Baseline Scenario: Health Care Rationing For Beginners (Paul Ryan, ACA, Medicare)

[Fergasun]

Baseline Scenario: Health Care Rationing For Beginners

I'll post the final paragraph and hope you guys read the rest. When I read stuff like this, I think this guy should be writing copy for the Democrats rather than whoever they have (do they have anyone doing this?) and the GOP is winning the "messaging war" over the health care bill and Medicare. IPAB is the Independent Payment Advisory Board.

So yes, the national challenge is spending less on health care in the future, whether or not you call it rationing. The Ryan Plan does it by eliminating Medicare (for all practical purposes) and leaving seniors to depend on their private savings and deliberately underfunded vouchers. IPAB does it by doing what the free market is supposed to do, but doesn’t. IPAB is not a complete solution, and the biggest criticism one can level at the Obama administration is that its enacted and proposed solutions aren’t enough to close the long-term Medicare deficit. (My solution is to increase Medicare payroll taxes to account for the fact that Medicare is becoming more valuable today to future beneficiaries.) But IPAB at least tries to improve Medicare and solve the cost problem. Paul Ryan simply wants to toss the elderly into the same toxic pool that tens of millions of the non-elderly are already drowning in.

[DRSmith]

Ryan's plan is complete crap, Vermont just went single payer and it will bring down cost and put more money into the system

[Mursilis]

Vermont just went single payer and it will bring down cost and put more money into the system

Since you can look into the future and all, when will the lockout end?

[ABQCOWBOY]

Ryan's plan is complete crap, Vermont just went single payer and it will bring down cost and put more money into the system

This sounds very familiar. Sounds like exactly what Massachusetts was supposed to be able to do.

We all know that that has not worked out according to plan.

[DRSmith]

This sounds very familiar. Sounds like exactly what Massachusetts was supposed to be able to do.

We all know that that has not worked out according to plan.

No Mass is the same as the new health care law

Mass does not have a single payer system

[ABQCOWBOY]

No Mass is the same as the new health care law

Mass does not have a single payer system

Still, it is exactly the same message we heard from Massachusetts. The point I am trying to make is that we really will not know what the results will indicate until the program has had time to actually work.

[Burgold]

I agree ABQCowboy's last thought... that you don't know what you will get until it takes place in the real world. However, I've been in too many nursing homes where a seniors private funds are zapped to 0 within weeks. Health care prices are absolutely insane and if we institute a system like Ryan suggests it will be a travesty. Private fundng and vouchers will put 100,000's on the street within a few months... and that's not boogeyman talk. It's reality. Consider the price per day at a hospital or nursing home. The average cost at a nursing home is about 80,000 per year (http://www.ehow.com/about_5602262_average-cost-nursing-home.html) and in my experience which is already 5 years old, that seems pretty low esp. if the patient needs OT, PT, or any type of medical car.

Not sure what the answer is, but the problem is that hospitals, insureres, and nursing homes are gouging us (and the government). A voucher system will crash and burn pretty quickly.

[Thiebear]

No chance 100,000's are put on the streets. None! Wouldn't be allowed to happen.

Hospitals with no patients do not need prices as the people that work there are now out of work and cannot pay THEIR bills.

Won't happen mr. boogeyman.

I have a Grandmother in a nursing home in Raleigh for 6k a month. You Have to pay attention and fix everything they do.

If not, your family member will not get treated as they should. Nothing is going to change there in 'months'

States should be able to have different systems until we can find combinations that work.

I'd prefer: Semi-Free clinics is the first stop for everyone not in an ambulance or life or death emergency. (Military like).

From the Clinic you get for example a motrin, or a pass to the hospital.

[Burgold]

I don't think it would happen, but if we stuck to the draconian Ryan plan (IE a combo of limited pay vouchers plus seniors savings) that would be the result. There's got to be a better solution than that!

[Thiebear]

Burgold, Have you lost your mind?

NBC 2013: 20 seniors put out on the streets with nobody to claim them. Two were stolen before cops could arrive and put the rest down?

See: DeathPanels for Unicare: Seniors will be killed due them not having enough "Life years" to justify that bypass sugery.

Given a Gov't Scooter with optional cup holder instead.

[Burgold]

No, I haven't. Then again, if I had how would I know.

But I think the reason why the Ryan plan can't be enacted as written is the above. Actually, states would probably try to step in to fill the gap and present this, but then the Ryan plan is really just another form of :kickcan: down the road and not a solution at all.

[Thiebear]

Do you believe the House of Representatives will get a Republican plan through unaltered?

As the Democrats did with Unicare owning the House of Representative, a supermajority of the Senate and the new President that just kicked ass?

[Burgold]

No, I don't. Mind you, I fear for the Frankenstein Monster (the mismatched compromises that will form a new plan) sometimes more than the original monstrosity. The Dems proved that building a Frankenstein is not necessarily the smart way to go... and yet somewhere in the universe of ideas there's has to be a way to create a mosaic which is better economically and still serves us well. Ryan's plan ain't it though.

[PeterMP]

I agree ABQCowboy's last thought... that you don't know what you will get until it takes place in the real world.

Well, single payer systems all over the world have decreased overhead as compared to non-single payer systems.

I guess it is possible that VT will run one that doesn't, but it isn't like there aren't templates that they can pull from where it has happened.

[Thiebear]

I would love to grab tips from places that worked... but we keep grabbing small countries with no immigration. Of course they work.

Iceland should never be brought up for anything. France is the only country remotely close and they are stopping immigration for health care?

[ABQCOWBOY]

Well, single payer systems all over the world have decreased overhead as compared to non-single payer systems.

I guess it is possible that VT will run one that doesn't, but it isn't like there aren't templates that they can pull from where it has happened.

I think that if you are going to have an honest discussion about healthcare, single payer or otherwise, that discussion has to start from the standpoint of intellectual honest. Not trying to impy that you are not being honest but I do think that a statement that says single payer has decreased cost all over the world is not completely accurate.

I do not believe that we can afford to take this approach and be wrong.

[shk75]

This sounds very familiar. Sounds like exactly what Massachusetts was supposed to be able to do.

We all know that that has not worked out according to plan.

Actually this is untrue. If you look at the supporting documents and the vision of those who reformed the system in Mass the goal was to improve access. They were hopeful that it would cut costs in the future but that was not the primary goal.

[ABQCOWBOY]

Actually this is untrue. If you look at the supporting documents and the vision of those who reformed the system in Mass the goal was to improve access. They were hopeful that it would cut costs in the future but that was not the primary goal.

According to the interview I watched, just yesterday, the goal was certainly to improve access but also to cut costs. Now, this may or may not be true but for the purposes the countries situation, we can not afford to adopt any plan that creates more expense.

[shk75]

According to the interview I watched, just yesterday, the goal was certainly to improve access but also to cut costs. Now, this may or may not be true but for the purposes the countries situation, we can not afford to adopt any plan that creates more expense.

The primary goal was to improve access. The reformers were aware that it would be impossible to improve access and reduce costs at the same time over the short-run. Now they did certainly hope to reduce costs over the long-run and they believed that more access to care would reduce the use of emergency room care but this has not proven to be the case so far. One reason is because of physicians not taking on new patients when all of these new people are insured who did not used to be. Therefore, many still use the emergency room because they state that they have no access to GPs.

Now single-payer systems can work on reducing costs but only if there is a strict central budgeting and rules authority. This means overt and clear rationing which many in the US have been unwilling to support. The other problem is that while Vermont can institute its system, it still must abide by federal rules which complicates the matter even more. There are nations like Canada that let each province run their own system, but only if it is in accordance with the 5 national principles of public administration, comprehensiveness, universality, portability, and accessibility

[PeterMP]

I think that if you are going to have an honest discussion about healthcare, single payer or otherwise, that discussion has to start from the standpoint of intellectual honest. Not trying to impy that you are not being honest but I do think that a statement that says single payer has decreased cost all over the world is not completely accurate.

I do not believe that we can afford to take this approach and be wrong.

Overhead not just costs.

Canada:

http://www.masscare.org/wp-content/uploads/2007/05/PNHPAdminCosts.pdf

Taiwan:

http://content.healthaffairs.org/content/22/3/61.full

"The program’s administrative burden was 2.2 percent of the NHI’s total budget in 2001, although the NHI Law (Article 68) allows the BNHI to spend as much as 3.5 percent of its annual budget for administration.18 This low—perhaps too low—overhead rate is quite similar to that of the single-payer U.S. Medicare program of less than 2 percent.19 The low administrative overhead ratio in Taiwan reflects in part the fact that 99 percent of all BNHI claims are processed electronically. "

Europe:

http://theglitteringeye.com/?p=3246

Can I count as on 3 different continents as all over the world?

It isn't hard to understand. Think about it. No more companies involved in health insurance. What does that mean?

Well, no more commercials, or at least a lot fewer of them. The government might "advertise" for educational purposes, but not as much as a whole bunch of individual insurance companies competing for business.

Every time I take my child to the doctor, they copy my insurance card. Guess what, not in a single payer system.

All those records about what your insurance plan is and your co-pay, etc.

Guess what? GONE!

I'm not saying that we should go to a single payer system (in fact, I've argued several times that we shouldn't because it doesn't really address the problem), but I'd be surprised if VT manages to go to a single payer system and not lower overhead/administrative costs.

You are right. We need to be honest about this issues in this debate, and one of the overwhelming facts is it would be difficult to design a single payer system that wouldn't have lower overhead costs than your system. Simple logic tells you that and that is the experience of countries from all over the world.

Now, I think we can do somethings that will lower overhead w/o going to a single payer system (but probably not bring us to what you see in a single payer system).

[ABQCOWBOY]

The primary goal was to improve access. The reformers were aware that it would be impossible to improve access and reduce costs at the same time over the short-run. Now they did certainly hope to reduce costs over the long-run and they believed that more access to care would reduce the use of emergency room care but this has not proven to be the case so far. One reason is because of physicians not taking on new patients when all of these new people are insured who did not used to be. Therefore, many still use the emergency room because they state that they have no access to GPs.

Now single-payer systems can work on reducing costs but only if there is a strict central budgeting and rules authority. This means overt and clear rationing which many in the US have been unwilling to support. The other problem is that while Vermont can institute its system, it still must abide by federal rules which complicates the matter even more. There are nations like Canada that let each province run their own system, but only if it is in accordance with the 5 national principles of public administration, comprehensiveness, universality, portability, and accessibility

Understand the points you are making about Mass HC Plan. It makes sense. In regards to Single Payer, I do not believe that it will work in the U.S. Some of the things you mention, along with simple things such as improvements to infrastructure and simple facilities access carry astronomical costs. I just don't see single payer ever working in this country because we do not adhere to immigration controls. We have no way of doing any long term planning for out costs because we do know, from year to year, how many people are going to come into the system. I think that's a problem.

[shk75]

Understand the points you are making about Mass HC Plan. It makes sense. In regards to Single Payer, I do not believe that it will work in the U.S. Some of the things you mention, along with simple things such as improvements to infrastructure and simple facilities access carry astronomical costs. I just don't see single payer ever working in this country because we do not adhere to immigration controls. We have no way of doing any long term planning for out costs because we do know, from year to year, how many people are going to come into the system. I think that's a problem.

Fair enough. In France, a universal system, they have recently experienced record-high levels of immigration and there is increased support to no longer provide health care for illegal immigrants. They cite rising costs as a reason for not providing care to this population. However, I have seen no literature that supports the notion that providing care to illegal immigrants is a real culprit of increasing costs. So, while your concerns may be valid I think as a fear they are overstated, but I cannot say that with certainty.

[elkabong82]

Implement cost control (medicine, equipment, supplies that are ridiculously over-charged) and administrative reform

[LadySkinsFan]

Taking the profit out of healthcare, take the grossly inflated salaries out of healthcare (top executives) and utilize the power of quantities of people signed up for a public option and costs will be reduced, immediately.

[Baculus]

I think that if you are going to have an honest discussion about healthcare, single payer or otherwise, that discussion has to start from the standpoint of intellectual honest. Not trying to impy that you are not being honest but I do think that a statement that says single payer has decreased cost all over the world is not completely accurate.

I do not believe that we can afford to take this approach and be wrong.

Well, from the get-go, you tried to characterize the MA and VT systems as being the same, which I am not sure if a good example of "intellectual honesty."

Single-payer health care, the most common system in the world, has many examples which demonstrate better outcomes, in cost and health service delivery, over the U.S. health care system. Our health care system certainly has some strengths, but that doesn't mean that the cost side of things doesn't need a great deal of reform.

Here is some information:

http://www.pnhp.org/facts/single_payer_system_cost.php?page=all

No country in the world is trying to emulate the American health care system -- that should be very telling. And it really comes down to this: health insurance companies are an unneeded layer of profit between you and your doctor. We can literally save billions by removing this middle man and putting that money back into the health care infrastructure itself.

To ignore this fact is ideological and irrational.