TW: I have posted before about the senior voting bloc. It is large, it votes and it is growing. The Republicans have found political gold in claiming Obamacrats are seeking to slow medical spending on seniors. We are. But then we must slow the rate of increase on medical spending across all demographics or else medical spending will grow from the 8% of GDP of the 1970's to the 16% of the naughties to 30%+ by the 2030s.
Conservative columnist Douthat asks whether the Republicans are opening a pandora's box by pandering so baldly to the 65+ yr voters.
From Ross Douthat at NYT:
"...If the Democratic Party’s attempt at health care reform perishes, senior citizens will have done it in, not talk-radio listeners and Glenn Beck acolytes. It’s the skepticism of over-65 Americans that’s dragging support for reform southward. And it’s their opposition to cost-cutting that makes finding the money to pay for it so difficult.
That’s because they’re the ones whose benefits are on the chopping block. At present, Medicare gives its recipients all the benefits of socialized medicine, with few of the drawbacks. Once you hit 65, the system pays and pays, without regard for efficiency or cost-effectiveness.
...Republicans find themselves tiptoeing into an unfamiliar role — as champions of old-age entitlements.
....You can understand why Republicans, after decades of being demagogued for proposing even modest entitlement reforms, would relish the chance to turn the tables. But this is a perilous strategy for the right.
Medicare’s price tag, if trends continue, will make a mockery of the idea of limited government. For conservatives, no fiscal cause is more important than curbing this exponential growth. And by fighting health care reform with tactics ripped from Democratic playbooks, and enlisting anxious seniors as foot soldiers, conservatives are setting themselves up to win the battle and lose the longer war.
...But for now, their strategy means the country suddenly has two political parties devoted to Mediscaring seniors — which in turn seems likely to make the program more untouchable than ever.
And if you think reform is tough today, just wait. We’re already practically a gerontocracy: Americans over 50 cast over 40 percent of the votes in the 2008 elections, and half the votes in the ’06 midterms. As the population ages — by 2030, there will be more Americans over 65 than under 18 — the power of the elderly and nearly elderly may become almost absolute.
In this future, somebody will need to stand for the principle that Medicare can’t pay every bill and bless every procedure. Somebody will need to defend the younger generation’s promise (and its pocketbooks). Somebody will need to say “no” to retirees.
That’s supposed to be the Republicans’ job. They should stick to doing it."
http://www.nytimes.com/2009/08/17/opinion/17douthat.html?_r=1&scp=1&sq=ross%20douthat%20grandma&st=cse
6 comments:
Yep, medicaire spending is a pickle, all right. And the Rep. perscription benefit, for example, was stupid. (And the NRO-nics went *insane* over it, btw. . .)
But let's not forget this lesson: Medicaire was/is a progressive idea, the seed of which was planted by a progressive administration. Looked great on paper. It's a great ideal. Now look what we're stuck with. And there's no repealing this entitlement.
What I don't understand is the type of policy wonk (like you, I think, if I understand your position) who points the finger at medicaire and its problems and then says, "We want that for everyone else, only less of it for the old folks." The phrase "Good money after bad" is ringing in my ears.
As for who paid for Pedro's surgery/care. Sigh. Talk about a Top 5 List of things I do NOT want to have to talk with my in-laws about. . . He is OBSESSED with health care reform issues right now (again: retired physician, time on his hands. . .) and I knew it would not be a simple Q & A phone call.
I KNEW I'd have to listen to all that is wrong with the proposed 1000 pages of legislation (and the fact that it's 1000 pages doesn't really help the Dems, who haven't read it, does it? I mean, they're not really helping themselves out much. . .) and then, in connection, all that is wrong with Obama.
But I made the phone call. For you, Mr. White. And I got the relevant data:
80% covered by medicaire.
20% covered by his supplemental insurance policy.
His PSA was a 2.5. The doctors said to come back in 6 months and if it was bigger than a 4, then they'd know it was cancer. But Pedro's research had revealed that the jump from 1 to 2.5. in 1 year was itself an indication that this was cancer.
The test he insisted on, that the doctors said was not necessary, wouldn't have been administered if this were a single payer system. (Unless that system permitted patients to pay for their own tests, which he would have done. Of course, this means the system would also have to assure availability in its rationing, and not just cost control.)
And it was that test, as I said, that proved he had cancer and should be concerned about it. Had they waited the 6 months to see whether the PSA would go to 4, they would have found it metastatic throughout his body.
Finally, you've asked me how costs would be controlled in a more free market solution. And you say that health care is not bread.
But. It's kind of like bread. At least, a lot of it could be like bread: the meds, the check-ups, the routine tests--the stuff we use insurance for right now. But if we were paying for all this stuff out of pocket, and not letting someone else pay for it, we would pay attention to who gives the service cheapest. Dr. Smith is running a special on strep tests this January? I'm taking my kid to her because it'll save me 50% over Dr. Jones.
So. Just dreaming here. . . What if instead of paying LOADS of cash into insurance that covers everything, we pay only a bit of cash into insurance that pays for catastrophic care? We keep the rest of our money/the money our employers pay on our behalf. Maybe there could even be mandatory but individually held accounts to cover the pre-catastrophic expenses. E.g. Each money you have to pay X into your account until it gets to 15 grand, and you can use that account only to pay for medical expenses.
The cost control of all non- catastrophic services would then be the market.
While we're add it, a government voucher every one or two years for a mandatory health physical/screening. And the amount you pay into the insurance (I think I'm picturing a national insurance plan, believe it or not) is dependent upon your health risk. Fat people pay a lot more. Smokers pay a lot more. And if you don't want to go for the physical, fine. You pay the highest rate.
Key to this is that there's no one at the national insurance desk determining whether X gets funded. If the doctor orders a treatment, it is covered, either by you pre-cap, or by national insurance, post-cap.
As for costs of catstrophic events? I'd need to see what percentage of the health care pie these add up to. My guess is that it'd be OK for these costs to be high if we end up saving a great deal on all the other stuff.
How do physicians get paid? I have no idea. What's going to keep them well-distributed throughout the medical fields and not clumping up into the catastrophic zones where there's less competition to keep their costs down? No idea.
The Herp post comes tomorrow morning (11 am CST), then probably more screeds on Medicare. Agree with much of your "insurance" post. Getting folks away from not paying for most medical care out of pocket IS a huge problem. If it were up to me, we would go towards abolishing employee based insurance (a policy enthusiasticaly advocated by conservative think tanks and a few Dem ones and unethusiastically by Republican politicians due to its unpopularity).
Re Mr. Pedro, am not catching the connection between single payer and his treatment. Why was his doctor saying not to get the test, because of cost explicitly or just because the doc believed a protocol. No protocol is perfect obviously and at the end of the day Medicare covered the procedure.
The point about Pedro is not what actually happened, but what COULD happen under the reform currently proposed.
e.g. Can we envision a "reformed" system that simply would not have granted the test and/or would not have granted the surgery on a 75 year old man? (I should clarify that even after the test showed it to be cancer, the stats were still such that it wasn't likely to be an aggressive cancer. They can get that biospy only after the fact, and when they did, they learned it was a 9 on a scale of 1 to 10.)
I don't think it's medi-scare rhetoric to envision a "reformed" system that would have told Pedro "No" to both.
Back to my original question, then, WHAT'S THE GARAUNTEE that rationing in the reformed system won't tell patients like Pedro "No"? Where's your control for that?
There is no guarantee tomorrow just like there is no guarantee today. Why are you trying to create a level of perfection that has not, does not and will never exist?
Pedro due to his own expertise and work found an exception to a protocol. Why do you think in the future under reform the same result would not have occured?
If we spent even more money today on health care, more folks would live longer. Where does it stop? How is the baseline established.
Is your stance is that every humanly known test/treatment should be applied even if the probabilities are minimal.
Did not want to let this dangle...
"What I don't understand is the type of policy wonk (like you, I think, if I understand your position) who points the finger at medicaire and its problems and then says, "We want that for everyone else, only less of it for the old folks."
I do not want Medicare for everyone. Medicare is single payer, Obama's plan is not single payer.
Obama's plan has two primary goals: 1) universal coverage and 2) the initial steps in creating structures by which society can more rationally define how much it can afford to spend on health care.
I am not saying universal coverage should be applied on the backs of seniors. I am saying Medicare costs like ALL health care costs are going up too rapidly for our society to fund them.
I am saying ALL health care costs need to be addressed for efficacy and fairness.
I believe certain types of universal care should be available and I am asking why only seniors should get universal care but not others.
I am saying Dems are at least confronting these issues whilst generally the Republicans are demagoguing the issues. I acknowledge the opposition regardless of party has the easier job.
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