Monday, June 08, 2009

A more detailed look...

Update: This started as a comment on Dr. Dave's blog, then I reposted it here and expanded it when I realized, "No way would he ever post it there, it has too many actual facts in it to refute his scare-mongering!" Guess what: I WAS RIGHT! This, friends, is why we're winning: Our opponents are cowards who are scared of the truth, who piss their pants upon demand of their Party commissars and repeat any idiotic easily-disproven lie that they're told by their Party commissars, and who believe that actual, like, facts, are "liberal" and thus can be ignored (wow, Stephen Colbert nails it!). Brave free men will *always* win out over cowards in the end. Well, unless there are a *lot* of the cowards, but the 27%'ers aren't going to overwhelm us like the English overwhelmed the Scots -- as I pointed out previously, the MAJORITY of Americans want singlepayer health insurance. All the 27%'ers have is fear, not facts, not courage. That is why they fail.

Now back to our show...

I snarked at Dr. Dave, but there's actually good refutations of his scare-mongering. Okay, here's the deal: the statistics I mention below can be easily verified and are from the OECD, from the CBO, or other reliable source (i.e., *not* pulled out of ass). I have numbers for all of them. I don't publish all the references here because I'm out of time (I need to sleep sometimes!), but they're available either from other posts on my blog or by going to the actual source and looking them up for yourself (I recommend the latter

1) Medicare's current financial problems are because the Medicare drug benefit was poorly conceived. Allow Medicare to negotiate preferred prices with drug companies, and the financial problems disappear. And that ain't no bull. That's the bipartisan Congressional Budget Office, in a report written back when REPUBLICANS controlled Congress (but not released until the Democrats came into control). Not to mention that the problems are nowhere near as bad as the tighty righties claim.

2) My grandmother is actually dead now, she died pneumonia in her sleep after being diagnosed with cancer of the throat, but while she was living she never encountered a single instance of a government official telling her what kind of care she could get. None. Zero. It was between her and her physician. Meanwhile, my HMO's accountants decidedly tell me what kind of care I can get. My doctors don't decide, the beancounters decide. I much prefer my grandmother's experience under Medicare to my current nightmare under the U.S. "managed care" industry. Your notion that the government would "tell doctors what kind of care to provide" just doesn't pass the laugh and giggle test, it doesn't happen with Medicare today, there's no reason it would happen with Medicare For All.

3. Government currently provides pays for 55% of the healthcare in the United States, between Medicare, Medicaid, VA, Tricare, state and county hospital districts, etc (statistic courtesy of the OECD). Health care currently consumes 16% of the U.S. GDP (statistic courtesy of the OECD). So *worst case* is that an 8% increase in the Medicare payroll tax (4% paid by employer, 4% by employee) would pay for Medicare for *all* Americans. But wait, there's the fact that Medicare has 3% administrative overhead and private health insurance has a 33% administrative overhead. What that means is that it'd actually be 30% less -- i.e., 3% paid by employer, 3% by employee. And that, in addition to the taxes *currently* being paid to fund health care, would suffice to provide Medicare for all Americans, not just wrinkly old prune-Americans. That's how the numbers work.

4. I notice you don't mention overcrowded emergency rooms. You should. Multiple times over the past five years, *EVERY* emergency room in the Phoenix metropolitan area has been on diversion. EVERY SINGLE ONE OF THEM. Leaving ambulances with nothing to do but go around in circles hoping that the patient they're carrying doesn't die before a slot opens up at one of the area emergency rooms. The point, the point... we're already providing health care to the people you claim would clog waiting rooms, except we're doing it through emergency rooms, the most dangerous and inefficient way of doing it. If I get scraped off the road in an auto accident I want to be seen by an ER doctor right away, not after he has to see five hundred children with the sniffles who showed up at the ER because they have no health insurance. THE CURRENT SYSTEM ENDANGERS THE HEALTH OF EMERGENCY VICTIMS EVERY DAY BY OVERCLOGGING ER'S WITH PEOPLE WHO SHOULD NOT BE THERE. And that ain't no bull.

5. You seem to have disdain for the notion that Medicare For Wrinkly Old Prunes could be scaled up to be Medicare For All. The problem is that wrinkly old prunes use an enormous amount of medical services compared to youngsters -- over 32% of all current U.S. medical spending goes towards care for those 65 years of age or older (statistic: U.S. DHHS MEPS system, 2006), despite the fact that the 39 million elderly account for only 13% of the U.S. population. Indeed, this is why private insurance would not cover the Medicare population in the first place, thus necessitating a government program to do so -- because old people are, well, sick a lot. Anyhow, the point is that 1/3rd of healthcare spending is already under the Medicare/Medicaid/Medigap system, and expanding the system to the rest of the population would be much easier than you hypothesized, since the mechanisms for both funding (the Medicare payroll tax) and claims are both established, and enrollment could be automatic for anybody with a Social Security number. This is *much* easier than the billing and administration tasks needed for private insurance -- thus why administrative overhead would be so low.

6. Nobody argues that health care is "free" or that Medicare For All would be free. Please find a better man of straw. (Note: The AARP says the elderly spend approximately 13% of their income on health care, between Medicare and Medigap premiums and co-pays, so it certainly isn't free even for the wrinkly old prunes).

7. The notion that doctors would quit being doctors under Medicare For All is just plain ridiculous. Doctors in France are paid on average HALF of what U.S. doctors are paid. Yet France has TWICE as many doctors per-capita as the U.S. does (statistic courtesy of OECD). Of course, in France doctors don't have multi-hundred-thousand-dollar student loans to pay off (medical school is free in France), which I suspect helps a whole lot, but we could do that here in the US. But of course the AMA *prefers* there to be a doctor shortage, because it drives up doctors' salaries.

8. All of the arguments you mention were used against the original Medicare program in 1968. They did not come true then, and will not come true now. Come on, it's been 40 years since Medicare passed Congress. Come up with some new arguments against it, already!

And finally: 9. Medicare For All would be funded by increasing the Medicare payroll tax, not via taxing the rich. But really, how many people are employed by the rich? Most people are employed by small business owners (who I guarantee you are *not* rich) or by major corporations (which are mostly owned by pension funds, 401k's, overseas Chinese investors, etc., i.e., *not* the rich). And, uhm, you *do* know that the U.S. is the least-taxed of all the major Western economies, right? Last year according to the OECD the U.S. collected roughly 26% of its GDP in taxes. The only other major economy which collected so few taxes was South Korea, at about 27%. There is clearly some number at which taxes hurt an economy, but most of our economic competitors have a combined local-state-national tax as percentage of GDP at around 35% and are, frankly, whupping our rears right now. The only OECD nation that has lower taxes than the USA is... uhm... that wonderful paradise nation is, err... why, it's MEXICO! Which is such a low-tax Paradise that Americans are clamoring, swarming I say, to escape the horrific high-tax USA to escape to Mexico! Uhm, that's not true, you say? My bad!

Anyhow, none of that is really relevant since all I'm proposing to do is shift the current hidden "health care tax" from the one pocket to the next. It really doesn't matter to me who takes that 16% out of my pocket -- whether it's a private insurer or Medicare For All, I still don't have it. A tax is a tax regardless of who takes it out of my pocket -- a private health insurer, or a public one. The only difference is that if Medicare screws up, I can call my Congressman's constituent service office and b*tch about it and it might get fixed, and yes I've seen that happen before, a Congressman's office descending upon the Medicare bureaucracy like the cloud of doom at which point the Medicare bureaucracy swiftly shifts gears and does right. If Blue Cross screws up, well... after five years of appeals of denial of service and lawsuits and yada yada yada, I'm sure my survivors , (since I'll be dead) will love the results of their lovely lawsuit. Of course, I won't care by that time, since I will be, like*dead*, but hey,we gotta preserve those gross profits that the private insurers get out of our pockets, right? Anything else would be, like, UN-AMERICAN!

- Badtux the Snarky Healthcare Penguin


  1. BT
    I know, I know cliche but you go dude. (Haven't seen a good dude sighting in quite a while)

    I don't think Medicare as it now stands will work well enough for us all but I don't think it would take that much enhancement to make it much better.
    And of course you are correct that the money just needs to be moved around to pay for it.
    Which is why, given the first rule of government - never make anything work or easy if there is a way to make it more expensive or crappy, that I don't see it happening in my lifetime. I hope I'm wrong, I need to be wrong, but given my experience in life I suspect I'm just screwed.

  2. I'm screwed. Spent a huge chunk of my retirement funds (so I could live to see retirement) on medical expenses that my "insurance" company refused to pay. Meanwhile, if I was poor and on Medicaid or older and on Medicare, the government would pay for all my procedures even if death was imminent. The bastards.

    Hell medicare used to pay for any little thing my parents needed and operations that we knew wouldn't save their lives. Except for the pharmacy benefits which sucked, medicare was pretty good for them. My friend's parents were on Medicaid and they got even better care... and they were over 85 years old. The way things are now we'll be lucky to live that long.

  3. Thank you, Mike. That was an interesting paper. One thing that they try to slip by you (but do mention) is that Medicare costs are not rising as fast as costs in the rest of the healthcare system. That is, yes, Medicare costs are rising, but so are all other costs. On the other hand, some things they view as "flaws" in Medicare, most people view as features -- i.e., "decentralized provision of services" is a *feature* to most people, because who wants dreary British Public Health Service (or Kaiser-Permanente :) clinics?

    Secondly, they make an outrageous and untrue claim that the Medicare Drug Benefit (Part D) is coming in at 40% under budget predictions. As a matter of fact, that is an outright lie. Actual Part D expenses are actually OVER 200% HIGHER than initial projections, and according to healthcare advocates, the Part D program could easily save 30% of its current costs. And if you eliminated the 10% overhead imposed by the insurance companies administering Part D and had it go to a straight Medicare plan administered by the Medicare Administration, you could save an additional 10% -- i.e., you could easily make Part D *truly* 40% less expensive than its current costs (not less expensive compared to some bullshit projection, but less expensive compared to REALITY). So Part D is certainly NOT the solution to Medicare's woes, and the authors of this paper are dishonest hacks for saying it is. 'Nuff said on that.

    - Badtux the Dollars-and-cents Penguin


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