Instapundit explains the insane Obama rationale for nationalizing health care.
40 thoughts on ““Pathological Dishonesty””
Reynolds’ post doesn’t “explain” anything, it just calls Obama (and his policies) names. There’s no evidence that Obama doesn’t believe what he says, and therefore no evidence for a charge of dishonesty.
What’s more, there’s plenty of evidence that Obama is right — that the most responsible thing to do to address the deficit is to reform health care. Click my name for Jon Chait’s demolition of the “Obama is exploding the deficit” canard. One tidbit:
According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade.
18% of GDP goes to health care badly.
Health caere inflation is eating our country up.
Obama has a plan. You may not like it, but Health spending is a critical bleed.
Here is the original context: “www.c-span.org/pdf/obamainterview.pdf”
Obama makes much more sense if you actually read his comments in context. But Drudge, Instapundit, and you, Rand, didn’t go to the original source, and didn’t even provide a link to it. (This out-of-context no-original-source blogging is a common problem, despite the fact that the web makes it easier than ever to provide the original source.)
The relevant context starts on page 3 of the transcript, and Obama’s “out of money” comment didn’t come until the bottom of page 4. He spends the preceding paragraphs building his case. You might not agree with it (well, that’s a certainty) but Obama was building an argument – not just spewing unconnected non sequiturs the way Instapundit and Drudge make it appear.
Oh, and I should that Obama continues his argument on page 5, addressing Instapundit’s concerns. No doubt that the argument will not be to Instapundit’s satisfaction, but Instapundit makes it appear as if Obama didn’t address his concerns at all. This is rather ironic If we are throwing around changes like “dishonesty”.
I went and read the whole section from your pdf link. Well, after eight paragraphs of nothings (“I really thnk the stars may be aligned here…”) he gets down to some specifics. (1)Investment in prevention and wellness programs, (2)manage how treatments are provided more effectively, for two examples. (1) means do what we say or we won’t treat you, and (2) means health care rationing. You did hear that the latest colonoscopy treatment has been denied for claims by Medicare, didn’t you?
Obama’s “plan” for saving money might make more sense if it weren’t for those pesky steadily-increasing deficits his “plan” will incur. But who am I gonna believe, numbers or the mellifluous baritone of Dear Leader?
I guess that’s what a “net spending cut” is to a serial liar.
According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade.
Far from being a ‘demolition’, the article is pretty vague – is this particular assertion the one that assumes indefinite surge-level spending in Iraq?
Far from being a ‘demolition’, the article is pretty vague
As opposed to Reynolds’ fact-free name-calling? Another tidbit:
We spend more than twice as much on health care as most advanced countries without getting better results, which means our system is filled with waste. The Commonwealth Fund recently analyzed an Obama-like health plan, which would encourage efficiency through information technology, outcome-based care, and other methods. It found that such a plan would reduce national health care spending by $3 trillion over ten years.
is this particular assertion the one that assumes indefinite surge-level spending in Iraq?
So Obama campaigns for two years to pull out of Iraq, is hammered mercilessly for that position by opponents who gradually come around to agreeing with him, and now he gets no credit for reducing spending in Iraq?
OK, Jim and Jack, tell me:
1. What is the proper % of GDP to spend on health care?
2. As a people get richer, what happens to the proper % of GDP to spend on health care?
Your basic premise is stupid. Initially, people work really hard at getting the basics. Once you have the basics, increasing personal health care spending is a really good idea! Our “industry” consists of millions of individual actors, each choosing what they believe to be best for themselves – and they are choosing to spend more money on healthcare, in order to improve the care they receive.
And you want to enslave them, taking away that basic human right to choose how to invest their assets.
So Obama campaigns for two years to pull out of Iraq, is hammered mercilessly for that position by opponents who gradually come around to agreeing with him, and now he gets no credit for reducing spending in Iraq?
No, Obama gets no credit for assuming that the surge-level spending (a temporary measure) would continue indefinitely.The surge worked, over the opposition of craven cut-and-run perpetual defeatists like Obama and Reid, clearing the path for troop reductions in Iraq. For Obama apologists to now pretend he’s saving money which would never have been spent is pretty absurd.
According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade.
The only way to achieve that kind of cost reduction is to ration health care. Digital medical records won’t do it. Wellness programs are one of the defining features of HMOs but they don’t substancially cut health care costs either.
Every year or so, the government tries to “save” Medicare by cutting reembursements to health care providers. That’s why so many health care providers won’t take any new Medicare patients – they actually lose money on them. The government already manages health care for a substancial percentage of the American public through Medicare, Medicaid, the Veterans Administration, the active duty military, etc. They manage it poorly – as much as 10% of all Medicare payouts are fraudulent. Let them prove they can do a good job with the programs they already manage before giving them control over everyone’s health care.
Today, the government health care bureaucrats are like the well meaning but inept handyman who manages to botch every job he takes on. Only, this handyman now wants to build complete houses.
1. What is the proper % of GDP to spend on health care?
No more than what peer countries spend for better results.
2. As a people get richer, what happens to the proper % of GDP to spend on health care?
I reject the premise. The median American has not been getting richer, but the fraction of her income going to health care has been shooting up, without improved health outcomes.
No, Obama gets no credit for assuming that the surge-level spending (a temporary measure) would continue indefinitely.
It isn’t Obama making the assumption, it’s the non-partisan CBO. If we should credit someone other than Obama for post-surge savings in Iraq we should also credit someone other than Obama for post-financial collapse increases in all sorts of social spending. The CBO doesn’t play those games.
The only way to achieve that kind of cost reduction is to ration health care.
Go read the Commonwealth study. It isn’t rationing to stop performing procedures that either have no benefit or actually harm health.
The government already manages health care for a substancial percentage of the American public through Medicare, Medicaid, the Veterans Administration, the active duty military, etc. They manage it poorly…
Not so. Read Best Care Anywhere: Why VA Health Care Is Better Than Yours by Phillip Longman.
It isn’t Obama making the assumption, it’s the non-partisan CBO.
Yes, the CBO plays by certain rules in extrapolating spending to create a baseline. The fact remains that because the surge wasn’t going to last forever, the baseline money would never have been spent, no matter who was President. Claiming budget-tightening chops for the new President based on savings which would have accrued to any President is bizarre. Claiming them for one who plans trillion-dollar deficits for ten years smacks of delusion.
Jim, thanks for answering.
1. What is the proper % of GDP to spend on health care?
No more than what peer countries spend for better results.
Then show me that. Explain how you can improve the cost/benefit ratio, not how you can lower spending. I don’t want lower spending!
2. As a people get richer, what happens to the proper % of GDP to spend on health care?
I reject the premise. The median American has not been getting richer, but the fraction of her income going to health care has been shooting up, without improved health outcomes.
Then explain that – explain how the median American’s spending on health care is increasing, when the median American pay nothing for health care. The median American’s employer may be paying more, but certainly not the median American.
I think that if you really research this, you will discover some obvious facts:
1. Most spending is done by people that are old, and close to dying.
2. Those old people (while perhaps in a lower “income” bracket) are among the richest in the nation – they control the most wealth, and are choosing to spend it on health care.
Liberals keep confusing “wealth” and “income”.
“Obama has a plan.”
So did Hitler and Napoleon.
“According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade”
This is laughable on its face and Chait is a notorious ideologue. To make make the assumption that current policies will be the same is the only way his argument works. There have been plans to reform education by providing school choice which has worked in other countries. Dems shot them down. Bush wanted to reform SS. Dems shot him down. Obama’s plan is a statist plan that will involve rationing. Hope your grandma lives a healthy lifestyle.
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The fact remains that because the surge wasn’t going to last forever, the baseline money would never have been spent, no matter who was President.
Not necessarily — depending on the situation in Iraq a President McCain might have exceeded surge-level spending.
And if you aren’t going to credit Obama for savings that would have occurred with a different president, you can’t then ding him for spending that would have occurred with a different president (which is most of the deficit).
Jim, I will look at “Why VA Health Care Is Better Than Yours” more closely later – but first, a few things right off the bat…
My father (previously a medical doctor in the Air Force), is currently retired. One of the things he and I discussed previously was how terrible the VA medical coverage was – and what a terrible model it was. Basically, it was the whole “die waiting for care argument” – and remember, he is a doctor!
Your response is likely along the lines of “well, it used to be bad but it is now much better – in fact, it is better than anywhere else!” OK, let’s allow that as wrote… why is it better now than ever? Why was it bad previously? What is it’s likely state in 20 years?
That fact is, if the VA hospital has improved it improved because by random chance a competent person was placed in charge by the political process. Perhaps you haven’t notice, but politics tends not to advance the most qualified among us… so while things may be good now, we now that regression to the mean is right around the corner – because if things are good, I might as well give that appointment to my brother in law.
If health care is nationalized, it will not be given to the VA – it will be given to Obama’s friend’s brother in law. If that happened to my local doctor, I could change doctors. It is much harder to change governments – though I am being pushed in that direction.
Explain how you can improve the cost/benefit ratio, not how you can lower spending.
Check out the Commonwealth study referenced by the Jon Chait article, or Shannon Brownlee’s Overtreated, or the previously mentioned Phillip Longman book. There’s lots of data out there. One factoid: Ireland spends 7.5% of GDP on health care, the U.S. spends 16%, and an American mother is ten times as likely to die in childbirth than an Irish one.
I don’t want lower spending!
Why not, if the extra spending isn’t buying anything valuable?
explain how the median American’s spending on health care is increasing, when the median American pay nothing for health care
If you are going to make outrageous claims, you should provide evidence. The 2008 Joint Economic Report found that between 2000 and 2007 the average worker contribution for family health coverage doubled to $273/month, while real household incomes fell. And that doesn’t even include the growing ranks of the uninsured, who pay out of pocket.
David:
My dad is a retired Army doctor, so I’ve heard lots of doctor stories too. The VA has changed a lot, as Longman’s book details, and it isn’t because of good luck in political appointments. It’s because they are paying attention to health outcomes, have adopted electronic medical records, and because they have a long-term connection to their patients.
> One factoid: Ireland spends 7.5% of GDP on health care, the U.S. spends 16%, and an American mother is ten times as likely to die in childbirth than an Irish one.
Factoid is correct. The populations are different.
Or, do you really think that pregnant American women do meth because of the health care system?
And then there are the “slip across the border to have a citizen” folk. Care to explain how better US healthcare will help with women who spend most of their pregnancy in Mexico?
As I’ve said many times, let’s experiment on govt employees and dependents. Enroll them all in the VA, Medicare, or whatever.
If you’re really confident, cut the per-capita spending for that program by 25% (which is less than the promised savings from govt healthcare).
Let’s see it work.
>> The only way to achieve that kind of cost reduction is to ration health care
Well if is patriotic to pay taxes, is it heroic to die to economize national health car costs?
do you really think that pregnant American women do meth because of the health care system?
Do you think that American women do 10x as much meth as Irish women?
Care to explain how better US healthcare will help with women who spend most of their pregnancy in Mexico?
And the U.S. is the only rich country with immigrants from poorer countries?
Let’s see it work.
It already does, in some parts of the country. If every state treated Medicare patients like the lowest-spending ones, we’d save 30% of Medicare spending. Note: the lowest-spending states have health outcomes that are just as good as the high-spending ones.
Well if is patriotic to pay taxes
You must be questioning the patriotism of many of Obama’s cabinet members and nominees!
is it heroic to die to economize national health car costs?
Former Colorado governor Richard Lamb (D, of course) thought so. He said the old have a “duty to die.” We spend a lot of money on cancer treatments, heart surgery, premature babies, etc. Perhaps those people also have a duty to die. Regardless, when cost savings become the driving factor in health care decisions, they will be the first to go (unless they have good political connections).
We spend a lot of money on cancer treatments, heart surgery, premature babies, etc. Perhaps those people also have a duty to die. Regardless, when cost savings become the driving factor in health care decisions, they will be the first to go (unless they have good political connections).
Tell that to the countries that spend half as much as we do, and yet have lower infant mortality and longer life expectancy.
That’s a meaningless comparison unless you also factor in societal factors like drug abuse, teenage pregnancies, and prenatal care. You also have to use equal factors for evaluating mortality statistics. For example, in America, every baby born alive, no matter how premature or with complications, is counted as a live birth even if they die soon afterwards. In many countries, that isn’t the case. Factors like that tend to skew infant mortality statistics.
That’s a meaningless comparison unless you also factor in societal factors like drug abuse, teenage pregnancies, and prenatal care.
Um, prenatal care is health care. If other countries do a better job of delivering prenatal care, that’s something we should learn from. And it isn’t as if peer countries don’t also have high rates of drug abuse and teen pregnancy.
Factors like that tend to skew infant mortality statistics.
They don’t skew the closely related maternal mortality statistics, where the U.S. fares even worse.
Prenatal care should begin as soon as the pregnancy is confirmed. That isn’t likely to happen when someone is intent on coming across the border to give birth to an instant US citizen. It happens – a lot. Prenatal care also depends on people taking advantage of existing medical opportunities such as Medicaid. What are we supposed to do when someone doesn’t take advantage of the health care being freely offered, arrest her?
Prenatal care also depends on people taking advantage of existing medical opportunities such as Medicaid. What are we supposed to do when someone doesn’t take advantage of the health care being freely offered, arrest her?
No, we should do what other countries do, which is make it easier for her to get that care. Qualifying for Medicaid is no walk in the park — even knowing whether you are eligible is a challenge. States can save money by denying eligibility for all sorts of reasons. I know one pregnant woman who married a man who hasn’t filed tax returns in recent years, so they’re ineligible for Medicaid. If your priority is tax law enforcement, that makes sense. If your priority is prenatal health, it doesn’t.
Meanwhile, in other countries, everyone knows that everyone is covered, without exception. So even young, poor, single, law-breaking, drug-abusing mothers get prenatal care.
“Regardless, when cost savings become the driving factor in health care decisions, they will be the first to go (unless they have good political connections)”
Um the decisions for health care are made for cost savings now, it’s done
by MBA managers at Aetna, UH and BCBS. I have a family member who is a PM at BCBS and he says it’s company policy to approve payment based upon how much money BCBS makes off the client firm.
Can anyone explain why the cost of largely-uninsured LASIK (at least it was uninsured when I got it done) goes down while the cost of insured medical procedures goes up?
>> Well if is patriotic to pay taxes
>>You must be questioning the patriotism of many of Obama’s cabinet members and nominees!
One wonders how well they get along with Biden?
>> …is it heroic to die to economize national health car costs?
> Former Colorado governor Richard Lamb (D, of course) thought so. He said the
> old have a “duty to die.” —
Common attitude in places with socialized medicine. Hence why in places with state run health care (like Canada) thers a tendencey to bury expensive treatments in paperwork until folks tend to die. Also in Canada dogs have better access to health care then humans EVEN BETTER ACCESS TO THE SAME MEDICAL GEAR! Since theirs no buracracy to go through, and folks are free to choose where they take their dog (but not what doctors they go to) a dog can get to a MRI opr cat scan in days, that it would take weeks for a human to get to.
>== We spend a lot of money on cancer treatments, heart surgery, premature babies,
> etc. Perhaps those people also have a duty to die. Regardless, when cost
> savings become the driving factor in health care decisions, they will be the first to go
> (unless they have good political connections).
Certainly seen that under Obama. Like the car companies going into bankruptcy. The stockholders who legally had first right to any equity were shoved asside – and politically privlasged unions were given the lions share, though they had no logal right to any.
Organizations always work toward their own best interst. Once the gov sees itself as the big brother taking care of everyone – it has a right to decide who lives adn dies in the best interest.
Oh, places with socialized medicine also seem to often offer assistend suicide “rights”, adn “encorage” folks who are a bureden to use them.
;/
> Can anyone explain why the cost of largely-uninsured LASIK (at least it was uninsured
>when I got it done) goes down while the cost of insured medical procedures goes up?
LASIK is purly market driven. No gov “fairness” decisions deciding who should be covered, for what, by who and how they are certified, what paperwork. Even insurance companies have to maneuver through the maze of legal directives, and political and PR spin needs. Its purely market. Each person chooses with their money. No bureaucracy needing to develop a consistent policy, and ration according to public perception of best use of the funds. Its you’re money, you are using as you want. So the LASIK companies don’t have the ballooning overhead, but do have to compete with innovative products at lower cost and more convenience.
The LASIK companies are directly accountable to the customers. Doctors are accountable to bureaucracies. Bureaucracies are not accountable to the patient or voters.
No, we should do what other countries do, which is make it easier for her to get that care. Qualifying for Medicaid is no walk in the park — even knowing whether you are eligible is a challenge.
It depends on the state. When my oldest son became a poor single father here in Colorado, he was able to qualify himself and his two kids for Medicaid in a couple weeks. It may well be harder in other states but you have to allow for the fact that the case workers have a vested interest in growing and maintaining the welfare rolls in order to justify their jobs.
If your priority is tax law enforcement, that makes sense. If your priority is prenatal health, it doesn’t.
Jim, government’s priority should be neither prenatal health nor tax law enforcement.
LASIK is elective; most health care isn’t.
“Can anyone explain why the cost of largely-uninsured LASIK (at least it was uninsured when I got it done) goes down while the cost of insured medical procedures goes up?”
LASIK is maturing technology, as the laser cutters become sourced from competitive producers, and as more providers enter, the excess profit of LASIK drops. Bear in Mind, most eye surgery for refractive purposes has dropped. RK used to be 50K/eye, and now LASIK is down to about $1K/eye.
Now some Insured medical procedures are also dropping in price. Open Heart Surgery and Cardiac Catheterization is dropping as it matures.
Radiology, particularly MRI is dropping.
LASIK is elective; most health care isn’t.
Pretty much what was said earlier. Elective procedures aren’t insurable, hence they have to compete on price and other features.
>Do you think that American women do 10x as much meth as Irish women?
I think that there are a lot of differences.
>> Care to explain how better US healthcare will help with women who spend most of their pregnancy in Mexico?
> And the U.S. is the only rich country with immigrants from poorer countries?
At the rates of illegal immigration, yes.
> It already does, in some parts of the country. If every state treated Medicare patients like the lowest-spending ones, we’d save 30% of Medicare spending. Note: the lowest-spending states have health outcomes that are just as good as the high-spending ones.
Do you really think that the population of LA is like the population of Utah or Wisconsin?
However, feel free to impose the same Medicare rules everywhere. I’m perfectly willing to let you have a free hand with the folks who currently get their healthcare from the US to make your case.
You’re claiming that US govt healthcare can produce results that it doesn’t. It’s absurd to argue that it will if it becomes universal.
Reynolds’ post doesn’t “explain” anything, it just calls Obama (and his policies) names. There’s no evidence that Obama doesn’t believe what he says, and therefore no evidence for a charge of dishonesty.
What’s more, there’s plenty of evidence that Obama is right — that the most responsible thing to do to address the deficit is to reform health care. Click my name for Jon Chait’s demolition of the “Obama is exploding the deficit” canard. One tidbit:
According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade.
18% of GDP goes to health care badly.
Health caere inflation is eating our country up.
Obama has a plan. You may not like it, but Health spending is a critical bleed.
Here is the original context: “www.c-span.org/pdf/obamainterview.pdf”
Obama makes much more sense if you actually read his comments in context. But Drudge, Instapundit, and you, Rand, didn’t go to the original source, and didn’t even provide a link to it. (This out-of-context no-original-source blogging is a common problem, despite the fact that the web makes it easier than ever to provide the original source.)
The relevant context starts on page 3 of the transcript, and Obama’s “out of money” comment didn’t come until the bottom of page 4. He spends the preceding paragraphs building his case. You might not agree with it (well, that’s a certainty) but Obama was building an argument – not just spewing unconnected non sequiturs the way Instapundit and Drudge make it appear.
Oh, and I should that Obama continues his argument on page 5, addressing Instapundit’s concerns. No doubt that the argument will not be to Instapundit’s satisfaction, but Instapundit makes it appear as if Obama didn’t address his concerns at all. This is rather ironic If we are throwing around changes like “dishonesty”.
I went and read the whole section from your pdf link. Well, after eight paragraphs of nothings (“I really thnk the stars may be aligned here…”) he gets down to some specifics. (1)Investment in prevention and wellness programs, (2)manage how treatments are provided more effectively, for two examples. (1) means do what we say or we won’t treat you, and (2) means health care rationing. You did hear that the latest colonoscopy treatment has been denied for claims by Medicare, didn’t you?
Obama’s “plan” for saving money might make more sense if it weren’t for those pesky steadily-increasing deficits his “plan” will incur. But who am I gonna believe, numbers or the mellifluous baritone of Dear Leader?
I guess that’s what a “net spending cut” is to a serial liar.
Far from being a ‘demolition’, the article is pretty vague – is this particular assertion the one that assumes indefinite surge-level spending in Iraq?
Far from being a ‘demolition’, the article is pretty vague
As opposed to Reynolds’ fact-free name-calling? Another tidbit:
is this particular assertion the one that assumes indefinite surge-level spending in Iraq?
So Obama campaigns for two years to pull out of Iraq, is hammered mercilessly for that position by opponents who gradually come around to agreeing with him, and now he gets no credit for reducing spending in Iraq?
OK, Jim and Jack, tell me:
1. What is the proper % of GDP to spend on health care?
2. As a people get richer, what happens to the proper % of GDP to spend on health care?
Your basic premise is stupid. Initially, people work really hard at getting the basics. Once you have the basics, increasing personal health care spending is a really good idea! Our “industry” consists of millions of individual actors, each choosing what they believe to be best for themselves – and they are choosing to spend more money on healthcare, in order to improve the care they receive.
And you want to enslave them, taking away that basic human right to choose how to invest their assets.
No, Obama gets no credit for assuming that the surge-level spending (a temporary measure) would continue indefinitely.The surge worked, over the opposition of craven cut-and-run perpetual defeatists like Obama and Reid, clearing the path for troop reductions in Iraq. For Obama apologists to now pretend he’s saving money which would never have been spent is pretty absurd.
According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade.
The only way to achieve that kind of cost reduction is to ration health care. Digital medical records won’t do it. Wellness programs are one of the defining features of HMOs but they don’t substancially cut health care costs either.
Every year or so, the government tries to “save” Medicare by cutting reembursements to health care providers. That’s why so many health care providers won’t take any new Medicare patients – they actually lose money on them. The government already manages health care for a substancial percentage of the American public through Medicare, Medicaid, the Veterans Administration, the active duty military, etc. They manage it poorly – as much as 10% of all Medicare payouts are fraudulent. Let them prove they can do a good job with the programs they already manage before giving them control over everyone’s health care.
Today, the government health care bureaucrats are like the well meaning but inept handyman who manages to botch every job he takes on. Only, this handyman now wants to build complete houses.
1. What is the proper % of GDP to spend on health care?
No more than what peer countries spend for better results.
2. As a people get richer, what happens to the proper % of GDP to spend on health care?
I reject the premise. The median American has not been getting richer, but the fraction of her income going to health care has been shooting up, without improved health outcomes.
No, Obama gets no credit for assuming that the surge-level spending (a temporary measure) would continue indefinitely.
It isn’t Obama making the assumption, it’s the non-partisan CBO. If we should credit someone other than Obama for post-surge savings in Iraq we should also credit someone other than Obama for post-financial collapse increases in all sorts of social spending. The CBO doesn’t play those games.
The only way to achieve that kind of cost reduction is to ration health care.
Go read the Commonwealth study. It isn’t rationing to stop performing procedures that either have no benefit or actually harm health.
The government already manages health care for a substancial percentage of the American public through Medicare, Medicaid, the Veterans Administration, the active duty military, etc. They manage it poorly…
Not so. Read Best Care Anywhere: Why VA Health Care Is Better Than Yours by Phillip Longman.
Yes, the CBO plays by certain rules in extrapolating spending to create a baseline. The fact remains that because the surge wasn’t going to last forever, the baseline money would never have been spent, no matter who was President. Claiming budget-tightening chops for the new President based on savings which would have accrued to any President is bizarre. Claiming them for one who plans trillion-dollar deficits for ten years smacks of delusion.
Jim, thanks for answering.
1. What is the proper % of GDP to spend on health care?
No more than what peer countries spend for better results.
Then show me that. Explain how you can improve the cost/benefit ratio, not how you can lower spending. I don’t want lower spending!
2. As a people get richer, what happens to the proper % of GDP to spend on health care?
I reject the premise. The median American has not been getting richer, but the fraction of her income going to health care has been shooting up, without improved health outcomes.
Then explain that – explain how the median American’s spending on health care is increasing, when the median American pay nothing for health care. The median American’s employer may be paying more, but certainly not the median American.
I think that if you really research this, you will discover some obvious facts:
1. Most spending is done by people that are old, and close to dying.
2. Those old people (while perhaps in a lower “income” bracket) are among the richest in the nation – they control the most wealth, and are choosing to spend it on health care.
Liberals keep confusing “wealth” and “income”.
“Obama has a plan.”
So did Hitler and Napoleon.
“According to the Congressional Budget Office’s numbers, Obama’s budget–compared to continuing current policies–would make the deficit $900 billion lower over the next decade”
This is laughable on its face and Chait is a notorious ideologue. To make make the assumption that current policies will be the same is the only way his argument works. There have been plans to reform education by providing school choice which has worked in other countries. Dems shot them down. Bush wanted to reform SS. Dems shot him down. Obama’s plan is a statist plan that will involve rationing. Hope your grandma lives a healthy lifestyle.
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The fact remains that because the surge wasn’t going to last forever, the baseline money would never have been spent, no matter who was President.
Not necessarily — depending on the situation in Iraq a President McCain might have exceeded surge-level spending.
And if you aren’t going to credit Obama for savings that would have occurred with a different president, you can’t then ding him for spending that would have occurred with a different president (which is most of the deficit).
Jim, I will look at “Why VA Health Care Is Better Than Yours” more closely later – but first, a few things right off the bat…
My father (previously a medical doctor in the Air Force), is currently retired. One of the things he and I discussed previously was how terrible the VA medical coverage was – and what a terrible model it was. Basically, it was the whole “die waiting for care argument” – and remember, he is a doctor!
Your response is likely along the lines of “well, it used to be bad but it is now much better – in fact, it is better than anywhere else!” OK, let’s allow that as wrote… why is it better now than ever? Why was it bad previously? What is it’s likely state in 20 years?
That fact is, if the VA hospital has improved it improved because by random chance a competent person was placed in charge by the political process. Perhaps you haven’t notice, but politics tends not to advance the most qualified among us… so while things may be good now, we now that regression to the mean is right around the corner – because if things are good, I might as well give that appointment to my brother in law.
If health care is nationalized, it will not be given to the VA – it will be given to Obama’s friend’s brother in law. If that happened to my local doctor, I could change doctors. It is much harder to change governments – though I am being pushed in that direction.
Explain how you can improve the cost/benefit ratio, not how you can lower spending.
Check out the Commonwealth study referenced by the Jon Chait article, or Shannon Brownlee’s Overtreated, or the previously mentioned Phillip Longman book. There’s lots of data out there. One factoid: Ireland spends 7.5% of GDP on health care, the U.S. spends 16%, and an American mother is ten times as likely to die in childbirth than an Irish one.
I don’t want lower spending!
Why not, if the extra spending isn’t buying anything valuable?
explain how the median American’s spending on health care is increasing, when the median American pay nothing for health care
If you are going to make outrageous claims, you should provide evidence. The 2008 Joint Economic Report found that between 2000 and 2007 the average worker contribution for family health coverage doubled to $273/month, while real household incomes fell. And that doesn’t even include the growing ranks of the uninsured, who pay out of pocket.
David:
My dad is a retired Army doctor, so I’ve heard lots of doctor stories too. The VA has changed a lot, as Longman’s book details, and it isn’t because of good luck in political appointments. It’s because they are paying attention to health outcomes, have adopted electronic medical records, and because they have a long-term connection to their patients.
> One factoid: Ireland spends 7.5% of GDP on health care, the U.S. spends 16%, and an American mother is ten times as likely to die in childbirth than an Irish one.
Factoid is correct. The populations are different.
Or, do you really think that pregnant American women do meth because of the health care system?
And then there are the “slip across the border to have a citizen” folk. Care to explain how better US healthcare will help with women who spend most of their pregnancy in Mexico?
As I’ve said many times, let’s experiment on govt employees and dependents. Enroll them all in the VA, Medicare, or whatever.
If you’re really confident, cut the per-capita spending for that program by 25% (which is less than the promised savings from govt healthcare).
Let’s see it work.
>> The only way to achieve that kind of cost reduction is to ration health care
Well if is patriotic to pay taxes, is it heroic to die to economize national health car costs?
do you really think that pregnant American women do meth because of the health care system?
Do you think that American women do 10x as much meth as Irish women?
Care to explain how better US healthcare will help with women who spend most of their pregnancy in Mexico?
And the U.S. is the only rich country with immigrants from poorer countries?
Let’s see it work.
It already does, in some parts of the country. If every state treated Medicare patients like the lowest-spending ones, we’d save 30% of Medicare spending. Note: the lowest-spending states have health outcomes that are just as good as the high-spending ones.
Well if is patriotic to pay taxes
You must be questioning the patriotism of many of Obama’s cabinet members and nominees!
is it heroic to die to economize national health car costs?
Former Colorado governor Richard Lamb (D, of course) thought so. He said the old have a “duty to die.” We spend a lot of money on cancer treatments, heart surgery, premature babies, etc. Perhaps those people also have a duty to die. Regardless, when cost savings become the driving factor in health care decisions, they will be the first to go (unless they have good political connections).
Tell that to the countries that spend half as much as we do, and yet have lower infant mortality and longer life expectancy.
That’s a meaningless comparison unless you also factor in societal factors like drug abuse, teenage pregnancies, and prenatal care. You also have to use equal factors for evaluating mortality statistics. For example, in America, every baby born alive, no matter how premature or with complications, is counted as a live birth even if they die soon afterwards. In many countries, that isn’t the case. Factors like that tend to skew infant mortality statistics.
That’s a meaningless comparison unless you also factor in societal factors like drug abuse, teenage pregnancies, and prenatal care.
Um, prenatal care is health care. If other countries do a better job of delivering prenatal care, that’s something we should learn from. And it isn’t as if peer countries don’t also have high rates of drug abuse and teen pregnancy.
Factors like that tend to skew infant mortality statistics.
They don’t skew the closely related maternal mortality statistics, where the U.S. fares even worse.
Prenatal care should begin as soon as the pregnancy is confirmed. That isn’t likely to happen when someone is intent on coming across the border to give birth to an instant US citizen. It happens – a lot. Prenatal care also depends on people taking advantage of existing medical opportunities such as Medicaid. What are we supposed to do when someone doesn’t take advantage of the health care being freely offered, arrest her?
Prenatal care also depends on people taking advantage of existing medical opportunities such as Medicaid. What are we supposed to do when someone doesn’t take advantage of the health care being freely offered, arrest her?
No, we should do what other countries do, which is make it easier for her to get that care. Qualifying for Medicaid is no walk in the park — even knowing whether you are eligible is a challenge. States can save money by denying eligibility for all sorts of reasons. I know one pregnant woman who married a man who hasn’t filed tax returns in recent years, so they’re ineligible for Medicaid. If your priority is tax law enforcement, that makes sense. If your priority is prenatal health, it doesn’t.
Meanwhile, in other countries, everyone knows that everyone is covered, without exception. So even young, poor, single, law-breaking, drug-abusing mothers get prenatal care.
“Regardless, when cost savings become the driving factor in health care decisions, they will be the first to go (unless they have good political connections)”
Um the decisions for health care are made for cost savings now, it’s done
by MBA managers at Aetna, UH and BCBS. I have a family member who is a PM at BCBS and he says it’s company policy to approve payment based upon how much money BCBS makes off the client firm.
Can anyone explain why the cost of largely-uninsured LASIK (at least it was uninsured when I got it done) goes down while the cost of insured medical procedures goes up?
>> Well if is patriotic to pay taxes
>>You must be questioning the patriotism of many of Obama’s cabinet members and nominees!
One wonders how well they get along with Biden?
>> …is it heroic to die to economize national health car costs?
> Former Colorado governor Richard Lamb (D, of course) thought so. He said the
> old have a “duty to die.” —
Common attitude in places with socialized medicine. Hence why in places with state run health care (like Canada) thers a tendencey to bury expensive treatments in paperwork until folks tend to die. Also in Canada dogs have better access to health care then humans EVEN BETTER ACCESS TO THE SAME MEDICAL GEAR! Since theirs no buracracy to go through, and folks are free to choose where they take their dog (but not what doctors they go to) a dog can get to a MRI opr cat scan in days, that it would take weeks for a human to get to.
>== We spend a lot of money on cancer treatments, heart surgery, premature babies,
> etc. Perhaps those people also have a duty to die. Regardless, when cost
> savings become the driving factor in health care decisions, they will be the first to go
> (unless they have good political connections).
Certainly seen that under Obama. Like the car companies going into bankruptcy. The stockholders who legally had first right to any equity were shoved asside – and politically privlasged unions were given the lions share, though they had no logal right to any.
Organizations always work toward their own best interst. Once the gov sees itself as the big brother taking care of everyone – it has a right to decide who lives adn dies in the best interest.
Oh, places with socialized medicine also seem to often offer assistend suicide “rights”, adn “encorage” folks who are a bureden to use them.
;/
> Can anyone explain why the cost of largely-uninsured LASIK (at least it was uninsured
>when I got it done) goes down while the cost of insured medical procedures goes up?
LASIK is purly market driven. No gov “fairness” decisions deciding who should be covered, for what, by who and how they are certified, what paperwork. Even insurance companies have to maneuver through the maze of legal directives, and political and PR spin needs. Its purely market. Each person chooses with their money. No bureaucracy needing to develop a consistent policy, and ration according to public perception of best use of the funds. Its you’re money, you are using as you want. So the LASIK companies don’t have the ballooning overhead, but do have to compete with innovative products at lower cost and more convenience.
The LASIK companies are directly accountable to the customers. Doctors are accountable to bureaucracies. Bureaucracies are not accountable to the patient or voters.
No, we should do what other countries do, which is make it easier for her to get that care. Qualifying for Medicaid is no walk in the park — even knowing whether you are eligible is a challenge.
It depends on the state. When my oldest son became a poor single father here in Colorado, he was able to qualify himself and his two kids for Medicaid in a couple weeks. It may well be harder in other states but you have to allow for the fact that the case workers have a vested interest in growing and maintaining the welfare rolls in order to justify their jobs.
If your priority is tax law enforcement, that makes sense. If your priority is prenatal health, it doesn’t.
Jim, government’s priority should be neither prenatal health nor tax law enforcement.
LASIK is elective; most health care isn’t.
“Can anyone explain why the cost of largely-uninsured LASIK (at least it was uninsured when I got it done) goes down while the cost of insured medical procedures goes up?”
LASIK is maturing technology, as the laser cutters become sourced from competitive producers, and as more providers enter, the excess profit of LASIK drops. Bear in Mind, most eye surgery for refractive purposes has dropped. RK used to be 50K/eye, and now LASIK is down to about $1K/eye.
Now some Insured medical procedures are also dropping in price. Open Heart Surgery and Cardiac Catheterization is dropping as it matures.
Radiology, particularly MRI is dropping.
LASIK is elective; most health care isn’t.
Pretty much what was said earlier. Elective procedures aren’t insurable, hence they have to compete on price and other features.
>Do you think that American women do 10x as much meth as Irish women?
I think that there are a lot of differences.
>> Care to explain how better US healthcare will help with women who spend most of their pregnancy in Mexico?
> And the U.S. is the only rich country with immigrants from poorer countries?
At the rates of illegal immigration, yes.
> It already does, in some parts of the country. If every state treated Medicare patients like the lowest-spending ones, we’d save 30% of Medicare spending. Note: the lowest-spending states have health outcomes that are just as good as the high-spending ones.
Do you really think that the population of LA is like the population of Utah or Wisconsin?
However, feel free to impose the same Medicare rules everywhere. I’m perfectly willing to let you have a free hand with the folks who currently get their healthcare from the US to make your case.
You’re claiming that US govt healthcare can produce results that it doesn’t. It’s absurd to argue that it will if it becomes universal.
However, I note that Medicare doesn’t meet