Republicans will present this week a 2012 budget proposal that would cut more than $4 trillion from federal spending projected over the next decade and transform the Medicare health program for the elderly, a move that will dramatically reshape the budget debate in Washington.
.....The plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills. Mr. Ryan and other conservatives say this is necessary because of the program's soaring costs. Medicare cost $396.5 billion in 2010 and is projected to rise to $502.8 billion in 2016. At that pace, spending on the program would have doubled between 2002 and 2016.
Mr. Ryan's proposal would apply to those currently under the age of 55, and for those Americans would convert Medicare into a "premium support" system. Participants from that group would choose from an array of private insurance plans when they reach 65 and become eligible, and the government would pay about the first $15,000 in premiums. Those who are poorer or less healthy would receive bigger payments than others.
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The proposal would also convert Medicaid, the health program for the poor, into a series of block grants to give states more flexibility. And it is expected to suggest significant cuts in Social Security, while proposing fewer details on how to achieve them.
The federal government expects to spend about $275 billion in 2011 on Medicaid, the program that provides medical care to the poor and disabled, up from $117.9 billion in 2000. The Congressional Budget Office projects Medicaid spending will roughly double by 2021
This is not an endorsement of Mr. Ryans plan, as it has many problems which I believe are insurmountable -- the least of which is that $15,000 for private insurance for a person or couple aged 65 is not enough by far. I should also add that I fully advocate 100% public health care. The US is one of only three OECD countries that does not have fully funded public health care. At the same time, we pay far more than other countries, yet have a higher infant mortality and lower life expectancy. In short, we are clearly not getting what we are paying for.
However, Mr. Ryan deserves credit for actually dealing with the primary problem -- health care expenditures. While I believe his solution is incorrect, he is attacking the correct problem.
6 comments:
One thing about Medicare is that it's hard to evaluate its worst problems from the inside.
Anecdotes are not data, but they can be insightful if the difference is stark enough. When I took a business trip to Japan, I suffered a severe allergic reaction to the antibiotics I was taking. I wound up in a Japanese ER. It wasn't fabulous; there weren't enough beds so I was put on a bench. They wouldn't take any action until the specialist saw me, leaving me to writhe on the bench in agony. On the other hand, the allergy specialist came in on her day off just to see me. They made a proper diagnosis and I was feeling much better within an hour. In a refreshing display of how intellectuals can communicate without language, my stateside physician easily reviewed the blood test that was printed on the other side of the Pacific. The final bill for everything, including blood test, medication and WITHOUT INSURANCE:
$160.
How the hell do they do it? Let's look at some of the differences. First, the Japanese aren't just living longer; most are significantly healthier at 70 than most Americans at 50. Despite living longer, they rack up significantly less health care costs. Second, consider how they put me on a bench without fear of litigation. For starters I actually fit on the thing; the clients I visit in America that develop product for the medical industry say they now design for 600-, 800-pound patients. The right loves to brag about how advanced our care is, but honestly, EVERY doctor will tell you that simply laying off the donuts beats the best heart surgery in the world, EVERY time.
It's only one perspective, but you can see how our costs are rising out of control. Whether health care is government-run or company-run doesn't matter if it's not MANAGED care. I lived for two years in Japan at one point and saw exactly ONE obese person. Here in the 'states I see at least one morbidly obese person a week. Unfortunately Americans think of managed care as a level of intrusion with the same rationality, hyperbole and immaturity of a spoiled teenager.
I don't care if you're a business owner or a deadbeat; you don't have a god-given right to wreck your body if you expect society to deal with it. We can't have it both ways. Either government is going to have to crack down on our deep-fried Twinkies or costs (and the corruption that goes with it) are going to bankrupt us all. What we're eating today has huge economic impact years from now, but no one seems to want even a remotely honest discussion about nutrition. And we expect POLITICIANS to fix this problem for us??
Yes and no. He is making clear that the problem is the cost of health care, but his solution is to simply extract the government from paying for that problem, not dealing with it. This may seem a nitpick, but really it's not.
See, the real problem here isn't the debt and medicare's contribution to it. It's the underlying fundamental problem of health care costs rising and sucking dollars out of all corners of the economy. Part of this is obviously due to the fact that we have a larger proportion of elderly now and they are more expensive. But fundamentally our system is inefficient and numerous countries around the world are able to get better value for the money they spend.
What has made the US an economic powerhouse has been entrepreneurship. High health care costs are fundamentally a drag on economic growth because it makes stepping out on one's own very risky. If we want a country of wage slaves who do whatever the corporations ask of them, then let's keep this system. If we want a country where there's real ingenuity feeding real growth, then we need to fix this, not just avoid it.
Dragonchild, while certainly some portion of the expense of our system has to do with obsesity, etc, if you look at the fundamental costs of the system that's only a small part of the issue.
For example, there are nearly twice as many CT and MRI machines in the US per capita than any nation on planet earth. So taking out any other efficiency considerations, if we have twice as many machines, that means twice as large of a capital expenditure and that cost is carried forward in your bill for a scan.
The obvious question here is: why? To illustrate the reason, there's a great analysis that the New Yorker did a couple years ago that compared the most expensive US locales to get health care against the cheapest. In the most expensive, the doctors often owned their own testing equipment and they had a culture that favored a lot of diagnostic testing. Basically if you give somebody an MRI or a CT scan, you make more money, so why not do it?
Compare that to cheaper areas where doctors did more consulting with specialists and less testing. The outcomes were as good if not better, but much much less expensive.
It's all about incentives, and right now the health care system is incented to be inefficient and expensive. That's what must be fixed, not getting people to eat less donuts (though that would help too)
Steve -
I see your point and, in a vacuum, I strongly agree.
The problem with your example as a refutation of my point is that the Japanese require less care, period. Yes, we should compare the costs and results of a test vs. a specialist visit, but it's far, FAR more likely the Japanese "patient" doesn't even need to see the doctor at all. Your point seems to be dollars per treatment. My point is treatments per capita. Both are legit; I just wouldn't call the latter a "small part of the issue".
I know my experience is anecdotal, but I didn't just visit there; I also lived there. I am intimately familiar with just how incredibly differently the Japanese approach health and safety. The dietary transition alone is nothing short of full-blown culture shock. They're not cosmetic tweaks; managed health is built into the infrastructure itself. That's bound to get deliberately understated here because it's the least politically palatable facet of the equation.
In other words, Ryan faced a hostage crisis and shot the hostages, but the hostage takers were near the hostages, so Ryan deserves credit for shooting in the right direction?
I have read some of the comments and feel this, the GOP and big business interests want us all to pay the taxes, fight the wars, work for nothing and leave them alone so that can run the country into the ground and live the American Dream. Congressman with signs" pays my way and I will screw the people in every way possible"
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