Healthcare and the Supreme Court

[sukeban]

@pseudobio

 

Apology readily accepted. I realize that there is an enormous personal component to any discussion about this because we are quite literally talking about people's lives and livelihood. It is true that I am young and in good health. That said, there are several realities at play with our government's handling of healthcare as an issue.

 

1. Our government is, as far as constituencies are concerned, far more attentive to the needs of seniors than to the rest of the population. This makes sense, of course, because seniors vote in a a higher proportion than any other demographic in the nation. Politicians then, are catering literally to their electorate. Democracy at work, sort of. What I mean is that Social Security and Medicare (especially Medicare) are all but sacrosanct in our political debates, but all other outlays are viewed as eminently cut-able. Indeed, the Simpson-Bowles Committee did not bother to recommend any cuts in Medicare funding even when it mandated tax increases for many Americans, a 200 billion reduction in discretionary funding (anti-poverty, early childhood development, support for student loans, etc.), as well as entitlement (pension) reductions for veterans and non-military federal personnel.

 

http://upload.wikimedia.org/wikipedia/en/thumb/2/2b/U.S._Federal_Spending_-_FY_2011.png/800px-U.S._Federal_Spending_-_FY_2011.png

http://upload.wikimedia.org/wikipedia/commons/thumb/c/cf/Medicare_and_Medicaid_GDP_Chart.svg/689px-Medicare_and_Medicaid_GDP_Chart.svg.png

 

2. That is 43% of the budget and growing. Quickly. Yet none of it, in our present political environment, can be cut. Simpson-Bowles did stipulate raising the retirement age for Social Security--but they were pilloried as a result and the proposal was considered to be toxic. To be perfectly honest, however, look at where Social Security came from--from Bismarck's Germany, from 1889. In 1889, the age to receive benefits was 65 years old. 65 years old when the average life expectancy was something like 45! It was a cynical ploy to ward off socialist agitation in the country; Bismarck knew full-well that most Germans would be very much dead before they could ever collect their state-issued insurance. When FDR instituted Social Security, life-expectancies were not all that much greater. Thus, actual outlays for Social Security remained relatively small. It has not been until recent years, with huge advancements in healthcare that have extended the average American lifespan enormously, that Social Security's total outlay grown to be large.

 

But--before anybody takes a swing at me--I am very much for Social Security and a revamped, more efficient Medicare. In no way, shape or form do I want to see seniors cast aside or treated like second-class citizens. I am young now, but I too will be a senior at some point. More than that, I would consider our society barbaric if we attempted to shirk our responsibilities to our seniors, as they are individuals who have contributed so very much to our country and do not, under any circumstances, deserve to be ignored.

 

3. However, there are only so many federal dollars to go around. They are, in an economic sense, scare. Given this scarcity, a rational government must prioritize its interests. It can a) devote more resources to fully economically productive members of society and invest in the future (China), b) concentrate on pleasing one segment of the electorate whilst ignoring most everything else, potentially sacrificing the future in the process (USA) or c) strike a balance between the two. I think most of us would opt for "c."

 

It is also a fallacy that seniors are "just getting what they paid in" when it comes to Medicare. Monies that seniors paid in from 1940-1990 are definitely not going to be covering expensive end-of-life and palliative treatments received in 2012. If that were so, we wouldn't have to borrow nearly as much money as we do. The main culprit here is, of course, the ridiculous inflation present in the healthcare sector of our economy. This inflation originates from a repulsive pharmacological and insurance industry lobby, but also because seniors keep consuming expensive medical care without regard to its cost and/or efficacy (they don't need to care how much it costs because they are not paying for it). This creates an almost inelastic demand (like a heating bill in a cold city) for healthcare, which, as per Adam Smith, drives up the cost of said healthcare to whatever the market will bear. Which, so far, has proven to be anything. This is so because not only have seniors been exempted from paying for their expensive medical coverage--by and large the rest of American society has been exempted as well--through borrowing. We haven't bothered to raise taxes to actually pay for any of this, so everybody just assumes that it is all somehow free. Not me, however, because I know that all this Medicare-derivative debt is being placed squarely on my shoulders. And that is, completely and utterly, not fair.

Edited March 30, 2012 by sukeban

[HeyYou]

Part of the problem with the rising cost of health care.... is litigation. The doctors, are forever in their CYA mode, will run test after test, and procedure after procedure, all in the interest of 'being thorough', so that if something bad happens, they won't lose their shirt in the ensuing lawsuit. Doctors are more afraid of lawyers, than they are any disease that may walk into their clinic.

[Aurielius]

One concept that is rarely discussed is to open up the market of health care insurance providers to all comers globally. At the moment most areas within the US have an extremely limited choices of actual providers. I am not sure of how far it would drop the cost immediately but if it was an open market as in the cell phone market there would be a competitive advantage to lowering the prices of services. Just a thought to ponder.

[grannywils]

 

(snip) from Sukeban

It is also a fallacy that seniors are "just getting what they paid in" when it comes to Medicare. Monies that seniors paid in from 1940-1990 are definitely not going to be covering expensive end-of-life and palliative treatments received in 2012. If that were so, we wouldn't have to borrow nearly as much money as we do. The main culprit here is, of course, the ridiculous inflation present in the healthcare sector of our economy. This inflation originates from a repulsive pharmacological and insurance industry lobby, but also because seniors keep consuming expensive medical care without regard to its cost and/or efficacy (they don't need to care how much it costs because they are not paying for it). This creates an almost inelastic demand (like a heating bill in a cold city) for healthcare, which, as per Adam Smith, drives up the cost of said healthcare to whatever the market will bear. Which, so far, has proven to be anything. This is so because not only have seniors been exempted from paying for their expensive medical coverage--by and large the rest of American society has been exempted as well--through borrowing. We haven't bothered to raise taxes to actually pay for any of this, so everybody just assumes that it is all somehow free. Not me, however, because I know that all this Medicare-derivative debt is being placed squarely on my shoulders. And that is, completely and utterly, not fair.

 

 

Holy Cow, Sukeban, I don't get it. You are just wrong on this one. I am most definitely a senior, and I am here to tell you that I am not just getting what I paid in. I am barely getting an aspirin when I need it. I am not just discussing Medicare, but Social Security, Disability and just about anything else that the government is doling out to seniors these days; particulary the less well to do seniors. Yes, I am sure that Medicare does cover 80% of certain major medical surgical procedures, etc. But day to day life is a blitch, man. My husband and I live on Social Security and both receive Medicare. It provides a minimal amount of coverage at certain providers. If you cannot afford some sort of supplemental insurance, you can rest assured that you will not be getting any sort of prime coverage.

 

When I was considerably younger, before the insurance companies discovered what a golden goose they had; I had the best health care coverage there was. I was working at a good paying job, and I did not pay a dime for it. Well, not literally anyway. It was figured into my payscale. It was not until some years later that corporate insurance got wise and became the "Jabba the Hut" that they are now and began eating away at all of America's pocketbooks. So, you are correct when you mention the pharmacological and insurance industry lobby. However, to focus on the seniors or the disabled, or the poor or the wealthy or any other user of healthcare in a debate about the healthcare bill is, in my humble opinion a pure and simple red herring used to divert us from the real issue here and to yet again divide us.

 

America needs a healthcare bill that can and will serve all of us. I do not believe that this is difficult. I believe that the insurance industry and in many instances the medical providers and their lobbies do not want that for us. Therefore they continue to obfuscate this issue with all this nonsense over who needs what and how does it effect our budget, etc., etc., etc. In my opinion, they do not need to make the overwhelming profits that they are making while some of us in this country cannot afford to go to a decent doctor.

 

Period. The End.

 

 

[ginnyfizz]

Disabled myself (rheumatoid arthritis), and becoming somewhat elderly (almost 51)...and looking at this thread, perhaps rather glad to be British (my chemotherapy, thankfully, comes at the standard NHS prescription charge. No, contrary to popular belief, it is not totally free and some of us do pay for meds.)

 

Aurelius is quite correct to say that the British model is not generally one that you in the USA should be looking to emulate. The expense of our NHS is becoming increasingly unsustainable by taxation, the vested interests of the trade unions vigorously oppose any attempt to introduce reform. Ludicrous lack of the need to drive a hard bargain, because the health trusts are not business like, has led to them being caught out paying £300 for screws for hip replacements, when the surgeons themselves say that you could buy them in the hardware store and then sterilise them.

 

And yet, the way that cost savings are being implemented has led to de facto rationing, aka the postcode lottery, which means that if you live in one area you might get the drug or the op you need, if you live over the border in another area, you will not. Thus my mother, who is over 80, gets galantamine for her Alzheimer's, if we were a few miles down the road, she wouldn't.

 

I mention all this, as I say, as an example for the USA of "How not to do it in one very long and painful lesson". I agree that you have to tread very carefully when talking about any kind of rationing, as any suggestion that one group of people are a less rational use of resources leads me to say, just heed the warnings of history. That,perhaps, in addition to folks' personal situations, is why emotions ran a little high in here earlier. I must admit myself to finding some of the stuff that has been said very hurtful.

 

As I mentioned earlier sukeban, since we in Britain have found that we cannot sustain paying for the NHS through taxation, I suspect that the USA would be no more able to do so, and I suspect that the US people would not want to do so.

 

Grannywils - hear hear.

[Lisnpuppy]

Personally I would not mind paying taxes for something that may actually be of benefit to me. I am not sure where most tax money goes but judging from social welfare programs, education and the Nation's infrastructure it isn't on any of those things.

 

Oh don't forget the taxpayers pay for oil exploration subsidies.....that must be where it is. lol

[SilverDNA]

Dragging The debate only to the seniors Eh ?

Ya never heard of Eugenics and social Darwinism ?

Well on sukeban's post he avoided the word disabled persons completely and tried to drag it only to the seniors.

Could it be that in sukeban's mind Disabled Persons under a certain age don't exists?

Why for Disabled Persons healthcare is important?

US Current Population Survey of Disabled 2009

U.S. Employment Statistics for Persons with a Disability 2010

Might be Someone find more here

Disabled World

 

Well and in financial dire straits of a government guess witch group has to receive deviantly the 1st front line of those cuts from the government? ( this happen world wide not have heard/seen of any country that doesn't) You don't care ? I guess then you are one of the 85 to 90 % that hasn't a disability in your country.

( World report on disability )

But this can change quickly and it only needs a terrible accident or a severe Illness (cancer is only one of the top of the list and this list is mega long) It can happen very fast or very slow, but it always has a major effect. How much is Healthcare accessible and is always based upon income of yourself or your familial and of social status on the opportunities how to get better or well. Since most long term disabled Persons living with a low income If they have a job and since it isn't well know that disabled are 5 times more likely to be victim of a violent crime ( (easy victims picking by cowards who have a low self-esteem) that needs later medical aid often that requires measures of functional healthcare that defiantly are debated on the backs of the disabled. Include the Disabled in debate and not border them out in healthcare because they are the ones that need most often medial aid on the long run making them bankrupt even trying to get access to medical help . Want to mess with 1 billion of people world wide? ( only for the books China has a population that only 300 millions more ( official census 2010 from china not counting illegal children in china of course)).

Now how nice would it be if they would unite and protest everywhere? Afraid ? Only if Albeism continues on the back of disabled persons. ( It is a devils circle if you are afraid of disabled persons you only continue Albeism by establishing a hierarchy or functionalism or a exchange of power away from the disabled.)

Any one remember the 70's? It already happened once might be it has to happen twice and no nation can say it hasn't any disabled persons. Since I cant' uses religion in debates I relay on Shakespeare again Richard III (simply start reading the introduction it is there). How long Disabled persons are shunned from society and how much similarities with the Jews they have...

But back to health care most laws passed in my country about healthcare ( yes we have it and it is as expensive as the US military) for Disabled Persons are made of politics and government officials that never have been in the situation but only "Think they do good " but in fact they only do the same numtyness on a very modernized level as they did in Shakespear's time. Thy use to show the uneducated on the matter that they doing the right thing, while trying ignoring any disabled persons organisation in country that tries to step in and try to speak on the behalf of the disabled persons and make the laws better and more valid and not sportive for a minority of a minority. ( trying to divide them by laws is bad enough but in politics itis deadly for a democracy if politicians uses classicism in laws. No morals no ​​values, not even established standards and signed treaties are save then.)

Having no Healthcare for anybody helps to get rid only faster of the *prob*.. (sorry it was a try to display how some people ignore the word on purpose to express what they really think) ... of course i was trying to say... disabled persons and this would be on the long run. Ableism, social Darwinism and eugenics on politics are again on the rise and someone must be careful or we fall back in less civilized times. Nowadays with what to change for the better for the non disabled and then you need to watch out because if that happens nobody wants to have a disability and it is hard to lose one if you already got one.

( I here by offer my bad back and hip (reduced nerve strands) and my two hernia incidents that caused that to any non-disabled person. May somebody else walk like a Neanderthal man without pain. And my regards if you feel pain in seeing me in this topic in walking tall which is normally not my thing on the streets in RL *hope somebody got the irony here* )

[ginnyfizz]

Personally I would not mind paying taxes for something that may actually be of benefit to me. I am not sure where most tax money goes but judging from social welfare programs, education and the Nation's infrastructure it isn't on any of those things.

 

Oh don't forget the taxpayers pay for oil exploration subsidies.....that must be where it is. lol

 

Well, when you get "universal" healthcare that is of dubious benefit to many people and, as I have said, may still be a lottery anyway (hence why I said the benefit is dubious and may not even be universal), government spending goes something like this;-

 

British Government spending by department

 

Scroll down and you will see the figures in a table, and note the fact that welfare and health is a very monstrous slice indeed.

 

Don't you think you need oil exploration though to continue to fuel the country and ultimately the economy? Would it not be a sprat to catch a mackerel, gaining billions in tax revenue down the line, which could then go towards paying for health and education? By way of comparison, our barking mad Government subsidises not oil (North Sea is running out, but it is thought that there could well be sizeable deposits on shore)or gas (we have absolutely massive deposits of shale gas that could conceivably enable us to give the finger to Putin at whose mercy we currently are in regards to gas pipelines). Oh no, they subsidise alternative energy sources that do not bring much of a return in taxes and duties, eg the wind turbines that have to be switched off because...errmmm...it's too windy here.

[Lisnpuppy]

Personally I would not mind paying taxes for something that may actually be of benefit to me. I am not sure where most tax money goes but judging from social welfare programs, education and the Nation's infrastructure it isn't on any of those things.

 

Oh don't forget the taxpayers pay for oil exploration subsidies.....that must be where it is. lol

 

Well, when you get "universal" healthcare that is of dubious benefit to many people and, as I have said, may still be a lottery anyway (hence why I said the benefit is dubious and may not even be universal), government spending goes something like this;-

 

British Government spending by department

 

Scroll down and you will see the figures in a table, and note the fact that welfare and health is a very monstrous slice indeed.

 

Don't you think you need oil exploration though to continue to fuel the country and ultimately the economy? Would it not be a sprat to catch a mackerel, gaining billions in tax revenue down the line, which could then go towards paying for health and education? By way of comparison, our barking mad Government subsidises not oil (North Sea is running out, but it is thought that there could well be sizeable deposits on shore)or gas (we have absolutely massive deposits of shale gas that could conceivably enable us to give the finger to Putin at whose mercy we currently are in regards to gas pipelines). Oh no, they subsidise alternative energy sources that do not bring much of a return in taxes and duties, eg the wind turbines that have to be switched off because...errmmm...it's too windy here.

 

No...and I will explain it in a PM to anyone who wants to know. I am sorry it was not my intent to derail this thread. *hits self with newspaper*

 

No as to the Universal Healthcare...yes anytime you have something for everyone then...well it isn't as nice if only those who can pay for it. For me...if I were not married and I have not qualified for disability...I would have no health insurance and due to pre-existing illnesses would be unlikely to find any on my own--or if I could it would cost more than whatever it would be to pay outright for the services. I think all healthcare companies should sell it, I think a big pool of money should come from everyone involved in healthcare in some way....but I digress. I think the Supreme Court will probably shoot it down which I would actually hate because the chance of getting it through another time is about zero. Companies are raising the cost of their health benefits to their employees (if you are lucky to have any) and that is for those who are employed. Major healthcare dollars are incurred every year for the uninsured. Who do you think pays that now?

[sukeban]

@grannywils

 

Social security and Medicare are completely different animals. I am very much aware that Social Security is meager in its support of seniors, that COLAs have been way down the last several years--and I am not in support of this. Likely, the best way to increase Social Security benefits is to a) raise payroll taxes to cover it and b) raise the retirement age to 67-70.

 

I stand firm, however, that our federal budget is only so large. To give to one group is to take from another, either by way of direct taxes or by way of changing our budget's priorities. It is also a stone-cold fact that we have not paid for these programs fully over the last thirty years. That is why we presently have an enormous public debt and deficit. Said deficit is being placed on my credit card, though I have known none of the benefits that went into its construction. Likely, I never will either, because our present pace of spending is unsustainable.

 

But rather than make this all about "me," let us broaden the horizon. I refer to said graphics regarding medical inflation and Medicare's increasingly large percentage of our total federal budget and GDP. 18% of GDP in 2080? If Medicare is 23% of the federal budget now--when it is only at 5% (with Medicaid) of GDP--I truly shudder to think of what percentage it will be (85%?) in 2080. That would mean that our nation would pay for medical care for the elderly and young--and almost literally nothing else.

 

Previously (before I redacted it), I had used my grandfather as an example of out-of-control spending in the twilight moments of one's life. I still do not want to use his memory in that way, but suffice to say the cost was exorbitant--and it was also primarily picked up by Medicare. This "bought" him a few more months of life, albeit at a quality of life that I personally would not want for myself. Now, I am sentimental for my grandfather, but I am also real about this. It was by no means an efficient use of scarce taxpayer dollars. Full stop. Such treatment, IMO, should be available in privately purchased plans, not subsidized by the public.

 

Don't misunderstand me though. I am talking about the very end of a person's life, not quibbling about providing care to somebody who is in their 50s or 60s or even in their late 70s. My grandfather was 93. He had had a wonderful life. I am not saying that the government should not have looked out for my grandfather, but only that the government should have only taken him so far. Heartless as it may sound, I agree with Taiwan not providing chemotherapy to nonagenarians. Not when you could be spending it on education, of bringing the next generation into the world. End-of-life care is a huge proportion of our total spending on healthcare. I once read an article comparing our massive outlays purchasing this type of care as the contemporary equivalent of building Egypt's massive burial tombs and pyramids. This in that they are monumental expenditures of our national wealth, yet they serve absolutely zero functional or economic purpose after they are completed. And they represent the death of so many other possibilities, so many other purposes that that wealth might have been better used for. Medicare spends a full third of its annual budget on patients in their last year of life, and over half of its budget on patients in their last two. Source.

 

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact.

 

One of her doctors, Ira Byock, told "60 Minutes" correspondent Steve Kroft it costs up to $10,000 a day to maintain someone in the intensive care unit. Some patients remain here for weeks or even months; one has been there for six months.

 

In almost every business, cost-conscious customers and consumers help keep prices down. But not with health care. That's because the customers and consumers who are receiving the care aren't the ones paying the bill.

 

"The perverse incentives that exist in our system are magnified at end of life," David Walker, who used to be the government's former top accountant, told Kroft.

 

Walker used to be the head of the Government Accountability Office. He now heads the Peter G. Peterson Foundation, which is a strong advocate for reducing government debt. He says that 85 percent of the health care bills are paid by the government or private insurers, not by patients themselves. In fact most patients don't even look at the bills.

Source

.

 

Anyway, now it should be clear what I am talking about. If you are reading this, chances are I am not talking about you or your healthcare. I am talking about the terminally ill and the extremely old.

 

I definitely agree with HY when he states that fear of litigation is another massive engine driving up the cost of medical care. I will add that I believe in using the best medical practices to treat a given illness, that exotic or unproven treatments probably should be left to optional private plans purchased before the onset of sickness. Ditto for end-of-life care. I just posted about this in the election year thread.

 

Finally, this is about the budget, which means this is about our government and its priorities. A government is created through politics, which is a bare-knuckles contest over power. Thus, a budget is merely one of many expressions of the power different groups wield within a country. Right now, this should tell you that seniors are winning this contest for power, even if not every senior has realized an equal benefit. But when federal dollars spent on the last two months of medical care are larger than the entire budget of the Department of Education I can tell you very easily who is decidedly not winning in this contest for power. That is the young and their parents, the middle-aged. I do not want to come across as anti-senior, because I am definitely not. This is merely reality. I would like everybody in our country to have an excellent quality of life, but until we actually raise taxes to pay for these things, we will have to make due by taking from one group's budgetary allotment and giving it to another. Or by running up huge debt (which means taking it from ME). End-of-life healthcare means stealing from the future, to make almost a reverse-investment. We are all going to be old and, at some point, we are all going to pass away. It is senseless and wasteful to fight this in order to live a few more unhappy months.

 

EDIT:

 

@Silver

 

I did not mention those living with disabilities because I am not addressing those with disabilities. Please do not input motives to myself or to my posts that are not actually there. I am speaking of end-of-life care. It is barbaric to neglect those with disabilities, no matter their age.

Edited March 30, 2012 by sukeban