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Thu 7 Apr, 2005 08:39 am
President Bush travels the highways and byways in attempt to sell his proposed changes to Social Security. Which he claims without drastic change is destined to go broke some time in the future? On the other hand he talks very little if anything about the two government programs that have overwhelming financial problems. Medicare and Medicaid. His priorities would it would seem to be out of line with the crises at hand.
Fix Health Care First
By David S. Broder
Thursday, April 7, 2005; Page A31
Quote:At a moment when the whole world is rightly celebrating the life of a man of faith, Pope John Paul II, it may seem perverse to write of the value of skepticism. But in a long span of years covering public affairs, I have come to value the contributions of the naysayers, those brave spirits who -- right or wrong -- challenge the conventional wisdom.
I had a visit from two of them this week, Dean Baker and David Rosnick of the liberal Center for Economic and Policy Research. Their skepticism attaches to the notion -- propounded by the Bush White House and accepted by most of the inhabitants of the political and journalism worlds -- that the Social Security system is in crisis.
I should say at once that I am not convinced by their argument that this is, as Baker contends in the title of a little book he and Mark Weisbrot have published, a "phony crisis."
The increasing life span of Americans and the shrinkage of the workforce relative to the number of retirees are real and significant demographic changes that policymakers should not ignore. Changes could be made in Social Security that would extend its life and adapt to the altered economic and social realities of the 21st century. And those changes can be more gradual and less disruptive if they take place soon.
But Baker and Rosnick are on solid ground in contending that the Social Security system is not the most endangered of our basic national institutions -- or the one most in need of drastic overhaul.
Last month they completed a paper that ought to be on the reading list of the White House policy office and the leadership of the House and Senate. It is called "The Burden of Social Security Taxes and the Burden of Excessive Health Care Costs."
They start from the official estimates of what it would take to make the Social Security system solvent over the 75-year period that is the span economists use for their long-term projections. The Social Security trustees say that the financing problem can be solved with a tax increase of 1.9 percentage points, split evenly between employers and workers. The Congressional Budget Office, using slightly more optimistic economic projections, says the increase would have to be only 0.7 percentage points.
By comparison, the rise in health care expenses has put a much greater dent in the pay packets of workers -- and threatens to continue to do so.
Between 1980 and 2004, the growth in health care costs exceeded that of per capita gross domestic product by 12.6 percent. In just the next 10 years, that gap is projected to grow an additional 7.2 percent.
By either the CBO or the Social Security trustees' estimates, the hit to the economy from runaway health care costs is far greater than the potential damage of a Social Security tax increase. The ratios range from four times as great to 18 times as great, depending on which estimates one chooses.
Baker and Rosnick suggest another way of making the same point. The tax increase needed to keep Social Security solvent for 75 years is of the same size as the likely growth in health care costs (above per capita gross domestic product) in the next 48 months.
The implication is obvious. "Politicians and commentators who claim to be concerned about the living standards of future generations of workers seem to be misdirecting their energy by focusing on the comparatively minor problem of Social Security," Baker and Rosnick write. "Clearly the inefficiency of the U.S. health care system poses a far larger and more immediate danger to the [living] standards of our children and grandchildren."
Others have made the point that the Medicare trust fund is in far more fragile condition than Social Security and is in need of more rapid rescue. The decision to add a prescription drug benefit to Medicare, starting next year, did not solve the problem; it made it worse.
But it is more than Medicare that is spinning out of control. The Medicaid program, which pays for indigents and for long-term care, is bankrupting state budgets. Overall, Americans are paying more for health care than the people of any other advanced industrial nation -- and reaping fewer benefits, at least as measured by life-span statistics.
Note: added poll.
I read that editorial today and agreed with it. When it comes to medical care in this country we are pennywise and pound foolish. It's infuriating.
I also read an article about the Casey Family Program's recent study on mental health issues of children aging out of foster care:
http://www.casey.org/MediaCenter/PressReleasesAndAnnouncements/NWAlumniStudy.htm
"A new study released today by Casey Family Programs, Harvard Medical School, the State of Washington Office of Children’s Administration Research, and the State of Oregon Department of Human Services, shows that rates of Post-Traumatic Stress Disorder (PTSD) among adults who were formerly placed in foster care (alumni), were up to twice as high as U.S. war veterans....
....In addition to the PTSD finding, more than half (54.4%) of adults formerly in foster care had clinical levels of at least one mental health problem within the previous 12 months, such as depression, social phobia, panic syndrome, and anxiety."
One of their recommendations:
Increase access to effective medical and mental health treatment.
I just got off the phone after speaking to my brother in Oklahoma. He has diabetes among other things and must get his blood tested every three months. The DR informed him that they were notified by Medicare that it will only pay for the testing twice a year. He had to sign a paper agreeing to pay for the other two on his own.
That is exactly the kind of stuff that makes me so mad.
Let's say that your brother couldn't afford to pay so he skipped the tests. Because he skipped the tests he was taking the wrong dosage of his medication for six months. Because he took the wrong dosage he has complications and is taken to the emergency room and is then hospitalized for a week for treatment.
How many years of four blood tests could they have done for the price of emergency room and hospitalization?
Pennywise and pound foolish.
Because let's not forget - if he can't pay for a blood test then he can't pay the hospital bill. And if he can't pay the hospital bill the taxpayers and the people who pay higher rates on their insurance will pay the bill.
I, for one, would rather pay for his blood tests.
Bush plans to solve the high cost of medical care fixing the problem through tort reform.
Article from today's news.
Quote:W plan unplugs
patients' rights
If President Bush and his army of tort reformers have their way, future Terri Schiavos will be left without legal recourse for the medical malpractice that put them on feeding tubes and other life-support systems.Much has been said about the hypocrisy of those who fought for Terri to live while backing capital punishment. But there has been silence about the hypocrisy of those, like President Bush, who by statute would leave the victims of malpractice and their families with virtually no chance of compensation.
Michael Schiavo sued his wife's doctor and got a settlement of about $1 million - $700,000 for Terri's economic loss, meaning her health care, and $300,000 for his loss of "consortium," his wife's companionship.
The bill now promoted by Bush makes the famous "caps" on the pain and suffering of patients $250,000. And this means that no lawyer could be expected to take the case, because his expenses would far exceed any possibility of fees.
In other words, there's a right to life but no right to a lawyer.
Moreover, even the right to compensation for pain and suffering could be contested in cases like Terri's. If you're brain dead, you have no pain or suffering, right?
If you believe they'd be embarrassed to assert this, forget about it.
Tom Moore, one of the finest plaintiff lawyers in the nation, told me that's exactly what they did, the insurance companies, in a case where a botched birth left a mother in an irreversible coma.
"But the jury didn't agree," he said. "If the Bush bill goes through, however, the caps would end it; the jury would have no power to overcome the $250,000 cap."
Moreover, the way the Bush law will work is to deprive the victim of essential medical care. Assuming, for example, a $1 million verdict or settlement, the lawyer would get a $200,000 fee. This would come off the top from the medical expenses.
It's exactly the wrong way to do it. Because the patient will then not be allowed the required care. Right to life but not right to live.
When the malpractice money runs out, if there ever is money, the patient becomes a ward of the state.
The dough from Schiavo's settlement paid for Terri's feeding tube. The Bush administration and its congressional cohorts spent more on plane fare. All this, to save everything but her quality of life, about which nobody cared. Check it out
Bush hasn't submitted a plan to fix SS yet. His plan for partial privatization doesn't help at all.
Health care is in crisis, but you can bet that Bush won't do anything at all about that. It's hard to believe that American business can compete on a global scale when they have to add the cost of health care for their employees to the cost of their product while most industrialized countries have a national healthcare system.
I don't know what motivates Bush, but he seems to be completely dissociated from the needs of the country. I'd like to think that Bush is motivated by more than a personal neurosis, greed and mere egocentrism, but sometimes I wonder if we've just got another Nixon without the brains.
OP-ED COLUMNIST
Ailing Health Care
By PAUL KRUGMAN
Published: April 11, 2005
Quote:Those of us who accuse the administration of inventing a Social Security crisis are often accused, in return, of do-nothingism, of refusing to face up to the nation's problems. I plead not guilty: America does face a real crisis - but it's in health care, not Social Security.
Well-informed business executives agree. A recent survey of chief financial officers at major corporations found that 65 percent regard immediate action on health care costs as "very important." Only 31 percent said the same about Social Security reform.
But serious health care reform isn't on the table, and in the current political climate it probably can't be. You see, the health care crisis is ideologically inconvenient.
Let's start with some basic facts about health care.
Notice that I said "health care reform," not "Medicare reform." The rising cost of Medicare may loom large in political discussion, because it's a government program (and because it's often, wrongly, lumped together with Social Security by the crisis-mongers), but this isn't a story of runaway government spending. The costs of Medicare and of private health plans are both rising much faster than G.D.P. per capita, and at about the same rate per enrollee.
So what we're really facing is rapidly rising spending on health care generally, not just the part of health care currently paid for by taxpayers.
Rising health care spending isn't primarily the result of medical price inflation. It's primarily a response to innovation: the range of things that medicine can do keeps increasing. For example, Medicare recently started paying for implanted cardiac devices in many patients with heart trouble, now that research has shown them to be highly effective. This is good news, not bad.
So what's the problem? Why not welcome medical progress, and consider its costs money well spent? There are three answers.
First, America's traditional private health insurance system, in which workers get coverage through their employers, is unraveling. The Kaiser Family Foundation estimates that in 2004 there were at least five million fewer jobs with health insurance than in 2001. And health care costs have become a major burden on those businesses that continue to provide insurance coverage: General Motors now spends about $1,500 on health care for every car it produces.
Second, rising Medicare spending may be a sign of progress, but it still must be paid for - and right now few politicians are willing to talk about the tax increases that will be needed if the program is to make medical advances available to all older Americans.
Finally, the U.S. health care system is wildly inefficient. Americans tend to believe that we have the best health care system in the world. (I've encountered members of the journalistic elite who flatly refuse to believe that France ranks much better on most measures of health care quality than the United States.) But it isn't true. We spend far more per person on health care than any other country - 75 percent more than Canada or France - yet rank near the bottom among industrial countries in indicators from life expectancy to infant mortality.
This last point is, in a way, good news. In the long run, medical progress may force us to make a harsh choice: if we don't want to become a society in which the rich get life-saving medical treatment and the rest of us don't, we'll have to pay much higher taxes. The vast waste in our current system means, however, that effective reform could both improve quality and cut costs, postponing the day of reckoning.
To get effective reform, however, we'll need to shed some preconceptions - in particular, the ideologically driven belief that government is always the problem and market competition is always the solution.
The fact is that in health care, the private sector is often bloated and bureaucratic, while some government agencies - notably the Veterans Administration system - are lean and efficient. In health care, competition and personal choice can and do lead to higher costs and lower quality. The United States has the most privatized, competitive health system in the advanced world; it also has by far the highest costs, and close to the worst results.
Over the next few weeks I'll back up these assertions, and talk about what a workable health care reform might look like, if we can get ideology out of the way
E-mail:
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OP-ED COLUMNIST
The Medical Money Pit
By PAUL KRUGMAN
Published: April 15, 2005
A dozen years ago, everyone was talking about a health care crisis. But then the issue faded from view: a few years of good data led many people to conclude that H.M.O.'s and other innovations had ended the historic trend of rising medical costs.
But the pause in the growth of health care costs in the 1990's proved temporary. Medical costs are once again rising rapidly, and our health care system is once again in crisis. So now is a good time to ask why other advanced countries manage to spend so much less than we do, while getting better results.
Before I get to the numbers, let me deal with the usual problem one encounters when trying to draw lessons from foreign experience: somebody is sure to bring up the supposed horrors of Britain's government-run system, which historically had long waiting lists for elective surgery.
In fact, Britain's system isn't as bad as its reputation - especially for lower-paid workers, whose counterparts in the United States often have no health insurance at all. And the waiting lists have gotten shorter.
But in any case, Britain isn't the country we want to look at, because its health care system is run on the cheap, with total spending per person only 40 percent as high as ours.
The countries that have something to teach us are the nations that don't pinch pennies to the same extent - like France, Germany or Canada - but still spend far less than we do. (Yes, Canada also has waiting lists, but they're much shorter than Britain's - and Canadians overwhelmingly prefer their system to ours. France and Germany don't have a waiting list problem.)
Let me rattle off some numbers.
In 2002, the latest year for which comparable data are available, the United States spent $5,267 on health care for each man, woman and child in the population. Of this, $2,364, or 45 percent, was government spending, mainly on Medicare and Medicaid. Canada spent $2,931 per person, of which $2,048 came from the government. France spent $2,736 per person, of which $2,080 was government spending.
Amazing, isn't it? U.S. health care is so expensive that our government spends more on health care than the governments of other advanced countries, even though the private sector pays a far higher share of the bills than anywhere else.
What do we get for all that money? Not much.
Most Americans probably don't know that we have substantially lower life-expectancy and higher infant-mortality figures than other advanced countries. It would be wrong to jump to the conclusion that this poor performance is entirely the result of a defective health care system; social factors, notably America's high poverty rate, surely play a role. Still, it seems puzzling that we spend so much, with so little return.
A 2003 study published in Health Affairs (one of whose authors is my Princeton colleague Uwe Reinhardt) tried to resolve that puzzle by comparing a number of measures of health services across the advanced world. What the authors found was that the United States scores high on high-tech services - we have lots of M.R.I.'s - but on more prosaic measures, like the number of doctors' visits and number of days spent in hospitals, America is only average, or even below average. There's also direct evidence that identical procedures cost far more in the U.S. than in other advanced countries.
The authors concluded that Americans spend far more on health care than their counterparts abroad - but they don't actually receive more care. The title of their article? "It's the Prices, Stupid."
Why is the price of U.S. health care so high? One answer is doctors' salaries: although average wages in France and the United States are similar, American doctors are paid much more than their French counterparts. Another answer is that America's health care system drives a poor bargain with the pharmaceutical industry.
Above all, a large part of America's health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.
In my next column in this series, I'll explain why the most privatized health care system in the advanced world is also the most bloated and bureaucratic.
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