Blue Mass Group

Reality-based commentary on politics.

Isn’t what progressives want really Medicare For All?

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I’m unsure of what the “health care crisis” is all about in the first place.  I, for one, am happy with my Harvard Pilgrim HMO, my PCP, and the service I receive.

Then I look at the terrible shape Medicare is in.  I went through caring for my grandmother and observed how f’d up Medicare is.

So what it has lower administrative costs.  If it’s such a great system, why does it have an unfunded liability of $74 TRILLION.  That’s TRILLION, with a “T”.  

And $60 billion annually in fraudulent claims paid out.  The FBI even has a division to investigate Medicare fraud.  It’s that bad.  Perhaps there’s too LITTLE administration going on.

And that’s just covering the 65 and older population.

What happens when the rest of America joins?

I think liberals should fix Medicare first before solving their “health care crisis.”

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  1. My title answers your title question.  I’m all for fixing what’s broken and public programs need constant review and scrutiny, but Medicare is an entitlement which generally polls pretty well.  I’d be interested if you could back up your assertions.  There is definitely a crisis for those who have no or limited insurance.  People go bankrupt due to health care costs.  Keep in mind though, if Obama’s said this once, he’s said it a million times.  Under his plan if you like your plan, you keep it – no questions asked.  A public health system does not eliminate private options, either in addition to or instead of public insurance any more than the existence of public schools eliminates private schools or additional tutoring services.

  2. is a no-risk existence, with everyone guaranteed everything that they need.

    <

    p>Opposite of the principles our country was founded on, and stands for still, but hey thats what they want.  An end to all suffering.  At any cost.

    • Actually, I do want education and wellness to be part of health care as I subscribe to the idea that an ounce of prevention is worth a pound of cure.  That being said, being taken care of a la Europe would suit me just fine, and ultimately leads to a better quality of life for all of us.  “Everyone guaranteed everything they need” as you put it pretty much sums it up, though I acknowledge idealism and reality may well clash over concept.

      • as if life saving health care was some sort of natural resource being hoarded?

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        p>Not only was there no free health care, but there was no free anything.  Nor was it expected.

  3. Your HPHC HMO is not a health plan exclusive to seniors who receive most of our medical care.  Medicare doesn’t have 20 somethings as subscribers to balance risk.  HPHC and other private insurers benefit by seniors coming off their books and going to medicare.  

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    p>Anything sinking in yet?

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    p>You can keep your HPHC HMO, no one is making you switch.  What is one the table is a public option.  You choose.  But the public insurance runs more efficiently and with less cost.  That’s just plain fact.  Privates don’t want this as they need to make a buck off of your health coverage.

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    p>Help us out.  Get some numbers on fraudulent claims being paid out by private insurers.

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    p>This post is just plain dumb.

    • It is already insolvent, and by 2019 will require 25% of all federal tax receipts just to pay current year benefits.

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      p>It’s $74 TRILLION in the hole.  Here’s your citation.

      <

      p>But, stop the presses!  It’s administratively more efficient than the private sector.  Lower admin cost, yes, but insolvency too!  

      <

      p>Yes, YES, that’s the model we want for our health insurance system.

      <

      p>And regarding the “public option,” please read my post refuting how public and private systems can co-exist.

      <

      p>And please provide a citation for this claim:

      <

      p>

      But the public insurance runs more efficiently and with less cost.  That’s just plain fact.

      <

      p>And I don’t want to see only “administrative costs” cited.  I want to see the data that shows, dollar-for-dollar, that Medicare is, overall, a more efficient health care insurance system.

      <

      p>I think if Medicare carriers a $74 TRILLION unfunded liability, it cannot, by definition, be efficient.

      <

      p>You need to prove your case that Medicare is a better insurance system.

      • No, seriously. What is the future cost, currently unaccounted for, of maintaining the military alliances, hardware, software, bases, and people scattered around the world?

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        p>We don’t know – but we spend the money because we consider our national defense to be important and our national interests similarly so.

        <

        p>Those of us who advocate for universal healthcare know that a country of 300 million people with 40-50 million people without healthcare is just as vital to our national interest.

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        p>That’s why we advocate investing in it.

        <

        p>Comparing your HMO to Medicare is nonsense. Your HMO has the right to drop sick patients who cost too much to insure – and does. Medicare picks up the tab for the nation’s elderly – its sickest and most expensive patients.

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        p>”Estimates show that about 27% of Medicare’s annual $327 billion budget goes to care for patients in their final year of life.” Do you really think your HMO has numbers like these?

        <

        p>Source: http://www.usatoday.com/money/…

        <

        p>More: “The one in 20 Medicare patients who die each year use up almost one-third of expenditures by Medicare, the government health insurance program for the elderly and disabled.

        <

        p>One third of expenses in the last year of life are spent in the final month, according to the report, with aggressive treatments in the final month accounting for 80 percent of those costs.”

        <

        p>Source: http://www.reuters.com/article…

        • Yglesias recently commented on a NYT editorial about the House and the F22 program:

          Right now in political terms, [money spent on the Pentagon is] treated like Monopoly money. “Fiscally conservative” Blue Dogs don’t complain about defense spending. Conservative economists talk about “non-defense discretionary spending.” It’s as if-by magic-the federal government’s largest program isn’t a real program, or doesn’t cost money. In that framework, of course no weapons platform ever looks unnecessary.

    • Stats here but I see private fraud rates at 3% while Medicare is 3.9%, down from 4.4%.  Still Medicare is 33% WORSE than private insurance plans when it comes to fraud.

      <

      p>Gotta love this statement about claims fraud:

      <

      p>

      Medicare is particularly vulnerable, since it pays most claims unquestioningly.

      • you quoted error rate, not fraud.  There are automatic take backs in remittance advice to health care institutions when known errors occur.  If they know about it, I’m thinking they are known errors.

        <

        p>Second, the private insurance fraud you note is actually the entire heath care industry not private insurances.

        <

        p>But I am interested to hear your thoughts on the private’s benefit of getting seniors off their rolls by the government via Medicare.  What happens when a better run health plan like Medicare can operate with with subscribers from their 20’s on to balance risk.

        <

        p>Keep plugging away chief …

  4. “… because I have health insurance I like.”

    <

    p>”There’s no climate change; It’s cold today.”

    <

    p>”We’re not at war; no tanks on my street.”

    <

    p>”There’s no hunger; I’m stuffed.”

    <

    p>”There is no sun; it’s dark outside.”

    <

    p>Conservative solipsism at its finest.

    • Please tell me what the “crisis” is.

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      p>Life expectancies too short?  Co-pays too high?  Wait-times for MRIs and CAT scans too long?  Unavailability of life-saving Rx?  Crowded emergency rooms?  Bad breaks on ambulances?

      <

      p>Please, without condescension, without calling me a “denier,” and without resorting to insults, please point me in the right direction.

      <

      p>What’s the crisis?

      <

      p>I hear a lot about how much health care costs.  And how much of GDP we spend on it.  Why is this justification for a government take-over of our health insurance?  Why does government think they know exactly how much we should spend on health care, and we don’t?  17% of GDP too much?  How about 9%?  Why not 5%?  Or 25%?

      <

      p>And why do you think a single-payer government insurance plan will do ANYTHING to reduce costs?  The Medicare/Medicaid experience actually suggests otherwise.  (Please, spare me the “administrative savings” and “electronic records” arguments.  They are small potatoes when compared to “utilization.”)  

      <

      p>Can you give me an example where government provides ANYTHING at lower cost than the private sector?

      <

      p>Please explain why Medicare’s $74 TRILLION unfunded liability isn’t a crisis RIGHT NOW.

      <

      p>  

      • Many who do have inadequate coverage and people go bankrupt.  Ergo, there’s a crisis, at least for those in these predicaments.  At the risk of your dismissing out of hand any project of Michael Moore’s I’m going to go out on a limb and recommend you see SiCKO anyway.  It’s rather eye-opening and he answers all the usual objections.

      • Shep, you are so far in the weeds of talking-points that it’s prit-near impossible to imagine you actually wanting a good-faith explanation.

        <

        p>In any event, your concern about Medicare is spot-on. Medicare is subject to the same cost-pressures on health care as the rest of the economy — the same cost pressures that helped croak GM, and that choke off all manner of economic growth in other areas. So it’s the rate of growth that is indeed a crisis. BTW, even if you loves loves loves your HMO, the spiraling costs are definitely eating into your paycheck. You’re paying for it, whether you know it or not.
        CRISIS #1: Economic
        CRISIS #2: Fiscal (as you correctly note)

        <

        p>I actually agree — there’s no single GDP amount that is the “right” amount. I’ve said (and it’s not an original thought with me) that if we spent 20% of GDP on health care, and lived super-long and were super-healthy … hey, why not? What’s more important than health? But we don’t get those results, even as we spend so much more.
        CRISIS #3: Value (and opportunity cost)

        <

        p>And also, I actually care about justice — that 47 million uninsured folks — and millions more underinsured — a.) forgo care, or just don’t get it, and b.) undergo severe financial hardship if and when something does go wrong. This is so common as to be utterly banal. But still tragic.
        CRISIS #4: economic justice
        CRISIS #5: health

        • And “solving” #4 will bankrupt the system.

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          p>A government system will be MORE expensive per person than a private system, as shabby as you believe private plans are.  No amount of savings from administrative overhead or electronic records will come close to offsetting the explosive growth we’ll experience in a national plan’s burden.

          <

          p>Because … government consistently prices its service BELOW THEIR REAL COSTS.  They will do this to solve your #4.  The plan has to be “affordable” and so it will be priced well below its real cost.  Isn’t this the case with our plan here in MA?  Haven’t the costs exceeded prior estimates by 50% each year?  

          <

          p>This certainly was the issue with TennCare, in TN.  And look back at the cost estimates for Medicare, circa the late 1960’s, then again in the late 1970’s.  The actual costs are an order of magnitude — or two — above estimates of the time.

          <

          p>When something is underpriced, people demand more of it.  In a health insurance plan, underpricing will accelerate utilization and overwhelm the system. (In addition to premiums, co-pay and deductibles work into the equation to reduce utilization.)

          <

          p>Hasn’t this been the case with Medicare?  It has premiums, it has deductibles, it has co-pays — all set by the government.  And yet Medicare records a $74 TRILLION unfunded liability as of 2004.  Isn’t that a crisis?

          <

          p>How will these known economic forces “solve” your points #1, #2, #3, and #5?  Using the Medicare model, government exacerbates your points #1, #2, #3, and #5.

          • we’re getting somewhere.

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            p>First of all, your comment that somehow gov’t care will be more expensive than private is not supported. You can’t prove it, b/c it’s not so. I have heard that Medicare pays too little, and therefore shifts costs to the private sector. I’m not sure I believe it, but in any case it begs the question, which is what any system is paying for in the first place.

            <

            p>So the issue that you’re concerned about is systemic cost control. You think new legislation — including greater access — will exacerbate that. I’m pretty sure you’re wrong. Health care reform ought to include:

            <

            p>Comparative effectiveness data
            Electronic medical records (duh)
            Health insurance exchange, like the “connector” (creating real competition between insurers)
            Competition from public insurance will force insurers to bargain for lower rates.

            <

            p>Yes, if we’re talking about cost control, then we’re talking about paying less. Frankly I do not understand the concerns of docs who complain that they lose money on Medicare patients. Maybe their operating costs — and salaries — are too high.

            <

            p>(BTW, we agree that Medicare is indeed in crisis. I think I said so.)

      • The lowest drug prices in the United States are those negotiated by the VA.

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        p>There’s an example of something provided by the government at a lower cost than the private sector.

        <

        p>Of course, your question includes a logical fallacy – comparing the cost of services between private and public sectors.

        <

        p>We give certain jobs to the government because we do not trust the private sector with them, even when we know they’ll be more expensive.

        <

        p>Like law enforcement.

        <

        p>Paul Blart’s Mallcop notwithstanding, I’d rather be kept safe by police officers, not $8-an-hour private security guards.

        • First of all, please provide a citation substantiating your claim.

          <

          p>Even if it were true, the VA themselves didn’t create products or deliver services at a lower rate.  They secured a big discount through purchasing power.  Good for them.  But this can be emulated by any large organization.

          <

          p>Buying drugs cheaply is just a component of the VA’s total delivery cost.  Offsetting that fine Rx negotiating outcome is their generally poor level of care.  Do we hear anyone suggesting we should simple use the VA system, instead of the Medicare system, nationally?  I assume, although have no cite, that their services are expensive and sub-par, too!  The VA’s ineptitude is legendary.  

          <

          p>I present no logical fallacy.  There are many functions which the government assumes, and many more it WANTS to assume, that are provided at a lower cost and higher efficiency by the private sector.  Facility construction, road repair, garbage removal, IT services, welfare check processing, tax collecting, etc. etc.  

          <

          p>I bet Raytheon+Honeywell+IBM could design, install, and operate a private air traffic control system faster, better, and cheaper than the FAA certainly has.

          <

          p>But delegating its police powers is not something government does, or should do.  So too for manning ICBM’s and Cheyenne Mountain.  These are core government responsibilities … and are they not enumerated in the constitution?

          <

          p>However, if I wanted to be protected in Boston, I’d choose Blackwater over the BPD.

          • … unless the only services you’re thinking of are drug purchases, in which case they aren’t doing anything that WalMart isn’t doing also.

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            p>The VA is the only actual socialized medicine in the US.  The doctors and facilities are not ‘contracted out’, they are the VA.  

          • First of all, please provide a citation substantiating your claim.

            <

            p>Why? You don’t seem to cite anything at all? You want me to apply a standard to my claims that you’re unwilling to apply to yours?

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            p>Lets try this: http://www.kaisernetwork.org/d…

            <

            p>

            Even if it were true, the VA themselves didn’t create products or deliver services at a lower rate.  They secured a big discount through purchasing power.  Good for them.  But this can be emulated by any large organization.

            <

            p>Not every large organization – the most recent change in Medicare law, pushed forth by a Republican Congress and signed by President Bush, specifically and expressly banned Medicare from negotiating a lower price for the drugs it pays for. I imagine you’ll see this restriction done away with by the Obama administration, but at the moment, it’s federal law.

            <

            p>

            Buying drugs cheaply is just a component of the VA’s total delivery cost.  Offsetting that fine Rx negotiating outcome is their generally poor level of care.  Do we hear anyone suggesting we should simple use the VA system, instead of the Medicare system, nationally?  I assume, although have no cite, that their services are expensive and sub-par, too!  The VA’s ineptitude is legendary.

            <

            p>There was no argument made about the VA’s delivery cost. I’m not sure what or why you brought this up. You asked for an example where the government does something for a lower cost than the private sector. You got that example. You’re saying the VA does something else not as well? That’s not a response to my point, it’s another, unrelated point altogether.

            <

            p>A good counterpoint might be a study that some private market actor gets an even lower price. You’ve provided nothing of the sort.

            <

            p>

            I present no logical fallacy.  There are many functions which the government assumes, and many more it WANTS to assume, that are provided at a lower cost and higher efficiency by the private sector.  Facility construction, road repair, garbage removal, IT services, welfare check processing, tax collecting, etc. etc.  

            <

            p>You demanded cites of me. Now I demand them of you. Show me that these services are actually done at a lower cost and with higher efficiency. Saying they do doesn’t magically make it so.

            <

            p>

            I bet Raytheon+Honeywell+IBM could design, install, and operate a private air traffic control system faster, better, and cheaper than the FAA certainly has.

            <

            p>Again, this is conjecture without evidence. Show me a place where this has happened for proof, or at least say why you think it might be possible. Saying “I bet they can” isn’t the same thing as evidence of it actually being possible.

            <

            p>

            But delegating its police powers is not something government does, or should do.  So too for manning ICBM’s and Cheyenne Mountain.  These are core government responsibilities … and are they not enumerated in the constitution?

            <

            p>There’s nothing in the Constitution about ICBMs or Cheyenne Mountain, or even police powers. Closest you get to that is Congress getting the power to declare war and the President getting the powers of Commander in Chief.

            <

            p>

            However, if I wanted to be protected in Boston, I’d choose Blackwater over the BPD.

            <

            p>That might be your choice, but Blackwater charges a whole hell of a lot more for their services than BPD officers get paid. I thought you wanted to pay less?

    • “There’s no health care crisis …” (0.00 / 0)
      “… because I have health insurance I like.”
      “There’s no climate change; It’s cold today.”

      “We’re not at war; no tanks on my street.”

      “There’s no hunger; I’m stuffed.”

      “There is no sun; it’s dark outside.”

      Conservative solipsism at its finest.

      <

      p>You throw out some cliches, of course not fabricated because you’ll provide links to people who actually said them, no?  And the irony: “conservative solipsims”.

      • to the liberal mode of debate.  The “health care crisis” is an unassailable given.

        <

        p>Or is it?  Americans are split — some say spend more, other less.  From that Pew poll: “In the current survey, far fewer say health care expenses are a major problem for themselves and their families than was the case in 1993.”

      • …the climate change quote accurately reflects attitudes I have heard, including on this site.

    • “There’s no health care crisis–there aren’t even any co-pays on my meds since I’ve been on Medicaid.”
      “There’s no climate change (ahem, ‘Global Warming’)–this has been the coldest June since records have been kept.”
      “We’re not at war–ignore the crashing sound of those buildings!”
      “There’s no hunger–see how obese all the poor people are.”
      “There’s no sun, it’s midnight.”

      <

      p>Cynical musings at their nastiest from Edgar.

  5. I had an email back and forth with a friend of the Republican persuasion this morning, good guy but he seems to take his talking points from whatever is on the radio that morning.  But in his attack against health care reform after a few messages he came up with this:

    <

    p>”How do private companies compete with a company that has no interest in making money?”

    <

    p>Yes, that’s the point.

    • If the government does successfully eliminate the profit incentive in the production and distribution of medical services, prescription drugs, or other medical devices, don’t expect demand for these goods and services to be met or investment in research and development to continue at the existing pace.  There’s a reason that the US innovates for the world.

      • I can live without health insurance innovations by the private health insurance industry.

        • I innovation is still thriving in the financial or insurance business and see no reason to strive for it to stop.   You figure we have enough technology in for now.  YMMV.

          <

          p>One of many links on the topic:

          <

          p>

          Health insurance companies such as Cigna are implementing employee wellness programs, taking a longer-term view of policyholders instead of merely reimbursing claims. Fleet insurers pioneered the use of data on how people drive to understand risks more fully and adjust premiums accordingly, he said. Companies are dressing up what he calls “plain vanilla annuity products” with such bells and whistles as guaranteed returns, floors on returns and minimum death benefits.

          Another innovation Phillips has seen is the increased use of quantitative modeling using common metrics to evaluate risk-adjusted returns across product categories. This lets C-level executives make apples-to-apples comparisons of different business units.

          Recognizing a lack of innovation in the industry, several companies, including Allstate Insurance Co. and AXA Equitable Life Insurance Co., have created new executive-level positions focused on innovation.

          • This a re-thread of an old idea.  It does have it merits but innovation.  No.

            <

            p>Look at the health care industry and the role of the health insurers.  What have they done for us as an industry?  What is their role is the explosion of costs?  Cigna has a wellness program.  Woopie do!  We are going to need a lot more than that.  

            <

            p>We do need innovation, the health insurance industry’s track record is not good and what they are doing now is fighting change tool and nail.  But some have started to acknowledge that something has to be done, it’s not because of their good nature, it’s because they know it’s getting done with them or without them.

      • The US Government (i.e. taxpayers) spend billions on innovation, far more than anyone else spends.

        <

        p>For it, we get … innovation!

        <

        p>Also, who said anything about eliminating the profit incentive? The Defense Department runs national defense, and defense contractors seem to all make hefty profits making products for them.

        <

        p>What’s with all the straw man arguments?

        • The US Government (i.e. taxpayers) spend billions on innovation, far more than anyone else spends.

          <

          p>The U.S. government spends a lot on R&D, but the US private sector spends far more. Your assertion is therefore incorrect.

          <

          p>

          In real terms, spending on American biomedical research has doubled since 1994. By 2003, spending was up to $94.3 billion (there is no comparable number for Europe), with 57 percent of that coming from private industry. The National Institutes of Health’s current annual research budget is $28 billion, All European Union governments, in contrast, spent $3.7 billion in 2000, and since that time, Europe has not narrowed the research and development gap. America spends more on research and development over all and on drugs in particular, even though the United States has a smaller population than the core European Union countries. From 1989 to 2002, four times as much money was invested in private biotechnology companies in America than in Europe.

           

          • I wasn’t comparing US Government spending on research with private spending on research in the United States, but funding by the US Government in comparison to other governments.

            <

            p>You didn’t answer my main point – who said anything about eliminating the profit incentive?

    • it’s pricing and utilization.

      <

      p>Johnk, Medicare is projected to have a $74 TRILLION unfunded liability.  And Medicare is non-profit.  Can you explain that point?

      <

      p>Government can underprice its services because it can (1) simply print money to pay for the program deficit, and (2) increase taxes, and (3) borrow the money.  Private plans can only do (3), and only for a short time before bankruptcy.

      <

      p>Underpricing government service does 2 things: it (a) creates excess demand for that service, and (b) drives out competitors.  The can do (b) because the can do (1) and (2).

      <

      p>Medicare is real world proof of (a), (1), (2), and (3) to the tune of a projected $74 TRILLION.

      <

      p>If Medicare, i.e., the federal government, could not do items (1), (2), and (3), it would have been bankrupt by 1968.

      <

      p>Health care is an economic resource which, just like property insurance, frozen dinners, PCs, airline travel, and tax prep services, is rationally allocated in society on the basis of price.  (This is, I think, the point your friend was trying to make.)  

      <

      p>When the government gets involved, and sets prices too low, as sure as there’s rain there will be a explosive cost “crisis.”

      <

      p>This why we do not have a “crisis” in property insurance, frozen dinners, PCs, airline travel, and tax prep services.  For the most part, government keeps it nose out of it.  Mostly.

      • You willfully ignore questions that you do not want to address and repeat the same tired points.  

        <

        p>As for your “printing own money” line.  Funny, I got that same line in the email exchange.  You must have been listening to the same show.  But in reality we in effect subsidize private health care organizations in the form of taking those who are sick or with chronic disease that privates dump.  You pay with your taxes for persons that private insurance companies dump.  So in effect, they do print their own money.

        <

        p>In addition, Medicare insures a population that inherently uses the health care system more than other populations.  

        <

        p>Your main point is that Medicare has an unfunded liability so a public option will fail.  But you give absolutely no reason why, that in itself is not a reason.  If private insurance companies had to cover the sickest people the Medicare dumped and insure seniors only what would they look like?  Based upon what we know in how they are organized, it’s would be significantly larger that 74 trillion.

        <

        p>We know a few things as fact, Medicare has a more efficient operation with low administrative costs.  Health care reform is needed to change how we pay for services.  You do nothing to argue any of this.  

        <

        p>As part of the reform private insurances can no longer use taxpayers as their personal ATM machine.  They can no longer dump the sick, they will need to compete with a public option that doesn’t have millionaire CEOs and low administrative costs.  Some privates are on board with reimbursement based on outcomes rather than services provided, but they are late to the party.  If that’s what they wanted to do then why are they doing it now?  Why didn’t they start doing it a long time ago?  It’s too late for bogus reform.

        <

        p>How’s that for long winded.

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