@georgeob1,
Response to georgeob, sept 12, 2009 on Obama's Health Plan
Are you referring to our President - a master of carefully chosen, vague and often misleading assurances and promises.
A: Obama's health plan is detailed here: http://my.barackobama.com/page/content/hcsignon/?source=OM_LB_google_HC-search_O-search_tc&gclid=COfeiqnu7JwCFShRagodThWajw
He won't sign a bill that adds to our deficit - however the CBO has demonstrated that all of the bills circulating in the Congress will do that on a very large scale. "His Plan" (whatever that is) won't reduce existing Mediare benefits - however he indicates massive cuts to the Medicare program in his various speeches.
A: What Obama has said are: a) he's going to reduce waste and fraud, b) quality of care will improve, and c) doctors will still make the decisions.
Worse, Medicare is already massively underfunded relative to exploding entitlement costs and current and projected Medicare tax revenues, and he uses these cuts in Medicare to "offset" new entitlements without even acknowledging the Medicare crisis already at hand. Finally he proposes, as a cure for our current financial unsustainability, a massive new addition to the entitlements that created it. He assures us that under "his Plan" there will be no mandated rationing of health care, all while arguing for conditions that willl make it inevitable.
A: By reducing or eliminating most waste and fraud, Medicare will run more efficiently. The Medicare funding crisis is not Obama's fault, even though you may wish to put that on his shoulders. At the very least, lets give Obama some leeway in working out cost reductions before we cry wolf. You say rationing is inevitable, but you really don't know that until those cost cuts in waste and fraud are brought under control.
Our current insurance situation is in very large part a consequence of Federal Medicare and Medicaid programs. Both are seriously underfunded relative to the "rights" and entitlements they create (and assure their beneficiaries they weill receive). The predictable result is a massive transfer of costs to the private sector. Doctor, laboratory and hospital charges to individuals are grossly inflated to recover the costs government doesn't pay for services it requires. Those with insurance companies able to use their buying power to negotiate reduced charges escape this reaction, but those without it are screwed. The current administration blames the insurance companies for a situation which previous government programs themselves have created.
A: Where do you see this “massive transfer of costs” to the private sector? At the current rate of inflation on private insurance premiums, shifting more costs to the private sector can only result in more Americans without health insurance. Many companies and private health insurance buyers are all in agreement that some form of health care reform must be implemented; the only obvious option is to provide public and private health insurance to maximize competition.
All of these contradictions and economic dislocations are a result of government actions to increase the demand and expectations for medical care without any action to increase the available supply of services. Indeed, by requiring that providers accept the payments that government arbitrarily and unilaterally establishes, the government suppresses the very economic signal that would induce the increase of that supply - and the resultant lowering of average prices.
A: That's because you are myopic in how you view the logistics vs improved efficency. Also, the trends for applications to medical schools have been on the increase even before this recession. Here: http://handouts.aacrao.org/am08/finished/W0830a_K_Hartman.pdf We have six physicians in our family; I don't think we are an exception in this country.
Worse, Federal, state and local governments actively use their powers to reduce the numbers of hospital beds, laboratory facilities and clinics - all in misguided attempts to reduce their outlays for Medicaid and Medicare programs.
A: See my post on bed usage study in a previous post.
The essential point here is that the politics of government require that broad, (usually vague) and exaggerated promises are made to the voting public, while the economic and budgetary facts of it prevent their delivery. Together these factors breed general irresponsibility and permanent conflict -- all without any constructive incentive to rectify the situation.
A: That's been proven untrue when we consider some facts such as most countries of Europe, some in Asia, and South America offer universal health care without having resulted in “general irresponsibility and permanent conflict.” As a matter of fact, of most industrialized countries, we are the last holdout on universal health care, and our general health and longivity falls below some undeveloped countries. That's because over 47 million Americans don't have health insurance, and those who do have health insurance have inadequate insurance. Although most can go to the emergency room free of charge, the disease has developed too far for any cure.
Independent of all this is the fact of rapidly expanding new technologies for health care and their (initially at least) high costs. The fair distribution of these services will be a problem for us however we approach the situation. Government rationing or brueaucratic management ususlly results in grossly reduced investment and innovation -- in effect solving the problem of the distribution of the golden eggs by killing the goose that lays them.
A: I remember reading on this very subject about the overuse of these high cost equipment when the older ones would have sufficed, and accomplish similar results. I'll try to find that article and post it here.
What is 'the conservative plan"? The fact is there has been none. At best conservatives in government have warned about the fundamental contradictions built into existing programs, however they have offered no real alternatives. They have, however, lived up to the Hippocratian oath -- "first do no harm". Recently, though Republicans have proposed sensible legislation that would partially address current problems. This includes insurance reform that would permit competition among insurers across state boundaries; promote the portability of coverage; and prohibit the denial of continued coverage after chronic disease strikes; and tort reform which realy does drive up the costs of health care without any associated health benefit. In addition they would subsidize the education of general practicioners to increase supply ands availability. However, they have not addressed the insustainability of existing government programs any more than have the Democrats (at least they don't propose to make it worse).
A: That's a funny one georgeob; “first do no harm.” That should actually say “first be humane with your fellow citizens, because their good health helps our country.”
Finally, the only disagreement I may have with the Obama health plan is the simple fact that I would like to see his plan implemented in increments to make sure that the nuts and bolts have been fitted together in the most efficient and practical ways, and to give it time to work with results rather than guesses.
