ObamaCare: You Get What You Pay For

[GH253]

---

Members do not see this ad.

Michael J. Hurd, Ph.D.

November 12, 2010

One of the dirty little secrets of Obama's health "care" debacle is that Medicare reimbursement rates are set to go down for all health care providers effective December 1. This means that the medical professionals to whom you trust your health, and, indeed, your very life, are having a 20-30 percent pay cut forced upon them in less than a month. Imagine, say, the autoworkers--or the teachers' unions--having to take such a pay cut. The indignant outrage would be swift and immediate. The simple fact is that doctors, whose training and wisdom often stand between us and pain or death, are more important than autoworkers or even teachers.

Doctor's rates are going down to pay for ObamaCare. ObamaCare seeks to nationalize health care by placing so many restrictions and unfunded mandates on private insurance companies that they will go out of business. Government will then step in to "manage" Medicare for the entire population, rather than only the elderly. The government monopoly on health care will most surely go just about as well as the monopoly on the post office or public education. Medicare, even if kept only for the elderly population, is going bankrupt. The only question is when, not if, Medicare (along with Social Security) will run out of money.

So how is the federal government, who has been busy creating a national deficit stretching into the trillions of dollars, supposed to sustain a program for the entire population that can't even sustain for the elderly? Obama's supporters glaze over and mumble, "Well, it's Medicare. It cannot go away. So stop talking about it."

The psychological process required for a catastrophe to mentally "settle in" usually comes in stages. A catastrophe such as the future implosion of entitlement benefits in America will come in stages. The first stage is happening on December 1: The decrease in reimbursement rates for doctors under Medicare. Congress might reverse the fee reductions for another month or so, but then what? The rate cuts in the legislation prove that members of both parties are aware that the government cannot continue to finance Medicare as we know it--even before the mandates imposed by ObamaCare go into full effect when government becomes the primary payer for all medical care.

Perhaps you think doctors make "too much." Specialists working outside the third-party reimbursement system (plastic surgeons, for example) can do fairly well, but general practitioners who accept Medicare do not earn as much as the liberals would like you to think. So, by what formula do you determine the right amount? Do you trust the private marketplace to set the prices by negotiation between individuals and their doctors? Or do you trust politicians in Washington, DC to determine a "one size fits all" price? If you actually believe the latter, remember that "you get what you pay for." If you think doctors, who spent thousands upon thousands for their training, are going to work twice as hard for 30 percent less pay (at least), then you had better think again. Would you? If not, then why would a doctor?

Our only hope for maintaining the quality and availability of competent doctors is the possibility that ObamaCare will be torn apart by the new Congress, or struck down by the Supreme Court before it does too much damage. Of course, this doesn't change the fact that Medicare, not to mention the entire federal government, is long since bankrupt and wallowing in ever-increasing debt. By pumping money into the financial system, the Federal Reserve is risking the greatest run of hyperinflation since the Weimar Republic of Germany, the failed government that gave rise to Adolf Hitler in the 1930s. And bigger problems are looming. The massive course reversals required of our government, and needed by the entitlement-addicted American people, are much bigger than the Tea Party or anything stated in the recent election campaigns.

Don't just feel sorry for your doctors, who will be paying for our "free" health care. Feel even sorrier for yourself—whether you're currently a patient, or might need medical care in the future. Our lives will be in the hands of doctors who have been told that they don't matter and that they are employees of the state. Their incentive will no longer be to provide excellent care. Their incentive will be to simply clock in, clock out, go through the motions and retire as soon as the government pension kicks in. Not all that different from many existing government employees.

The solution? Restore the free market, where doctors who work harder will earn more for their skill and dedication. Patients will once again be consumers who choose from competing practitioners for the best care possible. The government must get out of the way, and let people purchase their own health care in the open market--no different than how we buy computers, cars, airplane flights, food and everything else produced and delivered by people who compete for your dollar.

The transition to the free market might be uncomfortable at first. But what's the alternative? If doctors work for the government, then medical care will no longer be a profitable profession. The best and the brightest will no longer be compensated for their efforts. As with anything the government touches, the mediocre will thrive, but the brilliant will not. Innovation (the cornerstone of our medical industry) will end. Oh, yes, medical care "for all" will exist on paper. But it won't be worth the paper it's printed on.

 

[MOHS_01]

While I appreciate the sentiment, Dr. Hurd misses the mark on the gravity of the reimbursement cuts. If MC rates drop 30% across the board, that translates into a much, much larger % cut in physician compensation. A 30% hit in revenues halves your pay at best... and may strip away upwards of 80% of your pay (if your office overhead is pushing 60%). In any event, the effects of any cuts are magnified in the compensation numbers.

 

[GH253]

email him and tell him that. I'm sure he'd love to know, and he could use the info since he's fighting to save your profession:

"Michael J. Hurd, Ph.D." <[email protected]>

 

[MOHS_01]

Done.

 

[JaggerPlate]

Michael J. Hurd, Ph.D.

November 12, 2010

One of the dirty little secrets of Obama’s health “care” debacle is that Medicare reimbursement rates are set to go down for all health care providers effective December 1. This means that the medical professionals to whom you trust your health, and, indeed, your very life, are having a 20-30 percent pay cut forced upon them in less than a month. Imagine, say, the autoworkers--or the teachers’ unions--having to take such a pay cut. The indignant outrage would be swift and immediate. The simple fact is that doctors, whose training and wisdom often stand between us and pain or death, are more important than autoworkers or even teachers.

Doctor's rates are going down to pay for ObamaCare. ObamaCare seeks to nationalize health care by placing so many restrictions and unfunded mandates on private insurance companies that they will go out of business. Government will then step in to “manage” Medicare for the entire population, rather than only the elderly. The government monopoly on health care will most surely go just about as well as the monopoly on the post office or public education. Medicare, even if kept only for the elderly population, is going bankrupt. The only question is when, not if, Medicare (along with Social Security) will run out of money.

So how is the federal government, who has been busy creating a national deficit stretching into the trillions of dollars, supposed to sustain a program for the entire population that can’t even sustain for the elderly? Obama’s supporters glaze over and mumble, “Well, it's Medicare. It cannot go away. So stop talking about it."

The psychological process required for a catastrophe to mentally "settle in" usually comes in stages. A catastrophe such as the future implosion of entitlement benefits in America will come in stages. The first stage is happening on December 1: The decrease in reimbursement rates for doctors under Medicare. Congress might reverse the fee reductions for another month or so, but then what? The rate cuts in the legislation prove that members of both parties are aware that the government cannot continue to finance Medicare as we know it--even before the mandates imposed by ObamaCare go into full effect when government becomes the primary payer for all medical care.

Perhaps you think doctors make "too much." Specialists working outside the third-party reimbursement system (plastic surgeons, for example) can do fairly well, but general practitioners who accept Medicare do not earn as much as the liberals would like you to think. So, by what formula do you determine the right amount? Do you trust the private marketplace to set the prices by negotiation between individuals and their doctors? Or do you trust politicians in Washington, DC to determine a "one size fits all" price? If you actually believe the latter, remember that "you get what you pay for." If you think doctors, who spent thousands upon thousands for their training, are going to work twice as hard for 30 percent less pay (at least), then you had better think again. Would you? If not, then why would a doctor?

Our only hope for maintaining the quality and availability of competent doctors is the possibility that ObamaCare will be torn apart by the new Congress, or struck down by the Supreme Court before it does too much damage. Of course, this doesn’t change the fact that Medicare, not to mention the entire federal government, is long since bankrupt and wallowing in ever-increasing debt. By pumping money into the financial system, the Federal Reserve is risking the greatest run of hyperinflation since the Weimar Republic of Germany, the failed government that gave rise to Adolf Hitler in the 1930s. And bigger problems are looming. The massive course reversals required of our government, and needed by the entitlement-addicted American people, are much bigger than the Tea Party or anything stated in the recent election campaigns.

Don't just feel sorry for your doctors, who will be paying for our “free” health care. Feel even sorrier for yourself—whether you’re currently a patient, or might need medical care in the future. Our lives will be in the hands of doctors who have been told that they don't matter and that they are employees of the state. Their incentive will no longer be to provide excellent care. Their incentive will be to simply clock in, clock out, go through the motions and retire as soon as the government pension kicks in. Not all that different from many existing government employees.

The solution? Restore the free market, where doctors who work harder will earn more for their skill and dedication. Patients will once again be consumers who choose from competing practitioners for the best care possible. The government must get out of the way, and let people purchase their own health care in the open market--no different than how we buy computers, cars, airplane flights, food and everything else produced and delivered by people who compete for your dollar.

The transition to the free market might be uncomfortable at first. But what's the alternative? If doctors work for the government, then medical care will no longer be a profitable profession. The best and the brightest will no longer be compensated for their efforts. As with anything the government touches, the mediocre will thrive, but the brilliant will not. Innovation (the cornerstone of our medical industry) will end. Oh, yes, medical care "for all" will exist on paper. But it won't be worth the paper it's printed on.

I think I want to get this tattooed somewhere on my body.

In all honesty though, a refreshing and also harrowing article. It's frightening to think of all the potential implications and whether or not the current congress will be able to truly 'remove and replace,' on any sort of significant scale, OR if this will even make the issue any better (although I'm definitely on the right ... my faith in politicians in general is on life support). I also really appreciate some of the issues he brings up with funding medicare in general, and pointing out government fallacies in other public service arenas (post office, DMV, etc) and what an absolute nightmare this would become for health care.

 

[Lokhtar]

It's frightening to think of all the potential implications and whether or not the current congress will be able to truly 'remove and replace,' on any sort of significant scale, OR if this will even make the issue any better

First, a true free market would cause physician salaries to plummet.

Second, I will bet the life of my unborn child that there will be no repeal or replace on any part that has the remotest impact on physician salaries.

In fact, even if they could, they wouldn't. ~45% of healthcare spending was government even before this bill and every politician of both parties will run, not walk, away from being associated with the words 'medicare benefit cuts'. Seniors vote, and they vote en masse. Even right wing darlings like Rand Paul, who was for a deductible for decades flat out said no to that as soon as he ran for the Senate.

It's really good political rhetoric, but that's all that is.

 

[MOHS_01]

]First, a true free market would cause physician salaries to plummet. [/B]

Second, I will bet the life of my unborn child that there will be no repeal or replace on any part that has the remotest impact on physician salaries.

...

Truthfully -- you have zero way of knowing this as no semblance of a free market has existed in medicine for decades. You may strongly believe it, but that does not make it any more true. FWIW, I agree that many incomes would go down -- including mine. Some would likely go up, however, including many E&M heavy specialties.

 

[Lokhtar]

Truthfully -- you have zero way of knowing this as no semblance of a free market has existed in medicine for decades. You may strongly believe it, but that does not make it any more true. FWIW, I agree that many incomes would go down -- including mine. Some would likely go up, however, including many E&M heavy specialties.

That depends though on how much of a free market? In a 'true' free market, you wouldn't have residencies funded by the government, no restriction on the number FMGs coming over here and practicing, no rules against midlevels or others opening up practices for many of the procedures, and 99% of the population over 60 would pretty much have no healthcare.

Now if you mean free market where the government continues to artificially keep the supply lower than demand, then you'd be right of course. But then that's not really a free market.

 

[MOHS_01]

Did we not just go over the difference between statements of opinion and those of fact?

 

[Lokhtar]

Well, the things that would happen are a statement of facts if the restriction of practices and residencies are removed. Whether that would lead to a decrease across the board in compensation is a statement of opinion, but the reasoning for which is pretty straightforward.

 

[JaggerPlate]

First, a true free market would cause physician salaries to plummet.

Eh ... depends on a lot of factors, and actually depends a lot on how 'free' the market is. However, I think moving toward a model where more choice/responsibility is put on patients and less power is given to organizations that want to see big centralizations/ACO models is a good thing, both salary wise and for those who want to hold on to the idea of a private practice (where salaries are normally higher anyway).

Second, I will bet the life of my unborn child that there will be no repeal or replace on any part that has the remotest impact on physician salaries.

In fact, even if they could, they wouldn't. ~45% of healthcare spending was government even before this bill and every politician of both parties will run, not walk, away from being associated with the words 'medicare benefit cuts'. Seniors vote, and they vote en masse. Even right wing darlings like Rand Paul, who was for a deductible for decades flat out said no to that as soon as he ran for the Senate.

Sadly, I think that 'repeal and replace' was much more of a nice sound byte than anything realistic. I'd love it to happen (for various reasons, many which are essentially unrelated to salaries), but I'm unsure. However, I struggle to see how repealing certain aspects of it won't affect salaries in general. Even if you have to essentially extrapolate it out to 'what could happen' with Obamacare, I personally don't think it's that difficult to pinpoint numerous areas that, if removed, could have an impact (maybe not immediate) on salaries.

Additionally, I agree that the AARP (and their phenomenal lobbying group) keep most politicians fearful of touching medicare. However, it's my understanding that around 16% (I could be off) GDP is spent on health care in general, and I'm not sure how big of a portion of that goes to funding programs like Medicare/Medicaid ... but I can only assume it's substantial. I think the point though is that almost everyone knows it's a big, bloated, inefficient system (for almost everyone involved), and it could be a frightening indication of what more government control of the health care system could mean.

It may sound biased, shortsighted, opinionated, err whatever, but I'm honestly in favoring of repealing almost any portion of the bill they can get through. I know you've studied it extensively and think that many of the reactions are misguided and too extreme, but I think I'd feel a lot more certain about the future of health care in general if it was reevaluated, slowed a bit, and tweaked.

 

[Lokhtar]

Eh ... depends on a lot of factors, and actually depends a lot on how 'free' the market is. However, I think moving toward a model where more choice/responsibility is put on patients and less power is given to organizations that want to see big centralizations/ACO models is a good thing, both salary wise and for those who want to hold on to the idea of a private practice (where salaries are normally higher anyway).

I would disagree with that, but that's another debate that's been done a million times 🙂.

Sadly, I think that 'repeal and replace' was much more of a nice sound byte than anything realistic. I'd love it to happen (for various reasons, many which are essentially unrelated to salaries), but I'm unsure. However, I struggle to see how repealing certain aspects of it won't affect salaries in general. Even if you have to essentially extrapolate it out to 'what could happen' with Obamacare, I personally don't think it's that difficult to pinpoint numerous areas that, if removed, could have an impact (maybe not immediate) on salaries.

Like which parts? I've read the bill - the only parts that deal with salary is for things like radiological imaging and the part which gives money for ACO pilots. It's a big bill, so maybe I missed something, I'd be interested in where else physician salaries come into play.

Additionally, I agree that the AARP (and their phenomenal lobbying group) keep most politicians fearful of touching medicare. However, it's my understanding that around 16% (I could be off) GDP is spent on health care in general, and I'm not sure how big of a portion of that goes to funding programs like Medicare/Medicaid ... but I can only assume it's substantial. I think the point though is that almost everyone knows it's a big, bloated, inefficient system (for almost everyone involved), and it could be a frightening indication of what more government control of the health care system could mean.

That depends how you looked at it. Physicians certainly are not paid nearly as well as they are by private insurance. That does not make it inefficient - medicare spends less on administrative costs than private insurance. Those numbers are slightly fudged due to the different nature (not having to turn a profit, not having to run departments that exist to deny claims, etc) but at worst, it's a wash.

In terms of bloat, Medicare spends 30% of its budget on the last year of life. Most people agree that is ridiculous and is a waste of resources. And politicians of both stripes are way too smart to try to do anything about that. Hell, even the mention of end of life counseling got termed death panels....imagine what would happen if someone actively tried to advocate pulling the financial plug on grandma's care when there is no hope of recovery.

It may sound biased, shortsighted, opinionated, err whatever, but I'm honestly in favoring of repealing almost any portion of the bill they can get through.

I'm not sure you want to hope for that. I'm in favor of single payer, and I'm hoping a few things get repealed by the Republicans. That should tell you something.

In fact, I just wrote to my newly elected Senator about how he should push for the repeal of the individual mandate (hint: insurance companies are lobbying hard to keep the mandate, for good reason).

It's going to be a fun Congress.

 

[bronx43]

That depends though on how much of a free market? In a 'true' free market, you wouldn't have residencies funded by the government, no restriction on the number FMGs coming over here and practicing, no rules against midlevels or others opening up practices for many of the procedures, and 99% of the population over 60 would pretty much have no healthcare.

Now if you mean free market where the government continues to artificially keep the supply lower than demand, then you'd be right of course. But then that's not really a free market.

Exactly. This point cannot be over-stated. A true free market entails that there is no artificial limitation on supply - in the case of the medical profession, there can be no legislation or organizing bodies to restrict number of providers. A system where there is just enough supply allowed to saturate demand is not representative of a free market, even if there are no third party payers.

With that said, I simply can't foresee any change to a true free market, as described by Lokhtar. It would result, at least during the time of transition, far inferior patient outcomes than this nation is accustomed to. Without heavy regulations and accreditation bodies, the only quality control is from the consumers, which in the early stages would be catastrophic. There would initially be a heavy influx of providers offering care on varying levels of quality. When the outcomes become apparent, certain providers would consolidate and brand themselves. From there on, quality control would stem from competition and consumer satisfaction, as it is in any other free market industry.

 

[morning]

Where in the healthcare bill does it cut Medicare reimbursement, and is that stacked on top of the Republican-sponsored, Republican-passed SGR Medicare cuts? Is this guy conflating the two?

Because if Obamacare is supposed to be cutting Medicare by 30% and the Republicans' baby - SGR - is supposed to be cutting Medicare reimbursement by 20%, you're actually looking at a cut of 50%.

Since he doesn't mention SGR anywhere, it's hard to tell if he actually knows the difference.

 

[bronx43]

Where in the healthcare bill does it cut Medicare reimbursement, and is that stacked on top of the Republican-sponsored, Republican-passed SGR Medicare cuts? Is this guy conflating the two?

Because if Obamacare is supposed to be cutting Medicare by 30% and the Republicans' baby - SGR - is supposed to be cutting Medicare reimbursement by 20%, you're actually looking at a cut of 50%.

Since he doesn't mention SGR anywhere, it's hard to tell if he actually knows the difference.

If I'm not mistaken, I'm pretty sure there are no scheduled Medicare cuts in Obama's reform bill. This guy is referring to the annual SGR "cuts" that are delayed everytime by Congress.

 

[cpants]

What all these scheduled cuts are leading to is the following. Government is going to say of course we can't cut reimbursement by 30%. Then they will say, but we're going broke and doctors need to give some too. They make us look like the greedy bad guys, and we are basically forced to take a more modest 5 to 10% cut on our noninflation adjusted payment from 10 years ago. Then they amazing success, compromise, saving the system, etc, etc. The screwjob.

 

[bronx43]

What all these scheduled cuts are leading to is the following. Government is going to say of course we can't cut reimbursement by 30%. Then they will say, but we're going broke and doctors need to give some too. They make us look like the greedy bad guys, and we are basically forced to take a more modest 5 to 10% cut on our noninflation adjusted payment from 10 years ago. Then they amazing success, compromise, saving the system, etc, etc. The screwjob.

What did you expect? To get out of this whole ordeal unscathed? I mean, that'd be nice, but unrealistic. A 5% pay cut would be a godsend.

 

[cpants]

What did you expect? To get out of this whole ordeal unscathed? I mean, that'd be nice, but unrealistic. A 5% pay cut would be a godsend.

No I didn't expect to get out unscathed. I fully expect to get screwed royally. There is no one out there protecting doctors' interests. The AMA is impotent. We cannot unionize. What other field in healthcare has accepted a pay cut year after year? Check out the average nurse's salary from 10 years ago. They have appropriately increased with inflation and even made gains in real dollars. Why aren't we calling them greedy and cutting their salaries for the good of the system? Honestly, we should be talking about a raise right now.

 

[lee9786]

In fact, even if they could, they wouldn't. ~45% of healthcare spending was government even before this bill and every politician of both parties will run, not walk, away from being associated with the words 'medicare benefit cuts'. Seniors vote, and they vote en masse. Even right wing darlings like Rand Paul, who was for a deductible for decades flat out said no to that as soon as he ran for the Senate.

It's really good political rhetoric, but that's all that is.

It won't be the politicians that cut Medicare. It will be the bankruptcy of the U.S.A. Senior citizens won't get the care they need and will die. There are two options: 1) cut government spending drastically (ie entitlement programs Medicare/Medicaid and many others) 2) watch the collapse of the American economy. I'm not optimistic #1 will happen. We will see the free market soon enough.

 

[Lokhtar]

Haha.

If I was a millionaire, I would bet my entire net worth that there is zero chance of a "free market system".

You forgot the third option, single payer system. There isn't any way in hell anyone will vote for a politician who will drastically reduce medicine. None. Even Rand Paul has pledged not to cut Medicare - the senior vote is that crucial. Try getting to the right of him on these issues.....

 

[SFO-IST]

I believe in the private market system. It's incorporation into healthcare can reduce cost structures - if done correctly. That's why I'm dissapointed that this article uses silly slogans like "you get what you pay for" and faulty logic throughout each paragraph. Japan, who has a private healthcare system has higher health markers like life expectancy (among many others) than the US. How is it that you get what you pay for and yet they pay less and have longer life expectancies? My point is, This post is an oversimplification whose basis is political, not factual. People on all sides of the healthcare reform debate - and especially physicians - would be well served by looking at the issues more analytically rather than glossing over them with charged language like this post.

Some specific areas where I disagree:

Reducing income for "all specialties". I have heard from numerous physicians that this will actually be an income redistribution. I even remember seeing a chart somewhere on SDN that expanded this by specialty. This ("a greater emphasis on primary care") is exactly what numerous public health sources have been recommending.

The healthcare reform (the bill is not titled "ObamaCare" as right wing spinmasters try to call it) does not nationalize healthcare. It creates incentives for reduced cost structure while keeping the private structure of healthcare. The author seems to believe that any regulation placed on private insurance companies will drive them out of business. I'm sorry, but that's exactly how countries like Japan keep downward cost pressure on companies to achieve optimum healthcare cost structures.

The post then goes on to blame Democrats for creating the defecit.

No, Obama's supporters rightly point out that the Democrats left with a surplus while Bush CREATED the defect by starting two wars he did not know how to finish and paid for it with defect spending. Blaming democrats for spending money to try and jump start an economy in tailspin is illogical. The author's last quote rests on the assumption that medicare will collapse, which I do not agree with.

Anyways, this is all for now, later guys.

Michael J. Hurd, Ph.D.

November 12, 2010

One of the dirty little secrets of Obama’s health “care” debacle is that Medicare reimbursement rates are set to go down for all health care providers effective December 1. This means that the medical professionals to whom you trust your health, and, indeed, your very life, are having a 20-30 percent pay cut forced upon them in less than a month. Imagine, say, the autoworkers--or the teachers’ unions--having to take such a pay cut. The indignant outrage would be swift and immediate. The simple fact is that doctors, whose training and wisdom often stand between us and pain or death, are more important than autoworkers or even teachers.

Doctor's rates are going down to pay for ObamaCare. ObamaCare seeks to nationalize health care by placing so many restrictions and unfunded mandates on private insurance companies that they will go out of business. Government will then step in to “manage” Medicare for the entire population, rather than only the elderly. The government monopoly on health care will most surely go just about as well as the monopoly on the post office or public education. Medicare, even if kept only for the elderly population, is going bankrupt. The only question is when, not if, Medicare (along with Social Security) will run out of money.

So how is the federal government, who has been busy creating a national deficit stretching into the trillions of dollars, supposed to sustain a program for the entire population that can’t even sustain for the elderly? Obama’s supporters glaze over and mumble, “Well, it's Medicare. It cannot go away. So stop talking about it."

The psychological process required for a catastrophe to mentally "settle in" usually comes in stages. A catastrophe such as the future implosion of entitlement benefits in America will come in stages. The first stage is happening on December 1: The decrease in reimbursement rates for doctors under Medicare. Congress might reverse the fee reductions for another month or so, but then what? The rate cuts in the legislation prove that members of both parties are aware that the government cannot continue to finance Medicare as we know it--even before the mandates imposed by ObamaCare go into full effect when government becomes the primary payer for all medical care.

Perhaps you think doctors make "too much." Specialists working outside the third-party reimbursement system (plastic surgeons, for example) can do fairly well, but general practitioners who accept Medicare do not earn as much as the liberals would like you to think. So, by what formula do you determine the right amount? Do you trust the private marketplace to set the prices by negotiation between individuals and their doctors? Or do you trust politicians in Washington, DC to determine a "one size fits all" price? If you actually believe the latter, remember that "you get what you pay for." If you think doctors, who spent thousands upon thousands for their training, are going to work twice as hard for 30 percent less pay (at least), then you had better think again. Would you? If not, then why would a doctor?

Our only hope for maintaining the quality and availability of competent doctors is the possibility that ObamaCare will be torn apart by the new Congress, or struck down by the Supreme Court before it does too much damage. Of course, this doesn’t change the fact that Medicare, not to mention the entire federal government, is long since bankrupt and wallowing in ever-increasing debt. By pumping money into the financial system, the Federal Reserve is risking the greatest run of hyperinflation since the Weimar Republic of Germany, the failed government that gave rise to Adolf Hitler in the 1930s. And bigger problems are looming. The massive course reversals required of our government, and needed by the entitlement-addicted American people, are much bigger than the Tea Party or anything stated in the recent election campaigns.

Don't just feel sorry for your doctors, who will be paying for our “free” health care. Feel even sorrier for yourself—whether you’re currently a patient, or might need medical care in the future. Our lives will be in the hands of doctors who have been told that they don't matter and that they are employees of the state. Their incentive will no longer be to provide excellent care. Their incentive will be to simply clock in, clock out, go through the motions and retire as soon as the government pension kicks in. Not all that different from many existing government employees.

The solution? Restore the free market, where doctors who work harder will earn more for their skill and dedication. Patients will once again be consumers who choose from competing practitioners for the best care possible. The government must get out of the way, and let people purchase their own health care in the open market--no different than how we buy computers, cars, airplane flights, food and everything else produced and delivered by people who compete for your dollar.

The transition to the free market might be uncomfortable at first. But what's the alternative? If doctors work for the government, then medical care will no longer be a profitable profession. The best and the brightest will no longer be compensated for their efforts. As with anything the government touches, the mediocre will thrive, but the brilliant will not. Innovation (the cornerstone of our medical industry) will end. Oh, yes, medical care "for all" will exist on paper. But it won't be worth the paper it's printed on.

 

[lee9786]

Haha.

If I was a millionaire, I would bet my entire net worth that there is zero chance of a "free market system".

You forgot the third option, single payer system. There isn't any way in hell anyone will vote for a politician who will drastically reduce medicine. None. Even Rand Paul has pledged not to cut Medicare - the senior vote is that crucial. Try getting to the right of him on these issues.....

You missed the point. There is no action politically to cut entitlement benefits. The economy crashes due to government overspending just like the U.S.S.R. There is no choice. Than again the government will most likely implement martial law to restore order. Political reformation will most likely be totalitarian. So I guess the pendulum could swing either way depending on the circumstances.

 

[Lokhtar]

You missed the point. There is no action politically to cut entitlement benefits. The economy crashes due to government overspending just like the U.S.S.R. There is no choice. Than again the government will most likely implement martial law to restore order. Political reformation will most likely be totalitarian. So I guess the pendulum could swing either way depending on the circumstances.

Neither will happen.

Taxes will be raised, we'll probably have a single payer. Both good things, as far as I'm concerned.

The costs are high but not as high as you make them out to be. We spend more on defense than medicare.

 

[MOHS_01]

Neither will happen.

Taxes will be raised, we'll probably have a single payer. Both good things, as far as I'm concerned.

The costs are high but not as high as you make them out to be. We spend more on defense than medicare.

Today we do, but what are the projections for the next decade? Remove the two ongoing wars and then how do the numbers stack up? The hard reality of the matter is that defense spending will be curtailed, but the real albatross is the social program spending and interest on debt payments. The whole mess was predicted by many before the programs were even enacted; politicians have always over promised and under delivered, and this is only compounded by our monetary policy. They rarely fully fund any of their "great" ideas in real time through taxation... knowing full well that those who are to have their labor and property seized will push back. By employing such a system they have removed a vital and necessary check against state growth...

Such is the case with both MC and SS. Their funding was structurally unsound from the beginning. In truth, the majority of our federal funding structure is unsound... but that is another discussion for another day. Medicaid was always a pure welfare program; MC and SS will likely have to become increasingly more so as time goes on. (As an aside -- they took great care to guarantee that these were NOT welfare programs when they were established... for if they were to have been honest about what these programs represented they never would have come into existence -- and they knew that.) SS should be easy enough to fix; just admit that it's a redistributionist/welfare program, means test, and raise the retirement age. Try some honesty with those who are currently working (you're f*****, sorry fellas. Maybe put some more in your 401k? While you're at it, stop smoking, eat better, and take care of that back.... because you'll be working until you can either afford to retire of your own accord, your family chooses to take you on as a dependent, or you check out of this world.) Medicare will be tougher because it will require rationing, something that will prove to be both politically and socially difficult.... and won't happen until after they have decimated our profession in the process.

In any event, it is just a touch ignorant to even hint that anything other than social program spending constitutes the major fiscal problem.

 

[MOHS_01]

Lokhtar,

Serious question -- how do you propose that a single payer system would correct the problems we now face?

 

[MOHS_01]

double post

 

[Lokhtar]

Today we do, but what are the projections for the next decade? Remove the two ongoing wars and then how do the numbers stack up?

You can't really do that though - can you? The wars are a huge part of the reason of why we are here now.

I agree that it wouldn't have passed if seen as a welfare program, but it's interesting that they are now so staunchly ingrained in our society that even the most right wing of libertarians in the Senate won't touch it (Ron Paul does, but he's in the house and the House always contains a few people that're a bit wonky at the best of times).

Lokhtar,

Serious question -- how do you propose that a single payer system would correct the problems we now face?

Well, the it's important to realize that you can't have costs increasing higher than inflation. At some point, something gives. It could be one of many things: you cover progressively less and less amount of people as more and more people are unable to afford care, or eventually go bankrupt.

The only way to stop that is by cutting salaries, decreasing services, and increasing efficiency - probably a combination of at least two out of three (obviously I'm a bit biased so I wouldn't like to see a cut in physician salaries, but there's no chance of that).


A single payer allows you to better do all three.

1. First, everyone is covered from birth to death. Meaning, you have a pool of healthy young adults who rarely if ever need coverage but are paying a 'SSP' (Single Payer Tax) which effectively help subsidize the care for the older and the sick. That is essential in any insurance system, private or public - the healthy subsidize the sick. But if you don't have a pool of healthy people, the system can't really work. The bigger the healthy pool compared to the sick pool, the better it is overall in terms of how much each person has to pay. This alone might increase overall spending (due to more people in the system) but decrease the individual contributions for each individual. Making it a win-win for most people. Except the young healthy who don't pay ****, but that's too bad because if they get into an accident without insurance right now - we (the taxpayers) are on the hook for them anyway. If you want to be treated by physicians when you get into an accident, you should pay into that system if you can afford it.
2. Second, it provides an automatic cap on the amount of spending. Meaning, the total budget is only so much, and to increase that, you need to increase taxes - a notoriously hard thing to do. It also allows the citizens more control over the costs - the fact of the matter is much of medicare spending is wasted on the last year of life (30% of it in fact). That's a huge waste that almost everyone agrees is a waste, but we do it. Every single payer or socializedd medical system realizes this - except for the US. Allowing more central control over these decisions will make it easier (especially if we don't give Congress direct control, e.g, there is a committee appointed by congress and who is given a budget and they decide the payment structure/coverage of procedures).
3. Increases efficiency - no more large departments that deal with insurance hassles, insurance companies not spending millions on finding loopholes in people's coverage, no retroactive cancellations, etc. Almost immediately, despite covering more people, we'd start by spending 100 billion less per year (and that includes keeping the current payment system of most private insurers) if we went to a single payer system (Congressional Budget Office) - we spend 80% more than other socialized countries on administration.

And by the way, other things have to happen as well. Things like malpractice reform where either the awards are capped or the accuser is forced to pay the physician's court costs if they lose. Moving away from a 100% FFS system to a more equitable system that closes the gap in payments between specialties (e.g, doctors should be paid for 'thinking' and 'diagnosing' and not just for procedures, etc). Maybe ACOs are part of the solution, maybe they aren't - but it's worth trying.

 

[hithere3387]

You can't really do that though - can you? The wars are a huge part of the reason of why we are here now.

I agree that it wouldn't have passed if seen as a welfare program, but it's interesting that they are now so staunchly ingrained in our society that even the most right wing of libertarians in the Senate won't touch it (Ron Paul does, but he's in the house and the House always contains a few people that're a bit wonky at the best of times).



Well, the it's important to realize that you can't have costs increasing higher than inflation. At some point, something gives. It could be one of many things: you cover progressively less and less amount of people as more and more people are unable to afford care, or eventually go bankrupt.

The only way to stop that is by cutting salaries, decreasing services, and increasing efficiency - probably a combination of at least two out of three (obviously I'm a bit biased so I wouldn't like to see a cut in physician salaries, but there's no chance of that).


A single payer allows you to better do all three.

1. First, everyone is covered from birth to death. Meaning, you have a pool of healthy young adults who rarely if ever need coverage but are paying a 'SSP' (Single Payer Tax) which effectively help subsidize the care for the older and the sick. That is essential in any insurance system, private or public - the healthy subsidize the sick. But if you don't have a pool of healthy people, the system can't really work. The bigger the healthy pool compared to the sick pool, the better it is overall in terms of how much each person has to pay. This alone might increase overall spending (due to more people in the system) but decrease the individual contributions for each individual. Making it a win-win for most people. Except the young healthy who don't pay ****, but that's too bad because if they get into an accident without insurance right now - we (the taxpayers) are on the hook for them anyway. If you want to be treated by physicians when you get into an accident, you should pay into that system if you can afford it.
2. Second, it provides an automatic cap on the amount of spending. Meaning, the total budget is only so much, and to increase that, you need to increase taxes - a notoriously hard thing to do. It also allows the citizens more control over the costs - the fact of the matter is much of medicare spending is wasted on the last year of life (30% of it in fact). That's a huge waste that almost everyone agrees is a waste, but we do it. Every single payer or socializedd medical system realizes this - except for the US. Allowing more central control over these decisions will make it easier (especially if we don't give Congress direct control, e.g, there is a committee appointed by congress and who is given a budget and they decide the payment structure/coverage of procedures).
3. Increases efficiency - no more large departments that deal with insurance hassles, insurance companies not spending millions on finding loopholes in people's coverage, no retroactive cancellations, etc. Almost immediately, despite covering more people, we'd start by spending 100 billion less per year (and that includes keeping the current payment system of most private insurers) if we went to a single payer system (Congressional Budget Office) - we spend 80% more than other socialized countries on administration.

And by the way, other things have to happen as well. Things like malpractice reform where either the awards are capped or the accuser is forced to pay the physician's court costs if they lose. Moving away from a 100% FFS system to a more equitable system that closes the gap in payments between specialties (e.g, doctors should be paid for 'thinking' and 'diagnosing' and not just for procedures, etc). Maybe ACOs are part of the solution, maybe they aren't - but it's worth trying.

In general, I think what you've said here is true. However, we cannot ignore the huge negative impact that a switch to a single payer system would have on the economy. About 1/6 of our economy is derived from the dealings of private insurance. Health care is good for most. Money is good for everyone.

 

[Lokhtar]

In general, I think what you've said here is true. However, we cannot ignore the huge negative impact that a switch to a single payer system would have on the economy. About 1/6 of our economy is derived from the dealings of private insurance. Health care is good for most. Money is good for everyone.

1/6 of our economy is not private insurance. ~45% of that 1/6 is already government spending. That spending wouldn't disappear, it'd be the government doing it instead of private insurance.

And even if there was a negative impact, I'm relatively sure it's better than total bankruptcy which is where healthcare spending is heading right now.

 

[MOHS_01]

You can't really do that though - can you? The wars are a huge part of the reason of why we are here now.

Of course you can -- bring the troops home. Try some objectivity -- it may hurt a little, but it won't kill you -- I promise. The wars, expensive as they were/are, are small fry compared to the other fiscal problems.

Well, the it's important to realize that you can't have costs increasing higher than inflation.

What? Just stop to think about that for a second.... that statement is no more true for healthcare than it is for any good or service (well, that is unless you want to proceed with your system of central planning with x% of GDP assigned to a sector.... a system that has demonstrated biblical failure with amazing uniformity throughout history). Of course there are limits to potential expenditures -- that is the natural and inevitable result of scarcity -- but nothing ties any good or service expenditure to "inflation"... and claims to the contrary speaks to a poor understanding of both "inflation" and freedom.

The only way to stop that is by cutting salaries, decreasing services, and increasing efficiency - probably a combination of at least two out of three (obviously I'm a bit biased so I wouldn't like to see a cut in physician salaries, but there's no chance of that).


A single payer allows you to better do all three.

Now we're getting somewhere; at least you are now acknowledging that your preferred system has to rely on force to accomplish its stated goals.

1. First, everyone is covered from birth to death. Meaning, you have a pool of healthy young adults who rarely if ever need coverage but are paying a 'SSP' (Single Payer Tax) which effectively help subsidize the care for the older and the sick. That is essential in any insurance system, private or public - the healthy subsidize the sick. But if you don't have a pool of healthy people, the system can't really work. The bigger the healthy pool compared to the sick pool, the better it is overall in terms of how much each person has to pay. This alone might increase overall spending (due to more people in the system) but decrease the individual contributions for each individual. Making it a win-win for most people. Except the young healthy who don't pay ****, but that's too bad because if they get into an accident without insurance right now - we (the taxpayers) are on the hook for them anyway. If you want to be treated by physicians when you get into an accident, you should pay into that system if you can afford it.

1. 
   
   That was one long winded way of saying "forced redistribution".
   
   

   [*]Second, it provides an automatic cap on the amount of spending. Meaning, the total budget is only so much, and to increase that, you need to increase taxes - a notoriously hard thing to do. It also allows the citizens more control over the costs - the fact of the matter is much of medicare spending is wasted on the last year of life (30% of it in fact). That's a huge waste that almost everyone agrees is a waste, but we do it. Every single payer or socializedd medical system realizes this - except for the US. Allowing more central control over these decisions will make it easier (especially if we don't give Congress direct control, e.g, there is a committee appointed by congress and who is given a budget and they decide the payment structure/coverage of procedures).

   
   More government / third party / philosopher king fiat. We simply must remove the freedom to choose...
   
   

   [*]Increases efficiency - no more large departments that deal with insurance hassles, insurance companies not spending millions on finding loopholes in people's coverage, no retroactive cancellations, etc. Almost immediately, despite covering more people, we'd start by spending 100 billion less per year (and that includes keeping the current payment system of most private insurers) if we went to a single payer system (Congressional Budget Office) - we spend 80% more than other socialized countries on administration.

I'll give a little on this one; efficiency improvements are always welcome. One question, though -- regarding that 100b saved -- when compared to the increasing MC expenditures, how long do you believe that effect will result in net savings? Unless MC starts enacting some rationing mechanisms similar to those utilized by private insurances, that 100b may not even last the first year...

And by the way, other things have to happen as well. Things like malpractice reform where either the awards are capped or the accuser is forced to pay the physician's court costs if they lose. Moving away from a 100% FFS system to a more equitable system that closes the gap in payments between specialties (e.g, doctors should be paid for 'thinking' and 'diagnosing' and not just for procedures, etc). Maybe ACOs are part of the solution, maybe they aren't - but it's worth trying.

I love how you justify conducting experiments with other people's lives just for the **** of it. Really, strong work there champ. I am still waiting for the explanation of why FFS is wrong -- hell, just make the case that it is not the most appropriate -- way of reimbursing procedures. The simple fact of the matter from where I sit is that I am paid for a job; that job is cancer removal. I should be paid for the amount, complexity, and number of services that I provide. If I provide the service for 20 people I should be paid better than if I only provided the same service for 5. If the procedure is appropriate and indicated, FFS is the most appropriate payment structure. If the procedure performed is neither appropriate nor indicated, it should not be reimbursed in any way. In fact, in that event, it represents both theft and battery...

"Equality" and "justice" are problematic terms; they are inherently subjective and undefinable. Attempts to design a system around such nebulous goals are predestined for failure as they must employ a system of individual (committee, same difference) value judgments, followed by force -- two very unjust actions which serve as the foundation.

 

[Lokhtar]

Of course you can -- bring the troops home. Try some objectivity -- it may hurt a little, but it won't kill you -- I promise. The wars, expensive as they were/are, are small fry compared to the other fiscal problems.

Sure. Let me know when that spending goes away. And no, the defense budget is not small fry when it comes to other fiscal problems.

What? Just stop to think about that for a second.... that statement is no more true for healthcare than it is for any good or service (well, that is unless you want to proceed with your system of central planning with x% of GDP assigned to a sector.... a system that has demonstrated biblical failure with amazing uniformity throughout history). Of course there are limits to potential expenditures -- that is the natural and inevitable result of scarcity -- but nothing ties any good or service expenditure to "inflation"... and claims to the contrary speaks to a poor understanding of both "inflation" and freedom.

Trotting out the old freedom line, eh? Most of our essential services are collectivized, like police protection. We've that access to these services should not be dependent on your economic ability. I feel (and all industrialized countries feel the same, and we feel that way about seniors) the same way about healthcare.

Now we're getting somewhere; at least you are now acknowledging that your preferred system has to rely on force to accomplish its stated goals.



That was one long winded way of saying "forced redistribution".

More government / third party / philosopher king fiat. We simply must remove the freedom to choose...

See above.

I'll give a little on this one; efficiency improvements are always welcome. One question, though -- regarding that 100b saved -- when compared to the increasing MC expenditures, how long do you believe that effect will result in net savings? Unless MC starts enacting some rationing mechanisms similar to those utilized by private insurances, that 100b may not even last the first year...

You're right. Rationing is absolutely essential. You don't have infinite resources, right now we ration based on ability to pay and other stupid criteria.

I love how you justify conducting experiments with other people's lives just for the **** of it. Really, strong work there champ. I am still waiting for the explanation of why FFS is wrong -- hell, just make the case that it is not the most appropriate -- way of reimbursing procedures. The simple fact of the matter from where I sit is that I am paid for a job; that job is cancer removal. I should be paid for the amount, complexity, and number of services that I provide. If I provide the service for 20 people I should be paid better than if I only provided the same service for 5. If the procedure is appropriate and indicated, FFS is the most appropriate payment structure. If the procedure performed is neither appropriate nor indicated, it should not be reimbursed in any way. In fact, in that event, it represents both theft and battery....

Err, I never said you shouldn't be reimbursed for your time.....

You can be paid by other criteria, like how ACOs work...

Anyway, it's really sad because many on the right could have gotten a lot of compromise on this bill (like malpractice reform, which was repeatedly thrown out there in exchange for some votes), but the wall of opposition simply means that reforms will continue to happen but without any input and compromise: e.g, people are just going to get completely screwed.

 

[MOHS_01]

Freedom never gets tired. 😀

Fine, sign me up -- as long as I don't become (even more so) the indentured servant of the state. How do you protect against that, by the way (within your system, I mean)?

Do you really understand the changes that will be implemented with ACOs and their corporate structure? I have to believe not based upon the statements presented thus far....

Your opinion... or that of other nations, for that matter, does not change a thing -- one man has no fundamental right to another man's labor or person. If you choose to provide a service through progressive income taxation you have no choice but to admit that it represents a disproportionate levying of the burden (i.e. redistribution). To employ force to enact this system is morally wrong... and no level of majority opinion changes that.

 

[IvyHopeful20]

Freedom never gets tired. 😀

Fine, sign me up -- as long as I don't become (even more so) the indentured servant of the state. How do you protect against that, by the way (within your system, I mean)?

Do you believe that police officers, people who work in the post office, the fire department are 'indentured servants'?

Are you saying there should no jobs in government whatsoever? I don't quite recognize the difference between that and being part of a universal healthcare system.

Your opinion... or that of other nations, for that matter, does not change a thing -- one man has no fundamental right to another man's labor or person. If you choose to provide a service through progressive income taxation you have no choice but to admit that it represents a disproportionate levying of the burden (i.e. redistribution).

EVERY government service is provided via progressive income taxation. To advocate something else is to advocate the abolition of civil society. You can't have a society where a guy making $20,000 contributes equally in dollars to a guy making $20,000,000. It's a pretty radical view you have, and it's fine that you have it but really that doesn't belong in this discussion.

By your example and your line of reasoning, it seems that you believe that a government job = indentured servitude. Which means, don't become a police officer if you don't want to be paid by the government. Don't see medicare patients if you don't want to be paid by the government (or CHIP, or medicaid, or subsidized high risk insurance pools)....

Very few people in healthcare can get away from being involved in getting government dollars in some way. Actually no doctor can, since they've completed a residency (paid by medicare..). You know that going in. Choose a different career.....

Most people don't goto a police academy with a plan to never receiving a public dollar.....

 

[MOHS_01]

.... and paying someone for "their time" is BS; you are not providing "time", you are providing a "service". If you switch to a system of paying either salary or hourly wage -- anything other than FFS -- you will be enacting the most inefficient change imaginable. Just ask anyone who was aware in the 90's during last round of physician practice procurement how well that worked out for them....

 

[MOHS_01]

Do you believe that police officers, people who work in the post office, the fire department are 'indentured servants'?

Are you saying there should no jobs in government whatsoever? I don't quite recognize the difference between that and being part of a universal healthcare system.

I'm going to be kind and explain this to you: they are employees. They punch their clock and are paid by their employer a salary or hourly wage. They entered into this arrangement with the prior knowledge that this would be the case. In the event that you are still a little fuzzy as to the differences here, they did not have prior ownership of a business that is in the process of being annexed under the pretext of eminent domain just because some either totally ****tarded or simply evil political body is tired or incapable of covering its debts. That is not what is being discussed here; what is being proposed, through a single payer system, is the creation of a single payer -- and a non-negotiated payment rate. This says "You work solely for us and you must accept what we offer as payment in full. I own you bitch." Hopefully this helps you "recognize the difference".

Now, on the other hand, if they wish to pay me the net present value of my future earnings in the absence of this change.... well....

EVERY government service is provided via progressive income taxation. To advocate something else is to advocate the abolition of civil society. You can't have a society where a guy making $20,000 contributes equally in dollars to a guy making $20,000,000. It's a pretty radical view you have, and it's fine that you have it but really that doesn't belong in this discussion.

By your example and your line of reasoning, it seems that you believe that a government job = indentured servitude. Which means, don't become a police officer if you don't want to be paid by the government. Don't see medicare patients if you don't want to be paid by the government (or CHIP, or medicaid, or subsidized high risk insurance pools)....

Very few people in healthcare can get away from being involved in getting healthcare dollars in some way. Actually no doctor can, since they've completed a residency (paid by medicare..). You know that going in. Choose a different career.....

We are all indentured servants of the state, but that is a discussion for another time... and one that you may not be ready to have based upon your statements to date. Progressive taxation is a relatively new development; you may want to brush up on your history. In fact, the 20th century (the only century to fully employ this weapon that is the current iteration of the State that you have so much apparent indoctrinated admiration for, by the way) was the bloodiest and most destructive in the history of man. I'm not sure what that says for your "civil society"...

In any event, there is quite a difference between providing a service and being paid on an individual basis and that of being an employee. Medicare created the system of PGY funding -- surely even you can see the problem with arguing that a previous annexation can be used to justify further annexation. Maybe not...

 

[badasshairday]

...

 

[themule]

I heard something regarding health care the other day and it was along the lines of "would you rather the market ration care or the government". One you have some control over the other you have no control over.

 

[bronx43]

MOHS, i notice that it is always the people who haven't even spent a day as a physician or a physician in training (3rd year of med school and beyond) who are always spouting this single payer crap.

What exactly are you insinuating?

 

[themule]

What exactly are you insinuating?

That it is easy to be ideological when you have little to no skin in the game. When you are responsible for the livelihoods of your family and the family of any employees your ideology might change a bit.

 

[bronx43]

That it is easy to be ideological when you have little to no skin in the game. When you are responsible for the livelihoods of your family and the family of any employees your ideology might change a bit.

Anyone can use this little rhetoric, including Wall Street bankers who were part of lead-up to the credit crunch. You can just as easily say that it's easy to be blinded by the necessity of reform when you have so much financial interest vested in the maintenance of status quo.
But more importantly, how is this an argument for one side or the other? It's simply a subjective conclusion drawn from the observation of a trend, which has nothing to do with the crux of the issue at hand.

 

[lee9786]

EVERY government service is provided via progressive income taxation.

I thought government services were to be provided via the Federal Reserves printing money and borrowing money from China. 😱 Sad reality. We are at debt level over 100 percent of taxation. Now is it a good idea to give the government more power to tax for the universal benefit of everyone at this junction? How would we be sure as citizens the tax money will be used for healthcare and not say wars (ehum ... clears throat... national defense)?

 

[lee9786]

I agree that it wouldn't have passed if seen as a welfare program, but it's interesting that they are now so staunchly ingrained in our society that even the most right wing of libertarians in the Senate won't touch it (Ron Paul does, but he's in the house and the House always contains a few people that're a bit wonky at the best of times).

I find peoples' views toward Ron Paul interesting. He is just about the only congressman talking about the dangers of the Federal Reserve. After all that has happened, I'm astounded people still have the blinders on. I guess I can't blame them they get their information from the mass media. Reality will hit us all when a loaf of bread costs $5 and gas is up to $10/gallon. I'm not 100 percent for him either as I think they're all corrupt. I just find this interesting. I also find it interesting how we'll let a lawyer attempt to reform healthcare, but not a physician like Dr. Ron Paul.

 

[MOHS_01]

EVERY government service is provided via progressive income taxation. ....

What about your roads? Excise taxes? SSI? MC? Customs? Estate? Google is your friend... perhaps that's graduate level work, though. 😀



http://www.usgovernmentrevenue.com/

 

[ronaldo23]

This goes way back to the earlier part of the thread, but, the laws of fraud and malpractice would still apply even in a free-market system. An upper level nurse that advertised themselves as a physician would be committing a crime and subject to prosecution.

The other thing is is that under a true free market system, people would make much more educated decisions about healthcare providers. Today, because of strict licensure and regulations, people take for granted researching doctors and often just take the first one they can find in the phone book. Under a free-market system, people would be meticulous about the malpractice records of a doctor, the educational credentials, the complexity of procedures and whether it is better suited for a physician or nurse. I'm sure there would also be plenty of rigorous "board-certifications" (perhaps modeled to be more like state-licensure tests) that private physician organizations gave out, as a voluntary credential physicians could receive. It's just that the government wouldn't be involved in regulating the industry, but professionals from within medicine/nursing/etc. would have optional credentials as one way to denote their competency to a patient.

Milton Friedman made this argument way back in the 70s, and it really is an interesting concept to wrap one's head around, even if one doesn't accept it (I'm not sure I even do).

http://www.youtube.com/watch?v=-6t-R3pWrRw




But the overall concept of more capitalism and free-markets in medicine as a means to lower costs, is very true. Look at Lasik Eye Surgery for instance. Prices have gone down every year for the past 15 years because of competition among ophthamologists, and direct-cash payments . Insurance should measure and protect against risk (major illnesses, cancers, heart disease), but it shouldn't be pre-paid healthcare in every facet. Direct transactions, like any other service between doctor and patient are better, and lower costs. Someone who has a sore throat or minor medical illness should pay out of pocket expenses (if they truly had insurance and not pre-paid healthcare as we do now, then they would have more money to spend on healthcare). Medical Savings accounts are also a good way to bring back more capitalism in medicine and promote personal responsibility and savings.

 

[ronaldo23]

Eh ... depends on a lot of factors, and actually depends a lot on how 'free' the market is. However, I think moving toward a model where more choice/responsibility is put on patients and less power is given to organizations that want to see big centralizations/ACO models is a good thing, both salary wise and for those who want to hold on to the idea of a private practice (where salaries are normally higher anyway).



Sadly, I think that 'repeal and replace' was much more of a nice sound byte than anything realistic. I'd love it to happen (for various reasons, many which are essentially unrelated to salaries), but I'm unsure. However, I struggle to see how repealing certain aspects of it won't affect salaries in general. Even if you have to essentially extrapolate it out to 'what could happen' with Obamacare, I personally don't think it's that difficult to pinpoint numerous areas that, if removed, could have an impact (maybe not immediate) on salaries.

Additionally, I agree that the AARP (and their phenomenal lobbying group) keep most politicians fearful of touching medicare. However, it's my understanding that around 16% (I could be off) GDP is spent on health care in general, and I'm not sure how big of a portion of that goes to funding programs like Medicare/Medicaid ... but I can only assume it's substantial. I think the point though is that almost everyone knows it's a big, bloated, inefficient system (for almost everyone involved), and it could be a frightening indication of what more government control of the health care system could mean.

It may sound biased, shortsighted, opinionated, err whatever, but I'm honestly in favoring of repealing almost any portion of the bill they can get through. I know you've studied it extensively and think that many of the reactions are misguided and too extreme, but I think I'd feel a lot more certain about the future of health care in general if it was reevaluated, slowed a bit, and tweaked.

In 2010, that is true. But come 2012, there is a good chance it will get entirely repealed/defunded if Republicans gain control. In the Senate, Democrats have 23 seats up for reelection, versus 11 for Republicans, and the Presidency could be up for grabs, especially when economists say unemployment will be at 8.0-9% best case scenario in 2012. Plus, two federal judges have allowed the AG lawsuits against ObamaCare to proceed. People from both sides believe the mandate provision may very well end up in the Supreme Court (though they disagree on what the Supreme Court will ultimately rule).

 

[ronaldo23]

First, a true free market would cause physician salaries to plummet.

Second, I will bet the life of my unborn child that there will be no repeal or replace on any part that has the remotest impact on physician salaries.

In fact, even if they could, they wouldn't. ~45% of healthcare spending was government even before this bill and every politician of both parties will run, not walk, away from being associated with the words 'medicare benefit cuts'. Seniors vote, and they vote en masse. Even right wing darlings like Rand Paul, who was for a deductible for decades flat out said no to that as soon as he ran for the Senate.

It's really good political rhetoric, but that's all that is.

Actually, Rand is still very much for a deductible on medicare, and more means testing, just not on current seniors or those nearing retirement. His position was always that these deductibles would be a great idea, but would apply to those 55 and under so that they can plan accordingly (aka he can still win the current seniors vote). He's said that medicare changes are very much on the table on his post-election interviews, and honestly, I don't think he could care less if he wasn't reelected (he talked about how he wants to go back to his medical practice after a term or two)

That being said, I do agree with your sentiment, that medicare deductibles or any real challenge to the seniors and AARP lobby is highly unlikely to happen.

 

[New Vocab]

Today we do, but what are the projections for the next decade? Remove the two ongoing wars and then how do the numbers stack up? The hard reality of the matter is that defense spending will be curtailed, but the real albatross is the social program spending and interest on debt payments. The whole mess was predicted by many before the programs were even enacted; politicians have always over promised and under delivered, and this is only compounded by our monetary policy. They rarely fully fund any of their "great" ideas in real time through taxation... knowing full well that those who are to have their labor and property seized will push back. By employing such a system they have removed a vital and necessary check against state growth...

Such is the case with both MC and SS. Their funding was structurally unsound from the beginning. In truth, the majority of our federal funding structure is unsound... but that is another discussion for another day. Medicaid was always a pure welfare program; MC and SS will likely have to become increasingly more so as time goes on. (As an aside -- they took great care to guarantee that these were NOT welfare programs when they were established... for if they were to have been honest about what these programs represented they never would have come into existence -- and they knew that.) SS should be easy enough to fix; just admit that it's a redistributionist/welfare program, means test, and raise the retirement age. Try some honesty with those who are currently working (you're f*****, sorry fellas. Maybe put some more in your 401k? While you're at it, stop smoking, eat better, and take care of that back.... because you'll be working until you can either afford to retire of your own accord, your family chooses to take you on as a dependent, or you check out of this world.) Medicare will be tougher because it will require rationing, something that will prove to be both politically and socially difficult.... and won't happen until after they have decimated our profession in the process.

In any event, it is just a touch ignorant to even hint that anything other than social program spending constitutes the major fiscal problem.

The deficit can be resolved merely through defense cuts (every program gets the axe), mild social security reform (retirement age raised to 68 or 70) , medicare insurance tax break abolition, tax loophole fixes, no tax breaks for the rich (back to Clinton tax levels), tax increases (millionaire tax; real estate tax; inheritance tax; bank tax).

 

[DoctwoB]

The deficit can be resolved merely through defense cuts (every program gets the axe), mild social security reform (retirement age raised to 68 or 70) , medicare insurance tax break abolition, tax loophole fixes, no tax breaks for the rich (back to Clinton tax levels), tax increases (millionaire tax; real estate tax; inheritance tax; bank tax).

1. Every program gets the axe? as in no millitary or R&D? I'm for cutting some defense spending, but this is just naive. Millitary R&D can have a huge trickledown to the rest of the economy (GPS anybody?)

2. Mild social security reform (changing retirement age to 70) makes sense. People live much longer now than when SS was enacted And good luck even suggesting that without getting voted out of office so fast your head will spin.

3. Everyone talks about closing loopholes, but to do that you increase inefficient tax beaurocracy, and new loopholes seem to spring up as others close. I'm personally for the fair tax proposal (federal 28% sales tax instead of income tax, business tax, estate tax, etc.), with mild rebates for low income individuals.

4. Tax increases? I'm all for a balanced budget, how about we cut spending instead?

Programs to go: Anything that pays people for doing nothing: Welfare, Unemployment, etc.

 

[lee9786]

Well gang it looks like China and Russia are no longer trading in the US dollar.

http://www.marketwatch.com/story/china-russia-to-drop-dollar-in-bilateral-trade-2010-11-23

The people in this country are still 😴

 

[morning]

1. Every program gets the axe? as in no millitary or R&D? I'm for cutting some defense spending, but this is just naive. Millitary R&D can have a huge trickledown to the rest of the economy (GPS anybody?)

2. Mild social security reform (changing retirement age to 70) makes sense. People live much longer now than when SS was enacted And good luck even suggesting that without getting voted out of office so fast your head will spin.

3. Everyone talks about closing loopholes, but to do that you increase inefficient tax beaurocracy, and new loopholes seem to spring up as others close. I'm personally for the fair tax proposal (federal 28% sales tax instead of income tax, business tax, estate tax, etc.), with mild rebates for low income individuals.

4. Tax increases? I'm all for a balanced budget, how about we cut spending instead?

Programs to go: Anything that pays people for doing nothing: Welfare, Unemployment, etc.

1. I agree that research money should not be cut (and it's a drop in the bucket anyway), and that military research has produced a lot of amazing inventions we use in our daily lives, but that's because they get SO much money - way more than any other sphere of research. If that money was diverted to other ventures, we'd still see some great inventions.

2. The unemployment rate for older people is high - I'm not sure where these jobs for old people are going to come from, or how the market could absorb higher rates of employment for senior citizens. Employment prospects for younger people is based off the idea that eventually, old people hang up and go home. If you raise the retirement age, you're going to find either of these situations depending on which sector you're looking at: older, experienced, people making it impossible for new graduates to find work, or older, unemployed people in danger of becoming homeless.

4. None of the budget cuts you've suggested even come close to closing the deficit.