So we've got a short-term problem, which is we had to spend a lot of money to salvage our financial system, we had to deal with the auto companies, a huge recession which drains tax revenue at the same time it's putting more pressure on governments to provide unemployment insurance or make sure that food stamps are available for people who have been laid off.Okay, but why is his health care proposal classified as a "short-term investment"? Isn't it long-term spending? I'm not talking about whether it's a good idea or not, but just whether he's bamboozling us by calling it both "short-term" and "investment."
So we have a short-term problem and we also have a long-term problem. The short-term problem is dwarfed by the long-term problem. And the long-term problem is Medicaid and Medicare. If we don't reduce long-term health care inflation substantially, we can't get control of the deficit.
So, one option is just to do nothing. We say, well, it's too expensive for us to make some short-term investments in health care. We can't afford it. We've got this big deficit. Let's just keep the health care system that we've got now.
Along that trajectory, we will see health care cost as an overall share of our federal spending grow and grow and grow and grow until essentially it consumes everything...
May 23, 2009
What does Obama mean by "some short-term investments in health care"?
He's talking about how we're "operating in deep deficits" and why it is therefore important to distinguish between short-term and long term spending:
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I'd say computerizing medical records would be at least one short-term investment. Hopefully the big investiment would be going from paper files to electronic ones, with future upgrades relatively inexpensive.
This interview is interesting in that President Obama recognizes the vast sweep of the spending that is going on and its long term unsustainability. He is also correct in saying that the medicare and social security entitlement obligations are even greater problems than the (hopefully) temporary deficits resulting from the financial crisis and the deficits.
Yet his response to this is to forge ahead with an entirely new and gigantic entitlement for medial care.
He did say no bailout for California. Let's see if he can make that stick.
It's really unclear whether computerizing medical records will save money. Even its proponents say that computerization will result in a cost reduction of 1-2%.
The real cost reduction will come from (1) reducing amounts paid to providers and drug companies and (2) limiting the reimbursements for certain procedures. The former is likely to reduce research and innovation, and the latter will certainly involve rationing care, especially for persons in the last year or two of life, where a disproportionate amount of cost is located.
We are not going to like the results of either approach. Thinking that cost reductions will come from painless ideas like computerization involves a long, harsh swallow of cool aid.
A short term investment is one where you get your money back quickly, not one where you spend your money quickly.
Easy. Have the government invest in health care now, with the goal of getting health care spending as a percent of GDP in line with the rest of the world.
I think it's something like 16% of GDP now, which is about double the share of Europe. I haven't researched it, so I could be off by a bit, but I think that is generally right.
If we can get health care spending to 8% of GDP, then yes, spending on medicare and medicaid will drop substantially, saving the government money in the long-term
I am NOT saying that I agree with this plan. As long as I have insurance, I honestly don't give a damn about anyone else.
I thought deficit spending was the point of the stimulus package.
It would be oddly appropriate if the effect of a poorly considered stimulus plan were to kill off a poorly considered health plan. Looking at the projected deficits, I hope it does. We don't have the finances to add a huge new entitlement right now.
In other news, Chrysler this week made a filing in bankruptcy court saying that, if Chrysler were liquidated, the United States Treasury would receive 3-5 cents for every dollar it has loaned to Chrysler.
The result would probably be similar for GM.
So I think we can be sure that the government will prop up these two auto companies until 2013, when Obama is either out of office or in his second term.
Then will come the reckoning.
Oh, we may get health care spending in line with the GDP percentages of the rest of the world. But we will also get health care quality in line with the rest of the world.
Why do you suppose those who can afford it come to the USA for treatment of difficult problems? Because the care is better, and more rapidly available.
Just great, the blogosphere strikes again: someone who apparently didn't fully realize until just now that BHO tends to try to bamboozle people weighs in apparently without doing even a basic search first, which would turn up this explanation of what BHO means by a short-term sacrifice.
If UHC is anything like imm. "reform", BHO is lying through his teeth. The problem is that most people won't know about it because the vast majority of those who (loudly) discuss this will not be experts. The experts will never conduct a very rigorous debate but instead will show up on CNN to through food at each other for two minutes. I weep for our Idiocracy.
(If there's anyone out there who's very familiar with this issue and who wants to get the truth out, do it yourself by asking the other side real questions on video. The MSM is not going to do that, so you have to.)
The real cost reduction will come from (1) reducing ... and (2) limiting ...
Those are long term policy shifts, not investments. What can he do over the short-term?
A short term investment is one where you get your money back quickly
The concept of "getting money back" does not exist within government, so "short-term" investment must mean something else.
Re: rhhardin:
A short term investment is one where you get your money back quickly, not one where you spend your money quickly.
Yes, but I think the President just means we'll pay down gobs of money right now in return for future cost reductions.
re: downtownlad
I think it's something like 16% of GDP now, which is about double the share of Europe. I haven't researched it, so I could be off by a bit, but I think that is generally right.
If we can get health care spending to 8% of GDP, then yes, spending on medicare and medicaid will drop substantially, saving the government money in the long-term
I think Medicaid + Medicare alone are already about 5% of GDP (not sure whether the statistics I saw from GAO include the Bush II drug benefit; if not, that may be understated). Health care in Great Britain is about 6% of GDP. I think France and Canada are both about 10%. Just adding for perspective here -- I don't have anything to criticise in what DTL is saying there.
Obama will use the same blueprint he followed for the highly successful auto bailouts.
For the auto bailouts, Obama gave them billions of our money, appointed a car czar who then forced them to close 3,000 dealerships. That makes it a bit harder to buy a GM or Chrysler car and so reduces the number of GM and Chrysler customers.
For healthcare I assume Obama will give them billions of our money, appoint a czar who will close down many hospitals, med schools, and other points of service. That will reduce healthcare spending because the customers (patients) can't get to the healthcare provider.
This is a very brilliant plan of course.
Last time I checked, France was number one in health care.
What is the US in terms of life expectancy? 45th. We're behind Bosnia. But hey - we beat out Albania!!!
http://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy
Obama's limitations as a thinker are starting to show. Over and over, he'll show that he can see the right thing to do, but he doesn't want to do it. So he'll think of an exception for why common sense doesn't apply, and do the wrong thing anyway.
You can see that with the stimulus bill, and the budget in general. We have a huge deficit problem this year (he knows this). Ergo, we should limit our spending. But we don't want to limit our spending! So we dig up an eighty year old theory that can't predict anything (Keynsian multipliers) and say we should actually be running huge deficits! Hooray, the general theory doesn't apply, and we should pass the stimulus bill after all!
Or take the car bailouts. We know the government shouldn't get involved in owning and operating car companies. But they're in a financial pickle right now, and layoffs or renegotiated union contracts might be necessary if the government stayed out of the picture. So the government will buy out the companies, push favored groups ahead of less-favored groups, fire the General Manager, and push for its guys on the board.
So far, Obama's thoughtfulness has mostly been good at thinking up excuses for bad policy.
Why do you suppose those who can afford it come to the USA for treatment of difficult problems? Because the care is better, and more rapidly available.
Why do you suppose those who can't afford it go outside the USA for complex treatment? Medical tourism is a growth industry:
From http://www.globehealthtours.com/
Globe Health Tours is a UK based company established by medical professionals to help people with medical needs to plan and schedule medical treatments abroad. We can help you plan treatment in India, France and Europe, Thailand and Singapore.
We arrange surgery on your behalf with internationally accredited hospitals of your choice.
We organise discussions between you and the Specialists who will be treating you
We manage travel and accommodation arrangements for yourself and party
We advise you and make sure you have all the information you need
Our aim is not merely to help you manage the process, but ensure that your experience is a huge bonus to your treatment through our choices of hotels, accommodation and other local services.
Wingnuts like to think that the US has the best healthcare system, because - well, because wingnuts don't like to think.
The US system has plenty of room for improvement. I know that as I have several doctor friends, and they tell me about the massive waste that goes on. Doctors performing useless tests just to prevent malpractice lawsuits, etc. Personally, the insurance coverage I have is somewhat limiting. I can only go to doctors that accept my insurance, and that doesn't include my primary care physician. So I have to pay out of pocket for that. Very annoying. And I know plenty of people, who when they needed medical care, had to wait for service. It wasn't available "immediately". So the US has rationing as well.
It's also disturbing that I can lose medical coverage if I lose my job.
I live in a foreign country now, which has nationalized Health Care. And very low taxes as well. I'm not afraid to get medical care here. From what I hear - it is the same as the US in terms of quality.
Medical care is not something I give much thought to though, since I'm insured. It's not my most important priority. And as I've said, I really don't give any thought to the uninsured - that is their problem. But if they want to reform health care so that everyone has universal coverage, I don't freak out about that either. Other countries have gotten along fine with it, and their life expectancy has not suffered - in fact it has surpassed ours.
Obama's next step is to fix education. He will close down every college in all but five or six states.
As a result, fewer people will even want to go to college. Thus the college affordability problem is fixed.
I'm not talking about whether it's a good idea or not, but just whether he's bamboozling us by calling it both "short-term" and "investment."
Yes. He's bamboozling us (See rhhardin's comment above.). He is The Great Bamboozler and little else.
There can be little doubt that a man of his financial acumen can be trusted to manage our economy and our health care system.
And Althouse, yes it is a bamboozle. I suspect Obama's worst college subject was economics.
Economist Arnold Kling's quick predictor of Obama policy is that every policy will transfer more power to the government.
What is the US in terms of life expectancy? 45th.
Is 45th reflective of our standards of health-care or of a more risky lifestyle, e.g., fast foods, drugs, cars, drinking?
Are there any stats?
Good question bearbee. Maybe we should look at infant mortality then - before any lifestyle choices come into play. Unfortunately, we're about 45th there too.
http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate_(2005)
Sigh; the US counts infant mortality different than Europe and most of the world which largely accounts to the apparent high number.
Last time I checked, France was number one in health care.
But (other than tiny citystates, like Gibraltar or Macau), Japan has the best actual health outcomes, at least judging from Wikipedia's life expectancy chart -- among the big countries, France is number 2. Japan also spends less on health care, as a percentage of GDP, than France. It's at about 8 percent. This is also with a population that skews markedly older than the other industrialised populations -- remarkable, given that expensive health care for old people is generally believed to be one of the primary long-term cost drivers for US health care.
Unfortunately, we're about 45th there too.
Does not show US as 45th. But if it did, life-style behavior or standard of health-care?
@Joe, how does the US differ?
Medicare and Medicaid aren't investment programs of any type.
"Investment" implies a return, and that's not likely to be the case with old people and people so marginal they qualify as poor. There's no ROI there.
It's just spending. Call a spade a spade.
He did say no bailout for California. Let's see if he can make that stick.
Calling it a "bailout" is, in my opinion, not very fair. Californians pay vastly more money in federal taxes than we receive in benefits. If that tax money stayed in-state we would have a budget surplus. If a man picks your pocket of $20 and then hands you a $20 bill, is that a bailout?
Now, it is certainly true that Californian government is horrible and mismanaged. But it is also true that California faces bigger challenges than most states, and has to do it with less federal assistance per capita than almost ANY state.
In short, our horrible governing class is just one problem. The bigger problem is that the federal government is fucking us in the ass.
DTL-
I wish it were as simple as Wiki makes it sound, but it is not. There is no standardized definition for a "live birth;" therefore, there is no way to compare infant mortality between countries. The US counts a baby with any sign of life as a live birth (and subsequent death), while many other countries count small or early babies as stillbirths. Here's an interesting article that discusses this: http://health.usnews.com/usnews/health/articles/060924/2healy.htm.
There just doesn't seem to be a lot that can effectively tell us reliable infant mortality rates across countries, or how ours stacks up.
As for life expectancy, (I'm out of time to do more research, but I'm going to make a few general stmts that I think we all can agree on), the US has higher levels of obesity than most other counties, has more deaths by violence than most other (industrialized) countries, and more deaths by auto accidents than most other countries (as we travel by car far more). I don't think that it can be argued that these cause a very significant number of premature deaths in the US, and I don't think that most other countries have similar problems that would match these, and gov't healthcare is unlikely to reduce them. So, straight life expectancy charts are not a good judge of our healthcare system, either.
Just some food for thought.
Medicare and Medicaid aren't investment programs of any type.
They're not, but they could serve as a proof of concept for cost reductions with universal health care. I don't really have a deep, fundamental objection to universal health care, I just think that trying to implement it given American systems -- particularly American government -- is a recipe for massive failure.
If you look at Medicare and Medicaid (~5% of GDP), they cover, it looks like, about 30% of the population, all together. But if you look at what Japan spends, to cover its entire population (~8% of GDP), clearly Medicare and Medicaid should be able to secure the same services at much lower cost. And this isn't even taking into account the fact that US GDP is higher, per capita, than Japanese GDP -- even if our percentage GDP spending on healthcare were the same, we would be spending more per patient, in absolute terms, than Japan. Nor, I think, is it just that there's private insurance driving up prices -- in Germany (and I think in Japan as well), private insurance can be purchased too, which will pay physicians/hospitals better and get you better service than the national health insurance. We're spending enough that we should be able to demonstrate cost savings now, without trying to overhaul the entire system first. But we can't -- that just isn't within the capabilities of our government.
So instead, the President is playing games with universal health care, without ever considering, seriously, how cost reductions will be achieved. He may not even realise there's a problem yet. To give him credit, though, he's already grown up a lot since taking office. On economic issues, he doesn't sound nearly as idiotic as he did during the campaign itself -- he was able to talk sensibly in an interview a few weeks ago with the NYT (I think it was), and he's backed away from the more asinine campaign promises, e.g. on free trade, etc. Some of that stuff slipped through while he was still learning, e.g. the "buy American" provisions in the stimulus monstrosity, but I get the sense that he would be a little more skeptical of that kind of thing now. Similarly, while he's struggled to preserve the rhetorical nonsense he campaigned on as far as national security, when it comes down to action, he's basically doing the same things as Bush did. Reading between the news reports, it looks like a lot of the things he's had to backtrack on are the result of his coming up with a policy before he learned anything about the issue, and then realising that his policy was stupid once he got briefed. So I think there's reason to be optimistic that he may realise that health care is a more problematic issue than he seems to think at the moment.
He's not a stupid or a malevolent man, he's just someone sufficiently arrogant and naive that he thinks he has all the answers, before he's done any of the work. Someone like us, frankly -- like an irresponsible blog commenter become president.
To answer Ann's initial question, the "short term investment" is the $600B to fund the govt health insurance program. It will soon be in the red, like France's program or Mass' program, and we will then need to nove to universal health care, which will again be an "investment." Of course this makes no sense, but it sounds full of empathy and business-like words, and he's so dreamy, so it must be true!
As for digitizing medical records, the only group that will help is GE, which hopes for a big contract, and whose CEO just happens to be on Obama's economic council. And GE owns NBC, MSNBC, also avid Obama supporters. Yes, it's Fox News that is investigating this story but even Fox is right sometimes.
http://www.gehealthcare.com/usen/hit/products/centricity_practice/emr_index.html
Maybe we should look at infant mortality then - before any lifestyle choices come into play.
Of course the lifestyle of the mother wouldn't come into play now would it?
Deep thinking there, DTL. Are you Barack Obama?
Barama means that in the long run we are all dead, but in the short run his political Gang will get all the money from the Health Care charades and the just plain useless green energy sources created only for graft, since there is not any connection with past Climate fluctuations and any thing that emits CO2 in any amount whatsoever.
Rev..Why can't California drill for offshore oil? Are you too pure to live like Louisiana and Texas? It is also rumored that China would like to loan California TARP funds for a controling ownership interest.The Dems will only want a kickback. Tell Swartz to think outside the Boxer.
Wait... something in Wikipedia wasn't telling the whole truth? Why, my core beliefs have been shaken to their core!
Meanwhile, rhhardin said... Economist Arnold Kling's quick predictor of Obama policy is that every policy will transfer more power to the government.Kling's dream policy would probably involve transferring all power to KochIndustries.
Damned if I know what he means. I just don't see any way, any way at all to give health care to everyone without reducing costs. That means denying care to someone, sometime. There's no way around it. That means some people are going to die sooner than they would under the current system.
So, you have to justify it as greatest good for the greatest number. It's not going to be better for everyone. That's just lying.
If we don't reduce long-term health care inflation substantially, we can't get control of the deficit.
Well, it's a good thing we have a president who doesn't deal in false choices. Here's an option: The government could stop funding healthcare. That would significantly reduce the deficit, even if there was still health care inflation.
Problem solved.
What does Obama mean by "some short-term investments in health care?" He means BOHICA.
Bend over, here it comes again.
Trey
Infant mortality in the US is mainly due to the insanely young age of a subgroup of our firt time moms. They are too young to be pregnant and their children die.
Trey
PatCa wrote: "As for digitizing medical records, the only group that will help is GE,"
Actually, insurance Companies will hire new auditors and computer programers to write programs to audit the files so that they can deny coverage of more claims.
Trey
David said...
It's really unclear whether computerizing medical records will save money. Even its proponents say that computerization will result in a cost reduction of 1-2%.
The real cost reduction will come from (1) reducing amounts paid to providers and drug companies and (2) limiting the reimbursements for certain procedures.
David, The way they express (2) is by saying "Imposing Clinical Best Practices", which mean, do it the way the Feds prescribe or do without.
I'd add (3) the big cost saver, Malpractice limits and tort reforms. Today's system not only drives up insurance costs, drives doctors out of high risk specialities, it also means that those doctors that do practice, do so defensively with excess tests, second opinions, C-sections, etc.
It's interesting that we have a for profit healthcare system, those bad bad HMO's. They have a profit motive to control costs, and yet there is a belief that by going to a Federal sngle paye system, we'll eliminate the profit incentive on cost control, increase the number of people covered, maintain quality and lower costs? BS
There is no way you can add 5 million uninsured and lower costs without rationing.
sorry, meant 50 million
Even though I'm somewhat happy with Obama as President, and I'm certainly glad he beat McCain, I can't help but think the Republicans will have a pretty strong argument to make against him in 2012. If we have an $11 trillion deficit and the solution is always more and more spending, I can see even Sarah Palin beating him with that argument if things don't change significantly for the better by then. I'm imagining Palin winning in 2012, then a Palin vs. Hillary showdown in 2016. Or maybe that's just wishful thinking, since those would be some pretty entertaining debates. I actually want Obama to be re-elected, so it can't be all wishful thinking.
I don't know if I ever mentioned it to you-all, but I have a strength problem coming, and I have to try to make some kinds of investments to head it off.
About a year back I made a commitment to hoist up a newborn longhorn bull calf once a day.
It's was OK for the first few months, he was pretty small.
But now he's getting really heavy, and I have to figure out how to rapidly bulk up my muscles so I can keep lifting him in the coming months and year.
Remember, the problem is that I need to get bigger muscles.
The problem isn't that I committed to lift the bull when it was young, and now its getting huge - that can't be the problem.
I'd add (3) the big cost saver, Malpractice limits and tort reforms. Which raises an interesting issue: if the government takes over the treatment plans, does that spell an end to medmal?
Surely it must, if the government takes over healthcare payments too.
Drill SGT - HMOs - "They have a profit motive to control costs, and yet there is a belief that by going to a Federal sngle paye system, we'll eliminate the profit incentive on cost control, increase the number of people covered, maintain quality and lower costs? BS
There is no way you can add 5 million uninsured and lower costs without rationing.
(meant 50 million).The 50 million are NOT without means. Part of the problem is that private care for working poor that lack a government job or are lucky enough to be working for a good private company not seeking to shed health care costs is too expensive.
Maybe they can afford 6,000 of a 12,000 dollar private health insurance policy. But since they cant pay it all, they are perversely incentivized to pay zero...then knowing one medical emergency could strip all their savings from medical bill collectors....seeing the "smart thing to do" is save little, have minimal assets.
Romneycare attempted to bridge the affordability gap - forcing families to pay based on income - then the state making up part of it rather than be stuck with all of it whenever a serious accident or illness struck. Mass also tried to force very profitable companies from deliberately shedding health care benefits for employees. And lower the lawsuits and admin costs that drove healthcare so high.
Romneycare is a partial success. Costs are now well below other states, families are coughing up money instead of freeloading, businesses are hesitant about making up new rules and employment situations that rob workers of health benefits, and insurance companies have cut private health
care insurance costs about 30%.
What has been a real problem is Romney and others did not adequately estimate how bad US healthcare coverage of people was...the demand was far higher...and costs were greatly above estimates.
And since it is only in one state, Romneycare could not force the changes to Federal regulated record-keeping, insurance administrative costs, and litigation limits...or eliminate citizens being billed for illegal alien care and excess benefits the Feds force states to help with with welfare clients.
And, Mass is a Democratic state - so Romneycare quickly got goldplated with many medical care "add-ons" not initially intended. Mental health care for "special ed, criminally inclined due to "behavior control issue" students. Huge neonatal costs.
===============
France and Japan are the leaders.
I like the Japanese model better because it has 6 insurance companies under constant pressure, as are medical caregivers - to innovate, lower costs, and yet provide quality care to all. And everyone pays in. Except the profoundly disabled. A portion of each income check, which in the USA would mean even illegals and welfare mammies would get docked on each check they get.
And the Japanese have no system where government and "old company unions" get Medical Care Plus - better than other comparable workers. Consumers are free to choose between insurers and providers,who in turn retain a profit motive...the more care they provide at good quality with institutional efficiency..the more they make. (Not like Britain's straight salary system)
But reasonable profit - not the US system where doctors, insurers, and tort lawyers can own the medical labs they refer people to, get treated like Gods with tons of graft and vacation "conference" deals by Big Pharma. In Japan, a basic doctor might get 200K, a good one 300K, and great ones of high skill that do tons of quality treatment get 350K a year. Not like "US stars" that see the Lear Jet in their future. But there are no shortage of top Japanese talent waiting to get in med school. And Japan out-innovates America in per capita medical research to approved applications and new drugs.
At 8% of GDP. Half of what we spend.
And are #1 in longevity, rehabilitative care. # 3 in cancer care.
Compared to us being 45th in longevity, 21st in rehabilitative care, 10th in cancer care.
There is no standardized definition for a "live birth;" therefore, there is no way to compare infant mortality between countries
One of the sticks that conservatives used to beat up Obama with was the definition of "live birth" that the World Health Organization put forth in 1980. As I read this authoritative Swiss medical education webpage, the WHO definition is used every where except the ex-Soviet Union countries.
http://www.gfmer.ch/Medical_education_En/Live_birth_definition.htm
DTL,
It is great to be a young man in a country with rationed heath care. Your illnesses and injuries are treated at relatively low cost and you can get out the door with a cast or stitches. The diseases of old age and birth are where the Canadian system (and I assume that is where you are) meets its downfall.
Break a hip or need spinal stabilization and you are on a very long wait list for treatment. You are about as likely to catch pneumonia and die (after lying in bed for months) as you are to get these surgeries.
Premature babies have a substantially higher survival rate in the U.S than just about any other country.
The difference in infant mortality rates is due to a difference in what is counted as a live birth. In the U.S. one extra-uterine heartbeat equals live birth. Other countries use very different standards, often only viable births are counted as live births.
The northern border of the United States has a very high density of MRI, CAT and NICU units because of the demand created in Canada.
U.S. residents should welcome this medical tourism because it increases machine usage for very expensive MRI and CAT machines and spreading the capital cost across more patients.
One problem that the US has is that they subsidize drug development for the rest of the world. Drugs developed in the US (approx 80% of global drug development) are paid for at market rates is the US; the rest of the world uses the power of the state to reduce prices. In the US it would be an unconstitutional "taking".
Complain all you want about the high costs of drug therapies in the US but without that high cost those drugs simply wouldn't exist.
Don't like the high cost of CIPRO? Penicillin is free ($3 at Walmart) go ahead and take your chances; lots of people don't die of MRSA.
FLS- Your link says nothing of the kind. And I am not intending to use infant mortality differential to beat up Obama.
Prof. Althouse- Am I allowed to respond to FLS or does that count as poking the troll?
"Prof. Althouse- Am I allowed to respond to FLS or does that count as poking the troll?"
You can respond to anyone you like, but what I object to is the combination of being irritated at a commenter (thinking he's a troll) and responding to that person (encouraging him). I'm tired of hearing complaints about trolls from people who are themselves encouraging trolling.
Yah, right, digitize health care records-the hobbyhorse of the policy wonk.
Only people who have never heard of ElectroMagnetic Pulse warheads could ever wish this upon the American people.
Jeebus Christmas.
Meantime, David wrote, and wisely:
This interview is interesting in that President Obama recognizes the vast sweep of the spending that is going on and its long term unsustainability. He is also correct in saying that the medicare and social security entitlement obligations are even greater problems than the (hopefully) temporary deficits resulting from the financial crisis and the deficits.
Yet his response to this is to forge ahead with an entirely new and gigantic entitlement for medical care. Obama is not stupid. He knows exactly what he is doing.
To achieve his aims, he must inflate the currency to unsustainable levels. This is a direct assault upon the purchasing power of the Middle Class, already put upon by the recklessness of the Bush years. A weaker middle class is, paradoxically, more dependent on government.
That suits the Democrats just fine.
Obama is Bush the Younger on steroids. This is not something that many of the swing voters who voted for him anticipated.
We have spent something like four trillion dollars in the past, what, nine months, most of it on Obama's watch. And we will spend trillions more. That's not sustainable without the forced devaluation of the dollar as a working currency.
All this will come back to bite him in the ass. Guaranteed. You can't cheapen the currency like this and expect a good end to things. Obama partisans skip merrily along thinking this state of affairs can go on forever.
It won't. It will come crashing down around them.
Lonedotwacko linked to an article about Rahm Emanuel's brother who is in charge of developing the Obama health plan.
Interesting. But this grabbed me:
"It is a complicated process and we have to try and make the choices clear and give people good reasons for making them," Emanuel explains. "I don't think that's an impossible task and thankfully we have one of the great communicators, Barack Obama, at the helm of this ship of state."
"...thankfully we have one of the great communicators, Barack Obama, at the helm of this ship of state." I am serious. What the hey do these guys drink in their coffee every day?
It's a "complex" problem alright, but having "one of the great communicators is reassuring?
Translation: "It's the President's job to bamboozle us."
Help. Someone please help. And deliver us from these religious zealots!
"And we will spend trillions more."
What you mean "we," section 9?
Trey
Why are the infant mortality rates for African Americans double that of white Americans? You don't think that has anything to do with the quality of healthcare and pre-natal care, or that fact that African Americans are more likely to lack health insurance coverage?
I'm beginning to think that Obama is still doing drugs.
Trey wrote:
"And we will spend trillions more."
What you mean "we," section 9?Like it or not, Trey, Barack Obama was elected by a constittutional poliitical process.
The people get the kind of government they deserve. Including Ann and others, who voted for him, and those who didn't, like me.
That would be "we".
Can't just "check out" like Tonto and the Lone Ranger in the fabled joke where the pair are surrounded by Indians and the Lone Ranger turns to Tonto and says, "Looks like we're in trouble, Tonto!"
Tonto turns to the Lone Ranger and says, "What's this 'we' bullshit, white man?"
DTL,
If infant mortality were related to "quality of healthcare and pre-natal care" I would expect whites have the best statistics, which is just not the case:
Non-Hispanic black women– 13.60 per 1,000
American Indian (8.45)
Puerto Rican (7.82)
Non-Hispanic white women (5.66)
Mexican (5.47),
Asian/Pacific Islander (4.67)
Central/South American (4.65)
Cuban ethnicity (4.55)
There are lots of factors related to infant mortality socio-economic status is not the sole driver.
DTL, is anxious to 'prove' US health-care quality is poor and adamantly refuses consideration of life-style behavior as part of the equation.
"The real cost reduction will come from (1) reducing amounts paid to providers and drug companies and (2) limiting the reimbursements for certain procedures. The former is likely to reduce research and innovation, and the latter will certainly involve rationing care, especially for persons in the last year or two of life, where a disproportionate amount of cost is located."
The basic problem with #1 is that drug companies and GPs are already getting pressed very hard by government health care spending. One of the dirty little secrets of government paid healthcare, such as Medicare, is that it is supported in a large extent by massive cross-subsidies from the private sector, and, in particular, from all of us with private insurance.
A month or so ago, on a plane flight from Reno to Vegas, the guy sitting next to me was the CFO of a hospital. I asked him about this at his hospital, and he indicated that Medicare was paying at about 25% of costs, and the state of California at less than that. In order to keep the doors open, they have to find that money somewhere, and the somewhere is mostly overcharging everyone else.
It may be worse for the drug companies, with our private insurers supporting drug development for the rest of the world, with so many countries mandating reimbursements close to the variable cost (which does not recover the massive fixed costs of R&D).
No, you can't cut reimbursements for most procedures and drugs without having major resulting supply problems. Obama may be the Second Coming, but he has yet to show that he is capable of repealing the laws of economics. The first law of economics is that of Supply and Demand. When you cut price, demand increases, while supply decreases.
Right now, we are in the position of underpaying GPs fairly dramatically. Starting pay out of law school for the top grads of the top schools was about the same as the average for GPs, and is lower than that of the average patent attorney (and, yes, we are brilliant, but our offices are nowhere as highly leveraged as are the GPs). Who in their right mind is going to incur the debts and years required for medical school and residency, with top civil servants earning almost as much?
No, the only way to make universal coverage, or anything near it, work, is to drastically reduce the procedures provided to all. That is what they are really talking about with "best practices", etc.
Also note that the technology is not yet available, and it may take awhile for it to become available, to really determine who the inefficient providers are in the health care industry. One reason for this is that it is hard to control for the quality of the patient load, when comparing doctors with their peers. Almost always, when you look really closely at the data, you will find that the biggest factor in explaining why one doctor looks more expensive than the next, is that his clients need more extensive care.
For example, you may have two back surgeons. For one, spinal fusions are the height of his expertise. So, he gets the run of the mill patients. Then, you have the guy doing cutting edge stuff. He gets the worst patients. Instead of spinal fusions, he may be installing artificial disks.
Or, take cancer. Some doctors may specialize in the active phase, and others in a maintenance phase. Again different patient loads and demographics affect the costs that the doctors incur.
So, the only real way to limit the costs of health care on a public provider basis is to ration or limit care based on determinations made by bureaucrats, instead of by the physicians or the patients. Worse, with bureaucrats, you don't normally have a cause of action when your own care or that of a loved one is going to suffer, but you do if an insurance company does.
This will primarily affect those who do have good coverage now. So, we are at the place where care for those paying for it is going to suffer, significantly, in order to provide universal care that includes those who don't want to pay, and/or have made bad life decisions. And that is the tradeoff that Obama and his side are trying to hide.
Let me add that whenever Obama mentions the word "investment", we now know that he just means more government spending. He called his "stimulus" plan "investment". He called his bank bailout "investment". He called bailing out the car unions "investment".
All of these are of less than questionable benefit, long term. The "stimulus" bill was nothing more than liberal spending justified as "investments" through the long debunked Keynesian multiplier. We knew that it was bogus, in terms of investment or stimulus, because it contained a lot of counter-cyclical spending, as well as a lot of stuff that was clearly designed to protect or benefit liberal constituencies, instead of actually helping us with the recession.
The problem, as I noted above, is that Obama and the Democrats cannot repeal the laws of economics. They can call things "investments" as much as they want to, but if they aren't really investments, as most aren't, they will hurt the economy (or health system), and not help it. The laws of economics don't care what these things are called, just what they really are, and they aren't "investments".
DTL, you referenced the rates of infant mortality in Black Americans- This is almost certainly related to the high teen birth rates- teen mothers have very high rates infant mortality, and, unfortunately, there are more Black teen mothers.
Any woman who needs medical care can go to the Health Dept and get it quite easily (I did it in college- wanted to make sure my parents didn't know I was on the pill- didn't cost me a cent.) This is not an issue of insurance, it's an issue of lifestyle.
If Obama were serious about investment in health care he could have ensured that some of the stimulus package went to medical R&D. The law actually provided for 'investment' in "technological advances in science and health."
Instead of actual 'investments' the stimulus funds are going to put shovels in hands for highway projects of dubious value and to prop up industries that have been firing employees left and right.
C.A.C. - just like Obama and many journalists, you do not seem to know the difference between debt and deficit.
Drill Sgt - "I'd add (3) the big cost saver, Malpractice limits and tort reforms. Today's system not only drives up insurance costs, drives doctors out of high risk specialities, it also means that those doctors that do practice, do so defensively with excess tests, second opinions, C-sections, etc."
-Yes, and the US Trial Bar is the biggest and most reliable donor to the Dems - so how likely is it that this will really happen? In reality, just putting a cap on Punitive Damages would have a huge effect on healthcare costs, especially for fields like obstetrics.
Another point, in the US, some folks pay a hell of a lot of money for groundbreaking treatments and drugs - usually these are rich people who can afford it, but in any case they consider it money well spent. Eventually, these treatments become less expensive, and are eventually copied if other parts of the world, after the US health consumer has already paid the up-front costs. If the US were to really adopt a Euro-style system and spend <10% of GPD on healthcare, then the rest of the world would be much poorer for it. I suppose it would serve them right, but it seems like a petty sort of revenge.
It's a "complex" problem alright, but having "one of the great communicators is reassuring?
Translation: "It's the President's job to bamboozle us."
You were reassured when St. Ronald O'Reagan explained how tax cuts were going to bring prosperity, right? Even though that old stick in the mud GHW Bush called it "voodoo economics."
You didn't feel bamboozled then, did you? Even though the national debt, declining since Truman, trended sharply upwards till Clinton took office.
El Presidente said...
FLS- Your link says nothing of the kind. And I am not intending to use infant mortality differential to beat up Obama.
I read the page, analyzed what it said, and summarized. If you have specific criticisms, kindly lay them out.
The idea that the US ranks 45th (or whatever) in infant morality, because the countries ahead of us have gamed the system somehow, is weak.
Infant morality? I didn't know infants had attained the age of reason.
My earlier comment--gummint health care spending is not an investment because there's no ROI on old and marginally functioning poor people--surprisingly drew no huffy reactions.
How dare I think of people as producing ROI for the gummint!
But that is exactly the metric that the gummint applies when it decides who gets what care when they have a fixed budget to administer. In the UK, if you are an Old Age Pensioner (senior citizen), you are automatically bumped down the waiting list behind younger (working, taxpaying) people. In the UK, there are ongoing discussions why nonwhites don't get their fair share of health care proportionate to their part of the population. The results show the discrimination. Canada shows the same policies and issues.
So AARPers better get ready to suck it up and face suffering and death stoically. And minorities, sick people, welfare people, net takers, better get ready to sacrifice and feel the pain like Obama promised they would.
The Big O is hot on gummintalizing health care because it's going to crash and burn during his watch. I bet he will encourages more states to adopt death with dignity laws to allow PAS. It all goes hand in hand--pressuring old people to just go on and die so that we can save Medicare, Social Security, and to accelerate collection of death taxes to Feed The Beast.
I will get effed over on day one because I've had three cancers and beaten them and so I've used up more than my fair share of resources (not paid for by gummint at all) and I'll be denied straight out of the starting gate. But I have a feeling I'll be praying for the sweet release of death if The Big O keeps getting his way.
"Why are the infant mortality rates for African Americans double that of white Americans?"
The teenage birth rate for blacks is 63.8 per thousand while it is 38.3 per thousand for whites according to the Feds from 1973 to 2003.
It took me less than 90 seconds to find this data. But then, I was interested in the facts, so I went looking for them. 8)
Trey
The punch line I was told was "What you mean "we" white man?"
Trey
Section9, my point is that my economic boning was not consensual. There was no we, I did not vote for the man. This is economic rape, not hanky panky.
Trey
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