I ask all my liberal friends: please tell me how Geoff Colvin is wrong in his recent Fortune column? Just because the Republican Party has devolved into a pack of Druids in bad suits doesn’t mean they can’t have a good idea now and then. And in fairness, Rep. Paul Ryan seems less Druid-like than most of them. Nor is he playing Chicken Little when he warns us that the budgetary sky is falling on top of us at this very minute, and the principal cause is Medicare.
It cost over half a trillion dollars last year and it is rising fast. “Well, the wars cost even more than that!” you reply? “So what!” says I. End them too; the hole we need to fill is big enough for both plus agriculture subsidies and one or two other big programs. (I nominate HUD, but that’s another post.)
Besides, money isn’t the only problem with the current system; it may not even be the biggest problem. Conservatives are right when they say little good comes from the government making health care decisions. That doesn’t mean they have no role to play, but when grandma is 92 and could use a new knee, or even worse, a couple of months in intensive care before finally kicking off, it is grandma and the family that should decide if the expense is really worth it – not the fact that, “Oh, what the hell, Medicare will cover it.” And grandma and the family should have some skin in the game.
Having some skin in the game would surely cut down on waste, fraud and unnecessary procedures. It might even put an end to ads for the Scooter Store (see 6/4/10 post), which is justification enough for me.
Colvin is correct in saying that “the people aren’t dummies,” at least most of the time but especially when it comes to spending their money. If you are worried that some people won’t do well at making health care decisions you would be right, but you could always join the ranks of the many that will step up and provide intelligent counseling to consumers who want it. In any event, it will cause less pain and suffering than the collapse of the entire system. Just remember, the U.S. has greater debt per capita than Greece; this isn’t a small problem we are facing.
So, how is Colvin wrong?
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13 comments:
We are not broke because of medicare. We take in less as a % of GDP than all the major industrialized nations, yet we spend more than all of those nations combined on defense. Britain spends 7% of revenues on Defense, or Defence, and we spend over 20%.They also take in a much greater percentage of GDP than the US. We borrow money from Europe to defend it.
I am also sick of hearing tax breaks create jobs...I'm expanding my company because there is a demand for what we are doing...supply and demand. If we were to pay no taxes and there was no increase in demand for services, we would not hire more people just because we had the extra money. It has the ring of truth but it is not reality.
There has to be reform of medicare but giving a 75 year old a voucher and telling them to hit the open market will be a disaster.
http://costofwar.com/en/
Aside from the argument on the cost of war:
1 - "giving a 75 year old a voucher and telling them to hit the open market will be a disaster." - spot on.
2 - If free market capitalism is the holy grail, why had the environment gone down the tubes without oversight?
3 - Too much faith-based thinking has brought us to this day in spite of actual science. However, science as viewed by the right wing is merely politics. To actually get all parties to agree on who to sit on panels to review which medical procedures have validity and which do not would be another circus. But the common good demands which way to spend limited resources: faith-based medicine or evidence-based? Correctly done, it would trim a lot of fat from the medical equation.
4 - Incentives/disincentives for "health related lifestyles."
Quit going to war. If that's not enough, raise taxes. Medicare is the most efficient delivery system of medical care in the country. Single payer health care was the right answer, but never considered. Other countries manage it, why can't we? Maybe because we have the lowest tax rates in over 50 years and keep up a bloated "defense" industry?
As Dennis can attest to -- it's all about the marketing. Unfortunately, the Dems portray ANY adjustment to Medicare/Medicaid as evil and throwing granny into the streets. And the GOP just robotically repeats, "No taxes!"
Thoughtful discussion, like Jeff Colvin's article, is rare and few voters are willing to listen to anything but the talking heads.
This circle-jerk will continue until both sides realize they will have to make concessions. Unfortunately, they've both dug themselves in so deep with their flawed ideologies, it will take a disaster to shake them up.
Talk about having skin in the game -- the majority are multi-millionaires with a gold-plated health care plan paid for by we the people!
Welcome Back Dennis. This was a well thought post, with which I completely agree (we're really on the same page about HUD.)
This can't continue !
"Single payer health care was the right answer, but never considered." We can all thank Joe Lieberman for kissing Christ on this one.
How about the first step is to eliminate the current health insurance for both houses of congress and put them in with everyone else?
Apropos, my wife called me from work yesterday (she is a retailer) to say that our health insurance, which she pays and covers 3 people, was going from $3500 to $5100 per month. Now looking for a different insurance carrier/plan...
I cant stop "going to the war." Americans have been way to brainwashed with the idea that war is an acceptable happening.Fighting for our freedom,my ass. We lose more freedoms in Washington than we will ever lose from some goat herders getting lucky with some airplanes.Then again,the Russians could roll into DC & take over.
@KG - agree with you completely on taxes, military budget et al, but on Medicare? not so much. You (and Hankster) fail to say why it would be a disaster for the 75 year old. No rational system would be dropped out of the blue -- phased in over many years with lots of time to get used to it.
Most important is that this is a system that needs more market discipline. It's the only thing that will bring down costs in the system as a whole. Having the gov as a backstop for everything just encourages waste and fraud.
Somehow I distrust corporate America to give us a fair shake on health insurance. Management/BOD is answerable to shareholders and profits, not policy holders and outcomes, although they would have us believe it so by burning incense at the altar of the free market model. I know all too well that business success does not specifically produce better dentistry.
Regarding Colvin’s view about Medicare: It seems to me that the “People aren’t Dummies” approach is just pop magazine shorthand for the issue that the economist von Mises summed up with his own shorthand as “the knowledge problem.”
What he meant by that is that very few issues can be better solved by government central planners than by the people themselves. Roads, highways, and arming for national defense are the obvious examples. (Although the record of those in charge of national defense activities has been pretty poor throughout my lifetime.) Much past a very limited set of activities, government always makes a hash of it. In fact, government often makes a hash even of those activities for which it is well suited – inequities in application, inefficiencies in performance, stunning rises in price, and corruption – precisely because the unified central planning authority cannot possibly know what each individual needs, and cannot therefore optimize to the extent that the people, who are, after all, not dummies, can. This is precisely the point you make, Dennis, knowingly or not, about the necessity for the family to have some skin in the decision regarding grandma’s new knee versus hospice care.
The question of whether the people are dummies can often be a close call. Who among us had not looked at some recent election and said, wow, I guess the bozo electorate will vote in any crook, idiot etc. On the other hand, when you look at any recent news and see things like the Atlanta public schools scandal, and realize that the late superintendent there was during her tenure the most honored public educator in the nation (and was compensated accordingly), or look at the course of the “kinetic action” in Libya that our Brittany Spears president assured the people would last “days not weeks,” or the euro debt crisis which is about to come to a head, or Operation Gunrunner, or the entire picture in the Afpak war, it’s hard not to conclude that no one could have performed worse than the elites who are in charge at the top center planning positions.
We are as a nation, in my view, not broken. But what is unequivocally broken is our leadership class. Across every sector, and across every political aisle: in business, the congress, both parties, the academy, the bureaucracy, we are seeing the most, the most obvious, and the most highly compensated failures in our lifetimes. It is the people, the undifferentiated people, alone that keep the nation from exploding in anarchy.
The first step to a remedy is widespread recognition of the abyss into which the nation dangles. We’re getting pretty close on that when guys like Dennis start writing posts like this one. It will get worse rather than better for quite a while, such is the mess that our betters have delivered to us.
Finally, I have to wonder who, among those of you who read Colvin’s article and shook your heads in an affirmative way as you contemplated his contrast of government “brute force” vs. “Peoples Aren’t Dummies” methods, supported the one party cramdown of the biggest non-military government brute force program in human history, ObamaCare. The whole point of Colvin’s article, and Dennis’s subsequent post is what a mess this group of crooks, parasites, and improvers of mankind has made of Medicare, to the point that it threatens the nation. And yet some of you apparently believe that if we just give them more power and more of our money, then presto chango, equality of outcomes, efficiency, and happiness all around will result. Are you daft?
My skepticism regarding seniors, a group I proudly belong to, negotiating and managing health coverage is based on dealing with our employees and health coverage. My partner's and I make the decision on what plans we will provide our employees. HR provides all the information to employees and yet we always have people who did not understand and believe they made the wrong decision as to which of the three offerings they chose.
I have a retired friend who has Medicare and is still on his wife's policy. First option is Medicare and then his wife's policy picks up the difference. He says he can go three to four months trying again and again to get the private insurance to pick up the part they should pay.
Most people who work for us do not use their health insurance very often and they seem to be happy. It is the people who must use it who are so often surprised by what they thought would be covered and what turns out to be what is covered. Most of these folks are relatively young college educated people. I think the morass that is private health insurance has the potential to be way too complicated to someone who is in their 80's and in poor health.
I have sat with HR and our agent and walked out of the meetings unsure as to which is the right policy to pick, and I have 30+ years dealing with it.
The fact is that you are in an adversarial relationship with insurance companies; anything they don't pay is money in their pocket. I have had much better experiences dealing with the Medicare folks than the insurance people. Medicare was looking out for what was best for me; the insurance company representative was looking out for what was best for the company.
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