From Obamacare. Hey, the money’s got to come from somewhere. The “rich” don’t have enough to pay for it all.
Also, speaking of health care, Mitt Romney has a decision to make. He can continue to defend his Massachusetts mistake, or he can win the Republican nomination. If I were him, I would acknowledge the problems, and describe what I’d learned from them.
if reform accelerates health benefit cost inflation, the associated cost increases might eat up most — if not all — of workers’ wage increases over the next few years
Of course that’s exactly what happened over the last decade, without health care reform. Doing nothing is a prescription for more of the same.
Of course that’s exactly what happened over the last decade, without health care reform.
Not because of health-care costs. Health-care deform will make it even worse.
Not because of health-care costs.
Yes, because of health care costs. Click my name for the data.
Jim, if ObamaCare’s “reforms” did anything at all to lower costs I’d be all for it. But ObamaCare is opposed to the easy sources of cost lowering, like tort reform, transparency in Hospital results & pricing, uniformity of pharmaceutical pricing, cross-State competition, etc. etc. If a special interest might be harmed, it’s off the table – and all we get for our trouble is Medicare On Steroids.
As for the Lower Wages, no worries Rand. We can always just legislate higher minimum wages. We could peg it to $35k/year (assuming a 35-hour work week, 4 weeks paid vacation and adjusted for inflation of course) and eliminate poverty entirely!
Jim, you’re a first-class idiot.
Let’s see, the ship just ran into an iceberg and is sinking slowly. Some doofus an third-clas suggests we open the big valves at the bottom of the ship to drain the water out. Lots of people jump up and say hold on a second.
But you step forward and say: hey! we’ve got to do SOMETHING. Doing nothing is a recipe for more of the same! Open those valves!
But ObamaCare is opposed to the easy sources of cost lowering, like tort reform
We have tort reform in Texas and California; it hasn’t helped.
transparency in Hospital results & pricing
How is Obama opposed to these things?
uniformity of pharmaceutical pricing
You want price controls?
cross-State competition
Which would let every insurance company relocate to the state with the laxest regulations, the way all credit cards come from Delaware or South Dakota. That’s a prescription for lousy coverage and insurer profits, not lower costs.
The bills before Congress have lots of cost-cutting provisions, including a public plan. Funny that that’s the first thing opponents complain about.
Medicare costs have grown rapidly, but private health care costs have risen even faster. If what you care about is costs, a bigger government role is a step in the right direction.
Something I find amazingly disingenuous, or deceitful, depending on how ignorant the speaker is, is how we arbitrarily separate wage income into health-care and “what you get to take home” or “what you have to spend.” That’s what allows idiots like Jim to claim your “net” wages have “fallen” because you’re spending a bigger percentage of your gross income on health care.
Amazing. Why don’t we do the same thing with, say, all the costs of electronic communication that are new to the 21st century? Let’s add up your cell phone bill, your cable TV bill, your broadband Internet, your subscription to New York Times Select (ha ha) or what you spend on downloaded porn. Gosh! It’s so much more than it was, say, 35 years ago. Increased way faster than inflation! Not only that, but if we add your rent and gas cost to the cost of electronics, call it — uh, I dunno, rent and online presence rent — then it certainly eats up a larger percentage of your wages than it did those of your grandfather. Aieee!! Crisis! Time to turn over all our liberty to a Strong Leader who can stop this mess.
Fact is, what we spend our wages on varies across the years. Duh. Once upon a time, we spent most of our money on food, and shelter and health care (such as it was) was cheap. Taxes were mostly nonexistent. We didn’t fly or drive anywhere, so we spent zip on cars and planes and gas.
But time and technology marches on. Now food is absurdly cheap, by our ancestor’s standards, and land and housing is wildly expensive. Now the average one of us travels thousands of miles a year, by car and by air, so we spend gobs of money on our cars, gasoline, our plane fares, not to mention all we spend on phones, cell phones, Internet this and that, big-screen TVs and Netflix subscriptions.
And, yes, if we still want the best healthcare the science and technology can provide, that’s going to cost us a greater fraction of our income than it cost our ancestors, who had access to nothing like statins or heart surgery or fancy chemo to keep you alive an extra year with advanced metastatic cancer.
And so what? Why does it matter that the way we divvy up our income differs from how our fathers did?
That idiot Jim says my God all your real wage increases for the past decade have been eaten up in buying you better and better healthcare! Eek! He might as well frown at the “poor” guy who just got a fat Christmas bonus and went out and traded in his Corolla for a BMW. You poor fool! Your extra wages are being all eaten up by your higher car payments!
According to the HHS, states with limits of $250,000 or $350,000 on
noneconomic damages experienced an average premium increase of just 12 percent to 15 percent in 2001, compared with a 44 percent increase for states with no caps on noneconomic damages.
I haven’t read the bill (either), but I would expect something similar to be incorporated into the money saving Obamacare bill.
Any day now.
Which is of course the ONLY available alternative to ObamaCare.
I won’t call you an idiot. I have far too much respect for idiots to insult them that way.
Instead I think I’ll call you “Senator.”
We have tort reform in Texas and California; it hasn’t helped.
It’s worked in Texas. New Doctor registrations are up.
That idiot Jim says my God all your real wage increases for the past decade have been eaten up in buying you better and better healthcare!
Premiums have doubled — do you really think that health care is twice as good? Meanwhile, the French are getting even better care, for 2/3rds the cost.
It’s worked in Texas. New Doctor registrations are up.
What does that have to do with health care costs? McAllen County Texas is the second highest-spending county in the entire country.
Which is of course the ONLY available alternative to ObamaCare.
The GOP had the White House and both houses of Congress from 2003 to 2007. If they thought that health care reform was important, they could have made it a priority then. Instead they pushed through tax cuts and the incredibly wasteful Medicare drug plan. For them to now complain that we aren’t considering alternatives to Democratic plans — plans that were vigorously debated for 18 months leading up to the 2008 election — is ridiculous.
Premiums have doubled — do you really think that health care is twice as good?
Which is completely irrelevant to the point that Obamacare will also depress wages themselves.
The GOP had the White House and both houses of Congress from 2003 to 2007.
Not filibuster proof. If it was that easy, they’d have reformed Social Security, as the Democrats maued maued them from doing.
What does that have to do with health care costs?
Supply-side economics.
McAllen County Texas is the second highest-spending county in the entire country.
Got that imagination going again I see. You really are a clueless dipshit.
There was a war on. It was in all of the papers.
And as your date range implies, in November 2006 the Democrats finally won.
Leland writes:
Supply-side economics.
Supply and demand as taught in Economics 101 does not apply to health care. Instead, there is a positive correlation between supply and cost. One example of this is known as Roemer’s Law:
Hospital beds, once built, will be used.
The same applies to physician office hours, MRI machines, etc. Click my name for the best research on the topic. A summary:
Some nuggets:
Leland, you are expressing opinions about an area of policy in which you do not appear to be well versed. Perhaps it seems to you that the ideas in the health care reform bills before Congress have sprung full-grown from the authors’ heads, or else must be a crude attempt to extend government power. But in fact the health policy community has been researching and discussing these ideas for decades. There’s lots of data out there — feel free to acquaint yourself with it.
I wrote: “McAllen County Texas is the second highest-spending county in the entire country.”
Leland insightfully replied:
Got that imagination going again I see. You really are a clueless dipshit.
I was wrong about the name of the county; the town is McAllen, the county is Hidalgo. But I wasn’t wrong about the costs.
Click my name for the source of this quote:
and:
Not filibuster proof.
And yet they passed an enormous tax cut, and Medicare Part D, and No Child Left Behind, because those items were higher priorities to the GOP than addressing health care reform.
The fact is, the Dems are the only party that is willing to put all of its political capital on the line to enact major health care reform. For all practical purposes, the alternatives are passing Democratic health care reform or doing nothing.
And yet they passed an enormous tax cut
It wasn’t a tax cut, it was a tax-rate cut, and it wasn’t that “enormous.” If it had been, they wouldn’t have been able to pass it. But please, continue to make an ass of yourself in your pathetic attempts to rewrite history.
Dr. Gawande worked on President… errr… Hillary Clinton’s Health Care Task force in 1993. Seems he has a bias for socialized medicine. Convenient that he wrote a illogical piece claiming tort didn’t work and socialized medicine would. It just happened to come out the same day President Obama went to sell the AMA on Obamacare.
So, do you have any facts, Jim? Editorials are not fact.
I’d like to point out a few things from the article Jim posted. Bear in mind, I only got to page 3, when the explanation of McAllen’s costs are high is revealed. It seems that the high costs come from Medicare being billed for unnecessary tests. How exactly does that argue that government controls costs better? Isn’t that actually an argument that government allows for flagrant cost overruns, as long as they are isolated areas and most people don’t figure out how to do it?
Secondly, the comparison town is El Paso. The last time I was in El Paso, it was in Texas. This has no relevance at all to the Texas litigation reform.
Thirdly, the article does implies that 1. malpractice is a major cost driver and 2. the litigation reform worked; malpractice suits went away (what’s the likelihood that no problems are actually there? Perhaps it’s too restrictive?). There’s no way that didn’t reduce some of their costs. It’s only a fact that other costs went up more.
I’m not a big fan of health insurance; it doesn’t operate how insurance is supposed to operate. Insurance isn’t really to distribute costs across many different people, but to distribute costs over a single person’s life time. Insurance isn’t supposed to be a collective action scenario. I don’t think it would have ever come into it’s current manifestation without the wage controls of the 40’s requiring that all raises were in non-cash benefits. However, there’s one thing that health insurance does well; it solves the asymmetrical information problem. The health insurance company knows which tests are necessary and which aren’t. While I don’t think HMOs are such good things, they’re not the result of a diabolical plot; they were responding to a real need to control these kinds of large costs.
The thing is, costs can balloon in a number of different ways in different scenarios. They’ll only stop when all of the problems are solved and solving one problem, and not seeing results immediately doesn’t mean that wasn’t a good thing to have done. You can’t always tell the good idea from a bad idea until other problems are also solved.
I’m also reading the Dartmouth Atlas piece (not for the whole period between my posts 🙂 ), and it doesn’t really make much sense to me, either. When they increase the number of beds, what happens to the price? Supply and demand works in a lot of places, and they make no mention that the price remains constant that I remember reading. Plus, economic “costs” are necessarily monetary costs. If the new wards are nicer, or if the rationing of the previous system was some non-price function, like they turned away the non-surgical patients when they didn’t have the beds, then of course they’d get more non-surgical patients when the number of beds went up. There may be a rational point being made here and I’m not seeing, but I’m not seeing it.
Besides, again, this is Medicare; even if there’s some point to be made here, it’s to be made about government-run health care.
Excuse me; economic “costs” are NOT necessarily monetary costs.
I agree with you, Johnathan. The piece seemed very illogical. For instance, the Doctor quoted (and included by Jim) notes that the problem is protecting from Tort. He even says that reform has stopped the abusive lawsuits. It is easy to find where insurance companies cut their premiums in Texas by 15% in the two years after passing that law. So apparently, tort reform worked.
That conclusion doesn’t fit the Harvard professor’s narrative, so he avoids it. Instead, he makes a claim that the doctors are still providing care above and beyond what is necessary, which create higher costs for little gain. If what he says is true, then doctors appear to be gaming the system. But again, that conclusion is avoided, since it would show that Medicare can be manipulated.
So when a logical conclusion can not be made, the Harvard professor drops his “apples to apples” comparison of El Paso to McAllen (they are in the same state and same border don’t you know… just 800 miles apart, with one near desert mountains and the other near a coastline, exactly the same…) and jumps to comparing McAllen with comparative population centers that have socialized medicine. With none of the same social economic factors being in comparison, the Harvard professor claims they are the same except for one provides free preventive care that lowers costs (heh didn’t El Paso have lower costs, similar size, similar environment, and no social healthcare?).
And that’s if you take the article on face value. But if you read it again, you note that many of the arguments are annecdotal stories. In fact, the sources of the annecdote are anonymous. You can’t verify any of the stories being told. And those stories are chopped full of opinions, and low on facts.
It wasn’t a tax cut, it was a tax-rate cut, and it wasn’t that “enormous.”
The CBO puts its price tag at $340B, so as passed it was both a tax rate cut and a tax cut.
If it had been, they wouldn’t have been able to pass it.
And yet Bush was able to pass a $1.35T tax cut (amount according to the CBO) in 2001, when the GOP had smaller majorities in Congress.
These changes were more expensive than the health care reform plans being proposed now, and clearly were higher priorities to the GOP than doing anything about health care.
The CBO puts its price tag at $340B
There’s no way they can know that.
And your other two idiotic examples were Bush priorities, not GOP priorities. Kennedy helped write NCLB. And the Democrats love to enlarge entitlements like Medicare. No wonder they were easy to pass.
Dr. Gawande worked on President… errr… Hillary Clinton’s Health Care Task force in 1993. Seems he has a bias for socialized medicine.
This is a poor argument in a number of ways. First of all, the notion that belief is the same thing as bias. Gawande is a surgeon and researcher (he has a degree in public health). Like many experts on public health, he’s seen lots of data and research to suggest that socialized medical care delivers better results for less money. So he may well believe that socialized medicine is better; that does in and of itself not make his reporting of facts (e.g. what Medicare spends in McAllen, or what doctors told him there) suspect. If it did, we would not accept any facts from reporters who had ever drawn any conclusions from what they learned — we would require that all reporters be incapable of thought.
In fact, the bias argument works more strongly the other way. Gawande may think that socialized medicine works better, but he makes his money as a pay-for-service surgeon and as a writer. The current system gives him more money from both professions: sky-high reimbursements from Medicare and other insurers, and lots of great stories generated by a failing system. If anything, Gawande has a strong personal interest in stopping change.
But most of all, this argument falls on its face because the article isn’t about whether socialized medicine is good or bad. It’s about why health care costs so much. And most of the examples come from Medicare — a government-run, single-payer, socialized system. If he had a bias for socialized medicine, wouldn’t he focus on how Medicare is better than private medicine? Instead he focuses on Medicare’s Achilles Heel, it’s rising costs.
Finally, Leland does not dispute the easily verified fact I passed along: that McAllen, Texas has extremely high medical costs, despite tort reform. In fact, Leland has offered no evidence to suggest that states with tort reform (like Texas) are seeing less health care inflation than the rest of the country. Continuing to argue that tort abuse is a major part of health care inflation, and that tort reform is therefore a solution, is a clearly a matter of ideology triumphing over evidence.
It seems that the high costs come from Medicare being billed for unnecessary tests. How exactly does that argue that government controls costs better?
It doesn’t, obviously. It does argue that Medicare will need to control costs better, or else the rest of the country could go the way of McAllen.
Secondly, the comparison town is El Paso. The last time I was in El Paso, it was in Texas. This has no relevance at all to the Texas litigation reform.
McAllen was also compared to every other town in the country, most of which are outside of Texas and do not have tort reform; its costs exceed those in every other American town except Miami. That is not what you would expect if tort abuse was the #1 cause of health care inflation.
There’s no way [tort reform] didn’t reduce some of their costs. It’s only a fact that other costs went up more.
Which, again, suggests that malpractice isn’t the biggest part of the problem.
Insurance isn’t really to distribute costs across many different people, but to distribute costs over a single person’s life time.
Where did you get this idea? I pay for homeowner’s insurance that I statistically will never need. A lifetime’s worth of homeowner’s insurance premiums would not be enough to replace my house. But if something does happen to my house, the insurance company will use premiums paid by other, luckier people, to make good on my coverage. Of course insurance spreads risk across multiple people.
When they increase the number of beds, what happens to the price?
Nothing. The Medicare reimbursement rate for a bed does not go down when there are empty beds, and up when they’re all full. Neither does the reimbursement rate offered by private insurance.
It is easy to find where insurance companies cut their premiums in Texas by 15% in the two years after passing that law. So apparently, tort reform worked.
Cut their malpractice premiums, or their health insurance premiums? If it was the latter, note that health insurance premiums have been going up about 10% a year. An 18 month hiatus from that inflation is nice, but it doesn’t address the real problem, which is the underlying 10% inflation rate.
Instead, he makes a claim that the doctors are still providing care above and beyond what is necessary, which create higher costs for little gain. If what he says is true, then doctors appear to be gaming the system.
No, they are just responding to the incentives in front of them. Medicine is full of judgement calls. One doctor may choose option A, another option B, and both are medically defensible. Option A may increase the doctor’s income more than option B; that doesn’t mean that choosing option A is “gaming the system.” But we shouldn’t be surprised if more and more doctors find themselves choosing option A — from their perspective, what’s the downside? And the doctor’s financial interest isn’t the only factor at play. The patient may be reassured that the test-ordering doctor is covering every base.
Similarly, there may be no strong medical case for keeping a patient at the hospital another night, and if there were no free beds, you’d send them home. But if there is a free bed, why not play it safe and keep them in another night? The patient may be relieved to have another night of nursing care before having to rely on friends or family at home. Then you notice that there aren’t as many free beds as there used to be — perhaps we should build a new patient wing?
With insurance (private or public) paying the bills, you don’t have to assume doctor or hospital malfeasance to see how costs can escalate.
Which is why Gawande talks about the local physician culture. If your peers look at you suspiciously when you order more tests than are common in that town, you might think twice about it. If everyone is ordering lots of tests, and setting up nice offices, and buying nice houses and cars, you aren’t going to feel like there’s a problem doing the same. McAllen seems to have crossed a group tipping point in that regard. And there isn’t anything to stop other communities from doing the same.
I wrote: The CBO puts its price tag at $340B
Rand wrote: There’s no way they can know that.
We’re talking about how the GOP expressed its priorities. When they voted for Bush’s two big tax cuts, the CBO price tags were $1.35T and $340B — that’s what they voted for. Now they whine about ARRA, which the CBO scores as having spending that is one third as large as the Bush tax cuts they voted for. They whine about health care reform, which the CBO pegs as much smaller than the tax cuts they voted for.
That great sage Joe Biden quoted his father as saying something like: “Don’t tell me what your priorities are, show me your budget and and I will tell you what you value.” The GOP has shown that it values tax cuts much more than any sort of health care reform.
And your other two idiotic examples were Bush priorities, not GOP priorities.
Bills originate in Congress, and do not advance without the consent of the majority party leadership. NCLB and Medicare Part D were GOP bills, and they passed because they were GOP priorities.
We’re talking about how the GOP expressed its priorities. When they voted for Bush’s two big tax cuts, the CBO price tags were $1.35T and $340B — that’s what they voted for. Now they whine about ARRA, which the CBO scores as having spending that is one third as large as the Bush tax cuts they voted for.
Because letting people keep their own money promotes economic growth, instead of big government. “Tax cuts” are not the same as spending increases. I know that Marxists like you think that everything belongs to the state, and that we should be grateful for anything it is generous enough to let us keep, but it’s not true.
Because letting people keep their own money promotes economic growth, instead of big government.
Whatever. The fact remains that the GOP is more interested in tax cuts than in reforming health care in any fashion. That’s why the choices today are Democratic health care reform or no reform.
From the supposedly unbiased Dr. Gawanda, who just happened to get paid by the Clinton White House:
I gave the doctors around the table a scenario. A forty-year-old woman comes in with chest pain after a fight with her husband. An EKG is normal. The chest pain goes away. She has no family history of heart disease. What did McAllen doctors do fifteen years ago?
Send her home, they said. Maybe get a stress test to confirm that there’s no issue, but even that might be overkill.
And today? Today, the cardiologist said, she would get a stress test, an echocardiogram, a mobile Holter monitor, and maybe even a cardiac catheterization.
Here is what happened in the UK last week:
Debra Beavers, 39, phoned NHS 24 twice in two days before getting a hospital appointment. But a doctor gave what her family described as a cursory examination lasting 11 minutes, before advising her to buy over-the-counter medicine Ibuprofen.
Family members claim the medic was abrupt and rude – and when Debra clutched her chest, he told her: “Your heart is on the other side.”
Seven hours later, the mum-of-two collapsed and died from a heart attack in front of her 13-year-old boy.
Cut their malpractice premiums, or their health insurance premiums? If it was the latter
Heh… still clueless.
Leland does not dispute the easily verified fact I passed along: that McAllen, Texas has extremely high medical costs, despite tort reform.
Because it is an illogical conclusion, which is a point I did make. By the logic Jim provides, why has tort reform worked in McAllen to lower malpractice insurance and also in all other locations in Texas? There are plenty of arguments explaining why medical costs are higher, just go to the Texas Medical Association to see their rebuttal of Dr. Gawanda’s argument. And get this, TMA compares McAllen to other Texas towns, that have the same laws, and also have lower healthcare costs. In fact, Texas is below the national average for healthcare costs. And that’s an interesting fact, since it does have some tort reform and doesn’t have socialized medicine.
By the logic Jim provides, why has tort reform worked in McAllen to lower malpractice insurance and also in all other locations in Texas?
Because it’s lowered malpractice exposure. But it hasn’t brought health care spending under control, because malpractice isn’t the primary reason for health care inflation.
And get this, TMA compares McAllen to other Texas towns, that have the same laws, and also have lower healthcare costs. In fact, Texas is below the national average for healthcare costs. And that’s an interesting fact, since it does have some tort reform and doesn’t have socialized medicine.
It does have socialized medicine, it has Medicare (and Medicaid, and VA medicine, and DOD health care…). That’s what the article was about.
Meanwhile, you think Gawande is biased by a paycheck he got 16 years ago, but you take the Texas Medical Association’s word that doctors aren’t ordering unnecessary tests in McAllen?
As for your UK heart attack story: is your argument that every town should practice medicine like they do in McAllen, to prevent that sort of misdiagnosis? Are you prepared to spend $15k per Medicare recipient per year to do that? Have you noticed that all that money spent in McAllen hasn’t actually saved lives or improved health compared to lower-spending towns like El Paso?
It does have socialized medicine, it has Medicare (and Medicaid, and VA medicine, and DOD health care…). That’s what the article was about.
You’re right. That’s the part considered too expensive.
Meanwhile, you think Gawande is biased by a paycheck he got 16 years ago, but you take the Texas Medical Association’s word that doctors aren’t ordering unnecessary tests in McAllen?
Since they didn’t make that claim, and neither did I; I think your strawman just fell down.
As for your UK heart attack story: is your argument that every town should practice medicine like they do in McAllen, to prevent that sort of misdiagnosis?
Another strawman. My argument is that I don’t what UK like healthcare. I’ve been pretty clear about that argument.
Are you prepared to spend $15k per Medicare recipient per year to do that?
Apparently that is what is already being spent.
Have you noticed that all that money spent in McAllen hasn’t actually saved lives or improved health compared to lower-spending towns like El Paso?
Have you noticed that Texas Tort Reform covers El Paso?
Will an enthusiastic supporter of tort reform please provide an example proving it lowers health care insurance premiums for employers or individual policy holders?
I would like to see an example of a state where tort reform has been enacted and the state’s citizenry has since seen a refreshing drop in their premiums and deductibles. There are more than thirty states where tort reform has been enacted in the last couple of decades, so this should be an easy exercise, right?
Of course, judging by some of the ill-mannered posts on this thread, I’ll probably be called an “idiot” or “dipshit” for even asking the question.