The evidence.
I'd say he thinks you're not serious about the deficit if you let the term "death panels" scare you away from making tough decisions about what medical treatments the government should pay for.
November 15, 2010
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In that sense, Krugman's quite right: If you accept gov't health care, you certainly have to recognize that there will be limits to who can access what.
(the other kev)
Well, after all, a million deaths is merely a statistic. It's amazing how many allegedly-educated people veer so quickly to seeing some form of genocide as a solution.
w/f - 'bacon' mmmmmmmm, bacon.
This quote seems to be the crux of the matter...
Now, to be sure, Krugman was likely being derisive using that term. However, the point Palin and others were making during the ObamaCare debate - and getting great criticism from folks in the media for doing so - was that once government gets involved in these decisions, it's a slippery slope to federal officials determining who lives and who doesn't.
This encapsulates both the argument she was trying to make originally and points out that she was lambasted in the press for making the argument in the first place.
I wonder if Krugman is as romantic about the British system as Berwick is.
there will be limits to who can access what.
Supporters of the wrong party will get very limited access. Supporters of the right party will get much more.
Yes. Medicare can't pay for everything. I certainly don't want it to. In the same way, insurance companies decide what they will and will not pay for. The trouble is that when the government gets involved, the cost of medical treatment goes UP. So when Medicare--or my insurance company--tells me it won't pay for the red pill that I prefer, the cost of the red pill has been driven beyond my means.
Of course he did. The pretense by our liberal media overlords that Palin spoke a lie when she spoke the obvious truth about the Cost Savings intent of ObamaCare may have to go down the memory hole now. One more time, the SarahCuda was ahead of the curve on dealing with reality. And how is that Qualitative Easing doing that SarahCuda pointed out is a Death Panel for the value of our dollars? The US Federal Government is now on a full covert war footing against the interests of the American people.
The payer decides.
Gubmint pays, gubmint decides.
But it shouldn't forbid you from using your own money to go outside Medicare, which it currently does (by limiting doctors from accepting opt-outs).
Hey, maybe doctors should yell Opt out!! when oldsters refuse Medicare, and we get to do a genital pat-down, and handcuff you to a chair.
The White House and its allies used Palin's invocation of the term "death panels" to run from any serious discussion about health care costs.
They lie to this day about what she was referring to (they still pretend she was talking about living will counseling). The problem was, the SEIU had already spent a great deal of money convincing people we would get rid of the insurance companies' "Murder by Spreadsheet" (see Daily Kos and FireDogLake).
After 'death panels', Obama started saying we only have to give up that which won't make us healthy, like unnecessary tonsillectomies.
In this, Krugman is correct.
No matter what kind of health care you have, at some point you run into limits.
Life isn't fair.
Here is what the sort of a god president had to say as well:
THE PRESIDENT: So that’s where I think you just get into some very difficult moral issues. But that’s also a huge driver of cost, right?
I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.
Q: So how do you — how do we deal with it?
THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now.
The Democrats want to ration health care treatments.
That is an undeniable fact.
Krugman, Journolist member. I remember when Bush was president and Krudman thought that the fillibuster was a great thing to have. Now that Obama is president, he wants it eliminated. What a jerk.
"...at some point you run into limits. Life isn't fair."
Few but the most unicorned believe there is a system without rationing.
But that is not the question. Rather, the most important issue is to answer 'Who decides?'.
Canadians and the British may be fine with unelected gubmint bureaucrats making decisions for you, but I'm not. And if we had any actual insurance reform, people might be able to choose from hundreds of products on the market, rather than the paltry few gubmint allows.
This isn't about health and never has been.
It's always been about gaining control over you in as many ways as possible. They see most of us unwashed as mere cattle.
The crux of Obama and Kurgman's argument:
1. We wanted to be compassionate so we over promised medicare and medicaid.
2. Then the actual costs of our over-promises went through the roof.
3. To help spread around those cost overages we need young people to help pay.
4. To sell the idea of making young people pay, we had wrap it in a claim that we were going to insure 30 million new people, which is another over-promise.
5. Oh hell, we just need to cut costs. Your Grandma will have to die sooner because we originally over-promised.
6. Unions are exempted.
as oldirishpic said in the first post--not enough money in any health care system to pay for all the procedures that might be required--
The question, of course,is who decides what procedures can be paid for and the process to be employed. I trust bureaucrats to take out the garbage--beyond that--very little.
Our health system will, I suspect, have all the grace and elegance of driver's license/vehicle registration ooperations.
It seems Krugman purposely used the phrase to be "courageous" (i.e. "I'll say what others won't) That political grandstanding aside:
Yes Medicare will need to decide what it covers and what it doesn't. In fact it does already. In my day to day work I have to look up what is covered under the Medicare benefit. While its generally less "restrictive" than many other health plans, among the items that Medicare doesn't cover because it (CMS) does not believe the intervention is effective are:
-pacemakers in certain situations ( such as asymptomatic second degree heart block)
-hyperbaric oxygen for bed sores
-acupuncture for fibromyalgia
-bone marrow transplant for breat cancer
any many others. If people want to call that process a "death panel" then so be it. But help me understand the rationality of any insurance company paying for an ineffective therapy.
Now I have no problem with an individual paying for such a therapy; it happens all the time (pick your preferred cold therapy) but a health plan, public or private, has a duty to apply scarce resources to those interventions that make a difference
Krugman only wants death panels if the person is a Republican or Tea Partier. Nuance.
but a health plan, public or private, has a duty to apply scarce resources to those interventions that make a difference.
@c3
Say it brother!
So when Medicare--or my insurance company--tells me it won't pay for the red pill that I prefer, the cost of the red pill has been driven beyond my means.
Probably. And on the flip side when the market has influence, prices tend to go down (note the cost of LASIK surgery)
The hard question is how much should a health consumer pay and should that amount vary based on the effectiveness of the intervention as compared to cheaper alternatives. Here's a real hard example:
-research suggests that back surgery for a slipped disc generally leads to no better outcome in terms of pain and disability after 18 months. Clearly surgery leads to less pain relief in the first 18 months in those individuals who have failed "conservative" therapy. Should an individual be expected to pay more for the expensive surgery?
Gee, what do the people on this list of obamacare waivers have in common?
#12– UFCW Allied Trade Health & Welfare Trust
#14– IBEW No.915
#19– Asbestos Workers Local 53 Welfare Fund
#33– Plumbers & Pipefitters Local 123 Welfare Fund
#35– UFCW Local 227
#52– UFCW Maximus Local 455
#55– Local 25 SEIU
#60– UFCW Local 1262
#78– Local 802 Musicians Health Fund
#83– Local 17 Hospitality Benefit Fund
#89– International Union of Painters and Allied Trades (IUPAT)
#91– Transport Workers
#92– UFT Welfare Fund (United Federation of Teachers)
It is a strange coincidence I'm sure...
Yes Medicare will need to decide what it covers and what it doesn't
How about it decides not to cover illegal aliens and other people who have NEVER EVER paid into the system.
How about deciding to NOT use Medicare for welfare purposes such as Medicaid/Medi-Cal. Find another funding source for welfare than the one that workers have been paying into for generations.
Citing that you use Medicare in your later years is a stupid argument. First of all, (unless you are in the groups I mentioned above) you don't get coverage until you are 65.
So, you pay in for 40 years and when you get sick and need to use the 'insurance' you get treated like you are some sort of thief and the government wants you to just DIE already.
Can Medicare cover everything? Of course not. But it should cover what people have paid into it for and what people are STILL paying for when on Medicare.
Medicare is NOT a free program, unless you are one of the illegals or on welfare.
The rest of us pay and pay and pay.
VW: I kid you not inflaton
Get a grip on both sides of this argument:
1. Palin is right.
2. What are you going to do about the costs of housing the disabled and aged?
Have you ever worked in a nursing home?
Nursing homes are full of people who've been in a vegetative state in a bed for decades. Any idea what this costs?
Nursing homes are also full of Alzheimer's patients who are completely delirious. Many of them live that way for 10 to 15 years. Any idea what this costs?
Medical technology has created a bitter dilemma. The body can be sustained for decades after the spirit and identity have departed.
Yes, we do have to make some decisions about this, else we will be bankrupted.
Actually, the care of an Alzheimer's patient is primarily expensive because the regulatory burdens are enormous.
Besides, most of them aren't dying all that fast. You can't just shoot them.
I mean, this isn't China. Yet.
Nursing homes are full of people who've been in a vegetative state in a bed for decades. Any idea what this costs?
Nursing homes are also full of Alzheimer's patients who are completely delirious. Many of them live that way for 10 to 15 years. Any idea what this costs?
Medicare does NOT pay for those situations. Medicare does not cover long term care.
However, if people make themselves indigent (welfare) they may get some coverage under Medicaid.
In California, if you are on Medi-Cal and need LTC coverage you have to be impoverished, or purposely make yourself impoverished to hide assets. Then you might get some coverage which is horrible. I would rather have a pillow put over my face than be in a Medi-Cal nursing home.
Then, if you have any assets left at all (not likely), such as your home, the State puts a lein on it and takes what little it can to cover the costs.
The tea partiers have spoken. They want Medicare and Social Security eliminated immediately.
I'm all for - let's abolish it immediately. I want to see the teatards fend for themselves.
DBQ said:
"So, you pay in for 40 years and when you get sick and need to use the 'insurance' you get treated like you are some sort of thief and the government wants you to just DIE already."
This needs to repeated loudly over and over and over again because it is obvious dopes like Hdhouse don't understand it.
The community that Obama and Soros want us all organized into is a death camp, like the ones Soros knew as a boy. He thinks that is good enough for all worthless people not smart enough like he was to currency manipulate a billion dollars into their pockets.
They want Medicare and Social Security eliminated immediately.
Actually, they said no such thing.
However, means testing would be a good start.
So okay. The free market is bad because some people are refused coverage but the government taking over is good and we should be open to allowing it to... refuse coverage?
Isn't what he saying the justification he uses for a government takeover of the private sector in the first place?
Denying people over how much they'll cost some evil corporation is the most horrible thing any human has ever done in history but denying people over how much they'll cost the government is super wonderful sunshine rainbow time?
However, means testing would be a good start.
I have no problem with that.
Also the ability to OPT OUT of the system if you want to. Opting out for a portion of the contributions would allow you to invest your SS and Medicare contributions elsewhere into investment vehicles that you would control and own.
Of course if you OPT OUT completely (100%) That means ....out. No coverage.
how do you accidentally say "death panels." no, he meant what he said and said what he meant.
And its being done wherever the government runs healthcare.
The pertinent question is why Krugman insists that government must intrude and ration health care when it does not have to do so to feed everyone.
The market has a very low cost answer to universal health care. Why does Krugman insist we shouldn't use it?
"how do you accidentally say "death panels." no, he meant what he said and said what he meant."
Yes, he said it on purpose. Twice. His point is people need to stop giving their opponents so much power. Stop being cowed by that rhetoric. Let's be adults.
Re: Long-term care.
I've a ward in long-term care. She has been for well over 50 years (She's 68 or 69 now, but functionally about 18 months, due to seizure disorders that are now mostly treated -- "only" 40 or so big ones per year). That's really long-term. This is at the Central Wisconsin Center here in Madison, and she gets excellent care there. She has outlived her parents, but has an older sister in Arizona, I think. The entire cost is paid for by the State, AFAIK. Periodically I'm asked if she could move to a less restrictive facility -- usually these are in-home facilities (I have a second ward -- Hmong woman with Alzheimer's in something like that ) or Nursing Homes -- but I don't see how that would improve her quality of life. I do see how it might improve the State's finances.
I do wonder what her life would be like in another State. I think Wisconsin is treating her very well.
The problem that I have with the Federal government *deciding* what they will or won't cover as opposed to insurance companies or individuals is that top down one-size-fits-all thinking does not serve the individual. Placebos work in about 1/3 of trials. That tells me that an individual's belief system matters greatly in regard to outcomes.
In other words some proclamation from a bureaucrat in Washington won't work. Unless you actually involve the patient and determine, by working with them, what will work, for them, you aren't practicing good medicine, imo. Chemo is going to work for a certain amount of the population - but not for everyone. Certain medications may be detrimental to lots of people - but may be lifesaving for others.
It is a prescription for harm, imo, to take away the individuals role in their own health and healing.
@Althouse: "Stop being cowed by that rhetoric. Let's be adults."
This generally means you can make your own decisions.
Death panels are paternalistic, treating citizens as children. Merely voting for it doesn't give you any choice, but instead removes it, far from your influence.
Saw a 72 year old woman today. 10 concerns.
If the Medicare changes go as planned, she'll get to talk about one, maybe two.
Or none; the gubmint may demand she comes in to be seen for what it deems important (diabetes follow-up, not just her damned knee pain).
So death panels will ration by time spent with providers, as well as limiting available services.
His point is people need to stop giving their opponents so much power. Stop being cowed by that rhetoric. Let's be adults.
The Democrats in this debate were not cowed by that rhetoric.
They seized upon it to paint their opponents as ridiculous, and to paint their proposal as having no such limits.
Ann wrote:
Yes, he said it on purpose. Twice. His point is people need to stop giving their opponents so much power. Stop being cowed by that rhetoric. Let's be adults.
Except people like Palin had to be essentially told that they were lying when they said the dems plan would lead to death panels. Part of being an adult is actually saying what your platform is all about and standing by it. The dems should have said, yeah there will be death panels, so what? Instead we get politicians denying what is obvious and demonizing those who point out the obvious.
And if govt is going to ration care and deny pre approved conditions (if they allowed all care then it wouldn't be rationing) what was the point of going the federal route again?
use Medicare for welfare purposes such as Medicaid/Medi-Cal.
and later this
Nursing homes are full of people who've been in a vegetative state in a bed for decades. Any idea what this costs?
Medicare does not pay for "custodial" care in a nursing home. Largest payors for that are "private pay" and Medicaid.
As so a program created to provide a safety net for the poor more and more pays for the old and infirm.
If you don't like that then the first thing you should do is go out and buy LTC insurance.
"Death panels" would apply to massively expensive treatments that would prolong life only a few weeks. Medicare hasn't had death panels in its 45 years of existence -- we as a society have decided to spend whatever it takes, as long as the patient pays for part of it.
Screw means testing when everyone pays into the system for 40 years.
WTF should anyone save money if means testing is used to salvage govt programs that have been looted by politicians? Today, if you plan and save for your kid's college tuition, you get less financial aid than those who failed to save! How is that fair and appropriate?
Now they want to do the same for medicare and social security? Like DBQ said let us opt out and poll a bunch of 25 year-old and see if they even get 10% who want to participate!
We Cub Scouts visited an outpost of the 19th Century welfare state, the County Poor Farm -- at that time the nursing home of last resort, a Bedsore Manor. So the tradition of the taxpayer caring for the aged without resources goes back a long way.
Now the old folks have been outplaced and the nursing home -- now called a hospital -- has been repurposed.
Medicare is insurance that we pay for, that's true. But government bureaucrats control what Medicare pays for and how much. That is a big part of what has driven up the costs of health care. Wouldn't you rather save your own money and shop for your own insurance? A little competition would be good for everyone. I don't see the point in shouting that we're entitled to Medicare, when it's against our best interests.
@FLS
Did the explosion of nursing homes occur when Boomer parents started getting old? Just wonderin'...
Our health system will, I suspect, have all the grace and elegance of driver's license/vehicle registration ooperations.
Or the Social Security Administration, where an employee told me that they were just too busy to process claims and that my calling and asking about the status was one reason they could not get their "work" done. The irony escaped her.
wv: eledest. Not for long.
I'm sure Krugman's enthusiasm with wane when he's selected for death.
"Did the explosion of nursing homes occur when Boomer parents started getting old? Just wonderin'..."
Nope; it dates to the 1930s, when FDR left boarding houses, group homes, and poor farms without any funds, as Social Security wasn't allowed to be spent on them. A second explosion of nursing home building occurred in the 1960s, when Medicare was introduced, when investors were mistakenly assuming Medicare would pay for it.
Few nursing homes have been built in the last 20 years.
If you really want a summary of old age in the US, try this article. Warning: NSFA.
(NSFA=no safe for alertness)
Typical Liberal Straw Man Non Logic. Relativism at it's finest.
Few nursing homes have been built in the last 20 years.
The one where my grandparents lived -- a "continuum of care" facility -- was completed in 1994. It could accommodate everyone from active seniors, to assisted living, to dementia patients, to nursing home patients. Members of my wife's family lived in a facility of similar age. Maybe few pure nursing homes were built in the last couple decades, but the "continuum of care" complex seems to have been fairly common.
How much money does Medicare spend on Viagra and the Scooter Store?
I'm so serious about the deficit that I think the government shouldn't take over healthcare and spend a giant pile of money on it.
Take that, Krugman!
"The one where my grandparents lived -- a "continuum of care" facility -- was completed in 1994. "
If you look at the majority of those, the nursing home pre-existed, and the rest was added on. Some places closed an old facility and moved the beds to the "new" nursing home.
Few states have actually added any nursing home beds in the last 20 years, and some have even reduced their number.
"Assisted living and in-home care increase as nursing home beds decline.
"Even with the U.S. population rapidly aging, a smaller proportion of elderly and disabled people live in nursing homes today compared to 1990. Instead, far more depend on assisted living residences or receive care in their homes, according to a study published in the August 2005 issue of the Journal of Applied Gerontology.
Residential care and assisted living facilities are designed to meet the needs of older people and people with disabilities who need some assistance with activities of daily living, meals and other support services. According to study findings, the capacity for this type of care nearly doubled in the 12 years from 1990 to 2002, to more than 1 million beds nationwide. When the growth of the population is taken into account, the number of such beds grew from 20.9 to 35.6 per 10,000 people.
In contrast, while the majority of people who need long-term care still live in nursing homes, the proportion of nursing home beds declined from 66.7 to 61.4 per 10,000 population."
Boring, yes, but it is exactly that dull bureaucratic mode which will serve the new American NHS so well, deleting services bit by bit at the edges.
Rationing by any other name would smell as sweet.
If you think this is all fun, just wait until the "romantics" get their way and make us as much like Britain's system as possible...then sit back and watch the fireworks as the first baby that's born on the wrong side of 22 weeks is simply allowed to die. That kind of thing may only get page 13 in London, but, for some reason, Americans are twitchy about their offspring, regardless of how many weeks along they are.
The Tea Party was mis-named. I am becoming more and more convinced it should be called The 2nd American Revolution.
There is no mystery here, just snark. Krugman addressed this yesterday.
http://krugman.blogs.nytimes.com/2010/11/14/death-panels-and-sales-taxes/
I said something deliberately provocative on This Week, so I think I’d better clarify what I meant (which I did on the show, but it can’t hurt to say it again.)
So, what I said is that the eventual resolution of the deficit problem both will and should rely on “death panels and sales taxes”. What I meant is that
(a) health care costs will have to be controlled, which will surely require having Medicare and Medicaid decide what they’re willing to pay for — not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care
(b) we’ll need more revenue — several percent of GDP — which might most plausibly come from a value-added tax
And if we do those two things, we’re most of the way toward a sustainable budget.
More at the link.
Interesting, Pogo. I have seen the increase in assisted living facilities...didn't notice the decrease in nursing homes.
I do have LTC insurance but I wonder how long Obamacare will let me keep it or--for those who think I would never be forced to drop the insurance I like--how long before insurance companies are forced to stop offering it?
But that shouldn't matter if we are able to repeal O-care. If only I had faith that the Republicans are actually going to try to do that. I think they will try to "fix" it, instead.
Krugman: "not really death panels, of course, but consideration of medical effectiveness and, at some point, how much we’re willing to spend for extreme care"
That is, death panels.
@prairie wind: "I do have LTC insurance but I wonder how long Obamacare will let me keep it..."
Me, too.
I suspect they'll disappear.
I know Krugman is a Nobel Prize winning economist but I doubt he has the savvy to even run a lemonade stand.
RE: LTC insurance
Already disappearing. Met Life is not issuing any more policies.
If you have a policy don't be late in your payment for even a milisecond or they will cancel you!!!
Medicare is insurance that we pay for, that's true.
Medicare is not insurance. Its a payment scheme, some would say a Ponzi scheme.
And to all of you under 30 I have one word to say:
SUCKERS!!!!
Krugman could endorse Santa Claus and no one will give a fuck except to try and punch that phony, fraudulent faker in the face. I'll be the first if I could actually get within range of him.
Shorter Althouse shortening of Krugman: Don't let the rhetoric of death panels deter you from embracing the substance of death panels.
I do have LTC insurance but I wonder how long Obamacare will let me keep it
Apples and oranges. "Obamacare" will not change your diaper.
We have had death panels for decades, in the medical insurance industry.
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