Healthcare Reform With Rabbits and Hats
A scene from somewhere in my imaginary world:
“Good news!” said Madge, my hypothetical business unit manager. “You’re getting a raise!”
“Really? That’s great!” I hypothetically responded in the precise fashion that I always react when somebody tells me I’m getting some money.
“Yep,” she answered. “An extra two thousand per year. Just sign these forms and we’ll get it all processed.”
“Yes indeed!” I beamed, grabbing a pen. “Hey… wait a minute. This says I’m going to be taking home less money. What gives?”
“Ah. You know, a number of our consultants seem confused over this. You see, given the current economic conditions, we’ve had to reconfigure our base business model. This means that we basically had to recalculate how much total funding is paid to consultants, how much work is assigned, etc. and then it’s divided up between all of you.”
“But… but… this means you cut my pay!” I cried.
“Not at all,” she responded quite reasonably. “We raised your pay. We just raised from a newly redefined and somewhat lower base model.“
I bring up this brief bit of pythonesque humor only to prepare you both mentally and emotionally for some news from Charlie Rangel. (D – NY) Some of you will doubtless already know the Congressman from his groundbreaking work in funding the Charles Rangel Center for the Advancement of Charles Rangel in Brooklyn.
Health-care overhaul legislation being drafted by House Democrats will include $600 billion in tax increases and $400 billion in cuts to Medicare and Medicaid, Ways and Means Committee Chairman Charles Rangel said.
Democrats will work on the bill’s details next week as they struggle through “what kind of heartburn” it will cause to agree on how to pay for revamping the health-care system, Rangel, a New York Democrat, said today.
Rangel said Democrats are still considering options for tax increases that might be in the bill, including a possible end to the income tax exclusion for employer-paid health benefits.
So originally nobody was going to be paying more taxes except for a tiny sliver of the very, very rich. And now you’re thinking that perhaps I don’t need to have my own health-care (which I already arranged for on my own, thank you) remain free of taxes? Rangel himself is admitting that the total price tag for the health care makeover project will exceed 1.5 trillion dollars. At the same time, the President is telling us during his Saturday morning radio broadcast that the initiative will be paid for without increasing the debt by finding savings and eliminating waste, fraud and abuse. If you can find one and a half trillion in waste, fraud and abuse, then you shouldn’t have had the system in place to begin with.
I’m no expert, but this is looking increasingly clear to me. You simply can not keep spending this amount of money – which Obama admits we don’t even have – while not increasing the amount of money you take in (i.e. tax increases) without the system collapsing into a metaphorical black hole. Are there some problems in health care? Is there room for improvement? Obviously the answer is yes. But come on, folks. Don’t rush us off another cliff like you did with the magically disappearing TARP money. (And yes, I know, TARP happened on George W. Bush’s watch. There’s blame to go around on all sides here.)
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20 Responses to “Healthcare Reform With Rabbits and Hats”
Another thing to keep your eye out for is all cost increases starting immediately, undefined cost savings in the unspecified future.
As you may know, people who currently have health insurance plans through their employers or through their spouse's employer do not currently pay taxes on the benefits they receive through those health insurance plans. One proposal being considered by Congress is to tax these benefits in order to help pay for the cost of expanding health coverage to Americans who currently don't have health insurance. Do you support or oppose this proposal?”
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Support Oppose Unsure
% % %
26 68 6
pollingreport.com
Some of the banks are repaying the TARP money.
Jazz, your hypothetical example may not be that hypothetical at all. According to this, the numbers can indeed be played with to make things a bit more palatable.
The soon-to-be-delivered estimate on Democratic healthcare reform proposals is expected to be so expensive that lawmakers are talking about changing the chamber’s normal accounting procedures.
Heh, you gotta love Washington.
What makes this more surprising is Rangel appears to be the honest one in this debate.
“I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”
We'll see how it all works out. We'll likely be paying more specifically to maintain obscene profits for insurers, drug companies, doctors and hospitals. Single payer looks better all the time.
Since I don't have employer paid health care, I'm already subsidizing the whiners who do.
“You simply can not keep spending this amount of money – which Obama admits we don’t even have – while not increasing the amount of money you take in (i.e. tax increases) without the system collapsing into a metaphorical black hole.”
Apparently the size of the ignorant or careless horde that forms so much of the Dem voter base right now is so large and their ignorance or carelessness is so great that Obama is confident enough to proceed on health care even before the economy (and federal finance) has recovered. He's in full campaign mode now and it's disturbing as well as disgusting when one stops to consider it how cynically the public opinion among these easy-to-fool-and-lead people is being deliberately manipulated, enhanced by Obama's celebrity appeal and personality cult among these people. A horde of people doesn't care!
(Note: They're the true low-rent resentment crowd, to correctly apply someone else's misdirected term elsewhere on this site.)
“One proposal being considered by Congress is to tax these benefits in order to help pay for the cost of expanding health coverage to Americans who currently don't have health insurance.”
Note the irony here (or the hypocrisy, actually). Many want to provide health care to those who don't have health insurance, and even go so far as to want gold-plated super-sized health care that includes all kind of preventive care, which so many people who already have it don't bother to use it. Yet on the other hand, the obvious tax grab in the works on employee health benefits (that exceed a certain value; talk is of $15,000 annually) has been rationalized by an argument that may conceal envy or class-warfare resentment, but actually provides an example of what critics of government health care have correctly been warning people about all along: The rationale is that the good-quality benefits “encourage excessive use of health care services.” So as an incentive to these people to get _less_ health care, that is why the health care benefits “should” be taxed. I'm (almost) disappointed that these people haven't said that they need to reduce the benefits of those who have too much, to give them to those who don't have enough, in one and the same sentence — and follow it by saying they will review “overuse” and “costly duplication” and “appropriate” health care services (and the rationing of those permitted) in the future.
Jazz Shaw — yes, rabbits and hats, for after all, the appeal is being aimed at those who believe in magic.
I wonder if they believe in elevated, progressive income and wealth taxes as well as in a new federal value-added tax, like the one that is being resurrected from the early Clinton years already once more here, in the minds of those who are thinking about how to pay for all this magic.
Yes, it WOULD take magic to reduce costs while protecting the profitability and 10.5 million dollar annual salaries, which are sacred to Republicans. It does NOT take any kind of magic to get far better outcomes for far less money. Every developed country on earth has proven that.
[emotional stuff skipped] “It does NOT take any kind of magic to get far better outcomes for far less money.”
Federal health care never has been nor will be a magic solution. Costs will grow, though in theory not as much. There will still be middlemen in an all-federal (say, all-Medicare with VA folded into Medicare along with Medicaid and Indian and other related services, the simplest and best model I envision) health care system, just in government rather than the private sector. There will be bureaucracy and it will be much worse than advocates ever will admit, or probably more than most of them ever have conceived. Even if it is centralized and made totally federal, there will be large bureaucracy. Rather than cynical financial motives as a major complaint, we'll see politicization of and political interference with medicine as a huge problem. (We already see this starting to happen with General Motors and plant closure redecisions and more to come with Congressional as well as executive branch interference with company operations!) And costs will be a problem and will be limited through rationing, not only to control costs but also as a tool to embody and enforce political considerations and goals and values. (It is not inconceivable someday for transplants to be limited, or to be no longer provided in some cases, say to liver patients in order that many more, often younger-with-greater-potential-remaining-lifetimes-as-taxpayers alcoholics get treatment instead. A harsh but completely realistic example of not merely ethics, but politics in action.)
I needn't go on — it's not the magic solution people think, and there won't be instant cost savings. (Especially not if the Constitution is honored if we convert forcibly from private to public health care, in which case 20-30+ years' profits are due the private owners as legitimate compensation for taking of property, for example, something deliberately refused in the unconstitutional Conyers Medicare bill — I wonder what moral shortcuts many are willing to take with public health care, even more than with General Motors and Chrysler bondholders…)
The “public option” is the camel's nose, head, and front quarters in the tent, as I have already said elsewhere. The question is, how much more gets into the tent, and how soon.
“it WOULD take magic to reduce costs”
It is a vast _increase_ in federal expenditures, and thus in a need for more taxes or borrowing. That is more important than (largely claimed, not achieved) cost reduction (actually, cost _growth_ reduction).
Assuming we aren't going to continue the Obama tradition of dwarfing Bush's debt in addition to deficits, how will we pay for the vast _increase_ in federal expenditures to provide “optional” (for now) health care?
We're not afraid of big bureaucracies, but if we were, it would be the private bureaucracies (insurers') that have grown 100 times faster than the Medicare bureaucracy (.03% vs 3.4%). We are not afraid that the army is a huge federally run bureaucracy. The federal government already covers health care for about 20% of the population. The costs are less, the savings greater, the increases less, the waste less, the fraud less, and 97% of doctors gladly accept new Medicare patients, the same % that accept new insured patients.
Pappy Bush:
“Read my lips: no new taxes.”
Now we've got the next Pappy Bush in office:
“I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.”
Pappy Bush breaking his tax promise is infamous to this day and it played a role in not only having a third party challenger enter the Presidential race, but in having Clinton defeat Pappy Bush. Obama is setting himself up to be a one-hit wonder by his emulating another one-hit wonder.
97% of doctors gladly accept new Medicare patients, the same % that accept new insured patients.
What is your source for that? Your numbers are way off from everywhere else I've read.
DaGoat: “the Medicare Payment Advisory Commission reports that 97% of physicians accept new Medicare patients, with 80% taking all or most patients, which is comparable to HMO acceptance rates. And with the massive consolidation of insurance companies and of HMOs, doctors and hospitals report to our group that Medicare payments are often as generous, if not more generous, than those of HMOs and private plans — and received with less hassle and more consistency. Studies by AARP and the Commonwealth Fund also show that Medicare patients are more satisfied with every aspect of their care than patients with private plans.”
That page is HERE. For more surprising details, all referenced, check out THIS site. The pdf file seems to be broken, but the powerpoint contains much of the illuminating detail.
I don't think this supports your contention that 97% of physicians gladly accept Medicare. It looks like at least 20% have some sort of restriction on Medicare patients and 17% of patients on medicare said they had a “big problem” finding a primary care doc.
I have personally interacted with thousands of physicians in the past 20 years and I can assure you 97% do not gladly accept Medicare, many do so grudgingly or out of a sense of responsibility.
DaGoat, look at Chart 5-3. Physicians’ acceptance of new patients is highest for private PPO and Medicare patients, 2006. Rates of acceptance were not significantly better for acceptance of new patients regardless of the payer. And it was significantly greater than acceptance of HMO patients. Health care reform is not going to be easy for anyone, nor is the current situation. Yes, doctors and hospitals will be paid less (19% less for Medicare), but the aging population will pretty much make them accept older patients. We may all have limits on what gets covered, but that's the situation already. Anyone who wants to pay out of pocket or get supplemental insurance is free to do so, just like now. And your assurance from personal experience is significant, but not a reputable study as I have linked to. Remember this report was made under oath (report to Congress).
“I have personally interacted with thousands of physicians in the past 20 years and I can assure you 97% do not gladly accept Medicare, many do so grudgingly or out of a sense of responsibility.”
I've noticed the same thing for ages. Doctors routinely don't accept Medicare (also Medicaid) patients. They are underpaid, for one major reason. (In fact, some providers actually lose money treating Medicare patients.) They recover at least some money by charging privately-insured and other patients additionally.
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“Obama is setting himself up to be a one-hit wonder by his emulating another one-hit wonder.”
People gave Bush the Elder the benefit of the doubt on his “no new taxes” pledge. That he broke his word was a, if not the, major reason he was not re-elected in 1992. At least among those of us who can think (as well as remember), Obama never fooled us from the start. And it's no surprise that his deeds don't match his words (as is true with running General Motors and directing Chrysler, too). What can be remarkable is actually what he does (and how much his deeds diverge from his words).
He's telling us right now with a straight face that a “public option” incrementalist move is not leading to a broader provision of health care later. Ha.