I’m not a huge fan of Clive Crook, but he is a lot smarter about the Ryan plan than some other Tories you all like to talk about.
I think it is fair to criticize Obamacare for failing to take cost control in health seriously. But Ryan’s plan has the same defect. It holds out no more hope of controlling costs than Obama’s. And under Ryan’s proposal, an ongoing failure to economize would simply be passed through to the retired as reduced coverage and/or higher premiums. This is not something that the retired–or people who one day expect to be retired–are likely to embrace. Politically, this plan to privatize Medicare, which is how it will be characterized, is surely suicidal.
The Ryan budget as a whole is a frontal assault on the administration’s priorities. You might say: Mission accomplished. A frontal assault is what the GOP promised. But what, exactly, does this achieve? What hope of compromise does a plan like this allow? The US system of government divides power between the parties, an obvious fact, but one that the contending forces on Capitol Hill lately find hard to take in. How do you get from unyielding, no-surrender proposals like this to workable commonsense reforms that actually confront the problem? In short, how do you get from a posture to a policy? The ongoing shambles over the continuing resolution and the immediate budget impasse suggests one rather disturbing answer. You don’t.
This is about as kind-but-accurate an analysis as you’ll find, even without getting into the numbers. Ryan doesn’t do anything to rein in health care costs, which is the real problem with Medicare/Medicaid, and it’s just a shot across the bow, not a real attempt at reaching consensus. In that sense, it is very different, and much worse, than Bowles-Simpson.
The Village embrace of Ryan’s plan shows that as long as something fucks the poor and middle-class, they’ll support it, even if the numbers don’t add up, it does nothing to address the real underlying crisis (medical costs), and it has no chance of being enacted.
someguy
Easy, you don’t. Sit tight, obstruct obstruct obstruct, let them talk about how they want to put granny on the street for the next two years, then cock punch the bastards in the 2012 elections. This budget plan should nicely kill off the Republicans over the next couple election cycles.
spongeworthy
The only thing that will control costs is putting the consumer back into the bargain. Ryan-Rivkin does this by letting the consumer decide what type of coverage to buy and subsidizing it. To say otherwise is dishonest.
You may claim it won’t work and give your reasons, but you can’t be taken seriously if you simply claim Ryan-Rivkin “doesn’t do anything”. That’s simply untrue.
Strandedvandal
Why is it so very hard for these Republican dirtbags to not resort to 6th grade name calling? Is it physically impossible for them to call it the Affordable Healthcare Act or Healthcare reform? As soon as I read Obamacare, I discard anything written afterward as republican douchebaggery.
Mandramas
Well, the numbers are pretty fantastic in any case. Check the krugman blog.
Omnes Omnibus
@spongeworthy: If your appendix bursts, do you call around to get estimates? What if you are unconscious and bleeding to death?
Lolis
It privatizes Medicare and repeals the law that forces insurance companies to take the sick and disabled. Brilliant!!!!
spongeworthy
Sit tight, obstruct obstruct obstruct, let them talk about how they want to put granny on the street for the next two years, then cock punch the bastards in the 2012 elections.
Exactly. Then we’ll have Democratic control of all three whouses, something we haven’t had in 2 whole years! Wow, things were great when the Democrats held ALL THREE!
Meantime, the debt keeps spiralling, seeling more debt just to pay the interest on what we have already. The entitlement nightmare compounds. But hey, if we can return to those halcyon days of controlling ALL THREE, well, that would be worth the pain.
As long as the pain is somebody else’s, right?
bleh
Ol’ Clive might want to look at the responses of the healthcare economics profession to the plans for cost control incorporated in the ACA. IIRC, as one leader of the profession said, it includes “just about every serious proposal” in one form or another.
It’s really hard to take conservatives seriously when they let their ideological biases drive them to make sweeping statements such as his that are so evidently incorrect.
lllphd
glad you’re following these analyses (and especially loved dean baker’s), but wondered if you have looked at digby’s take.
she totally echoed my suspicions by pointing out the fake-off potential here (hence ryan’s “courage” in taking the fake ball to the front line). now the B-S proposal we all hated with a purple passion just short months ago will seem like manna from heaven. especially as it’s from obama’s own appointed/anointed commission, the repugs can now point to this concession as such a generous compromise on their part, etc.
if rove is not personally pulling these strategic strings, i’ll be shocked.
sukabi
Ryan’s “plan”… and that of all teh Repubs ( and a good part of the Dems) isn’t to actually do anything to fix the deficit or balance the budget… their purpose is to kill the social safety net, that’s the only thing this “plan” would accomplish…
the question is, are the folks that have faithfully paid into these programs (medicare, social security, ect.) going to sit by while the money they’ve already paid in is stolen and given to the rich to fund (tax cuts) their lavish lifestyles?
Tonybrown74
@spongeworthy:
How utterly … naive!
You honestly think that the consumer, who is in desperate need of medication or procedure in order to, you know, LIVE, is in an equal position of a hospital or pharmaceutical company to haggle over price?
You really think that is the case?
The Political Nihilist Formerly Known As Kryptik
@someguy:
Wasn’t this stuff said about around 2006-2008? How’d that turn out?
Passively trying to get the GOP to hang themselves has only made them bolder and the country more willing to get behind them as ‘doing something’ while we get the blame for every shit thing that passes through, even after it became clear that the Republicans, de facto, still ran the whole of Washington.
This passivity is why we keep getting fed the shit sandwich.
rickstersherpa
When the Republicans rejected participating in the plan, Crook rejected AHCA, and then he freaked about the deficits, kind of forgetting that big recessions always lead to big deficits and the best way to cure it is to end the recession.
Surprisingly, Dana Milbank and Matt Miller in the WaPo found the Ryan plan a joke. Apparently, Milbank’s little encounter with Citibank has radicalized him. http://www.washingtonpost.com/opinions/paul-ryans-irresponsible-budget/2011/04/05/AF4O7PlC_story.html
spongeworthy
@Tonybrown74: Oh for crying out loud.
We’re subsidizing the insurance purchase. This has nothing to do with any desperate haggling over procedures or drugs.
*sigh*
Omnes Omnibus
@spongeworthy: You suggested that people take control of costs, didn’t you? What exactly did you mean?
Napoleon
@Omnes Omnibus:
People who think like him are complete morons. How you could live in society and observe people for a number of years and then think people are going to comparison shop for medical services reveals you as an idiot, an ideologue or both.
Ana Gama
@spongeworthy: Yeah, it does plenty.
It makes retirees absorb more and more of the cost of their care the older they get.
It makes pre-existing conditions a viable way for insurance companies to refuse coverage.
It does nothing at all to improve the delivery system.
It does nothing to contain costs.
The one thing it does do is transfer a shitload of money to private insurance companies. Brilliant!
Bullsmith
@spongeworthy: Medicare is the consumer you idiot, or more accurately it represents and acts in the interests of the collective American citizenry over 65 years of age. On their behalf it sets compensation caps and has enormous leverage to negotiate lower costs on, for example, expensive drugs. In other words it can be hugely effective in bringing costs down precisely because it acts collectively for the consumer.
But no, putting each individual at the mercy of private insurance and adding not only profits but the vastly higher cost of separating out who you don’t want to insure into the picture will bring costs down.
The work that goes into painting these logical turds into swallowable lies, gods. No wonder the Right needs so many think tanks.
Ed in NJ
“unyielding, no-surrender” only describes one side of the aisle.
The next conservative or beltway insider to point this out will be the first, and therein lies the problem.
cat48
HCR had several different ideas that will be tried to control costs. Since we obviously don’t do that now, there were several things recommended that are included in the HCR Bill. Those “laboratories of Democracy” that rethugs always speak so fondly of…..
Omnes Omnibus
@Napoleon: I vote for both. I can vote for both, right?
spongeworthy
@Omnes Omnibus: Just what I said: We subsidize the insurance purchase.
While I don’t know why you folks think people won’t or shouldn’t comparison shop for medical services, that isn’t at issue here. They’ll buy the insurance plan that makes sense for them.
Incidentally, you do know that wealthy seniors don’t get nearly the subsidy poor ones do, right? That’s gottas warm some hearts here. (It does mine!)
Tonybrown74
@Omnes Omnibus:
Inquiring minds want to know.
Napoleon
@Omnes Omnibus:
Yes
Yutsano
@Omnes Omnibus: I am deadly serious: if I ever need a lawyer in Wisconsin, I’m calling. Seriously. And I know a good immigration attorney in Seattle too if you have cause for a referral.
Omnes Omnibus
@spongeworthy: That’s all you got? Wow. I guess I shouldn’t have expected any better, but wow.
spongeworthy
In other words it can be hugely effective in bringing costs down precisely because it acts collectively for the consumer.
This is supposed to be funny, right? I mean, I know that’s what you guys think should happen with a controlled economic system, but where are the results after all this time?
See, the governement has no incentive to bring costs down–quite the opposite. See: Free Viagra. There’s always somebody clamoring for more and they vote.
Insurance companies are trying to make a profit by keeping the cost of their policies competitive and their costs low. This may mean you buy a plan that doesn’t give you free Viagra.
Turgidson
@spongeworthy:
Vastly better than the shitstorm of fail that preceded it, and the one that’s brewing now with the Teatards trying to run Washington from the back benches of the House.
Yeah I’ll admit, that’s a very low bar.
Thanks to aforesaid shitstorm of fail brought to us by GOP misrule. And which the GOP has still not seriously offered to address.
No it doesn’t. Nice talking point though.
Well, yeah. The Democrats, however clumsily, do attempt to govern when they have control.
That’s the whole goal of the Ryan budget. “Somebody else” being everybody except the super rich.
Loneoak
The core, and lunatic, assumption of the Ryan Medicare/Medicaid plan is that individual risk is necessarily more economically efficient than distributed and government managed risk. It assumes that millions of likely sick, forgetful, and not-rich, seniors will be able to individually innovate a magic market-based bullet to get gigantic monopolistic health care corporations to treat them fairly and efficiently. This is literally an insane belief. And we don’t even have to consider the entirely made-up economic numbers to know this.
Yes, when the government negotiates for health care as a single-payer there are inefficiencies. But the other option is far, far, far less efficient.
I really hate these people for their idiocy and their cruelty. Hate, hate, hate.
Meanwhile, this is a nice little article from the Economist.
Shalimar
@spongeworthy: The insurance purchase which the insurance company will make a profit on, in addition to all the other costs already there as a government program. Privatization is about letting big campaign contributors profit without risk. All the bullshit about efficiency and innovation is cover for giving away tax money to people who are already rich.
Turgidson
@Napoleon:
Indeed. Not to mention, “freedom” to shop means nothing when you have no money and probably have a preexisting condition of some sort.
Poor people are “free” to walk into a Ferrari dealership and “shop” for a car there. Doesn’t mean they can actually buy one. That’s the direction health care will go, even faster than it is already, if we let charlatans like Paul Ryan dictate policy in any real way.
cleek
@spongeworthy:
the vouchers don’t keep up with the expected rise of health care costs. their growth is capped at GDP + 1%, where “GDP” includes inflation.
so, they’ll buy what the ever-diminishing value of the vouchers allow them to buy.
piratedan
@spongeworthy: yeah stuff actually got done…
DADT repeal
Stimulus package
HCR
student loan reform
more would have been done if McConnell and Kyl hadn’t gone scorched earth on Senate filibusters regarding government appointees and hoping that Senator Byrd and Kennedy would die. Other than that, they were helpful lil’ dobees.
Was the Democratic legislative agenda perfect, no, far from it, but you have seen what the Republicans did after they took control of the House last year right? Culture War, Son of Culture War and return of the Culture Wars.
If the Rethugs hadn’t held the country hostage (or the current administration had more nads, your call) the Bush tax cuts would have expired and the freaking deficit would have been reduced dramatically and we wouldn’t be having these hand-wringing distractions about the deficit which no one gave a shit about until the Dems were left with having to deal with that reality post the Rethug turn at the wheel. So spare us the concern trolling will you?
fasteddie9318
Idiot troll is troll, also idiot. More as this breaking story develops.
Mary Jane
OT — from Steve Benen
Watch out for flying teabagger brain bits.
Yutsano
@Mary Jane: I’m awaiting the inevitable front page announcement. With popcorn.
Martin
Well, it does rein in health care costs by stripping funding for health care. There’s only two ways to drive prices down in that kind of market – either regulate the market or starve it. The GOP simply wants to starve it. The problem is that the byproduct of starving a health care market is by killing people prematurely. Not the ideal solution.
cyntax
@spongeworthy:
Until we’re ready, as a country, to address the fee for service model we’re currently using, nothing major is going to change in terms of controlling health care costs. Putting the consumer “back into” the equation isn’t going to do it.
With our current fee for service model, doctors are financially incented to run up costs, not to care for patients. The insurance companies, and competition among them does next to nothing to hold down the costs that the provider (the doctor) incurs.
Dan
Ryan’s proposal is a death panel, much moreso than anything that was in the various formulations of Obama’s health care bill.
The govt will determine that across the board, regardless of your individual circumstances, you are on your own finding coverage for medical treatment beyond 15k. This will be a death warrant for many people. Some courage
Joseph Nobles
Yep, this plan to voucherize Medicare amounts to the government saying, “Here you are, a nice check! Now run off and die somewhere I don’t have to lookacha.”
I really don’t understand this mania for vouchers in the Republican Party. How about next we all take out the knives to the Defense budget? Yes, let’s all get a nice check from the government to purchase our own invasion insurance from Xe or Boeing and let them protect the border. That should just work out smashingly, don’t you think?
batgirl
@Omnes Omnibus: And if you bought a plan that didn’t cover “appendix bursting” do you say fuck it and die?
spongeworthy
@cyntax: You are absolutely correct. Why do we buy insurance from companies that send us to doctors so mis-incentivized?
Well, we don’t. Our employers do. This, and the Medicare debacle, is what happens when the actual user is out of the decision-making process. At least as I see it.
You have definitely identified a major problem. Well said.
batgirl
@cleek: Oh, I have no doubt that there will be a shitload of health “insurance” policies available for exactly whatever the voucher is worth. The problem is that these policies will be worth shit. The people would probably be better off keeping the $15,000 grand to pay medical costs if they could.
Judas Escargot
@spongeworthy:
The only thing that will control costs is putting the consumer back into the bargain.
Ah yes, the all-wise, all-knowing “consumer”, who has 100% total access to all information, would never ever be mislead or misinformed by the unscrupulous, and whose good ol’ common sense trumps any of them fancy degrees in medicine, biology, chemistry and/or economics.
Chomsky pegged you years ago. You really are just Maoists in reverse.
cyntax
@spongeworthy:
It’s not the actual user that is going to make the difference in this process. Explain what that would look like? We buy our insurance once a year, how can we know at that time what level or type of coverage we need?
It’s not the user, but the provider who needs to be responsible in the decision making process. The doctor’s need to be incented to maximize care at minimize costs. That’s why they’re supposed to be the expert. They’re the ones whose time and energy need to be focused on being well-informed and up to date on current medical practice so that they recommend the appropriate level and type of care.
Pretending that the user can fill that role is a free-marketeer’s fantasy and one that ignores basic principles of economics.
batgirl
@Joseph Nobles: Vouchers are the Republican’s way of transferring taxpayer dollars to corporate profits. End of story.
Chris
@Omnes Omnibus: Whenever I fall into a coma, I take a survey of local hospital prices, or wait for a sale for coma-care. Don’t you? :-)
spongeworthy
@cyntax: No, your insurance carrier should be the one making sure the doctors they send you to are doing all that stuff. They’re the ones who should be making sure the doctors don’t keep sending you for MRI’s when you have arthritis. Otherwise you don’t re-up with them–their doctors suck and their policies are too expensive.
Ana Gama
@Chris: I only do this when I break a bone or have a car accident.
Omnes Omnibus
@Yutsano: Thanks. I actually might need a referral for a good immigration lawyer in the Seattle area at some point. So that would be cool. I will let you know.
cyntax
@spongeworthy:
Trying to control this through insurance company is completely pointless. You’re ignoring the fact that competition only works when it’s applied at the time the decision is made. That’s the provider. Historically, insurance companies have never been good at controlling costs. All they can do is control who gets covered, not how well they get covered.
If you’re going at this through the insurance companies, you are misunderstanding the problem at a fundamental level.
agrippa
Pretty good analysis by Clive Crook.
Ryan is just another a game player; this “plan” of his is pure black humor; just like most of the games going on in Washington.
Those people like to go on about the “debt”; or,the ‘deficit”. But, very few are actually interested in doing anything about either one.
It is the provider who has the most control over costs.
It is very unlikely that the “consumer” of medical care can do anything constructive about the costs of medical care.
The behavior of the 111th Congress was very similar. Those people did not make any real progress in solving problems either.
sukabi
@Joseph Nobles: at the same time they are advocating vouchers, they are busy setting up their own entities to profit from the “voucher boom”… as batgirl said, vouchers are a vehicle to transfer tax dollars to private (corporate) pockets.
Martin
@Judas Escargot: Yet another reminder:
There are two health markets: Hospitalization and medical. You’re correct about the former, where consumers lack expertise and options. But on the latter, consumers make decisions all the time. Everyone decides whether they should get an annual physical, when they are sick enough to go to the doctor, whether they should buy this or that decongestant, and even if the should buy the name brand or generic prescription. Over 1/3 of our health care spending is fully consumer driven, and about 20% more of our physician spending is also fully consumer driven under the restrictions that our health insurance provides.
There’s no reason why that half of our health care spending shouldn’t largely be in consumer hands with properly regulatory oversight. It mostly already is, although with a lot of really perverse incentives and penalties. The other half of our health care spending really should be out of our hands. When you’re on a gurney in the back of an ambulance, you aren’t going to price shop.
sukabi
@cyntax: plus they aren’t in the business of controlling costs, they are in the BUSINESS of turning a PROFIT.
Julia Grey
How do you envision that working, exactly, that comparison shopping? When you’ve just been in an accident and the ambulance crew who have picked you up from the pavement, bleeding in six places and only 3/4 conscious, ask you if you have a preference on the hospital you want to go to, you’ll be able to say, “Oh, I researched this particular injury, and Hospital A does a better job with it, but wait, my insurance doesn’t cover me there. Hospital B where my insurance is accepted is a lot cheaper for the general care but they charge extra for the particular surgery that this will likely require, and at Hospital C I’ll have a higher co-pay but all the drugs I’ll need are included for nothing, which reminds me that I think crutches would be covered at Hospital B but not at Hospital C, so I think I’ll go to…”
Right.
There’s a reason Medicare was begun in the first place, which is that private insurance companies really didn’t want to cover the elderly AT ALL. There’s really no percentage in it, even if you take on a senior who’s apparently in perfectly good health for their age at 65. Old people inevitably end up using a lot of medical care, and it’s really really hard to figure out the underwriting so that you can make a steady profit. Unless you can just toss people off your rolls whenever you feel like it, of course. Like when they get a diagnosis that could prove costly to you. Or maybe by just refusing to take you at all if you have diabetes or heart disease or…you know, lots of those diseases that OLD PEOPLE tend to have.*
Ryan’s plan supposes that there will be insurance companies out there who will be willing to cover seniors — at something close to the current level of care Medicare provides?– for what comes down to a fixed amount, or at least one that does not keep up with inflation in the medical services industry. I think the profit margin on that kind of thing would be, at best, on a razor’s edge, especially over the long term as the clients aged.
_________________
*Surely Ryan does not propose to force companies to take all comers? Without also forcing everyone into the risk pools of all the insurance companies (i.e., instituting a –gasp! — mandate)? That would REALLY cut into profits….
Joseph Nobles
@sukabi & @batgirl:
Yeah. Whenever I see things like this, I always am reminded of the last scene of Chinatown.
sukabi
@Martin: Over 1/3 of our health care spending is fully consumer driven, and about 20% more of our physician spending is also fully consumer driven under the restrictions that our health insurance provides.
except that if you are restricted by your insurance provider (if you’re “lucky” enough to be able to afford insurance) then your ‘choices’ are limited to what your insurance provider says they are… it’s not really consumer driven, it’s insurance managed ‘choice’….
the only way you get actual consumer choice, is if the person can freely seek the medical care / treatment they desire / need — WITHOUT having an insurance adjuster between you and your doctor of choice.
and the poor folks that can’t afford any kind of health insurance are left with either emergency room triage care, free clinic care – if it’s available in their area, or nothing… not much choice or quality of care there…
cyntax
@sukabi:
Absolutley, and simply trying to control costs for the whole healthcare system through the insurer’s profit levels is myopic at best.
Roger Moore
@lllphd:
I said it in a previous discussion, but I think this is overthinking things. They want what they want, and they’re going to whine, bitch, and obstruct until they get it. This time they ask for more in the hope that they can get a compromise that gives them something, but the basic strategy is to be so obnoxious that it’s easier to give in to their demands than to put up with them. It’s the whiny toddler negotiating strategy.
Calouste
@spongeworthy:
spoofworthy, that job you have spouting talking points about Paul Ryan’s WeDontCare plan, how much does that pay? I know someone in need of a job.
cyntax
@Martin:
I’m skeptical that the medical decision-making has been that accurately quantified. Where exactly are those numbers coming from?
Legalize
@spongeworthy:
Wait. What? What would that look like? Would a panel of some kind tell my doctor if I need an MRI or not?
D. Mason
@Loneoak: What you said is true until you consider the perspective of those putting it forward. Efficiency is measured by how much wealth they can shuffle towards the top and managed care does the opposite.
In a government(or non-governmental collective) managed situation much of the benefits go to middle and lower class citizens while profits are restricted on both ends. Additional costs are required and charges are limited. Even the waste and fraud is distributed to middle class scoundrels for the most part. In a system where everyone is at the mercy of Mega-corps the net income goes down (who can pay for that shit?) but the outlay goes through the basement. And. Profits. Rise.
It’s easy to deduce why certain sectors are pushing for this type of “management”.
sukabi
@cyntax: my guess is they are pulled from a dark, moist, smelly place.
Tokyokie
The best way to bring down costs is to go to a single payer. Health insurance companies add no value to the healthcare system, just additional costs that most other industrialized countries don’t have.
sukabi
@spongeworthy: ummm, the reason Dr’s do unnecessary tests is precisely BECAUSE THE INSURANCE COMPANIES decide what they will pay for, and how much they will reimburse the Dr. for their time / effort… the entire health insurance / medical industry in this country is based on PROFIT. In order to maximize their profits, the insurance companies will only pay for the least expensive procedures/ medicines and set reimbursement scales for the Drs…. Doctors are also in the business of PROFIT… and want to maximize their patient / cost ratio… so if the insurance will only pay x for a procedure and the Dr. has his malpractice insurance, lease on space, equipment payments, ect. he’s going to at some point order tests that aren’t necessary. Insurance companies have the Dr’s by both balls… reimbursement for services rendered…and MALPRACTICE insurance.
totally f’d up system, where the only people that benefit are the Insurance co’s and some Drs / hospitals… patients, not so much.
Brachiator
The Republicans are not particularly interested in health care reform. Nor are their pundit fellow travelers. Sully makes a big deal about entitlement reform, and the Republicans are big on “reining in” federal spending and reducing the size of the government.
It doesn’t matter what the government does. It’s only that it is too big and must be cut. They’ll toss the public a bone about vouchers, etc., but in the end whether their plan does anything to reduce health care costs is irrelevant to their agenda.
Dr. Psycho
@Strandedvandal: Nah, let’s encourage them to keep calling it “Obamacare”. As its popularity continues to grow, they will live to regret tying it so firmly to the Democrats.
Mnemosyne
@spongeworthy:
No, they’ll buy the insurance plan that’s cheapest. Then they’ll get catastrophically ill, be unable to pay the bill, and it will be the taxpayers who have to pick up the tab so the hospital doesn’t go bankrupt.
It’s always amazing to me that you guys are so short-sighted: you insist that it’s somehow more cost-effective to spend $200,000 trying to save a kid who got a brain infection from a bad tooth than it is to have Medicaid pay for the $30 tooth extraction that would have prevented the infection.
I have no idea what it is you guys have against prevention, but when there’s a choice between spending a little money now to prevent a tragic outcome and spending a huge amount later after the disaster happens, you choose to spend the huge amount every. single. time.
(Edited to fix link)
General Stuck
They will for that reason, and just as much, because it is exciting and new, different, bold, with the kind of charisma possible when not constrained from telling lies . Which it is, a lie, Ryan’s claim this will rescue America and create prosperity for anyone but a few, and freedom to have that lie tool in your pol box opens up all sorts of opportunity to enthrall with fiction, full of imagined colorful dots that do not and never will connect.
All dems got is the drab confines of telling the truth and talking about what the real Jesus would do hanging out with lepers and tending their troubles, that most always involves being paid for with higher taxes, that even the most self described good moral American with any affluence will recoil from, even if they tell pollsters the opposite.
Dems win by persistently telling the truth, in all it’s icky drabness, and maintaining the faith that sooner or later, justice gets served in this democracy, in spite of all the obstacles and their boring blather about responsibility and paying for shit. And that justice is almost always late, but it usually arrives here battered and bruised, in the land of the free.
I support dems, warts and all, even if the Les Nessman in our national political sitcom
cyntax
@Mnemosyne:
I’ve begun to suspect it’s because they have a near religious faith in “free market” solutions and no understanding of even basic economic principles, but who knows?
KXB
The folks over at the American Conservative are not impressed with Ryan either:
Think Twice About Paul Ryan
“Paul Ryan is getting a rapturous reception — from Republicans, at least — for his plan to balance the federal budget a generation from now. I may be uncharitable, but I have my doubts about Washington’s ability to carry out even a four-year plan, let alone a two-to-four decade one. And as Chris Edwards notes at Cato, Ryan fails to take many obvious steps to reduce federal spending in the short term — “It is disappointing that his plan doesn’t include common sense reforms such raising the retirement age,” Edwards notes. Ryan’s near-term Medicare reductions are “modest,” while “the big savings occur beyond 10 years when his ‘premium support’ reform is fully implemented.” As for paring back our bloated, ineffective defense budget, Ryan goes only as far as President Obama, which is to say, not very far at all.”
Julia Grey
Ding ding ding!
An enormous risk pool + leverage on pricing because of the bargaining power + completely standardized paperwork and payment processes + no middleman skimming off a percentage = COST SAVINGS.
(You don’t want an NHS, where the doctors are actually government employees. They should do business with the government as private entities, and make their profits from what the government is willing to pay — as they do from Medicare patients. Over time the single payer system can then incentivize certain ways of doing business, such as paying well for an emphasis on prevention, and paying less for others, such as referral verticalization and circular back-patting schemes.)
But with less cost for the government comes less profit potential for private entities, especially the entrenched interest of private insurance companies, and we simply can’t have that!
jcricket
@cyntax: Begun? Begun? (i know, you’re just being straightforward). But I think it’s clear. You start with a religious faith the government is wrong, add a healthy serving of racism, homophobia, xenophobia and sexism, and boom – suddenly you can’t find the pragmatic solution to anything.
Fucking shocking.
jcricket
@Julia Grey: I’d love to see a single payer system that basically flattened the pay for preventative v. specialist care. Right now we’re nearing record lows of general practitioners and they get paid like nothing to spend time with you.
There’s no reason for an anesthesiologist to make $500k/year and a general practitioner only $100k. Move the GPs/Pediatricians/Internists to $250k/year (and on salary, not paid per patient visit) and the specialists down to $250k/year and we’d see some serious improvements in people’s day-to-day interactions with the medical system.
Martin
@cyntax: I’ll have to dig it up again – it was from last year during the HCR debate. It was a full breakout of all US healthcare spending by sector. For example, prescription drug spending was about 10% of all HC money spent in the US. Health insurance overhead was about 4%. A third was discretionary spending. Everything from boob jobs to band-aids.
Part of the problem with this debate is that we routinely do an apples-oranges comparison in debates. Someone will say that we need to provide universal healthcare and use skyrocketing health care spending as a justification. Well, if it’s skyrocketing because everyone is getting boob jobs, then no – that’s not a problem that needs solving. Nobody was taking out the discretionary spending as part of the equation (discretionary is hard to identify – we pay for generic drugs out of pocket because it’s cheaper than the copay under my insurance – is that discretionary? Is a pair of crutches? Are diabetes supplies?) – and what they labelled as discretionary spending was rising very quickly.
Many of the arguments in favor of single payer were complete bullshit. Relatively speaking, reining in drug costs and insurance overhead doesn’t make a big dent in the problem. You want to get spending in check, then you have to take a big swing at the big cost areas – testing, physician salaries, general hospital expenses. Those are all solvable under single payer, but they don’t have the panache of going after some faceless corporation. It’s a lot easier to beat up on Merck than it is to beat up on your ob-gyn, but it’s the ob-gyn that is in the really fat part of the graph that needs taking down. Merck is in the little slice of the pie. Single payer is the inevitable answer, but the arguments being presented were so shitty and factually wrong that I found myself having to defend insurance and drug companies.
Everyone really should stick to one issue: Medicare. It’s not that Medicaid and everything else doesn’t matter, but we have so much data on Medicare on revenue generation, pricing, spending, and overhead, and it’s such a large portion of our spending because it covers 95% of the end-of-life stuff, that if we can solve Medicare than using that as a roadmap to solve everything else is actually very straightforward. Things get impossibly complex when you get into Medicaid and employer and private insurance, SCHIP, out-of-pocket, and so on. Medicare is as clean a data set as you’re going to find, and Medicare breaks down revenue, pricing, spending, and overhead for Part A (hospitalization) Part B (medical) Part C (regulated private market coverage) and Part D (drugs) so you can see what’s going where and what’s blowing up.
Brachiator
@spongeworthy:
If the consumer is the key, why subsidize his choice? It shouldn’t be necessary if you really think that this is the solution. On the other hand, can you show me that consumer vouchers have actually brought costs down anywhere?
@Tokyokie:
Is “single payer” the Godwin word for health care reform? If it were the case that single payer were the magic bullet of health care reform, then every country with universal health care would have a single payer system. This is not the case. This has never been the case.
And yet some countries require that people buy health insurance through insurance companies; they don’t necessarily abolish them. Part of the reason for this is so that government doesn’t carry the sole burden of costs.
I get tired of both sides continually hawking their position while ignoring what has actually been implemented elsewhere.
Before the Internets came along, this was just a lame dodge. Now, it’s outright embarrassing.
Midnight Marauder
@spongeworthy:
I humbly submit this for “Dumbest Comment of The Year.”
cyntax
@Martin:
Yeah, I definitely agree that it’s important to change how doctors are incentivized to provide care.
I’ll look around for it; I’d be interested to see how the dollars break down by classification and what the classifications are. Thanks for contextualizing the numbers a bit.
Larv
spongeworthy,
“Ryan-Rivkin”? I didn’t know that Alice Rivkin was a member of Congress. Also, there’s the small problem that she’s saying that she doesn’t support the specifics of Ryan’s budget. So nice try, but you’ll need to find a new talking point.
Julia Grey
Not likely. The thing that happens with voucher-style subsidies is that they essentially create a floor price, not a ceiling.
Every salesman knows that when you know how much a buyer has in his pocket, you can tailor your pitch accordingly. Whatever the government subsidy is, it will inevitably only cover the BARE MINIMUM of coverage. It won’t come anywhere near the care that seniors are getting today.
I watched my father-in-law get sent home to die of heart failure because the doctor he got at the hospital the ambulance took him to wasn’t a member of his Medicare HMO, and the hospital wouldn’t accept his HMO’s assignment amount, therefore they wouldn’t (“couldn’t”) do surgery to install a pacemaker for his dangerously arrhythmic heart. Luckily, when the time came for his last gasp he was taken to a different hospital and a different doctor, who managed to scare up some charity funds for the “out-of-network” surgery. With his pacemaker he went on to live another 6 years.
And what do you know, this “Medicare Advantage” HMO was one of those the government pays MORE than standard Medicare rates to supposedly provide “better services”? The elimination of these ripoffs is another one of the great things about the ACA.
Fucking for-profit private insurance as a substitute for standard Medicare coverage? Only over a LOT of dead bodies.
OzoneR
@spongeworthy:
If it’s the rich fuckers, then I’m with it, the only pain they’re feeling is the hangovers from their expensive parties.
sukabi
@Martin: one HUGE cost you left out is the percentage that insurance companies take OFF THE TOP of all policies, for marketing and administration and BONUSES… also drug prices are inflated due to the HUGE amounts of money they use to advertise new prescription drugs to the population at large… money that would be better spent on R&D, which they haven’t been doing, or on manufacturing the “orphan drugs”… you’re looking at the soaring cost of healthcare from only ONE perspective, the medical providers costs, and not factoring in the overhead generated by simply having a FOR PROFIT health insurance and drug industry.
sukabi
@Martin: how much is malpractice insurance for an ob-gyn or any doctor? That is one of the factors in how much they charge…There are some parts of this country where it is difficult to find an ob-gyn… and one that specializes in difficult pregnancies is harder…
Brachiator
@Martin:
About those doctor’s salaries:
Now, there is a disparity between the incomes of general practice doctors and specialists, but even here, the income increase since, say 2002, is not as large as the overall increase in medical costs over the same period (the reference won’t link correctly). Health care reform is tough, but I am not sure where cost control efforts should be concentrated.
sukabi
@Martin: if, as you claim, health insurance costs aren’t contributing “that much” to the cost of health care, then how do you explain their record profits last year? Their insurance plans don’t cover as much as previous policies, yet cost much more…
you can’t have an industry that is reaping huge profits on one hand and on the other claim that they aren’t adding “that much” to the problem.
jetan
@D. Mason:
I think those are actually fair points respecting so-called govt. managed care. But don’t many of those objections evaporate in a straight single payer system?