Don’t expect this updated assessment, that Medicare now is expected to be viable till 2029, to stem the expected push to gut Social Security and Medicare. From Bloomberg:
Medicare will gain an extra 12 years of fiscal life as a result of the health law signed in March by President Barack Obama, a government report said, supporting the administration’s claims about the value of the overhaul….
A report issued by Medicare on Aug 2 predicted the overhaul may more than double the time before the program ran out of funds. Under the health law, $145 billion is scheduled to be saved over a decade as a result of payment cuts to Medicare Advantage while $205 billion in savings will come from as a result of lower payments to Medicare providers, according to an administration report released Monday.
Note the story recites a common mischaracterization: that the stresses on Medicare are due to both demographics and rising health care cost assumptions. The cause is fact is almost solely the rising health care cost projections. We cannot harp on this issue enough: the US has grotesquely costly health care which produces no better results than that of other advanced economies. And the differences, in terms of rationing and queuing, are exaggerated. What are insurer denials of coverage for costly treatments if not rationing? And delays in seeing a specialist are pretty common (indeed, in NYC, it’s hard to find a GP any more).
Obama, as with the banking industry, blew his opportunity to have a real impact on the underlying problems of health care that lead to high costs, including its fee for service model and perverse incentives.
22 comments
Comments are closed.
That the vaunted cost savings* from Obamacare will somehow not count in the “austerity” assault is typical, and also demonstrates yet again that all the alleged rationales for “austerity” are conscious lies, and that the real intent is robbery plain and simple.
[*Of course we know these “savings” are also a lie, but the point here is that the same kleptocrats led by Obama who alleged those savings are now turning around and pretending they don’t exist, since in this context their alleged existence isn’t convenient.]
We cannot harp on this issue enough: the US has grotesquely costly health care which produces no better results than that of other advanced economies. And the differences, in terms of rationing and queuing, are exaggerated. What are insurer denials of coverage for costly treatments if not rationing? And delays in seeing a specialist are pretty common (indeed, in NYC, it’s hard to find a GP any more).
Rationing by wealth is of course the most arbitrary, evil, irrational rationing of all. It’s unfortunate that so few commentators harped on the fact that the US system has by far the worst rationing as things are, since the wait time for the growing legions, soon to become the great majority, who lack access to basic, decent health care is infinite. A waiting time doesn’t get longer than eternity.
Why is rationing by wealth arbitrary, evil, and irrational?
Its obviously not arbitrary, its rationed based on ability to pay. A simple and easily understood metric, certainly less arbitrary then a government body deciding what it will and will not pay for and how much it will pay.
Its not irrational. We ration basically everything in our society, even food, housing, etc, based on the ability to pay. Its a rational system.
Evil? I don’t know. Murky value judgment.
Since wealth is distributed in a way patently unrelated to differing contributions, the distribution is very clearly arbitrary.
Here’s one study detailing how it’s disproportionately distributed to those who contribute nothing, but to destructive vandals.
http://globalsociology.com/2010/07/17/the-real-value-of-work/
Of course nothing could be more arbitrary than being born rich, so the inheritance mechanism itself (plus, even if one supports the basic idea, the absurdly low taxes on it) is invalid according to any coherent measure.
So the distribution is clearly arbitrary and irrational. What else can be said about a system which seems intentionally geared to distribute in inverse proportion to one’s contribution to the social wealth?
What should be needless to say, almost all wealth is socially produced. For example, most great ideas are, as Newton said, an innovator “standing on the shoulders of giants”, i.e. he adds a relatively small increment to an already collective project. And then there’s the fact that he never would’ve had his ideas except as the result of society investing in his education.
So even the idea-man is almost never the equivalent of a rugged individualist. On the contrary he spends his career in a commune, and could never accomplish much in any other way.
And once the idea is created, seldom can it get far without the work of others, usually many others. So even if we did have a rare example of a self-created idea-man, his personal contribution, for which he’d be entitled to a return from the social wealth, wouldn’t be sufficient to make him rich. At most he’d be entitled to a nice but not lavish stipend.
(In all the foregoing I took the actual innovation for granted. Of course, in today’s world there’s almost no real innovation anymore, but only worthless and destructive “innovation”. The most obvious example is of course the entire endeavor of the finance sector.)
So that wraps up the arbitrariness and irrationality of the distribution. As for “evil”, yes, that’s a value judgement. I do judge a system evil where it rewards vandalism and not only doesn’t reward but spits upon actual contribution. It’s evil where almost all the social wealth is systematically stolen by parasites from producers. It’s evil where this concentrated wealth is then invariably used as a weapon against those economically weaker. It’s evil that wealth assaults democracy, freedom, morality, justice, and every other human value.
Yes, I judge that all to be evil. I judge the distribution evil.
Because it is evil.
I won’t say certain high earning jobs aren’t socially useful.
I do take issue with the ridiculous study you linked, which of course defines socially useful in whatever way it desires to get the outcome it wants. Thus apparently if you are an advertiser you damage “through their promotion of environmental destruction and labor exploitation in the promotion of the consumption of cheap goods”. Oh christ, I’m not getting on board with that hippie garbage.
So getting passed the fact that some people make money doing things that aren’t so great (usually with the support of the government), pay is a decent way of looking at social value generated. For instance, engineers get payed more then the factory line workers that produce the goods they design. I certainly feel like the engineers are producing more social good then the line workers, and they deserve a better lifestyle as such, including better health care since they are more valuable.
All this stuff about the shoulders of giants is just gobbly gook. Things don’t design themselves. They take a ton of hard work. The reason you have to pay engineers more then line workers is because you wouldn’t be able to get enough people to be engineers if they earned the same. If they earned the same then people wouldn’t spent their nights studying math, programming, and such, they would go out and party and have a fun time. Pay is a decent approximation for the productivity of your work.
All people want to leave things to their children. Making a better live for ones children (not necessarily all children, their children) is a primary driving force for many people. That driving force pushes our society forward. So you have to allow people to leave something behind to their children.
“It’s evil where almost all the social wealth is systematically stolen by parasites from producers.”
Sounds Ayn Randy to me. What exactly are you trying to prove?
Those that earn more tend to produce more. Where this isn’t true (usually government and industries/individuals allied with government) we should attempt to fix that problem. I don’t see what universal health care has to do with that.
For instance, engineers get payed more then the factory line workers that produce the goods they design. I certainly feel like the engineers are producing more social good then the line workers, and they deserve a better lifestyle as such, including better health care since they are more valuable.
All this stuff about the shoulders of giants is just gobbly gook. Things don’t design themselves. They take a ton of hard work. The reason you have to pay engineers more then line workers is because you wouldn’t be able to get enough people to be engineers if they earned the same. If they earned the same then people wouldn’t spent their nights studying math, programming, and such, they would go out and party and have a fun time. Pay is a decent approximation for the productivity of your work.
You can write nonsense like that and accuse others of gobbledy-gook?
I’ll just tell a few truths to counter a few pieces of nonsense:
1. Under this rentier system most of what engineers design is worthless or counterproductive to the social welfare. Once we institute a producer-controlled economy then we can see how important engineers really are.
2. So it’s false to say such corporate flunkeys are “more valuable” than any ditchdigger. Under the circumstances they’re far less valuable, because their skill is being used not for the people but against us.
3. “Things don’t design themselves” – yes, and even less do they manufacture or otherwise realize themselves. The workers accomplish that. So no matter how original the idea was, it’s a comparatively small portion of the work that goes into realizing it. Put Henry Ford or Werner von Braun or Steve Jobs or anybody you like on alone on an island with all his ideas and all the raw materials to realize those ideas, and see how far he gets.
4. It’s definitely a lie that nobody would prefer to be an engineer to e.g. a miner if he were only paid e.g. 50% more. Those who really want to be engineers and have the aptitude would become engineers regardless. (In all these examples the same goes for other professions.) Obviously I posit a system where getting the requisite education doesn’t require taking on a debt load. The commodification of education is part of the nightmare your ideology created. I’d do away with that as well.
But I’ll take your word for it that you have no measure of anything in life but how much you or anyone else is paid, and in particular that one is paid far more than others, since that kind of anti-human contempt is a value with those who make your argument.
“It’s evil where almost all the social wealth is systematically stolen by parasites from producers.”
Sounds Ayn Randy to me. What exactly are you trying to prove?
Rand was telling an Orwellian lie when she said stuff like that, because she really wanted the dictatorship of parasites.
I’m speaking literally. I want the producers to control the system and keep ALL the wealth. I want the complete destruction of the parasites.
Those that earn more tend to produce more.
Anyone who has eyes knows that’s a lie.
Most of what engineers design is worthless? Okay bub, the market says different. People like these things and prove it by purchasing them. Take your sophomoric value judgments somewhere else.
Ideas are more valuable then grunt work. A person who invents a machine that can help one man do the work of ten men is more valuable then a single grunt. This should be obvious, and the inventor should be compensated as such. Desert islands have nothing to do with it.
So now engineers need to make 50%? Make up your damned mind. Do the productive deserve to make more then the less productive or not?
Education takes resources. An engineer who is teaching can’t be doing current productive work. That cost to society needs to have a price so it can be rationed to those most likely to use it well. Even if it were free it takes time and effort to use ones mind learn. People would much rather party and relax then study. If you want to get people to study you need to offer them a higher standard of living for doing so, including better health care.
I’ll let the obvious reality speak for me in response to anyone who still worships “the market” after how insane everything has gone, the fiance sector’s rampage only being the worst of it. “The market” as conceptualized by psychopaths has been proven once and for all to be the worst possible way of valuing anything.
Yes, the work of most professionals is no longer innovative under these bottlenecked circumstances. All sectors are mature, and what’s still being “innovated” is being done so from a purely antisocial, rent-seeking basis. We already have all we need, the problem is that it’s all stolen. Even where something new could be innovated, it too is immediately stolen and is therefore of no value to society. On the contrary, since everything monopolized by the corporations and the rich is used as a weapon of class warfare, everything “new”, and much that is old, becomes such a weapon to such a point that from the perspective of the people, it would be far better if that thing didn’t exist at all.
So now engineers need to make 50%? Make up your damned mind. Do the productive deserve to make more then the less productive or not?
The figure of the top professional salary being 150% of that of a rank and file worker was just an example. Sorry, I haven’t actually worked out the wonkery of the plan yet, so I don’t know the exact correct number.
But my mind is made up, thank you. The example is based on a producer-controlled economy where all work is productive, and all rents and parasites have been purged.
People would much rather party and relax then study.
I can well believe that’s true of you and your ilk. Who knows, under the kleptocracy it might even make sense.
But why do you keep arguing your own cesspool premises at me when I’m proposing to clean up the cesspool completely?
“I won’t say certain high earning jobs aren’t socially useful.”
My thoughts get jumbled this late.
There are jobs that aren’t socially useful (think IB), but I don’t think that applies to most peoples jobs. I think it mainly applies to elites that have the support of the government.
Although I am a bit sickened by the way healthcare reform turned out. It seemed like more a matter of timing in this context. I don’t know why they didn’t handle the financial aspect first instead of medicare, while it was fresh in the minds of the American public. Instead they tried to do everything and wound up dampening everything to the rapid onslaught of lobbyists and influence pandering.
Attempter, both are rather true the producers and the engineers waste a shitload of time. There is no ideal here where incentives are perfectly aligned. But, I agree with the sentinment completely that our workers have been maligned for some time now and the upper income categories have been grossly inflated by any comparison. It isn’t market forces that determine their wages any more that it is market forces that determine the value of anything. The may work in specific circumstances but when there are massive information asymetries, large concentrations of power and wealth, as well as a ‘drink the coolaid’ mindset we can abandon the prospect of the market forces deciding anything.
The ‘elite’ in this country have done a terrible job of management, and made short sited trade-offs for profit rather than long term sustainability. For all of their failures they have not been left on the side of the road to compete with illegal immigrants for daily construction work, they still live in luxury and maintain the social networks to garner support for their next failed project (see LTCM head’s new hedge fund). Income inequality in any developed country in the world is not close to ours and relations between labor and capital are quite better and create a more productive environment.
But, every socio-political system is subject to the ‘iron law of oligarchy’ whether it be the capitalist one or the socialist one. We need a better clearing mechanism in both systems or their hybrids to wipe away the cobwebbs social, political, and economic entrenchment.
Yes, that’s a good summary of the history so far and the predicament now.
Although I’d mention that the versions of capitalism and socialism which have been most prevalent have been Oil Age versions – highly centralized, highly industrialized.
I suppose my basic idea is that since the physics of Peak Oil will impose decentralization and relocalization regardless of which politics the people choose, this may be the great historical opportunity to make the virtue-of-necessity pitch for a true decentralized worker-controlled economy and politic. We already know from examples like the Spanish communes of the 30s that it can and does work where not destroyed by outside violence; and now that oil-driven centralization will not much longer be an option, and now that economic centralization, market ideology, and political centralization (including “representative” pseudo-democracy) have been practically, rationally, and morally discredited once and for all for the rest of history, perhaps the time has finally come for true positive democracy.
That’s the only thing proven to work.
More govt disinformation, believe any of it at great risk.
Clearly.
[No need for any explanations or accusations, though. We never believe anything that might change our worldview. It’s what makes us who we are. Why continue the charade of making accusations of others’ lying? It’s a vestigal, redundant step in the process of filtering the information so that only the stuff we want to believe makes it through.]
Peter Suderman notes here http://reason.com/blog/2010/08/05/do-medicares-trustees-believe the main issues with this claim: 1) The assumption that the provider compensation cuts will happen (when they almost certainly will not); and 2) The double-counting of projected savings, once for Medicare, and once for ObamaCare – it goes without saying that a dollar equals a dollar, not two dollars…
Which begs the question why even post this article?
Yves writes,
“…it’s hard to find a GP any more.”
This wouldn’t be the case if we don’t have such a severe shortage of primary-care physicians. But this don’t necessarily mean that we’ve got a glut of MDs employed as specialists. In fact, I’d say that the supply of physician specialists is just about in line with our population’s demand for them. So in order for us to overcome this problem of having too few primary-care physicians, we can either train more medical residents to become primary-care physicians or train more nurse practitioners to do their job. I think the latter solution is the better way to go.
Keep in mind, the AMA doesn’t want medical schools to greatly expand their enrollments. If they do, this will put downward pressure on physician salaries. The AMA, after all, is just like all other union of workers in that its primary job to keep our demand for its workers slightly ahead of its supply of them, preventing them from entering the great global wage race to the bottom. And with healthcare dollars becoming increasingly scarce, increasing the supply of primary-care physicians will cause more health-care dollars to shift away from the specialists into the hands of generalists, thus causing physicians salaries to drop across the board. So unless the AMA thinks it has something to gain by creating a rift between its specialists and its generalists, I think that the AMA would be acting in the best interest of all physicians by handing over most of the primary-care work to nurse practitioners. Don’t get me wrong, I’m not suggesting that primary-care physicians should be phased out all together. What I am suggesting is that they should take on the role as supervisors to nurse practitioners — very similar to the way anesthesiologists have been supervising nurse anesthetists in operating rooms over the decades.
But remember, Yves loves unions. Why pick on the poor AMA?
The AMA is more like a contractors’ association than a union. But if it were a union, it would be comparable to the Directors’ Guild, or players’ associations of professional sports leagues. (For GPs the MLS players’ association is probably the most comparable).
Go ahead, tell me these are typical, representative unions.
Interesting to observe the USA from across the border (Canada) while living there the past two years.
–Waiting 5 minutes for walk in medical care (free) instead of sitting for an hour without any clothes on for my overworked GP to make his $175.00 assembly line rounds back in the USA.
–You get the feeling that Canadians would rather hire Iranian, Indian, Serb or Asian immigrants rather than Americans. Might have to do with being patted on the head and called “boy” when it comes to the needs of the USA for all these years. Don’t expect Canada to be sympathetic to economic refugees from the US economic implosion.
–Banks that take deposits and make loans instead of running off to the casino with your money.
–$5 gasoline. Cars that are half the size of a Ford Expedition.
–In the Asian community, BMW’s and Mercedes are as common as Hondas.
–More jobs and fewer trophy houses. Real estate prices that still go up. Foreclosures as rare as banana trees.
–A surprising number of people who believe that the laws of physics were not suspended on 9-1-1, and that the world trade towers collapse was an inside job to provide cover for the middle east oil wars.
–Higher per-capita energy consumption even than the US. (After all the entire country is one big snowbank)
–Little old ladies who can recount every detail of the latest hockey fight.
Without the U.S. of A there providing commerce for your Canadian industries in your essentially socialist country you too will be singing a different tune too which starts with something like….”I too was once smug but now I’m getting wiser.”
One of the reasons that there will be savings, is that massive expansion of Medicare benefits, enacted by the Bush administration, as part of prescription drug benefits for Medicare part D will have cost containment measures. The previous iteration of non-competitive supply channels provided for mandatory price gouging, not tolerated by WalMart or the Girl Scout cookie sales drive. That is gone and been replaced with a statutory minimum of 85% of dollars going to goods and services, not profits and admin costs. That is where the cut backs to Medicare come from and that is why a fortune is being saved. And that is for starters. Look for Medicare to expand to cover any one from the age of 50 in the coming years. That would be the public option. Incrementalism at work for you as not to rile the natives. Does anyone do more than read blogs to get info?
I think those of us early in our career should accept the fact that there will be no social security when we are ready to retire. Find a viable investment, good luck with that, and stick with it!
Exceptionally fine essay in the August 2 New Yorker treating end-of-life choices and a host of related subjects – ‘Annals of Medicine: Letting Go’ – Atul Gawande.