Blue Mass Group

Reality-based commentary on politics.

It’s All. About. Health. Care. Costs.

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I'm going to de-shrillify the central argument of a Paul Krugman column, so that we can all try to get the point, minus the extra two-minute-hate adrenaline rush:

  1. The budget crisis is due to Medicare and Medicaid cost increases over time.
  2. Medicare and Medicaid cost increases are due to the rising cost of health care.
  3. Therefore, if you want to do something about deficits, do something about the rising cost of health care, ie. services.
  4. Health care reform of 2010 did a number of things on that front, like trying to pay for value/quality rather than volume of care.
  5. And if it's deficits that are the problem, you have two options: 
    1. cut outlays or
    2. increase revenues.

And now might be a good time to show a pie graph of the federal budget.

The big chunks are Social Security, Defense, unemployment, Medicare, and Medicaid.

And now a graph of Medicare/health care spending increases — note that Medicare/Medicaid slopes basically track with the general increase in health care costs:

 

So, conceptually, this problem is not hard to understand. Politically, it is difficult. But the discussion on Capitol Hill right now is simply not addressing it at all. If you think you can make a dent in the federal budget without looking at those big chunks, you're kidding yourself. Or someone's kidding you.

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  1. so if we identify the rise in healthcare costs as the culprit, can we mine down a little deeper and find out “WHY” the costs have exploded so much more than other cost increases? Have DR visits gone up 20%, 40%… prescriptions 20%, 50%… Are more tests being done than in the past… Where exactly is the problem?

    • When I was young, if you were given a diagnosis of cancer – you went home to settle you affairs before you died.  If you were born with certain diseases, you didn’t live to age 20.  ‘Incurable’ meant exactly that.

      <

      p>Now – with the advent of medication, tests, laproscopic surgery, and so on – things which were a death sentence only decades ago are now manageable condidtions.  BUT – that medication management costs money, and many people also develop subsequent conditions, like the heart attack victim that develops diabetes in a few years.

      <

      p>When is the last time you heard a doctor say to a family – ‘I’m sorry, there’s nothing we can do.  You can take him home’.  That happened fairly often when I was younger, but now not only is there no death watch – there’s hospice and PCA help.

      <

      p>Health care costs have exploded because HEATH has exploded.  This is not to say people are healthier, but they are not dead either.  I don’t think that gets acknowledged enough in these discussions.

      • And other countries get better outcomes for less money because they don’t get sick?

        <

        p>Please adjust the talking point.

        <

        p>Thank you.

        • But thanks for the nostalgia-based talking point, Mr. Porcupine. Novels do have a certain appeal.

          <

          p>And thanks for the reality, KB.

          <

          p>As you were, bloggers.

        • “Why did things get so expensive, relative to the past?” and was not a question of relative cost at present, and the answer has undoubtedly identified a factor– significant advances in technology– in the increase in costs compared with decades ago.

          <

          p>A different way of saying this– without the “we’re healthier” spin to which you object– is that the mean and median age of Americans is rising– and health care therefore costs more.  If there were substantially fewer people aged 70 or more, our costs would be lower.

        • Of course, you’re right that Western European countries get better outcomes for less money.

          <

          p>But, yes, European’s are “don’t get sick” as often as Americans (due primarily to healthier lifestyles and the better diesease prevention services that national health care provides in comparison, especially, to the large uninsured young adult population in the United States).  To my point, a few statistics:

          <

          p>The estimated adult diabetes rate in the United States is 11.3% compared to the Euorpean Union’s rate of 6.5%.  

          <

          p>This diabates disparity alone has a dramatic impact on spending, with the EU spending about $93 Billion annually to to treat and prevent diabetes and its complications for its population of over $500 million.  And the U.S.? We spend at least $116 billion a year on medical costs alone to treat diabetes for our $300 million population.  We spend 25% more for a population that is 40% smaller!

          <

          p>This same trend (higher U.S. rates of “sickness”) is reflected in a wide raneg of chronic diseases where Medicare alone pays huge amouunts for people with alzheimer’s disease ($100 billion), strokes ($65 billion), end-stage renal disease ($25 billion), chonic lung diesease ($10 billion), heart disease ($25 billion), and cancer (@$10 billion).

          <

          p>Ultimately, Americans “get sick” (defined here as “acquiring” a chronic disease due to unhealthy lifestyles, moslty obesity & smoking, and lack of access to primary/preventive care) at about twice the rate of Europeans.  After 65 (when Medicare and Medicaid really kick in for most non-disabled people), a full 1/3 of older U.S. adults are obese, compared with 17% of older European adults.  Despite the “Europeans all smoke” stereotype, about 50% of older U.S. adults were active or former smokers, compared with 40% of older European adults.

          <

          p>Talking point adjusted?

          <

          p>  

          • For example, lung cancer rates are significantly lower in the US.  Incidence rates are a mixed bag, but not so much different.

            <

            p>We do spend a lot of money on ineffective treatments that the Europeans do not waste money on, so certain diseases are far more expensive in the US, while not having better outcomes.

            • We do spend a lot of money on ineffective treatments that the Europeans do not waste money on, so certain diseases are far more expensive in the US, while not having better outcomes.

              <

              p>Sorry but I rarely get away with comments like this without someone asking for a link.

                • How should we proceed? I would imagine the Insurance companies would love to be able to deny services to customers based on these interesting stories. I imagine the tough part will be telling people they can’t get their tumor removed, stint inserted or many other operations based on a small scale study. Most people suffering from a cancer would probably jump at the idea of surgery to remove the cancerous tumor. So how do we implement a “no surgery” effort without starting a riot?

                • John, those four links had NOTHING WHATSOEVER about removing tumors, inserting stints, or removing cancerous tumors.

                  <

                  p>Instead, the links are clear examples of several common and expensive practices for which either no benefit has been demonstrated or for which a far less intrusive and far less expensive alternative gives superior results.

                  <

                  p>You asked for links, and you got them.

                  <

                  p>In fact, there is a wealth of evidence just like these links to support the perfectly reasonable and accurate claim that “We do spend a lot of money on ineffective treatments that the Europeans do not waste money on, so certain diseases are far more expensive in the US, while not having better outcomes.”

                  <

                  p>Nobody but you said anything about a “no surgery” effort, that is your invention.

                  <

                  p>You asked “How should we proceed”?

                  <

                  p>A foundation stone of scientific medical practice is to demonstrate that a given procedure or medication works more effectively than less intrusive, less dangerous, and — yes — less costly alternatives. It appears to me that MannyGoldstein is suggesting that we start there.

                  <

                  p>Do you REALLY oppose that?

                • I don’t support ANY procedure which doesn’t have a positive outcome. If we can take a medication which will give “as good or better” results as surgery then let’s do it. My question was… how do we do this without causing a panic/riot? If a procedure only helps 10% of the population, how do we decide to not allow treatment if someone feels they could be among the 10% successes?

                  <

                  p>My other comment was let’s get the insurance companies involved. My guess would be any insurance company out there which could deny a procedure (and not have to pay out anything) because the procedure showed no more benefit than a lower cost medication or alternative treatment would jump on this. The key would be to get these studies to be fully vetted and adopted by the Surgeon General and then the AMA. Without the support of the “established” medical community, most people would suspect this is more about saving money than saving lives.

                  <

                  p>So don’t get all jacked up Tom, I’m with you on this one.

                • Basically, it’s difficult for insurers to stop coverage for things.  Patients scream bloody murder that they can’t get an accepted procedure, insurer caves.  And the AMA, an extraordinarily effective lobbying group, doesn’t want to see docs make less money so they’ll fight.

                  <

                  p>Best bet might be to cover it, but have the patient sign something that says that they understand that there is not any good evidence that X will help them.  I suspect that patients will then voluntarily choose not to do X.  Medicare would likely need to be the first to do it.

                • From http://www.jmbblog.com/pushing… although I haven’t fact-checked:

                  <

                  p>

                  “Only 10 to 20 percent of all procedures currently used in medical practice have been shown to be efficacious by controlled trial. Therefore 80% to 90% of medical procedures routinely performed are unproven.”
                  — Assessing the Efficacy and Safety of Medical Technologies. Washington, DC, Congress of the United States,
                  Office of Technology Assessment, Publication No. 052003-00593-0.

                  <

                  p>

                  “Only about 15% of medical interventions are supported by solid scientific evidence. This is partly because only 1% of the articles in medical journals are scientifically sound and partly because many treatments have not been assessed at all.”

                  Richard Smith, Editor of the British Medical Journal

                  <

                  p>Note that the British Medical Journal is in the vanguard of evidence-based medicine and cost-efficacy.

                  <

                  p>Some more:

                  <

                  p>http://www.nytimes.com/2009/03…
                  http://voices.washingtonpost.c…
                  http://www.deccanherald.com/co…
                  http://www.bloomberg.com/apps/…

          • they have larger percentages of people over 65.   This is the most expensive group to care for.  That said, we all wish to be in that category some day.  It would be nice to know it will be one less thing to worry about.  Hmmmm, maybe the rest of us could use this system.  Yeah, but who wants a national insurance that pays the bills and maintains private physicians that we can choose from.  Ah, only a pipe dream.

            <

            p>We’ll see maybe one state will come to its senses, like Vermont.

      • You would think, then, that higher health care costs would correspond to longer lives and better health. Unfortunately, PP, both within the US, and the US vis-a-vis other countries, health care costs do not correspond with better health. If that were true, then we would be healthier than the Canadians, Brits, Germans, and so forth. If that were true, then the highest-cost health care areas in the US would be the healthiest. They’re not.

        <

        p>Atul Gawande’s article on McAllen, TX:
        http://www.newyorker.com/repor…

        <

        p>The Dartmouth Medical Atlas:

        In studying Medicare data , Atlas researchers have documented that more care does not necessarily mean better care. In fact, more hospitalizations and more procedures among similar populations can result in higher mortality than for populations that received more conservative care.

        <

        p>Pity about that.

        <

        p>In other words, if your thesis were correct — better care=higher costs — then more health care spending would be justified, even imperative! Heck, if you’re getting good results and people are running marathons at age 95, then why not spend, what, 25% of GDP on health care? More? On the list of things people value, is there anything more important than health and long life?

        <

        p>But it doesn’t turn out to be true.

        <

        p>Another good link: Institute for Healthcare Improvement. Unfortunately, Don Berwick’s appointment to head of CMS was blocked by Senate Repubs, so Obama recess-appointed him. It’s a shame — he’s a great guy for the job.

        <

        p>Another one, from one of our advertisers! A nifty precis on how to use IT and electronic medical records for better/more efficient care:

        Not to be too credulous, but I hope it’s true, and I hope it really works this well.

      • We can treat things we once could not, and we can prevent things that we once couldn’t prevent. Good things of course, but also expensive.

      • You might start here:
        http://www.kaiseredu.org/Issue…

        <

        p>Upshot:

        What is driving health care costs?

        Controlling health care expenditures requires a solid understanding of the factors that are driving the growth in spending.  While there is disagreement on exactly what those are, some of the major factors to consider are:

           * Technology and Prescription drugs – For several years, spending on new medical technology and prescription drugs has been cited as a leading contributor to the increase in overall health spending; however, in recent years, the rate of spending on prescription drugs has decelerated.  Some analysts state that the availability of more expensive, state-of-the-art technological services and new drugs fuel health care spending not only because the development costs of these products must be recouped by industry but also because they generate consumer demand for more intense, costly services even if they are not necessarily cost-effective. [My emphasis – C] [5]

           * Chronic disease – The nature of health care in the U.S. has changed dramatically over the past century with longer life spans and greater prevalence of chronic illnesses. [PP’s thesis — C] This has placed tremendous demands on the health care system, particularly an increased need for treatment of ongoing illnesses and long-term care services such as nursing homes; it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. [Includes end-of-life care — too bad about that whole “death panels” silliness … – C][6]

           * Aging of the population – Health expenses rise with age and as the baby boomers are now in their middle years, some say that caring for this growing population has raised costs. This trend will continue as the baby boomers will begin qualifying for Medicare in 2011 and many of the costs are shifted to the public sector.  However, experts agree that aging of the population contributes minimally to the high growth rate of health care spending. [My emphasis — goes against PP’s thesis — C.]

           * Administrative costs – It is estimated that at least 7% of health care expenditures are for administrative costs (e.g., marketing, billing) and this portion is much lower in the Medicare program (<2%), which is operated by the federal government. [8] Some argue that the mixed public-private system creates overhead costs and large profits that are fueling health care spending.

        • Kaiser would seem to think so as well.  Didn’t say it was the ‘solution’, only an ingredient in the mix.  I have a chronic condition, and have been on expensive medication for years – and if I were ten years older, it probably wouldn’t have worked out that way.  Things that were ‘Mayo Clinc’ rare years ago are commonplace now – especially for diseases like cancer.  And it has CONTRIBUTED to health care expense.

          <

          p>What triggered that visceral response is beyond me.

          • “I only said it was a factor”

            <

            p>You didn’t claim that it was a factor – re-read what you actually wrote.  JohnD asked the question “Where exactly is the problem?” and you replied with “Health care costs have exploded because HEATH has exploded.”, not “one factor is that we’ve improved health.”  

              • that all people who aren’t dead are healthier than any people who are dead.

                <

                p>Your opinion may be different.

              • I’m sure there are many reasons why the cost of healthcare has exploded and the fact that people are being treated for diseases and conditions in much larger numbers then before is part it. It makes sense that screening for cancer (breast, prostate…), finding the “silent killer” (Hypertension), diabetes and many other early screening has uncovered millions of people who would have gone untreated. Now we are paying for the screening and then paying for the treatment of those found with conditions. The result may be akin the military tactic of “shot to wound” with the intent of seriously wounded them so it takes 3 soldiers out of the battle (1 wounded and 2 to care for him/her).

                <

                p>Prescription costs… check out Genzyme’s product costs for Gaucher disease patients.

                <

                p>

                The average annual cost of therapy for patients receiving these products is approximately $200,000. For Myozyme, the average annual cost is approximately $300,000 because the dose of the product is significantly higher. Dosage for all of the products is based on a patient’s weight, meaning that the annual cost of treatment for children is less, and the cost for heavier adults is higher. Because so few people require these products, the cost to individual health care systems and insurance plans is very small.

                <

                p>Years ago, these patients simply died and added no prescription cost burden to our system.

                <

                p>Resulting in…

                <

                p>

                • Re-read your last sentence

                  <

                  p>

                  Because so few people require these products, the cost to individual health care systems and insurance plans is very small.

                  <

                  p>The cost is very small.

                  <

                  p>There’s no question that “screening” has raised costs significantly… but hasn’t it also raised GDP?  After all, people who aren’t sick tend to be more productive.

                  <

                  p>There are lots of ways to lower the costs of health care to society, but we may not think of them as fair.  We could focus much more effort on:
                  * keeping 20-65 yos healthy enough to work
                  * research to decrease costs of treatment
                  * research to reduce instances of expensive problems

                  <

                  p>But doing that [with the same health research budget] necessarily implies a whole bunch of other things that we’re not working as hard on, including:
                  * medicines more relevant to children and seniors
                  * research to expand treatments to more diseases
                  * research to improve management of existing diseases, perhaps at a higher financial cost

                  <

                  p>

                  <

                  p>In the mean time, if America wasn’t so invested in fat-assedness, we’d have much lower health care costs.  Everybody from corn based agribusiness to Detroit to home builders to the media have an interest in promoting an American lifestyle which increases our waistline and our health care costs.

                • In the mean time, if America wasn’t so invested in fat-assedness,

                  <

                  p>At last a mention of the important role of our tax dollars going to the kind of corporate welfare that is a BIG barrier to any efforts by our local, state and federal government’s  role in disrupting any of Michelle efforts at health prevention/promotion.

                  <

                  p>Gaurgh..  

                • I’m on board with you but prescription drug costs have skyrocketed and to ignore those costs is foolish.

                  <

                  p>As for the “cost being very small”…

                  <

                  p>

                  Consider Genzyme (Charts), one of the more prolific producers of orphan drugs, also known as “orphans.” The Cambridge, Mass.-based biotech has three on the market, including a $1 billion-a-year treatment for a debilitating, hereditary disease called Gaucher. Gaucher disease results from a specific enzyme deficiency in the body.

                  Cerezyme, Genzyme’s Gaucher drug, is one of the world’s most expensive drugs. An annual supply can cost $200,000. About 5,000 patients take Cerezyme, according to company spokesman Dan Quinn, who said that’s at least half the world population for Gaucher patients.

                  <

                  p>A billion dollars here, another billion dollars there and pretty soon we’re talking real money…

                  <

                  p>Good reading… Ten most expensive drugs

                  <

                  p>

                  <

                  p>Some good news from 2010…

                  <

                  p>

                  Over the next 5 years, several big patent expirations will continue to fuel the shift toward generic alternatives. IMS Health reports that the emergence of less expensive generics will “reduce total drug spending by about $80 billion to $100 billion worldwide through 2014.” The majority of the financial impact will be felt in the United States, peaking in 2011 and 2012 when 6 of the 10 highest grossing branded products will face generic competition. Among the products that will face patent expiration within the next 2 years include Pfizer’s top-selling Lipitor, Eisai’s Aricept, and Merck’s Cozaar and Hyzaar.

                  <

                  p>Don’t forget Viagra patent expires Mar/2012.

                • That’s a good question.

                  <

                  p>I will again use myself as an example.  My expensive medication has made me more productive than if I were in an unmedicated state or dead – but does that productivity correlate to or offset the medication cost? (As Craig Ferguson would say, I look forward to your letters.)

                  <

                  p>I actually have been consistently employed on a full time basis, but many others who are on maintenence medical costs are not, and many are not employed at all.  The severity/type of medical condition may not make employemnt possible, so the medical cost could be a drain on GDP rather than a boost.  This would be especially true as the population ages and the earning capcity overall decreases while the medical expense simultaneously rises.

                  <

                  p>This is a significant FACTOR in the increase in overall medical expense.  That’s all.

      • <

        p>Gasoline prices are kept in check because of competition.  It doesn’t matter that demand is large and rather inflexible if there are multiple suppliers competing for sales.

        <

        p>P.S. In 7 years, America could cut it’s demand for gasoline by 30%, simply by buying more fuel efficient vehicles.  Check out this chart: notice how the low-consumption states have virtually nothing in common?  Well, except something culturally which has led to lower consumption, that is.

        <

        p>

        • We have a glut of physicians. Why aren’t their rates kept in check by competition?

          <

          p>In fact the opposite is occurring — the competition boosts their rates, because one competitive dynamic is a top medical school. They spend more on their education, and then charge us more, and all doctors follow suit.

          <

          p>My point about gas is simply that most driving is not optional. Same with medical stuff.

          <

          p>

          • It all depends on your perspective. Perhaps there’s a glut in certain specialties, but across the board, I don’t think so. GPs and doctors in family practice are in short supply. It depends where you look, such as in a big medical education center like Boston, or in a rural area such as the heart of the Berkshires to give a couple of examples.

      • As a still recovering patient from treatment of multiple chronic conditions, I have benefited from the “best health care in the world” at the top teaching hospitals in Boston With excellent health insurance, I only have to look at the reports from our insurance company and gasp.  

  2. It is always tempting to approach this problem as a piecemeal issue.  It isn’t.  

    <

    p>The monies paid in are supporting the various providers and also providing services to the 20% that make up 80% of the costs.  What are called unnecessary tests and services are unfortunately part of the equation to keep this system together.  

    <

    p>If there is a successful plan to trim these items, some other source of revenue will have to be found.  There is not the savings people think by cutting out so called waste or even malpractice reform.  Because more are able to reach old age because of better care, the Medicare budget will also grow.  At present Medicare patients make up 12% of the population but generate 36% of the cost.  As a increasing percent of the census this number will only go up.

    <

    p>Health care costs have risen in other nations also but are controlled because of unified risk pools and proper uniform pricing.  The drug costs for Medicare recipients in this country is a prime example where Congress missed the boat.

    <

    p>The real issue is whose ox is going to be gored.  You have to either decrease practitioners or administrative personnel.  Take your choice.  It is time to face this unseemly reality.  

    <

    p>A certain number of people will lose their jobs.  However those on the administrative end have a better chance of making a successful transition(these bureaucracies represent true waste).  Quite frankly it would be a disaster to reduce our professional medical ranks.  We need them to maintain quality care.  

    <

    p>The savings to subscribers with whatever shakeout is decided upon will allow businesses to have more capital to hire workers or give raises.  Health insurance premiums must be lowered no matter what path is selected.

    <

    p>It is also unconscionable to endanger citizens’ health while a defense budget is so out of control.  The real decision is whether ensuring people’s access to health care is an essential aspect of society and should rank ahead of funding the military to multifold of what is needed.

  3. …but I was under the impression that Medicare, Medicaid, and SS were entitlements not included in the general budget, which is why they are withheld separately from regular income taxes.  Am I correct that single-payer would be a major cost-reducer, pretty much by defintion?

    • no

      <

      p>Yes, our current system sucks up a tremendous amount of money in administrative costs that are not socially productive. That alone is not the problem, though.

      <

      p>Part of why the rest of the industrial world gets better healthcare for less treasure is how the money is spent not just how it is administered.

      • … the problems with regard to how the money is spent are easier to manage with the pressure that a single payer system can exert on actual practices, not just administration.

  4. Health costs have risen absurdly because we are the only industrialized nation to not have a mechanism to control them, some sort of central planning.

    <

    p>Every other nation has controls of one sort or another that force medical professionals to control costs.  We have nothing.  A few tidbits:

    <

    p>1. Medicare is prohibited, by law, from considering cost in determining whether to cover a new therapy or diagnostic.  Medicare is the largest insurer, and once they reimburse for something, all other insurers essentially have to reimburse as well.

    <

    p>2. Doctors are essentially entrepreneurs in the US, as they are normally paid per procedure rather than on a salary.  Because of this, there are strong incentives to prescribe the most expensive diagnostics and treatments.  In some cases, they are the ones making the money directly from these treatments.  So it’s in their economic interest to do what makes the most money for the doc.  In other cases, they are paid off in various ways by drug and device makers.  For example, top docs (e.g., at Harvard, Cleveland Clinic, etc.) are paid as much as $1 million a year or more to be consultants to drug and device makers.  These are the same docs who set the standards of care for all medical care.  Nobody will pay them $1 million a year for a cheap, generic drug!  Similarly, spinal implant companies will pay a lot to top docs, but there’s no entity representing the proven alternative (doing nothing) that will pay docs to to consult to them.  So the spinal implants win, even though there’s no evidence that they work any better than doing nothing.

    <

    p>3. I work in the medical world.  A few years ago I was having dinner with the head of a department in a large German hospital.  He was very worried that medical spending in Germany was nearing 10% of GDP, and that Germans were starting to get angry about this.  I can’t conceive of having a similar conversation in the US.  The vast bulk of US docs and administrators have zero concerns over what % of GDP they absorb.

    <

    p>Also note that the US has far fewer docs per capita than most European countries, even though Europeans pay about half as much per capita compared to us (and enjoy better outcomes).

    <

    p>Until we recognize that medical costs are overhead to be controlled, not a growth industry to cheer on to greater revenues, we are harming ourselves.

      • And SS is relatively easy to strengthen for the long-term with minor tax tweaks (like raising the ceiling on payroll tax incomes to something greater than $106K).  

        <

        p>If someone talks about SS as a main area to cut to help reduce the deficit, you probably shouldn’t listen to anything else they have to say.  

        <

        p>The deficit problem is all about health care and revenue (as this post correctly identifies).   Cuts to discretionary spending, including Defense, are just ways for each political party to deal with what they view as “waste.”  The impact on the deficit of these cuts is basically meaningless.  Unfortunately, it seems that both political parties agree that cutting things for the poor is the best way to reduce “waste,” even if they disagree on the degree.    

  6. It may be “all about” health care costs going into the future, but the current mess is all about our loss of jobs, all about the banks, all about Wall Street, all about the rich getting tax cuts they don’t need — in other words, our current mess is all about the severe hits to our revenue streams. We need to think of ways of raising revenue — which comes in two flavors: 1) Growing the economy and making sure that growth is going to the Middle Class, who pay taxes, instead of Big Business, which doesn’t; and 2) making sure the wealthy elite and big business finally pay their fair share.

    <

    p>As much as health care cost issues is going to be something we have to solve, it is a longterm problem and the solution is going to have to come over time.  

    • We need to think of ways of raising revenue — which comes in two flavors: 1) Growing the economy and making sure that growth is going to the Middle Class, who pay taxes, instead of Big Business, which doesn’t; and 2) making sure the wealthy elite and big business finally pay their fair share.

      <

      p>

      <

      p>Heard about this tax reform campaign?

      <

      p>What We’re Doing

      <

      p>

      We are endorsing the “Act to Invest in Our Communities” sponsored by Rep. James O’Day and Sen. Sonia Chang-Diaz [House Docket 02261 & Senate Docket 1012] because we believe this bill is a step forward in creating a more equitable tax system for all and in addressing our current revenue shortfall.

      The act proposes an increase in the income tax rate from 5.3% to 5.95%, including an increase in personal exemptions from $4,400 (single) / $8,800 (married) to $7,900 (single) / $15,800 (married). It also proposes an increase of the dividends and interests rate from 5.3% to 8.95%, with an exemption for low and middle income seniors and disabled persons.

      The proposal would yield up to 1.2 billion dollars, necessary to taking a more balanced approach to the current budget gap and continuing to support our public structures.

      Representatives from organizations around the state have agreed to meet with legislators and poll them about their support for possible revenue options that would close the state’s budget gap.

  8. First they came for the communists,
    and I didn’t speak out because I wasn’t a communist.

    <

    p>Then they came for the Jews,
    and I didn’t speak out because I wasn’t a Jew.

    <

    p>Then they came for the trade unionists,
    and I didn’t speak out because boy, was Paul Krugman shrill in his column today…

  9. …have contributed to escalating costs, but take a hard look at clinical payroll as well.  For the better part of three decades, healthcare ignored the possibility that women would broaden their horizons and pursue other professions besides nursing.  The result?  An attrition of nurses from the field created a vacuum, and nationwide, health service providers paid the price.    

    <

    p>Nursing graduates couldn’t be recruited fast enough and pretty much wrote their own ticket.  Same thing occurred in Radiology, with sought-after X-ray and Nuclear Med Techs baited by offers of $50 and $60 an hour, sometimes more.  Add organized labor along with a 30% fringe to that equation and you’ve got a perfect storm for exploding HR costs…guess where that winds up?  

    <

    p>’Balanced budget’ acts and managed care did their share to pour salt on wounded relationships; between legislators who know little to nothing about patient care, docs who want administrators to get out of their way, and administrators who want MD’s to invoice every nickel from a revolving door of patients.  

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    p>With regard to staff, nonprofits have suffered and cut back their share in the recession – perhaps not as (management) top-heavy as they probably were.  Still, there’s a fine balance to bear in mind…too much weight on too little management will create an exodus of burned-out professionals.  I doubt hospital housekeepers struggling with $9 an hour wages are breaking the back of healthcare – it’s the stranglehold of Pharma, a lack of foresight, and a system that long-needed to focus on wellness, instead of illness.    

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