bush in blackface sought to retain.
Never mind going after the principal war criminals, he wouldn't even go after the Yoo/Feith legal duet who when Rummy and the gang said legitimize torture, they squatted and responded 'what color, boss?'...one teaching law the other a federal judge today.
Let's see...was it Obama's legal fast-footing on the Gitmo decision basically resisting restoring habeas corpus to detainees held in some cases for years...(we'll just ship them to Afghanistan...the finding only related to Guantanimo...)
Let's see. Thirty-some million Americans delivered to the rapacious clutches of the health(Hah!)insurance cabal to pillage at how many times the inflation rate?
That gang in DC -Demoplican or Republicrats- is just one massive three-card monte scam.
JESSE VENTURA FOR POTUS IN '12. YEAH. JESSE.
Please sign me BasicFunguist.
Figures don't lie but liars figure.
Note that the GOP's bogus "cost" calculations exclude most of the direct benefits and externalities of extending coverage.
That Medicare agency's cost calculations are suspect as well.
Think of the benefits of extending prenatal and preventative care to individuals who now lack primary care physicians, or well-woman care, or well-baby care.
Think about the millions of hours of lost time on the job that corporations will benefit from when tens of millions of Americans receive basic preventative care and counseling for illnesses like diabetes, hypertension, emphysema &c that people without preventative care fall victim to.
Note finally that the GOP's self-serving "cost" calculations ignore the quantifiable quality-of-life benefits that having a healthier population will afford.
Once again, the GOP shows that it knows "the price of everything and the value of nothing," in Oscar Wilde's timeless definition of cynicism.
Denying health care to the poor may increase happiness of the GOP's rich campaign contributors.
That's mainly because of the status effect of having health care while others don't.
Countless studies verify that most people would rather earn, say, $80,000 in an economy where the average household income was $20,000 than accept a job paying $150,000 (purchasing power parity) in a country with an average income of $200,000.
But the US government cannot sacrifice the well-being of tens of millions of citizens, as well as the prospects for the economy as a whole, to the selfish and cruel whims of wealthy GOP campaign contributors.
The results of rigorous, peer-reviewed studies of the effect of improved health care on human happiness and productivity conducted by economists and social psychologists are especially relevant here.
Do you still believe that the economic well-being generated by a nation's economy can be calculated by simply multiplying its per capita GDP by the number of residents, irrespective of the Gini coefficient and other social indicators such as longevity and educational attainment?
If so, you are almost 100 years behind the social psychologists.
The GOP are wrong, not only on the dollar numbers but on the equally quantifiable "happiness" indices.
--- Wilson P. Dizard III, Washington DC
It's a shame that the wrold's leading economy is likewise one of the worst in the state of welfare and medical care. Powerful lobbies will undercut Obama's efforts to bring quality of social living in the USA by working on the implementers now that the bill has been passed quited undergraded.
Tort reform is not that big of a cost and when it happens, as in Texas, has no real implications on cost drivers in essentially a Fee For Service environment. Illegal immigration is also a non-issue. It is an aging population and people, their families, and often their doctors think they deserve all that ultra-bionic technology, as long as someone else pays for it, up until the last moment. You spend half your health dollar in the last six months of your life and a third of Medicare costs come from that last month. It comes down to philosophy and understanding when it's time to graduate. And we may have to start making it really financially personal towards the end of this life. Philosophy and economics have much in common at times.
@eraserhead
You state "your infant mortality rate is higher than the average (6.7 vs an average of 4.0)."
You would be surprised to know that of the infants who have a birth defect, are premature, or have any complications in general, the survival rate in the US is much higher than that of the rest of the world. However, you are right to say that our infant mortality is the highest. This is not a result of our healthcare, this is the result of drugged up teen pregnancy rampant in poor communities, extremely obese mothers, meth babies, etc. We have a higher rate of complicated births, which would lead to a higher rate of infant mortalities.
One could say that California has a higher rate of mortality due to skin cancer than Alaska, therefore Californians don't use enough sunscreen. Valid argument? No. Most likely its just due to the fact that California gets more sun.
One needs to take a minute to think about what the statistics are actually showing. Statistics can be used to make any argument sound more legitimate, yet the statistic may have nothing to do with the argument. Such is the case with eraserhead's argument.
Before any significant reform can take place, there is a lot of opportunity on the table to reduce cost by eliminating waste and abuse. This should be bi-partisan.
Millions of people without healthcare in the "greatest country on earth." Thousands of middle class families going bankrupt because of cancer or other severe illnesses. A health system where costs have been spiraling out of control for years. An impending medical expenses time bomb due to baby boomers aging.
You may wish that a different health care bill was passed but you'd have to be crazy, dumb or callous to wish that the old status quo continued.
I think the brouhaha is occurring because the study further discredits the absurd claims of cost containment made by the bill's supporters. Of course these were never believed by the intelligent and well-informed. But they were swallowed whole by those who thought Obama was some sort of Jesus avatar.
Consider the following remarks made by Obama on December 15, 2009:
"We agree on reforms that will finally reduce the costs of health care. Families will save on their premiums; businesses that will see their costs rise if we do nothing will save money now and in the future. This plan will strengthen Medicare and extend the life of that program. And because it gets rid of the waste and inefficiencies in our health care system, this will be the largest deficit reduction plan in over a decade."
For more statements in the same vein made at the the same meeting see http://www.whitehouse.gov/the-press-office/remarks-president-after-meeti...
Anyone who wants to spend some time with Google searches will turn up thousands of similar statements by the bill's supporters and their toadies in the media. The problem for the Democrats is that these statements can be explained in only two ways. Either the utterers believed what they were saying, and were therefore incorrigible boneheads, or they did not believe what they were saying, and were therefore incorrigible liars. Hard to put a positive spin on either explanation.
Speaking as the grandson, great-grandson, grand-nephew and cousin of doctors who made house calls and never charged the patients who couldn't pay, I'd say that medicine in America has become an economic disease. We need to look closely at the healthcare policies in Northwestern Europe, China, and New Zealand, and reformulate our healthcare policies to conform with those foreign patterns that work best. Currently our US life expectancy is about 39th in the world, but our healthcare is the most expensive. And we have here in Maine a healthcare insurer that seeks ever greater premiums while paying its CEO something north of $5million a year. It's embarrassing and shameful, but don't expect any Republican to be shamefaced.
Super. Let's hire some unemployed people to fix it.
-Hire people to put in electronic medical records and billing systems
-Expand and streamline medical professional training programs
-Expand public health and community health departments to provide basic health care and preventive care to people, instead of at the emergency room
-Hire people to train doctors to work more efficiently. Give doctors incentives to make changes.
These are all in the health care reform, more or less, yes. But there aren't enough resources allocated for them to actually happen. Democrats need to try again. Medical inflation is eating up all wage growth for the middle class. They need to take it seriously.
As a health care professional, I view the health care delivery as a triangle.The first angle is a doctor, second angle is patient and third angle comprises of hospitals,insurance,pharmaceutical and technology industries.Interaction between this three angles have to be balanced to maintain the tringle.Poor delivery, exagarated costs and insensitivities are due to the wasted intersts of players sitting on the each angles.They have wasted interest in the interaction among each other which distorts the triangle.Health care delivery cannot improve or can get more cost effective by extending the coverage. Studying these angles, their wasted interests and their wasted interactions can only creat health care more cost effective,sensitive and patient friendly.
There is absolutely no doubt in my mind that Obama-care is the best thing to happen in the USofA, since slavery was abolished & racial segregation was wiped out.
Anyone who resorts to mudslinging the intrinsic virtues of Obama-care, is an inhumane, selfish, self-absorbed & narcissistic dog-in-the-manger sociopath.
They are unworthy of occupying space, where others also congregate. Pack 'e all off to some remote, dog-eat-dog island, where they can savage each other & cannibalise one another, to their heartless content.
They defile & defame humankind..