My brother offers up some inconvenient truths:
Why are both parties declaring war on Medicare when both know that it could lead to their own political annihilation? The reason is simple. While both Democrats and Republicans fear the wrath of the AARP and the exploding ranks of hard-pressed seniors—to say nothing of lobbies like the American Hospital Association—Medicare’s relentless squeeze on the budget seems to party leaders to give them no choice but to attack the program’s spending regardless of the political cost. Medicare’s ever-expanding claims on the treasury threaten to crowd out nearly every other priority on either party’s agenda, from bullet trains and decent public schools to, yes, avoiding future tax increases and draconian cuts in the military.
The U.S. wouldn’t even face a structural deficit, much less have to endure the downgrading of its credit rating, were it not for the cost of Medicare (and, to a lesser extent, Medicaid). Just the projected increase in the cost of these two programs over the next twenty years is equivalent to doubling the Pentagon’s current budget, and there is no end in sight after that. By contrast, Social Security will rise only gradually, from 4.8 percent of GDP to 6.1 percent in 2035, and then taper off as the large Baby Boom generation passes. Meanwhile, according to the same CBO projection, all other government programs—the military, the courts, farm subsidies, Amtrak, infrastructure spending, education, and so on—are on course to shrink dramatically as a share of the economy, from 12.3 percent of GDP in 2011 to 8.5 percent in 2035. As others have observed, the federal government is not so gradually being transformed into a giant, and insolvent, health insurance company.
We can at least be thankful that both parties are sane enough to recognize the problem and brave enough to offer politically courageous proposals to solve it. But here’s the bad news: neither side’s solution is likely to work.
His solution? Get rid of fee-for-service medicine.
How are doctors in other countries paid? Are they paid a set salary? I know the doctors here get paid the most in the world. Is fee-for-service the cause?
there are a lot of different systems. Some systems pay doctors a fixed fee per patient, which incentivizes them to do less testing and fewer procedures. Other systems are hybrids that have some fee-for-service.
I know that in Germany, the fees are regulated by the government much like a regulated utility here.
Is your brother campaigning for a spot on the NYT op-ed page? That’s positively Friedmany.
In what way is the Republican plan-bankrupting senior citizens by removing government subsidization while leaving the underlying cost structure unchanged-designed to “solve” the problem?
that’s selective reading. He says explicitly that their solution would not solve the problem.
More specifically, because MBAs are running the medical system like a corporation with micro-managed cost-analysis and micro-managed fee-for-service billing, get rid of the MBAs. Break up the large medical systems, whether corporate or university, and return to the era of small or single-physician practices.
That would require forgiving a bunch of medical student loans to release doctors and nurses from the golden handcuffs of the large medical systems. And startup financing for independent practices.
Extending Medicare for All would spread the costs in a more actuarially sound way and improve prevention.
Finally get rid of the deduction and co-pay nonsense that moves costs to when people are critically ill from something that could have been prevented earlier. Folks whose income is only Social Security are not getting good preventive and primary care because of the way these deductions and co-pays are applied. And there is no evidence that they prevent over-use. What they prevent is legitimate use of healthcare services.
But then you come up against the supply of medical personnel and the funds currently allocated by governments and university scholarships to increase the supply. And then the dirty little secret. The supply is constrained by the medical profession so as to increase their incomes. Physicians through their various associations operate as a cartel, with the government keeping track of the “usual and customary” cartel price.
So basically you’re saying we can’t afford it.
When did you become a Republican?