The Texas Medicare system is beginning to implode. That’s Medicare, not Medicaid.
John E. Calfee (The American): Too much transparency could mean higher health care prices.
Senior citizens are by far the biggest losers in health reform. Consider that:
So how did this happen? Aren’t senior citizens supposed to be the most powerful voting bloc? Aren’t they supposed to be represented by the all-powerful AARP?
Unfortunately for seniors (and indeed all Medicare enrollees), AARP sold out its own members. Just as the AMA sold out the doctors and the labor unions sold out their own members, AARP signed on to legislation that helps AARP but hurts the millions of people who AARP claims to represent.
A survey of the literature found 85% of emergency room “frequent fliers” have health insurance. Most of these had seen a primary care physician in the past year.
Sixty percent of frequent ER users (four or more visits per year) were enrolled in public coverage — either Medicaid or Medicare — compared with only 36% of occasional emergency room users.
How much time are people willing to spend calculating and arguing about the cost of something that cannot happen anyway? Apparently, quite a lot.
On Capitol Hill at least, the most important issues in health reform seem to be budget issues: How much will ObamaCare cost? Will it add to the deficit? Or reduce it? Poll after poll has shown the public is not buying the official estimates. And as often happens, public opinion on this matter is more reliable than expert opinion.
Here’s why. ObamaCare will require just about every nonelderly person in America to buy health insurance, the cost of which is going to rise at twice the rate of growth of their incomes. At the same time, the legislation will prevent people from all of the natural adjustments you would expect in the face of rising premiums. They will not be allowed, for example, to scale back and choose more limited insurance. They won’t be allowed to shift to catastrophic-only plans or rely more on self insurance through Health Savings Accounts.
In the short run, one of two things will happen with respect to this dilemma. The government (1) can insulate people from rising health insurance costs by providing them with ever increasing subsidies, or (2) it can allow the cost of mandatory health insurance to consume an ever-increasing share of the family budget. Neither approach is tenable.
Stupid Thing
Most summaries of ObamaCare focus on the benefits of reform and when they phase in. The Karen Davis summary, for example, lists only benefits — as though the entire package was one big free lunch. Benefits must be paid for, however. Here is how paying for reform phases in:
2010
2011
2012
2013
2014
This is Jim Capretta at National Review Online:
The big Medicare cuts in the president’s plan come from across-the-board payment-rate reductions. In particular, the president wants to cut the inflation update for hospitals, nursing homes, and others by half a percentage point every year, in perpetuity. On paper, this change produces huge long-run savings. But it does nothing to control the underlying cost of treating patients. It just pays everyone less, without regard to patient need or quality of care. The chief actuary of the program has said repeatedly that these cuts are completely unrealistic for these very reasons. If implemented, he expects they would drive one in five facilities into serious financial distress. And yet [Peter] Orszag and [Nancy-Ann] DeParle want us to believe these savings can be counted to finance the president’s massive entitlement promises.
And this is backed by the AMA?
Who would you put in charge of the investigation? Hercule Poirot and Jane Marple? Or the person most likely to have committed the heinous crime? Believe it or not, in health care we are about to do the latter.
Writing in Health Affairs, Ken Thorpe and his colleagues offer a description of the current phase of the problem:
Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs.
So how are we dealing with this challenge? Poorly.
More than half of beneficiaries are treated for five or more chronic conditions each year, and a typical Medicare beneficiary sees two primary care physicians and five specialists working in four different practices. System fragmentation means that chronically ill patients receive episodic care from multiple providers who rarely coordinate the care they deliver. Because of this structural deficiency, patients with chronic illnesses receive only 56 percent of clinically recommended medical care. That gap in care may explain a nontrivial portion of morbidity and excess mortality.
Now before moving on, let’s note that Prof. Thorpe is a long-time adviser to Democrats on health care issues. The reason that’s interesting is that the solution preferred by the entire left wing of the Democratic Party is to force everybody into Medicare (single-payer solution) and the only solution Democratic moderates have proposed is demonstration projects run by Medicare (ObamaCare)!
I hate to be the bearer of bad tidings, but isn’t this like putting Bernie Madoff in charge of the SEC? Although these reformers often call themselves “progressives,” they are really reactionaries. Their model for the future is the failed system of the past.
“I Believe in Yesterday”
Obama gets a test seniors on Medicare can’t have.
Doctors to Obama: Quit smoking, eat better, drink less.
Last year Americans took more aid from the government than they paid in taxes.
A “breathtaking act of staggering hypocrisy.” That’s Paul Krugman writing about moi and Newt Gingrich and Paul Ryan. It’s a rare day when Krugman can write about people he disagrees with without attacking their character and their motives. Today is not one of those days. Here’s more:
It’s not just the fact that Republicans are now posing as staunch defenders of a program they have hated ever since the days when Ronald Reagan warned that Medicare would destroy America’s freedom.
What’s truly mind-boggling is this: Even as Republicans denounce modest proposals to rein in Medicare’s rising costs, they are, themselves, seeking to dismantle the whole program.
And what, you may ask, provoked all this outrage? A Wall Street Journal editorial Newt and I wrote on Wednesday. One of our 10 reforms said “Don’t cut Medicare.” Yet all three of us (and everybody else with any sense) knows that this program must be reformed. Is that hypocrisy? I’ll let Newt Gingrich and Paul Ryan defend themselves. My brief response is below the fold.
President Obama has asked me for ideas on health reform. Okay, he didn’t exactly ask me. He asked Republican Members of Congress. And clearly the GOP needs help.
It isn’t that Republicans don’t have good health reform ideas. They have lots of good ideas. In fact, just about every good health reform idea on Capitol Hill has been endorsed by at least one Republican. The problem is that the party as a party can’t get behind any idea that’s bold enough to actually solve big problems.
So I’ve teamed up with Newt Gingrich to offer ten ideas — to Republicans, to Democrats and even to President Obama himself.
Details, which appear in today’s Wall Street Journal, are below the fold.
