Evidently there is a huge difference in Medicare spending depending on your local hospital region. From the Kaiser Family Foundation: “Adjusting for inflation, the analysis found that Medicare spending in Miami rose 5% annually between 1992 and 2006, compared with 2.4% annually in San Francisco. The analysis also found that Medicare spent about $16,000 per beneficiary in Miami in 2006, compared with about $8,000 per beneficiary in San Francisco (New York Times, 2/26).”
Furthermore, “David Goodman, a researcher at DIHPCP, said that spending less does not indicate a diminished quality of care but rather a greater reliance on primary care physicians and less on specialists and hospitals. The researchers determined that reducing the annual Medicare spending growth rate from the national average of 3.5% to 2.4% would reduce Medicare spending by $1.42 trillion by 2023 (Ruggles, Omaha World-Herald, 2/26). The authors added that a projected $660 billion deficit in Medicare in 2023 could become a $760 billion surplus if physicians were more conservative with their treatments (Dallas Morning News, 2/25).” [Emphasis added]
The DIHPCP is the Dartmouth Institute for Health Policy and Clinical Practice. In a White Paper based on 20 years of research that the DIHPCP recently issued, they discuss in great detail how Medicare spending can be reduced and medical outcomes maintained.
What about Medicaid (which has been growing at double digit rates in Delaware)?
DIHPCP reports that Medicare spending has been growing between 1.6%-3.0% per year in New Castle County (somewhat higher downstate, but still below 6% per year) since 1992. Why has Medicaid been growing so much more rapidly than Medicare? I know that they serve different populations, but with 130,000 Medicare recipients and 175,000 Medicaid recipients, these are likely statistically similar populations. Could the difference just be State policy? (Medicaid is run by the State)
Before we raise taxes, don’t you think that we could reduce Medicaid’s growth to that of Medicare, and standardize services reducing overall costs thereby saving both of these programs, maintaining medical outcomes, and not raising taxes? Seems like it’s worth a look.
Comparing San Francisco medicare experience with that of Miami is tricky at best. The census shows Miami-Dade with 3x more residents over 65. I would expect Florida in general to have higher Medicare costs considering all the retirees.
Comparing Medicare to Medicaid in Delaware, Medicare is mainly retirees over 65, Medicaid is for low income unemployed disabled. Does it not make sense as unemployment goes up Medicaid cost goes up, or are you talking about some different angle on costs?
The President proposes putting everybody into Medicare. Simply paperwork, solve the funding problem. Putting aside ideology blockage, it sounds like a viable path to a better health insurance future? I just started on Medicare and it is very simple efficient, low overhead, cool.
Don:
“tricky at best” — Thank you for stating the obvious. Try reading the report and they talk about that in more detail.
Thank you also for clarifying Medicaid versus Medicare. That, too, is well understood. That is why I said it was worth “looking” at. I didn’t say that it was a perfect fit. However, please check an earlier post of mine for a link to a report on Medicaid that I did in 2007.
The President did not propose your solution. He stated that the government would be “one option” in his speech the other night.
Charlie, not disputing anything you said nor trying to antagonize. Just shooting the breeze as they say. My writing style must come across as combative. I am working on that.
Obama didn’t say it, but that’s what folks get from what his administration is saying. There seems to be a pretty solid consensus now that single payer is the way to go, and the most efficient way of accomplishing that is to gradually fold the for profit insurance system into the non-profit public system.
Are you willing to consider single payer via Medicare?
A simple fraud hotline. The seniors know which doctors are abusing the system. Put some teeth behind it, or just get the State Auditor on it.
We have the Auditor’s fraud hotline already, just make it part of the list of things a social worker or care nurse has to mention in their annual or bi-annual interviews.
Then the seniors or their families will get involved ratting out the doctors for unnecessary procedures that are billed.
Also, require that all non-emergency procedures must go through their primary care physician.
Many seniors are used to going to the ER because they never had insurance. Just avoiding their primary care doctor adds about $1000 to each visit.
Oh, and the two of those are usually tied together. they avoid the primary because they think he’s a fraud, so they go to the ER.
Don:
Single payer? No thanks. I believe in competition and consumer choice. I think that the American Medical Association has the right ideas — check out their website http://www.voicefortheunisured.com.
Ultimately, there are 3 choices for who determines how healthcare dollars are spent. The DIHPCP report demonstrates the power of one choice (both in terms of costs and outcomes): focus on the primary care physician. The AMA also leans towards the primary care physician. The other two choices are 2) a government bureaucrat or 3) an insurance industry bureaucrat.
As for actual experience with government-run, single payer systems, we can look to England and Canada. England is beginning to re-introduce competition into their system due to problems. Canada’s Supreme Court ruled recently that the government could not ban competition (Doctors had begun to leave the system because they were not allowed to practice as they felt was appropriate). So we have good evidence that a government-only systems don’t work well and competition will be a necessary component.
Charlie,
1. Canada along with England Germany Japan all have higher life expectancy and lower infant mortality, due to much broader availability of preventive care across all income levels. We have no intention of doing it like England. They own the hospitals and employ the doctors. Here, we are just talking about the most efficient way to collect the money and do the paperwork.
2. It does not make sense to talk down “medical bureaucrats”. Bankers, brokers need regulation so do doctors. Medical bureaucrats stand between us and the doctors who do unnecessary surgery, implant too many embryos, conspire with lawyers to push phony disability claims, doctors who push unneeded drugs and medical supplies for profit, “medical bureaucrats” even busted a scheme where a renowned heart surgeon was mass marketing heart bypass surgery to patients who did not even need it. So to suggest there is some nirvana where it’s all between the doctor and patient is just not realistic.
The argument against single payer is not based on facts. It is almost entirely based on dogma.
Don:
Your reply is deliciously ironic. By stating that anyone who disagrees with you is simply being dogmatic, it removes any need on your part to provide support for your position or to respond to any contrary arguments. You state it; ergo it is true.
Sounds very similar to the Bush Administration – just with different policies. To quote John Kerry, “Just because you are certain doesn’t mean that you are right.”
To quote Abe Lincoln, “”The dogmas of the quiet past are inadequate to the stormy present”.
I did not state that anybody who disagrees with me is dogmatic. You said that. I said your argument against universal health care is based mainly on dogma. No?
I said was there was a need for medical bureaucrats to regulate doctors, you said there was no such need that a free market system without all that would work better. No comment? Then I stated most other industrialized nations with universal care have higher life expectancy and lower infant mortality due mainly to widespread availability of preventive medicine regardless of income level.
Most everybody agrees it is a set of beliefs that prevents the GOP base from considering single payer.
Dogma is the very heart of the matter, the fly in the ointment, the monkey wrench in the gears at the moment. Some people think health care is a free market item like TV’s, refrigerators, potato chips, or automobiles, others think healthcare it is more a national infrastructure issue like education and highways.
Speaking of John Kerry, when Rush Limbaugh was addressing CPAC yesterday he mentioned John Kerry being in Vietnam and the audience started laughing hooting booing and I am thinking – here is Rush Limbaugh a guy who never served ,encouraging the pubic to laugh in the face of a genuine decorated combat veteran. Limbaugh then mentioned Obama and socialism and Stalin in the same breath, before going on the condemn the push for “Socialized Medicine”. Maybe I should use the word insanity instead of dogma to describe what is going on in the GOP these days.
Don:
You state: “I said your argument against universal health care is based mainly on dogma. No?” Uh, no. If you’d spend less time listening to Limbaugh and CPAC speeches and reading the DIHPCP report, you’d have a much better argument.
Charlie:
“spend less time listening to Limbaugh and CPAC speeches” – how else do we learn what the Republican Party thinks?
It’s not the DIHPCP report holding up single payer universal healthcare reform in America. It is the anti-government dogma of the Republcan Party. You know, that “the government is the problem, not the solution”.
Listening to Rush Limbaugh gives us a clear understanding of GOP objections to healthcare reform. If you’re not familiar with Limbaugh and CPAC, they share your view on healthcare. So don’t make it sound like Limbaugh and CPAC are aliens. There is no real difference between them and the GOP and what most Republican politicians including yourself are saying. That is not an “attack”. This the way it is. And a lot of us who want to see some change are getting more outspoken. Is there some intellectual difference between CPAC and the GOP?
The payer ultimately has the power and the control. That’s why we should not endorse a single payer plan.
The single payer will be able to decided which treatments for which people. Something not working out so well in the U.K. and Canada.
Medicare has used their authority to set rates in ways that has caused a number of probably unintended effects, including weakening the primary care system just as we are coming to need it more for our growing elderly population.
As always, these effects hit the most vulnerable, i.e. the poor earlier and harder. If we want quality, accessible care available to all, we need a better plan than one with power relocated from individuals and communities to one distant, central authority.
I expect many middle-class patients would be horrified to learn that the doctor who actually cares for them is paid less for some services than the person who styles their hair. And that’s before the tip to the hairdresser.
Mary,
Your point about the hairdresser is well taken, however it does reveal a certain disconnect from what most people really experience. A huge number of Americans cannot afford proper health care much less visits to pay and tip the hairdresser.
I urge you to reconsider “not working out so well in the U.K. or Canada”. The evidence says that is not correct. When you hear people saying not-for-profit health insurance does not work, remember the biggest lobby against single payer is for- profit insurance companies. Much of our health insurance premium dollars go pay shareholder dividends, executive compensation etc. The CEO of US Healthcare amassed $1Billion in personal wealth before the law forced to return half. So there are many things to be considered. Remember, we are only talking about who collect the money and pays the bills – we are not talking about who delivers medical services in America – that stays the same. It is just about the most efficient way to manage healthcare premiums and mail checks.
When you say “power would be relocated from individuals . . . to one distant central authority” . . . if anything single payer would improve that – right now for-profit insurance executives make decisions from far away regarding what to pay based on profit to shareholders. There mission, as it should be, is not to improve healthcare, but rather to generate maximum return to investors. That is good for Starbucks and Sears, not good for health insurance.
Prior to going on to Medicare this year, I had private insurance all my life. The last plan I had was from Golden Rule Corp.. It cost about $1000 a month with perfect health and had a $5000 deductible. It was basically catastrophic insurance. The insurance company was just the distant central authority you describe. They gave a list of doctors and hospitals I could go to, decided what care was covered, and dictated how much they would pay. How is that different than Medicare?
Medicare offers more choice less red tape. Please reconsider how you look at this issue. More people are leaving the USA seeking affordable treatment, than are coming here from Canada and England for care. There is not nearly the dissatisfaction and clamor for change in Canada England Germany Japan as there is here in the United States. We are way behind on this.
Don, I am no fan of private insurance as currently structured. I favor using insurance as protection for the big ticket injury or diagnosis but not for our day to day medical care.
Trying a different analogy, using insurance to replace the totaled car, but paying for oil change and tire replacement out of pocket. Less paperwork, much more accountability between the garage and the car-owner.
I know there will always be some who can’t pay even another dime out of pocket and I don’t object to our helping them.
But most of us can pay much of our way, especially if we don’t pay for all the overhead you describe with 3rd party payers who aren’t all that well incentivized to be efficient.
The U.K. and Canada provide ample stories of people who did have the catastrophic diagnosis but couldn’t get the life-saving care we have here.
The Brits are known for having a different approach to dental care than we have. Wouldn’t want to trade.
Mary,
Canada and the other G8′s democracies with universal healthcare conduct regular elections, many have regular referendums – never have the people in countries with national health insurance expressed a desire to change their system. Certainly not change it to something like we have.
Those of us in the reform movement want a much better system, nobody I know wants a system that would be worse.
As you know our current system features $50,000 bills for three days in the hospital complete with $25 aspirins. Ask around at our local hospitals, the emergency rooms are a shambles with really scary long waits even if you come in with a broken arm. Our system is not good. It can be much much better.
Don, I agree with have lots of room for improvement. I think that the route here, as in most things is in returning decision making to the people closer to the situation. Government contracting won’t necessarily bring more efficiency to the system.
Much of the ER care could be handled by primary care docs if they could recruit enough people into the field. But the distortion of the system by disconnecting payment from receiver of service is ruining primary care in the US.
Some Canadians and Europeans vote with their feet and their wallets. Not practical for most. And I agree most folks get what they need eventually. I wouldn’t set up a system like the one we have, either. But I would chose it over the version that rations care.
Mary,
I understand what you mean, but health insurance by it’s very nature is a disconnect. It is not a normal consumer transaction. Needing major medical care is more akin to incarceration. Your are thrust into a system over where you have little or no choice. It is not like you “choose” to have cancer treated. You must or you die. So the normal buyer seller leverage is skewed to say the least. There are no market forces involved. So when the service provider tells you it will cost $200,000 to treat your cancer what exactly would a direct connection between consumer and supplier accomplish? Would we say that is an outrageous amount to charge? The doctor down the street will cure my cancer for half that? Can I get my money back if it does not work. What kind of guarantee do you give? Healthcare is not like any other business. Life would be simple if curing a brain tumor was like buying a new car but it is a whole different realm.
The real proof is in the doing. We have been doing Medicare since the 1960′s everybody loves it. John McCain has been on government health insurance all his adult life, not once have I heard him complain about rationing.. He loves it. We want to spread that kind of care to all Americans. Not just elected officials. Not just corporate employees. Not just high income people. All Americans deserve good healthcare. The concept squares with the Founders desire to promote the general welfare.
You seem to worry most about rationing. As if letting everyone get good care might somehow diminish how much you get. That will not happen. You will still get yours even if we share.
Actually, I don’t love medicare. It is seriously undermining our primary care sector. No trivial matter. The payments seem capricious. The penalties for their perception of wrong-doing by a physician are very frightening. It’s not easy for a private citizen to fight the federal government, yet that’s what doctors face with medicare.
Some seniors are having trouble finding doctors who accept new medicare patients given the state of reimbursement. I’m not talking about overly-greedy practitioners but professionals who can’t afford to treat people for less than overhead costs. The system coasts by because costs are passed on to private paying patients.
I’m not confidant that a single government payer would see fit to make sure I get my share of care if I’m not seen as worthy of it, i.e., over 80 or no longer competent. The Brits do not provide certain procedures to their elderly.
Outpatient care should largely pass back to out of pocket payment in my opinion.
Shrinking the insurance industry down to the brain tumor, etc. cases would allow more accountability with at least some competition based on pricing, service, etc.
Your points about these medical not being an exchange between equals is well taken. But I think we need to be very cautious about giving more authority to one entity.
Don’t you think John McCain has a fair amount of sway at this point in his career with his health system?
Mary,
You might think it radical, but there are those of us who believe the person laid off from GM deserves the same access to health care as John McCain. We don’t accept the idea that where someone “is at” in their career should have a bearing on whether their sick child can get adequate medical care.
Sounds like you are closely connected to the challenges facing primary care physicians – so I take your comments respectfully. I do however think you will having a hard time convincing folks physicians are in financial trouble. It may be harder to get rich being a general physician, but U.S. Department of Labor ranks medical and dental as the highest paid professions holding spots number one thru eight among the top 25 highest paid jobs in America. Family and general care physicians rank around 10th overall. To top it off the income tax for high earners was reduced in 2002. So let’s not cry poor. Medicare pumps $300 billion a year into heathcare – that’s hurting the profession somehow?
We have to control the fees or medical service providers would work the system. Why? Because people have to buy their products – consumers have no choice – physicians preside over a life and death monopoly – of course the public has to regulate the fees – how else do we decide how much it is worth to get our lives saved? That is a public policy question not a free market proposition.
You don’t love Medicare- it is seriously undermining primary care? That is one interesting way to look at things. The other way is the positive view that Medicare has greatly expanded primary care for 40 million Americans. I wonder how many primary care doctors we would even need if 30 million people could no longer afford to see a doctor? I am arguing for the powerless who need healthcare not the powers that control it.
The system we have now chains individuals to careers by favoring certain jobs and corporations. It is ever creeping into the bedroom. A recent survey by Kaiser tells us 15% of all marriages are arranged based on health insurance savings. If you work at Bank Of America you get great medical care for next to nothing. If you start your own small business you are out of luck? If you build a car factory in Canada Japan Germany Mexico you don’t worry about workers health insurance. Here it is a very big deal.
The ironic thing is the longer the established order resists reform, the greater the public frustration becomes, to the point where, like banking, people will begin to favor nationalization. Would it not be better for the intransigent healthcare establishment to help shape the new way rather than resist – only to be overpowered by the people. President Obama is going to retool this whole system. The change train is leaving the station, you either get on board or throw yourself on the tracks.