Thursday, April 14, 2011

Miscellaneous 65

1) I did a recent search for "Democratic plan to save Medicare". I couldn't find anything.......Look, folks, I agree, Mr. Ryan's new plan is exceedingly problematic. But at least the man has a plan. AND, in my opinion, the only way that we're truly going to be able to solve this health-care mess, in general, and Medicare, specifically, PERIOD, is to utilize the good ideas from both parties - in this instance, competition AND appropriate oversight. Again, I refer you all to Dr. Ezekial Emanuel's (yes, he's Rham's brother) excellent book/blueprint, "Healthcare, Guaranteed". He lays the whole thing out exceedingly well, I think.............2) Laura Ingraham was substituting for O'Reilly again. Holy shit, is she ever obnoxious. First of all, folks, the chick doesn't let anybody else talk. She knows EVERYTHING, end of discussion. I mean, just take tonight, for instance. She had this rich successful businessman on and he was arguing for the Bush tax cuts for the wealthy to expire. And he wasn't a damned flaming liberal, either. This, in that the guy was arguing just as vociferously for budget cuts. But, nope, Ms. Ingraham didn't want to hear any of it. We can totally balance the budget with spending-cuts - PERIOD!...Oh, and, yeah, Mr. Obama is always wrong. Let us not forget about that little song and dance, either. ALWAYS WRONG!!............3) Here's a good one, folks. According to OMB, the 38.5 billion dollars worth of spending cuts, it's only actually 352 million. Yeah, that's right. Much of the proposed savings actually come from rescissions (funds previously authorized but not spent) and reserve funds. And (and, yes, this is where it gets really good), if in fact you include emergency spending, the 2011 budget is actually 3.3 billion dollars BIGGER than the 2010 budget. Youza, does it ever suck to be a politician these days, huh?............4) Not that these rescissions and reserve funds wouldn't have eventually been spent, mind you. But, still, the courage - WHERE?

27 comments:

Jerry Critter said...

Ryan's plan is not a plan to save Medicare. It is a plan to limit the government's cost of Medicare.

Will "take no prisoners" Hart said...

Here's the way that I see it, Jerry. Yeah, Mr. Ryan's plan alone would probably be quite inadequate. Insurance companies, in many instances, would no doubt simply refuse to unsure the elderly, the sickly ones, especially. BUT, I do like the fact that Mr. Ryan introduces competition into the system. And that's why I think that elements of his plan, in conjunction with independent review boards (setting up minimum standards of care, rules against discriminating against sick people, etc.) could in fact be the solution here.......The bigger problem is getting the 2 sides to speak.

Rusty Shackleford said...

Ryan/Rubio 2012

Will "take no prisoners" Hart said...

No Chris Christie, Russ?......I still like Bloomberg. It would be hard for him (as an independent) to get to 270, though.

Beach Bum said...

While early I have plenty of beer and this topic of discussion is boring.

Jerry Critter said...

If competition is the goal, then we must have a public insurance option, like medicare for all. With the low government overhead, it will provide the ultimate in competition.

Will "take no prisoners" Hart said...

The problem with Medicare, Jerry (and maybe having it as an option could in fact be a compromise), is that it's basically become a check-writing enterprise. 60 Minutes had a piece in which showed that Medicare fraud has eclipsed drug-dealing as the #1 crime in south Florida. And even in the more legitimate scenarios (I work in a healthcare facility), the system gets milked for all its worth. Maybe they actually need a little more "overhead".

Jerry Critter said...

Fraud is not a reason to eliminate the program. If it was, we should get rid of the financial industry...and maybe politicians. :)

Will "take no prisoners" Hart said...

Any financial institution that perpetrates fraud should be prosecuted. And they sure as hell shouldn't be bailed out. The rosiest scenario on Medicare is that it's going to be insolvent by 2029 - the rosiest scenario! We gotta start thinking outside of the box on this one.

Jerry Critter said...

I agree. And anyone that perpetrates Medicare fraud should be prosecuted.

The solution to Medicare is to stop the rapid increase in medical costs. Medicare is just a medical payment program like any insurance program. Limiting medicare expenses simply shifts the costs to the individuals, again, just like limiting insurance premiums. We must attack health care COSTS, not health care payment programs.

One question to ask is why are our health care costs twice as high as the rest of the world?

Will "take no prisoners" Hart said...

Jerry, before this goes any further, let me remind you, I am not in any way advocating for Mr. Ryan. I'm advocating for Dr. Emanuel (he actually served for a while as an adviser to Obama)......The costs of healthcare would go down in several ways. First of all, by having thousands of insurance companies competing for your business (Medicare, by comparison, would be a monolith), the cost of the coverage would go down. And, secondly, when you include oversight from an independent health board (kind of like the Fed is to banking), minimum standards, anti-discrimination practices, AND comparative effectiveness could all be addressed. This, too, would address the cost curve.

Will "take no prisoners" Hart said...

And to all of those people on the left and the right who say that comparative effectiveness is rationing, you're right, it is. But at least it's frigging rational rationing. For instance, if you have 2 different operations that are equally effective. But one of them is twice as expensive as the other, Emanuel's plan would only pay for the cheaper one. Now, a person could in fact get the more expensive one. BUT, they'd have to pay the difference out of pocket. That, to me, represents a pretty fair system.

Jerry Critter said...

On another blog I asked a Dr. why US doctors earn twice what European doctors earn based on equivalent purchasing power. His answer was very telling. He said,

"Because we can".

If I ask why drugs cost several times what they cost in other countries, I suspect I will get the same sort of answer -- because they can.

Why are Medicare drug costs so high. Because the drug companies can charge whatever they want. Medicare CANNOT negotiate.

Maybe part of controlling health care costs needs to be removing the answer,

"Because we can"!

Jerry Critter said...

Competition can bring down health care costs, but the competition has to be between the people/companies PROVIDING health care, not the people/companies paying for it. All competition between health care insurance companies will do is lower their overhead, bringing them in line with the government.

Will "take no prisoners" Hart said...

Competition between thousands of insurance companies will make the industry far MORE efficient than the government. What's the incentive for a government bureaucrat to be more efficient?......We need competition on both levels. One of the functions of the independent health board could be to provide consumers (and insurers) information on the comparative effectiveness of individual providers. That could enhance competitiveness - not just in terms of cost but in terms of quality.

Will "take no prisoners" Hart said...

Why is American healthcare more expensive? Wow. What was it that Mr. Obama said about his pay grade? Some of the reasons I suspect; fraud, the high cost of innovation, greed, defensive medicine, people living longer, red-tape, lack of a coherent/consistent record-keeping system, unscrupulousness, lobbying/special interests - a lot of stuff, probably.............I agree with you, btw. Medicare should be able to negotiate over drug prices. I would also argue that we should be able to reimport our drugs from Canada AND develop/investigate ways that we can get generic drugs into the pipeline faster. Every little bit that we can do helps, right?............I'm not an expert on European healthcare systems, Jerry. But, from what I've been able to ascertain, the German model sounds significantly better than the British model (I seem to remember it as being less centralized).

Jerry Critter said...

The problem with health care costs is not efficiency. Medicare is very efficient -- somewhere between 1 and 5% overhead. Efficiency in the business of PAYING health care costs is almost all in overhead. Medicare has that one covered (neglecting their fraud problem - but that's a paying problem.)

I repeat. The solution to health care costs has to come from the health care charging side, not the health care paying side.

Will "take no prisoners" Hart said...

Yes, Jerry, the overhead in Medicare is low. But there's an extraordinary cost to that fact as well; i.e., fraud.......Look, I've given you my solution; "Healthcare, Guaranteed" by Dr. Ezekial Emanuel. Your solution is what, single payer?

Will "take no prisoners" Hart said...

Fraud is a "paying problem"? Come on, Jerry. That's like saying that bank robbing is a withdrawal problem. Businesses and agencies have to be responsible for their own money.

Jerry Critter said...

Yes, fraud is a paying problem -- pay out money that it should not be paying out. In no way am I trying to say that Medicare should ignore their fraud problem. It is their responsibility and they should be doing more to combat it. The savings from reducing fraud will not come for reductions in overhead. They will come from reductions in payouts.

Jerry Critter said...

Will,
The solution to health care will not come from insurance companies or Medicare. They only pay the costs. The solution, whatever it may be, has to come from the healthcare providers.

For example, we need more doctors. Let's increase competition between doctors. We don't need competition between the people who pay doctors. We need competition between the doctors. It is "supply and demand". Increase the supply and the price goes down.

Of course the AMA would not like it!

Will "take no prisoners" Hart said...

How do you propose that we get more doctors?.....I also thought of another reason for the high cost of healthcare; the fact that we continue spend billions and billions of dollars on end of life care. We have people who we know are going to die in the next 3-4 weeks and we continue to treat them with expensive treatments and diagnostic tests. This, as opposed to simply making them comfortable.

Jerry Critter said...

Right now people have a choice - Hospice provides excellent end of life care for those that want it. Are you proposing Death Panels to decide rather than the individual?

Will "take no prisoners" Hart said...

Yeah, me and Sarah Palin. Seriously, though, there has to be a way curtail some of these needless expenditures that do not add ONE IOTA of days to a person's life.

Will "take no prisoners" Hart said...

http://www.cbsnews.com/stories/2010/08/05/60minutes/main6747002.shtml Here's a good CBS story, Jerry.

Jerry Critter said...

One thing that would help is end of life counseling, something that the republicans made a big issue about during the health care debates and was therefore dropped. Politics and lying win out again.

Will "take no prisoners" Hart said...

Not the Republicans' finest moment, I agree.