IT'S TIME FOR UNIVERSAL HEALTH CARE

@georgeob1,

georgeob1 wrote:

Cycloptichorn wrote:

No, they are not 'nearly bankrupt.' This is more of that good ol' Republican propaganda that you are throwing out there. Both of those programs can continue to exist for long amounts of time with only minor adjustments; and what more, neither was designed to be a permanent solution to our problems.

Cycloptichorn

Can you offer any factual evidence to support the assertion that medicare and SS are not bankrupt from an accounting and acturarial perspective?

Both Medicare and SS run smaller deficits then our Federal government does, in terms of both dollars and percentages, on a yearly basis. So it's erroneous to call them 'bankrupt' unless you agree that our nation is also bankrupt itself.

Quote:

What do you mean by "neither was designed to be a permanent solution to our problems"? Do you know the intent of the designers of these programs? I note that the enabling legislation behind them has no specified temporal limit to their applicability. They sure look permanent to me.

Exactly what "minor adjustments" do you have in mind and what will be their effects?

Over time the age that SS benefits kick in will continue to rise. This is inevitable and not even to be fought against, as better health care has extended the working life (and post-working life) of Americans tremendously. It only makes sense that people should work longer as their life increases.

Here's a nice article on how raising the retirement age by 3-5 years over the next decade will cut the government's obligations by 30-40% -

http://www.slate.com/id/2113883/

Additionally, means-testing, removing the payroll cap and other tweaks can help the program survive for quite some time in the future as well.

Not that complex if you stop and think about it for a minute.

Cycloptichorn

1 Reply

@Cycloptichorn,

Quote:

Both Medicare and SS run smaller deficits then our Federal government does, in terms of both dollars and percentages, on a yearly basis. So it's erroneous to call them 'bankrupt' unless you agree that our nation is also bankrupt itself.

is that before or after the taxpayers have paid a huge bill?

Quote:

The Part B premium you pay covers approximately 1/4th the cost of providing Part B medical benefits.
General revenues of the federal government provide for the balance of Part B benefits.

http://www.ehealthlink.com/Senior/MedicareFunding.asp

0 Replies

@Cycloptichorn,

Cycloptichorn wrote:

Quote:
I agree that the system is complicated. My entire point is that you have no idea just how complicated it is.

I do have an idea how complicated it is: massively complicated. You get around the no-first hand experience thing by assuming the situation is very complex.

Quote:
You support making all sorts of changes with absolutely no idea of the effects it will have on the various pieces.

I wouldn't say that we have no idea what the effects will be. Some of the primary effects are pretty clear while, as you say, secondary and tertiary effects are not so clear and will only become clear over time. However, this is a poor reason to recommend inaction on policy, for two reasons:

1, we (America as a country) regularly take action on issues in which the effects are unclear. We are forced to do so by the world around us and by our limited ability to predict the future. This means that sometimes we will get it 'right' and sometimes not. However, we cannot choose to take NO action due to our inability to predict the future, becuase

2, the current situation is highly unsustainable. We wouldn't be talking about this if the costs of our current system were not already spiraling out of control. There is very little discussion on this point by opponents of the current reform package, in large part because I think that said opponents tend to have their own health care squared away, and really don't give a **** that the system doesn't work for many Americans.

Cycloptichorn

I agree the current system is not stable. The problem I have with all of this legislation is that it is fixing the wrong problems. And without very careful consideration of just what will be affected, we could quickly go from a bad system to worse.

1 Reply

Health Reform Myths

By PAUL KRUGMAN
Published: March 11, 2010

Health reform is back from the dead. Many Democrats have realized that their electoral prospects will be better if they can point to a real accomplishment. Polling on reform " which was never as negative as portrayed " shows signs of improving. And I’ve been really impressed by the passion and energy of this guy Barack Obama. Where was he last year?

But reform still has to run a gantlet of misinformation and outright lies. So let me address three big myths about the proposed reform, myths that are believed by many people who consider themselves well-informed, but who have actually fallen for deceptive spin.

The first of these myths, which has been all over the airwaves lately, is the claim that President Obama is proposing a government takeover of one-sixth of the economy, the share of G.D.P. currently spent on health.

Well, if having the government regulate and subsidize health insurance is a “takeover,” that takeover happened long ago. Medicare, Medicaid, and other government programs already pay for almost half of American health care, while private insurance pays for barely more than a third (the rest is mostly out-of-pocket expenses). And the great bulk of that private insurance is provided via employee plans, which are both subsidized with tax exemptions and tightly regulated.

The only part of health care in which there isn’t already a lot of federal intervention is the market in which individuals who can’t get employment-based coverage buy their own insurance. And that market, in case you hadn’t noticed, is a disaster " no coverage for people with pre-existing medical conditions, coverage dropped when you get sick, and huge premium increases in the middle of an economic crisis. It’s this sector, plus the plight of Americans with no insurance at all, that reform aims to fix. What’s wrong with that?

The second myth is that the proposed reform does nothing to control costs. To support this claim, critics point to reports by the Medicare actuary, who predicts that total national health spending would be slightly higher in 2019 with reform than without it.

Even if this prediction were correct, it points to a pretty good bargain. The actuary’s assessment of the Senate bill, for example, finds that it would raise total health care spending by less than 1 percent, while extending coverage to 34 million Americans who would otherwise be uninsured. That’s a large expansion in coverage at an essentially trivial cost.

And it gets better as we go further into the future: the Congressional Budget Office has just concluded, in a new report, that the arithmetic of reform will look better in its second decade than it did in its first.

Furthermore, there’s good reason to believe that all such estimates are too pessimistic. There are many cost-saving efforts in the proposed reform, but nobody knows how well any one of these efforts will work. And as a result, official estimates don’t give the plan much credit for any of them. What the actuary and the budget office do is a bit like looking at an oil company’s prospecting efforts, concluding that any individual test hole it drills will probably come up dry, and predicting as a consequence that the company won’t find any oil at all " when the odds are, in fact, that some of the test holes will pan out, and produce big payoffs. Realistically, health reform is likely to do much better at controlling costs than any of the official projections suggest.

Which brings me to the third myth: that health reform is fiscally irresponsible. How can people say this given Congressional Budget Office predictions " which, as I’ve already argued, are probably too pessimistic " that reform would actually reduce the deficit? Critics argue that we should ignore what’s actually in the legislation; when cost control actually starts to bite on Medicare, they insist, Congress will back down.

But this isn’t an argument against Obamacare, it’s a declaration that we can’t control Medicare costs no matter what. And it also flies in the face of history: contrary to legend, past efforts to limit Medicare spending have in fact “stuck,” rather than being withdrawn in the face of political pressure.

So what’s the reality of the proposed reform? Compared with the Platonic ideal of reform, Obamacare comes up short. If the votes were there, I would much prefer to see Medicare for all.

For a real piece of passable legislation, however, it looks very good. It wouldn’t transform our health care system; in fact, Americans whose jobs come with health coverage would see little effect. But it would make a huge difference to the less fortunate among us, even as it would do more to control costs than anything we’ve done before.

This is a reasonable, responsible plan. Don’t let anyone tell you otherwise.

0 Replies

@sstainba,

Quote:

I agree the current system is not stable. The problem I have with all of this legislation is that it is fixing the wrong problems. And without very careful consideration of just what will be affected, we could quickly go from a bad system to worse.

Well, it does seem that strategists for the Dems have been studying this issue for many years. It isn't as if the ideas behind the proposed reforms were cooked up by Pelosi and Reid over a couple of beers one day; these changes have been carefully considered. You should realize that there are plenty of policy experts on the other side of the fence from you who are making arguments counter to yours.

What problems do you recommend we work on fixing? One that I will mention, is the stranglehold the AMA has on licensing in this country; not that I have a problem with doctors and PA's who are competent, but if we need so many more physicians, we are going to have to do SOMETHING to increase the numbers we are training.

Once again though there are added effects to this; more doctors means lower pay per doctor as the demand for their services drop... something the AMA specifically doesn't want. Thorny issue.

Cycloptichorn

2 Replies

@Cycloptichorn,

Shouldn't we assume the converse? That is, fewer doctors would mean higher fees for doctors. I don't see this being addressed in any proposal, past or present. In fact, I'm expecting the opposite effect, though not immediately.

1 Reply

@stlstrike3,

Quote:

We might have more doctors than we did 10 years ago, but we also have more people. And those people are fatter, sicker, and expect more out of the healthcare system.

Keep in mind that while the total number of physicians may be going up, the proportion that are in the front-lines of medicine, primary care, is plummetting.

ROFLMAO....
Your rhetoric just doesn't match your admissions of what the facts are.

1. we have more doctors (a fact you agree with)
2. we have more population. (a fact I agree with)
The doctors per 1,000 people has barely changed in the last 10 years.

3. You conclude the number of doctors is plummeting.

Something the Census bureau says isn't happening
http://www.census.gov/prod/www/abs/statab2006_2010.html
See table 156, 157 in the 2009 abstract

Since 1980, the number of doctors practicing general and internal medicine has increased from 103,000 to 166,000
a 50% increase is quite a plummet over the last 26 years.

1 Reply

@roger,

Well, I think that this already describes our current situation pretty accurately, and it's not a mistake or coincidence that this is the case.

And yes, I agree that neither the Dems nor the Republicans are proposing much of a solution to this problem.

Cycloptichorn

0 Replies

@parados,

parados wrote:

Quote:
We might have more doctors than we did 10 years ago, but we also have more people. And those people are fatter, sicker, and expect more out of the healthcare system.

Keep in mind that while the total number of physicians may be going up, the proportion that are in the front-lines of medicine, primary care, is plummetting.

ROFLMAO....
Your rhetoric just doesn't match your admissions of what the facts are.

1. we have more doctors (a fact you agree with)
2. we have more population. (a fact I agree with)
The doctors per 1,000 people has barely changed in the last 10 years.

3. You conclude the number of doctors is plummeting.

Something the Census bureau says isn't happening
http://www.census.gov/prod/www/abs/statab2006_2010.html
See table 156, 157 in the 2009 abstract

Since 1980, the number of doctors practicing general and internal medicine has increased from 103,000 to 166,000
a 50% increase is quite a plummet over the last 26 years.

You do realize that not every doctor is a primary care doc, right ? The "total" number of doctors doesn't mean anything when the majority of them are subspecialists. The number or physicians going into primary care is dropping. There are several estimates that we will need at least 40,000 more in the next several years. That's 40,000 primary care docs, not 40,000 cardiologist, or oncologists - primary care.

Again, this demonstrates my complaint about all of this. You look at those stats and think they say something that supports your argument when they do not. For example, a physician might be an internist (included in your increase) but that doesn't mean he is a PCP. He could also be a hospitalist which doesn't work in clinics as primary care.

0 Replies

@Cycloptichorn,

You'll never get more people to practice primary care without some sort of incentive. Right now, they take on massive debt to work in clinics that are poorly reimbursed and swamped with paperwork. Cutting their reimbursement rates even more isn't going to attract more people into the field.

Demand for medical services will never drop because Americans will not drop the fatty foods and smokes. If you want to positively affect the amount we spend on healthcare, you need to start by forcing people to take better care of themselves.

I mentioned this before but you dismissed all of my assertions because I didn't post stats. Then I did post stats and you made no comment.

The top 5 chronic illnesses in this country are disease pathways that begin with obesity and tobacco use. Those 5 illnesses consume about 75% of all healthcare dollars. If you want the source, check back 3 pages or so.

1 Reply

@sstainba,

Quote:

You'll never get more people to practice primary care without some sort of incentive. Right now, they take on massive debt to work in clinics that are poorly reimbursed and swamped with paperwork. Cutting their reimbursement rates even more isn't going to attract more people into the field.

There are other methods for attracting people to the field, not the least of which is lowering the cost of their schooling through government incentives. We currently do this (loan repayment programs and such) for many professionals, and the amount of money it would cost to expand this to doctors is trivial compared to, say, a month's worth of spending on our foreign wars.

Not complicated to figure out - if you bother to put thought into things.

Quote:

Demand for medical services will never drop because Americans will not drop the fatty foods and smokes.

Again with the pronouncements about what Americans will or won't do! You'll never get them to pump their own gas, either. I mean, it's perfectly obvious that people and populations and cultures are fixed and never change over time. Right?

Yeah; not so much.

In the last 40 years tobacco usage by adults has dropped by half, from 42% to 20.8%. It is quite obvious that large amounts of Americans have in fact given up smoking, and the trendlines are clear: the problem is a decreasing, not increasing, factor in our healthcare equation.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm

What more, studies have clearly shown that taxation provides a strong disincentive to smoke. As Cigarette taxes have risen, rates of usage have gone down accordingly; with youths and minorities more likely to quit due to the taxes, exactly the populations we want to quit.

Quote:

I mentioned this before but you dismissed all of my assertions because I didn't post stats. Then I did post stats and you made no comment.

Well, I commented on the ones that were wrong. You don't seem to mind getting things wrong by almost double, though. That makes me wonder about your understanding of the statistics you post.

Quote:

The top 5 chronic illnesses in this country are disease pathways that begin with obesity and tobacco use. Those 5 illnesses consume about 75% of all healthcare dollars. If you want the source, check back 3 pages or so.

Agreed, and there are methods for countering these problems; not the least of which is MORE involvement in the Healthcare industry for the people who are affected most by these problems, not less. A smoker who has access to a regular doctor visit gets far more pressure and professional advice to quit then someone who never has that access.

Cycloptichorn

1 Reply

@Cycloptichorn,

Cycloptichorn wrote:

Quote:
You'll never get more people to practice primary care without some sort of incentive. Right now, they take on massive debt to work in clinics that are poorly reimbursed and swamped with paperwork. Cutting their reimbursement rates even more isn't going to attract more people into the field.

There are other methods for attracting people to the field, not the least of which is lowering the cost of their schooling through government incentives. We currently do this (loan repayment programs and such) for many professionals, and the amount of money it would cost to expand this to doctors is trivial compared to, say, a month's worth of spending on our foreign wars.

Not complicated to figure out - if you bother to put thought into things.

I'm well aware, thanks. I like how you try to sound so smug with that last little jab. I don't really have to figure it out. We're just about done paying for the med school loan balance left over from one such program. Though, the availability of the programs is drying up, not getting better. They now pay much, MUCH less than they used to.

Cycloptichorn wrote:

Quote:

Demand for medical services will never drop because Americans will not drop the fatty foods and smokes.

Again with the pronouncements about what Americans will or won't do! You'll never get them to pump their own gas, either. I mean, it's perfectly obvious that people and populations and cultures are fixed and never change over time. Right?

Yeah; not so much.

In the last 40 years tobacco usage by adults has dropped by half, from 42% to 20.8%. It is quite obvious that large amounts of Americans have in fact given up smoking, and the trendlines are clear: the problem is a decreasing, not increasing, factor in our healthcare equation.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm

What more, studies have clearly shown that taxation provides a strong disincentive to smoke. As Cigarette taxes have risen, rates of usage have gone down accordingly; with youths and minorities more likely to quit due to the taxes, exactly the populations we want to quit.

Like I said, Americans will not drop those habits. When I say they need to be forced, that's what I mean. Taxation is one way of doing that. We need more money for healthcare, that's a fact. And we need to tax tobacco, alcohol and sugar. It will cut down on consumption and provide money to support healthcare.

Cycloptichorn wrote:

Quote:

I mentioned this before but you dismissed all of my assertions because I didn't post stats. Then I did post stats and you made no comment.

Well, I commented on the ones that were wrong. You don't seem to mind getting things wrong by almost double, though. That makes me wonder about your understanding of the statistics you post.

Exactly. You swoop in to point out typos or whatever you think you can turn upside down. But if it's data you can't argue with, you ignore it.

Cycloptichorn wrote:

Quote:

The top 5 chronic illnesses in this country are disease pathways that begin with obesity and tobacco use. Those 5 illnesses consume about 75% of all healthcare dollars. If you want the source, check back 3 pages or so.

Agreed, and there are methods for countering these problems; not the least of which is MORE involvement in the Healthcare industry for the people who are affected most by these problems, not less. A smoker who has access to a regular doctor visit gets far more pressure and professional advice to quit then someone who never has that access.

Cycloptichorn

Bull. Smokers lie in office visits. And they also get pissed when confronted or told to stop. They get mad when they can't have their narcotics or benzos refilled for the 10th time. A lot of people don't want advice on how to live better, they want a pill.

1 Reply

@sstainba,

Quote:

Bull. Smokers lie in office visits. And they also get pissed when confronted or told to stop. They get mad when they can't have their narcotics or benzos refilled for the 10th time. A lot of people don't want advice on how to live better, they want a pill.

Assertions about what people do in visits with their doctors are a poor form of argument. The truth is that you have no idea what the vast majority of people do in their doctor's offices whatsoever - outside of your limited anecdotal evidence. There is no reason that anyone would think the above account is credible in this discussion in any way.

You are carping around the edges, using questionable data, while ignoring the larger point. You claim to be a perfect predictor of human behavior and what people will or will not do. I assert that you are no more competent in predicting these things, or the impact of the changes HC reform will bring to the system, then anyone else.

Quote:

I'm well aware, thanks. I like how you try to sound so smug with that last little jab. I don't really have to figure it out. We're just about done paying for the med school loan balance left over from one such program. Though, the availability of the programs is drying up, not getting better. They now pay much, MUCH less than they used to.

So we need more programs of that type. You asked for an incentive, I provided you with an excellent example of one. This counters your point pretty well. How hard is that to understand?

And I wasn't trying to sound smug, I was smug. Because it's plainly obvious that you haven't put any real critical thought into this issue at all, instead pretending that your position somehow gives you special insight into the problem, and mixing your political beliefs in for fun. In an earlier post you bitched about the 'taxpayers' having to cover the cost of athsma patients; that's a dog-whistle there if I ever heard one.

Quote:

Like I said, Americans will not drop those habits.

I just gave you evidence that they are dropping those habits - the counter of what you claimed - and you think this somehow proves you correct? It does not. It doesn't matter WHY they dropped those habits, all that matters is that it clearly is shrinking as a problem in our society, not growing. This means that health-related problems due to smoking will also shrink over time. So, when you say,

Quote:

Demand for medical services will never drop because Americans will not drop the fatty foods and smokes.

You are quite incorrect.

Quote:

Exactly. You swoop in to point out typos or whatever you think you can turn upside down. But if it's data you can't argue with, you ignore it.

I assure you, you haven't presented any data which I can't argue with. You have presented data which isn't germane to the discussion. Big difference between the two.

Cycloptichorn

1 Reply

@Cycloptichorn,

So when is evidence not anecdotal? These are experiences I know from real-world examples. You're right, they don't come with a PDF document on a link somewhere in the google, but they are real, actual experiences. I'm not claiming that I know what the majority do, but if these patients are anything like the majority, I have a good idea. And these anecdotal accounts are more evidence/experience that you have. My comments are at least based on some real-world scenarios of which I have personal knowledge, which is more than you can say.

AND FOR THE LAST TIME, I DO NOT CLAIM TO PREDICT ANYTHING.

My position absolutely DOES give me special insight into the situation that primary care faces. You have ZERO real knowledge of it. All the statistics you can find on the web won't actually tell you the things that primary care physicians face on a daily basis.

2 Replies

@sstainba,

sstainba wrote:

So when is evidence not anecdotal?

Seriously? When it's statistical or logical.

Quote:

These are experiences I know from real-world examples. You're right, they don't come with a PDF document on a link somewhere in the google, but they are real, actual experiences.

So you state, but this is the internet, isn't it? You could be making it all up.

Now, I'm not claiming that you are doing that. Most people wouldn't bother. But it does happen, and that's the major reason that Anecdotal evidence isn't really evidence when it comes to online discussions - it's not verifiable. There's no way to move forward with the conversation based upon it.

Quote:

I'm not claiming that I know what the majority do, but if these patients are anything like the majority, I have a good idea. And these anecdotal accounts are more evidence/experience that you have.

Once again, this is untrue. I have the experience of BEING the smoking patient who was told over and over to give it up by my GP. Which was one of the major reasons I DID give it up. Now, I'm not claiming that this is everyone's experience, but I certainly would take issue with your claim that patients all lie to their doctors and just want their meds and that's it. I also know several other people who went through roughly the same thing - I used to be part of a smoking cessation support group in Austin TX. So, yeah. We all have our little bits of experience to relate, don't we?

My guess would be that patients who tell the truth about smoking and listen to their doctor's advice to quit are essentially boring patients, and you don't hear as many stories about them. My friends and family don't hear stories about the boring people I work with, they hear stories about the interesting and frustrating ones. Another reason that Anecdotal evidence is not really valid for this.

Quote:

My comments are at least based on some real-world scenarios of which I have personal knowledge, which is more than you can say.

Untrue, as I posted above.

Quote:

AND FOR THE LAST TIME, I DO NOT CLAIM TO PREDICT ANYTHING.

Except that: people won't quit smoking, that people won't quit eating fatty foods, that the proposed HC reform will make the problems worse, and that we can't give people incentives to become GP's. So, nothing but those things, is probably more like what you meant to say.

Quote:

My position absolutely DOES give me special insight into the situation that primary care faces. You have ZERO real knowledge of it. All the statistics you can find on the web won't actually tell you the things that primary care physicians face on a daily basis.

Are you a primary care physician? No? Then you don't have first-hand knowledge of it. You have second-hand knowledge of it, from people who - as I stated above - likely screen their stories for the level of interest they have in them.

I do find it humorous how you like to quote statistics you find on the web, but then turn right around and attack them when it suits your argument.

Cycloptichorn

0 Replies

@sstainba,

I find that the Happy Hospitalist says it all when it comes to this one.

http://thehappyhospitalist.blogspot.com/2007/12/thats-less-than-burger-king-pays.html

It's an outstanding read.

0 Replies

Demonstrated in favor of health care reform with the local chapter of moveon.org. Felt great!

One demonstrator had a sign that read, "Democrats, Grow a Back Bone."

As I am older than the current president, I feel I can talk to him in the way a maiden aunt would. I told my fellow protestors that I sent him a post card on which I had written, "Barack! Grow a pair! America wants and needs single payer." I then signed my real name, my address and my email addy. Boy, did those moveon folks respect me.

0 Replies

@Cycloptichorn,

Cycloptichorn wrote:

One question for you then: does your company, and by extension yourself personally, stand to suffer at all if these reforms are passed?

I think I've seen you ask this question several times. I'm not certain of your intention of asking it, but it seems that you are trying to invalidate his message by implying that there is some financial motivation for his opinion.

If that's your plan; do you do the same for those who say they support healthcare. I mean there are billions of dollars of subsidies going to the uninsured; is their support for the plan invalid because they have a financial motivation for their support?

1 Reply

@maporsche,

maporsche wrote:

Cycloptichorn wrote:
One question for you then: does your company, and by extension yourself personally, stand to suffer at all if these reforms are passed?

I think I've seen you ask this question several times. I'm not certain of your intention of asking it, but it seems that you are trying to invalidate his message by implying that there is some financial motivation for his opinion.

If that's your plan; do you do the same for those who say they support healthcare. I mean there are billions of dollars of subsidies going to the uninsured; is their support for the plan invalid because they have a financial motivation for their support?

That's a fair question to ask. Cui Bono? It is a prime indicator of motivator.

I am fortunate that I have good health insurance through my provider, and that my family is covered; but that isn't good enough for me, that things are ok for me.

Cycloptichorn

1 Reply

Dr. Marcia Angell on Bill Moyers' Journal: http://www.pbs.org/moyers/journal/03052010/watch3.html

0 Replies

IT'S TIME FOR UNIVERSAL HEALTH CARE

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