६ सप्टेंबर, २०२३
"Medicare may even wind up saving money because of Covid-19 — because the older Americans who died from the disease tended to have other illnesses that would have been expensive to treat if they had survived...."
"If Medicare spending had grown the way it had for much of its history, federal spending would have been $3.9 trillion higher since 2011, and deficits would have been more than a quarter larger.... The difference is more than could be saved by raising the eligibility age for Social Security or converting Medicaid into a block grant, controversial proposals raised by legislators concerned about the federal debt. It’s so much money that almost no major legislation passed during this period comes close in scale. Even some major deficit reduction proposals, like the one known as Simpson-Bowles, aren’t much bigger.... The recent deficit reduction deal passed by Congress will save a relatively modest trillion dollars in comparison. A new Medicare policy that will allow it to negotiate on the prices of some prescription drugs is expected to save just under $100 billion over a decade...."
But Covid doesn't explain the trend, which begins in 2010:
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2010 would be the start of Obamacare. Health insurance and its costs were radically restructured. How would that impact Medicare, though?
The obvious thing that happened in 2010 was the passing of the Affordable Care Act. Why Obamacare would have this impact I haven't figured out yet.
Yahoo Finance article from August 2021:
COVID-19 didn't hurt Social Security or Medicare as much as experts feared, report finds
Money quote from the article:
"On the other side, a senior administration official described increased deaths from the pandemic as helping the program's bottom line. It had a "small effect in the other direction" compared to the drop in revenue from fewer workers paying into the system. The sad result of the hundreds of thousands of additional deaths meant that fewer older Americans were available to receive Social Security and Medicare benefits."
"But Covid doesn't explain the trend, which begins in 2010: ... "
But the only thing that many readers will "remember" is that Covid-19 saved money. Next week we'll read about all the money saved by automobile accident deaths and how wrecking cars helps the auto industry.
I haven't read the article (paywall issues), but are people in general getting healthier (hah!), or are people simply avoiding treatment?
I'm eighty. I have several progressive diseases. End game will not be fun. I'd just as soon die after a brief respiratory illness. So that's the plus side of Covid. My heirs will not be inconsolable if I die after a brief, inexpensive illness that doesn't require long term custodial care.
The article is paywalled, but the part quoted by our blog hostess is a reminder that governors such as Cuomo and Whitmer deliberately put patients with COVID-19 into nursing homes, successfully killing off elderly patients who otherwise would be costing Medicare large sums of money for their treatment.
At 77 I’m quite aware of quiet pressures to get us old folks to sign “do not resuscitate” orders. That may also play a part. I resist them, of course. I have grandchildren to enjoy.
From a demographic standpoint, the baby boom showed up on Medicare in 2011. Since they had a more affluent childhood, perhaps they are healthier in old age.
I'll let my family know we should be proud of the death of our loved one (kept apart from us behind glass) during covid because some government accountant sent out articles to be printed at the NY Times telling us how good things are getting by their dying. All the while our government cannot stop massive grift and spending on bullshit to the tune of trillions of dollars in 'programs' that changes nothing and no one ever sees. Maybe they expect us to forget? And by 'us' I mean thousands of people.
In the meantime, the real totals: Interest payment on national debt is now the largest Federal expenditure.
The Times article talks about a fleeting aberration, while the massive problem is knocking at everyone's front door. Those interest payments don't get smaller or go away. The problem is greater by the time you've finished reading my comment than it was when you began.
Yes, a feature of deliberately spread chinese lung rot, not a bug. Vile disgusting things they are, evil.
Per some international comparisons of COVID outcomes, the USA had a high death rate because of extremely poor health relative to our national median income. Our national death rate follows from extremely high levels of diabetes, obesity, plus self-defeating "equitable" urban drug and violent crime policies, and other conditions.
COVID seems to have mainly taken the lives of those who would have otherwise died from the flu, heart failure, etc. One underlying problem is that you can't eat carbs and nothing but carbs and expect to be healthy. Thank our retarded/corrupt federal agencies that previously sang the praises of sugar, created an asinine carb-heavy food and diet pyramid, wrongly warned against eating meat and eggs, covered up Tuskegee Syphilis Experiment crimes, and who demanded masking and other unproven nonsense rather recently.
Fitch itself noted that some of those debt statistics have actually improved recently: debt-to-GDP, say, is slated to be “only” 112% in 2023, down from 122.3% in 2020.
This is the up-is-down quality of the hyperventilation over debt: Things are getting better, so doom is at hand!
If one looks at the long-term causes of the rise in the debt burden, it's not due to overspending per se. It's due to poor governance.
Something like two-thirds or more of the rise in debt-to-GDP occurred during Republican Administrations, administrations that were for the most part slashing social benefits. The US has one of the worst social benefits of the industrialized world.
Now, there is some overspending--on defense. Not that we have too few weapons. The war in Ukraine has shown that the entire western alliance does not have enough missiles, artillery, air defense, and other basic materiel to handle even a fairly small war. The weapons we have tend to be overpriced (the F-35), too heavy (the Abrams), and too short-range (our air defense systems). We just scrapped our littoral combat fleet without having used them at all! The entire procurement system is corrupt, and we could probably save $200B a year while improving our level of readiness.
But we have been spending too little on things like infrastructure, education, research, and other things that increase productivity. We have wasted enormous resources on trying to prevent migrants from entering rather than giving them reason not to flee their home countries. We infamously had just about the highest Covid death rate in the entire world. And in this country, we are pouring all our national energy into fighting one another rather than climate change, which is very likely going to kill us all.
These are the fruits of bad governance.
The ratings agencies have a point.
But Covid doesn't explain the trend, which begins in 2010
Well done, Ann…the trend correlates highly with boomers dying, the fat blob in the snake finally being digested. Shorter lifespan and lower quality of care account for the rest…
Are there fewer people than expected in the relevant age group? Is obesity killing more of them at an earlier age than expected?
Since I don’t read the NYT,, I can’t comment intelligently. By which I mean, I can’t read this without giving them money. And that’s not something I will do.
So apparently we need more engineered viruses funded by the U.S. and stealthily released in China to kill off lots of old people.
Now I get it!
How convenient. Praise God from whom all blessings flow.
We probably shouldn't ask why or how this happened if we know what's good for us. Shame if anything bad happened to anyone reading this, eh?
Save Medicare. Protect the NHS.
Uh-oh. They said the really chilling quiet part out loud: it's expensive to keep old sick people alive.
Here we go, everybody.
Robert Cook, you were talking yesterday about gutting defense to fund universal healthcare (and universal college). We see where Canada is going with MAID - mental illness alone will soon be sufficient to get you "on the list." We've heard about the recent UK ruling against the young woman who wants to be kept on life support long enough to raise money to go to North America for an experimental therapy - the judge ruled that her doctors can withdraw life support against her and her family's express (and literally expressed - she is conscious and communicative) wishes simply because he says she's not appropriately believing her doctors when they tell her she's terminally ill - and also, they can't use descriptions of her condition to fundraise. We've heard about the young woman in Belgium, a survivor of the Belgian airport bombing, who was so traumatized that, years later, she asked to be euthanized, and her government granted her request, adding another victim to the bombers' tally.
It's expensive to treat sick people who aren't going to get well, even if their quality of life may be improved. The obvious answer: give them access to the Final Solution. Isn't that what compassionate nations do?
because the older Americans who died from the disease tended to have other illnesses that would have been expensive to treat if they had survived
So they had all these other diseases that are expensive to treat, but it was COVID that killed them, right there on the death certificate. Right.
Good job!
Always look at the graph. At best, the verbiage doesn't give the whole story. At worst, the verbiage hides what doesn't fit the desired narrative.
Also, note the unrealistic extrapolation on the graph. It not only assumes an endless increase but it assumes the rate of increase is accelerating. Medicare spending can't endlessly increase because it would eventually exceed 100% of federal spending. What can't continue won't continue. At some point, some limit on medicare spending has to kick in, which happened in 2010 for some reason.
culled; culling; culls
2: ... to reduce or control the size of (something, such as a herd) by removal (as by hunting or slaughter) of especially weak or sick individuals
The town issued hunting licenses in order to cull the deer population.
Merriam-Webster
Well that was an unsustainable trajectory!
And gee I wonder what major changes to health care policy took effect in 2010.
If one looks at the long-term causes of the rise in the debt burden, it's not due to overspending per se. It's due to poor governance.
and (one bitty snip from the long para about defense overspending)
The entire procurement system is corrupt
Mm hmm. So how do we guard against these same problems in providing a massive benefit like universal healthcare? What is the government program that has kept its costs in check, has spent taxpayer money in the right places and not the wrong ones, has proven immune to procurement and other forms of corruption, and has not set up a poisoned incentive structure?
Is there one? I'm not saying there isn't - it's possible that some Parks & Rec backwater is doing a great job. But if it is - will it scale?
I've been saying since Democrat governors purposefully contaminated nursing homes early on in COVID that is was no accident. NY, MI, NJ, PA, CA.
1) It quickly bloated death numbers for their planned political gain in spreading fear and gaining control.
2) It was a quick way to this out the Medicare rolls for Blues States that are massively in debt.
Democrat governors basically sent small pox blankets to kill the elderly.
Note the chart is measuring “mandatory Medicare outlays” and not all government spending on healthcare. Look at the sharp drop Q1 2010. The money was shifted to a different program. They took from Medicare to fund Obamacare just like Palin said they would. I remember clearly AARP throwing their members under the bus and spreading the misinformation that it wouldn’t affect Medicare. The stats beg to differ.
Re the relatively steady state of Medicare spending since 2010, I think we first need to account for how Medicare spending is tracked, ie if any budgetary gimmicks were employed, how much of the costs were shifted to Obamacare subsidies, how and when any Medicare reimbursement reductions took place etc. In other words, that’s a pretty dramatic change to work with without the baseline info of why it happened. It’d be unwise to make any conclusions at this point.
Note that the graph is spending per capita, and in no way represents an actual savings of $3.9 trillion. How many more people went on Medicare starting in 2010 and moving forward? How much more money is being spent overall? As someone above suggested, this could be the result of the pre-boomer population being much smaller (less quality healthcare during life, effects of great depression while they were developing, WWII killing a significant number) that then was swamped by an influx of much younger (i.e., much more clustered around 65-year olds) whose youth (and much of the rest of their lives) were times of plenty, Older boomers are now hitting 75, youngest are seven years from qualifying, lets see what this chart looks like in 15 years.
Don't let yourself be gaslit.
2010 would be the start of Obamacare. Health insurance and its costs were radically restructured. How would that impact Medicare, though?
@Kate, perhaps under Obamacare more people die before they become Medicare eligible? I don’t know either, just a guess.
They have discovered that people in bad health can be taken out by a bad flu/pneumonia/covid season.
Shocking.
The chart shows spending *per beneficiary.* The enormous Baby Boom cohort started moving into Medicare in 2010, so the denominator got a lot larger. This says nothing about whether total spending dropped, but I'm guessing that it didn't.
Never forget that medicare - basic medical care for a small part of the population who needs it (as originally envisioned), is now 12% of all government spending.
COVID-19 was simply used as an agent to kill off old folks in NY... they even put them in old folks rest homes just to kill them all off (which it did!) They just didn't use a needle so overtly like Hitler's henchmen did.
We truly do have mass murderers in our government.
Soylent Green is people!
One thing that is going on is de facto rationing; the mechanism being unavailability of physicians.
It's not unusual to hear of people waiting 6-8 weeks for a specialist appointment, and again that long for needed surgery or procedures. We once made fun of Canada for that kind of stuff; now it's us (we still do relatively well for urgent things, but that makes the non-urgent wait even longer). Primary care docs who once saw chronic patients every month now push it out to 6 or 8 weeks to keep their appointment books reasonable.
Why? 3 things:
Obamacare mandated electronic health records- doctors (and nurses) now spend hours each day entering data, taking time away from actual health care. A few minutes here, a few minutes there, it adds up.
A more subtle thing, which I have not seen mentioned, is the mindset change that resulted from the limitations on resident training hours in 2003. Before that time, residents were trained with the concept that patient care comes first, last, and always. Every physician understood that he or she would miss birthdays, anniversaries, and funerals if a patient requires his or her presence.
Starting in 2003, resident work hours were limited to 80/week. That sounds like a lot, but more than the number, the overriding concept was that if a resident worked more than the limit, it could be a firing offense for the resident, and a decertifying event for the training program. Not every resident became a clock watcher, but every resident did become aware that 100% dedication to patient care was no longer the ultimate goal.
The pre-2003 trained cohort is aging out, many are slowing down, or retired. The clock-watching cohort has taken over. It's being described as young doctors looking for "work-life balance," but what it really is is less overall productivity per physician-life, so fewer appointments being available for each patient.
The 3rd reason is women. Women are now a majority of medical students, and female physicians are less productive than male when they are working, and they work less (fewer hours per week, fewer years per career). There are certainly advantages to having women in the medical workforce, but efficiency is not one of them.
If I were tasked with slowing the growth of health care spending, I would use physicians as the limiting factor, keep them busy with tasks that don't spend money, somehow get them to work less, and have them see fewer patient overall. Fewer appointments, fewer interactions, less dollars spent.
The hard stop coincides with Obamacare. All of the other trends, healthier seniors, etc…, mentioned would take effect gradually, or happened later, so the default explanation is Obamacare and any other explanation has a hill to climb. Assuming that the numbers are not cooked.
Oh here we go again. The Great threat to the US Budget is "Entitlements". You know the one part of the US budget that the Pols can't control and people have earned through hard work and payroll taxes.
I'm not going on my usual rant. I'll just repeat that the entire SS "bankruptcy" could be solved by getting rid of the Payroll tax ceiling. Medicare costs could be controllled by setting up an audit agency to reduce waste, fraud, and abuse.
And no one in DC seems care how much illegal and legal immigrants are costs the Health care system. Any Immigrant over the age of 65 is going straight on medicare, all the poor workers who pick your lettuce go on medicaid. The illegals are using the ER, and we're paying for that too. But of course Mitt Romney and mcconnnell only care about those damn working class people collecting SS checks and using medicare. Those damn Freeloaders.
We need save money on "entitlements" so we can send more to the Ukraine to kill "Russkies" says Miss Lindsey.
Obamacare took a large chunk of money out of Medicare.
Also, tommyesq is right, that spending is per capita. To first order you'd expect the outlay per recipient to be flat. New procedure coverage and costs per procedure would affect that.
I don't believe the headline: "A Huge Threat to the U.S. Budget Has Receded. And No One Is Sure Why". No one is sure why? It can't be that hard to understand, with half a brain and access to all the data.
Don't these old people's doctors REALIZE?
That if they'd JUST Murder young children, and inject their blood.. They'd live FOREVER?
Isn't THAT WHY we're luring all these Honduran kids here?
Were some costs shifted into other programs by the Affordable Care Act?
Jamie said...
where Canada is going with MAID - mental illness alone will soon be sufficient to get you "on the list."
So serious (hypothetical) question..
first: gender dysphoria is by definition a mental illness, not a life choice (That's WHY we treat it)
so.. If the "Preferred treatment" for gender dysphoria was Medical Aid In Dying (MAID)..
Would we STILL have the huge amount of Rapid Onset Gender Dysphoria ?
I mean: It's a mental Illness, right? It's NOT a choice.. IT'S WHO THEY ARE.. Right?
the final question is: Would you rather have a live daughter.. Or a dead FtM son?
Jamie at 9/6/23, 7:57 AM had one criticism of Rich's lengthy post.
I'd like to offer another one: which branch of government has had the "power of the purse" and thus the power to distribute largesse via lawmaking? Hint: it's not the executive (unless you count extra-legal things like "sue and settle" and some efforts to use EOs.)
My preference, when lodging criticism of spending, is to examine which party held the spending power during years of budget generosity? I'm in no way trying to claim that one party is "better" than the other. Just trying to keep the discussion somewhat more honest. :-)
https://wiredpen.com/resources/political-commentary-and-analysis/a-visual-guide-balance-of-power-congress-presidency/
Freeman Hunt said...
Were some costs shifted into other programs by the Affordable Care Act?
shhh!! we're having fun here!
Don't be pointing out the changes in Medicaid that switched HUGE numbers off of Medicare and ONTO Medicaid
Is there any evidence to suggest that the trajectory would have continued?
"If I were tasked with slowing the growth of health care spending, I would use physicians as the limiting factor, keep them busy with tasks that don't spend money, somehow get them to work less, and have them see fewer patient overall. Fewer appointments, fewer interactions, less dollars spent."
Great comment. My experience is that waiting times for specialists have gotten insane, and even our primary doctor needs to booked 4 weeks in advance. To fill the gap, the place I go to is using "Physician Assistants". Don't know what they are, but if we need an appointment within a couple days, they are the only ones available.
Hmm...Obamacare signed by the lightbringer in 2010.
Were some costs shifted into other programs by the Affordable Care Act?
Did per capita Medicare spending nosedive just after ACA passed? Yes.
Do you believe that we (government + private) are spending less per capita overall on health care now? No, you don't.
I know my personal share of insurance + expenses continues to go up up up every year.
So there is a definite "shift of costs" and if its not partially or fully attributable to ACA, which started just before the sharp downturn in the graph reversing 40 years of steady trend upward, then we need more info to eliminate that monstrosity of a bill as a suspect.
What do you think, Freeman?
This is a sort of fallacy of composition error, but with the average beneficiary being compared to the group as a whole. Note that the graph is spending per beneficiary. The average age of Medicare beneficiaries started a fairly steep demographic dive when the Baby Boomers began to qualify in 2011- in short, there were suddenly lots more beneficiaries turning 65 than there were beneficiaries turning 75 or 85. Overall program costs, however, have continued to climb because even with the drop in average spending/beneficiary, there are lots more beneficiaries every single year. Just wait until the first wave of Boomers turns 80 in a few years- that is the age demographic that will begin an explosion in size in 2026, and that is also the age demographic that absorbs tons of Medicare money. The older Generation X people like me are much smaller. I turn 65 in 2031 while the oldest Boomers turn 85- my beneficiary grouping will grow much more slowly than that 85 year old group for a generation.
Here you can see actual spending in constant dollars from the St. Louis Fed. That plateau doesn't exist. In fact, the biggest significant decline in overall spending since 1966 came during the mid to late 1990s when the 1900-1920 generation began to die off and their numbers weren't being fully replaced by those born during the Great Depression.
An alternate headline would be, "The model predicting per capita medicare spending was wrong and no one is sure why."
Also, a labeling a "trend" that ended 13 years ago a "recent trend" should tell you that you are being manipulated.
Solving this great mystery might begin with a look at the leveling off of per capita spending from 1997 through 2000 and why the numbers began increasing beginning in 2001.
And compare that with a study of increases in the incomes of medical professionals over the same time periods and how that was moderated by the takeover of the MD profession by the hospital chains.
One thing that is going on is de facto rationing; the mechanism being unavailability of physicians.
With de jure rationing on the way, per the story of the Canadian veteran who, entitled by Canada's universal healthcare system to a new wheelchair every 5 years and having kept her current one for 12, has been told there will now be a 5-year wait for a replacement. When she cried out in despair that she "can't live like this," the Canadian healthcare rep oh-so-Canadian-ly reminded her that she has the right to die under MAID.
She says she's periodically suffered suicidal thoughts over the years since her debilitating injury, and now she not only has to battle those internal thoughts but also the gentle and frequent reminders from her government that she can "just" end it all. Doesn't that sound like just the kind of thing you want a person with PTSD to have to cope with?
This is the logical end of the road for universal healthcare - or almost the end of the road: get the citizenry to take themselves out of the system, and never lose an opportunity to suggestive-sell that choice. The ultimate end is... wait for it... "death panels," rationing boards who will hear the cases of people whose conditions are - let's start with terminal. Who could object? That's just merciful, isn't it?
But they don't end there; how about those whose conditions are very painful or arduous? How about those who have nothing physically wrong but who suffer from mental illness? March 2024, that's when mental illness alone as a criterion for physician-caused death is to be added to Canada's MAID policy. Nothing like approaching a depressed or otherwise vulnerable person with the offer to ease their physical or psychic pain permanently. By killing them. These people are certainly capable of resisting that offer, right? If they really don't want to die? Nothing about chronic pain or mental illness could interfere with their momentary decision about how worth living their lives are, right?
What guards against this end, universal healthcare proponents? Our common values? What are those again?
I don't have an answer to the question of how to distribute healthcare - but it's a pipe dream to think that it could ever be as "equitable" as it's envisioned on the left. Whether you use a universal system or a market-based system, rich people are going to have access to more lifesaving or life-improving care than poor and middle class people. Even if you do away with payment for services in any form, the connected will still have greater access than the unconnected. What I object to is that proponents of universal healthcare scoff at the idea that rationing, up to the point of withholding care, will take place, calling it fear-mongering by the right in order to shut down discussion.
If Rich thinks ending the LCS program is worse than keeping if, then I have to discount every other opinion Rich has posted.
Planned parent/hood, Obamacares price shifting... does Medicaid allow asset stripping?
rcocean:
...the entire SS "bankruptcy" could be solved by getting rid of the Payroll tax ceiling
I have not seen any numbers to confirm this, but does that include capping benefits for high earners at present levels? If so, that would turn SocSec, which now has a relatively low level of progressiveness, into yet another federal welfare program.
I agree that this may be the least worse way of fixing it, but let's see the numbers.
Medicare Advantage plans increased during that time. Government pays a fixed amount to an insurance company for each Medicare enrollee and the insurance company manages the risk, which means all their members cover the extra expenses with premiums. Cost is shifted from government to private.
Also fair to keep in mind the trick from how to lie with charts and graphs- notice where the ‘trend’ line begins and the curve extrapolation….
I wonder if this is related to the advent of Medicare Advantage plans, which were changed into their modern format around the late 90s. I get a lot of advertising pumping these things - but really, these are plans designed to benefit the health insurers, not the insured patients. They've got built-in caps on medical spending for the patient, for one thing (i.e. the insurance payout is capped). So. let's see..... say around 2000 a 65 year-old Boomer gets snookered into the 'free Medicare Supplement ! ' TV ads and signs up. 10 years later, he's reaching the average American life expectancy, around 2010..... Hmmm.
Planned parent/hood, yes. Also: progressive prices a.k.a. "inflation". Education, too.
Gilbar is right that there was a shift of many people from Medicare to Medicaid and ACA (the latter at ridiculously low prices -- $5 a month, etc.). Temujin is right that debt is dwarfing and affecting everything else.
This chart doesn't address populations shifted from Medicare to either Medicaid or completely subsidized ACA, both of which uniquely burden the working and middle classes by taxing far higher percentages of their income through payroll tax to pay for the nonproductive. There used to be a psychiatrist blogger called The Last Psychiatrist who treated low-income clients in NYC who could explain this healthcare shell game in detail, but he decided to become a pornographer instead (seriously).
The payroll tax ceiling is currently incredibly regressive. As payroll taxes as a percentage of income exploded and inflation crept up, more and more of the burden lies on families earning less than $125K per year, especially affecting self-employed people who own small businesses and earn between $50K and 125K per year and must buy their own health insurance.
There is no excuse for the payment (not benefit) ceiling to not rise with inflation.
The payroll tax is probably the biggest single driver pushing out the middle class and pushing the middle and working classes to decide, rationally, to not get married, to rely on government benefits, and to not create businesses or grow their businesses. It is at least on par with health insurance costs.
If there is any overarching goal here, it is to systematically eliminate the middle and productive working classes, not kill old people.
Right now, someone earning $125K pays 11.4% of their income in payroll tax. After paying the same amount on the first $125K they earn, someone earning $125 million a year pays .9%, but only for the part of their income that counts as income, not investments. Most wealthy people can avoid that .9%.
Our working and middle classes are being squeezed at both ends, paying for the flagrantly poor at wildly higher rates than the higher-income white-collar professionals who decide who pays what while not contributing nearly as much to the system.
"I have not seen any numbers to confirm this, but does that include capping benefits for high earners at present levels? If so, that would turn SocSec, which now has a relatively low level of progressiveness, into yet another federal welfare program."
I Like progressiveness. I don't think having poor people pay more in terms of taxes as a percentage income is either fair or just. And its already a "welfare program" since people who pay into it don't get a payout based solely on taxes paid. If you pay in 100K a year for 40 years and die 2 years into retirement, you get much less payout, than someone who pays in 50K for 40 years and lives 20 years into retirement. And if you die before 62, you get zero. And even if you both live 20 years, the man who paid twice as much wont get twice the payout.
Gosh, so its a welfare program. How horrible!
Hospitals did their best with Covid death protocol$.
If the drop is in 2010, wouldn't it make sense that whatever caused it came before that? A few years, a decade, maybe in 1945 (the year the people turning 65 in 2010 were born). This is if it's health related (but not COVID) and not creative bookkeeping.
Gosh, so its a welfare program. How horrible!
Not terrible because it's a welfare program.
Terrible because it's a welfare program that is 30 trillion dollars in the red. (Not that high by govt figuring, but that high or higher by GAAP). Medicare is worse (again by GAAP).
Terrible because a lot of people have been paying into it for their entire working lives, and they mistakenly expect it to be there in some semblance of its current form when they get to retirement age. It will have to turn much more progressive to remain solvent- only poor people will qualify, similar to Medicaid, and it will then have less than Medicaid level support, as people who previously were receiving SocSec benefits every month lose them.
That's gonna piss of a lot of Boomers, including this one. I have paid $406K in SocSec taxes in my lifetime (not inflation adjusted); that could have bought me a nice annuity, or have been invested in the S&P500 and been a multimillion dollar account at this point.
Instead, it's a badly mismanaged government program, that will turn into a self immolating welfare boondoggle. It's going to hurt a lot of people, rich and poor, as it self destructs.
Yancy Ward, 10:55 knocks the ball back into the other court. Total spending continued unabated, but somehow per-capita spending all but froze. Did we freeze benefits and immediately spend the savings by bringing a whole bunch of new people into Medicare? I can't find it in the numbers.
Sorry. It doesn't make sense that the trend in total spending continues to rise, the beneficiary population continues to grow at a steady rate, but the individual costs have stagnated.
Sanity check failed.
And compare that with a study of increases in the incomes of medical professionals over the same time periods and how that was moderated by the takeover of the MD profession by the hospital chains.
Courtesy of Obamacare which drove the profession into Industrial Medicine. The Electric Medical Record mandate drove some hospitals into near bankruptcy. It also drove doctors into selling their practices to hospital chains. U of Arizona had to sell the UMC to a for-profit.
The 3rd reason is women. Women are now a majority of medical students, and female physicians are less productive than male when they are working, and they work less (fewer hours per week, fewer years per career). There are certainly advantages to having women in the medical workforce, but efficiency is not one of them.
Yup. A lot of young docs work a sort of "Gig Work" system and work shifts unlike us old geezers. I finally quit Trauma Call after I worked two 40 hour stretches in one month. Women, especially do this Gig style in primary care. The agencies that manage this system estimate women physicians work 26% fewer hours than men month to month.
The ones I have talked to are not very happy with the profession.
Based on the experiences of my father, father-in-law, and my uncle, I am not planning to go to the hospital for anything short of an acute life threatening event. I believe others in my Boomer Medicare cohort are in agreement.
The agencies that manage this system estimate women physicians work 26% fewer hours than men month to month.
But if they're paid less than male doctors, it's not because they've made a choice about how to use their time, but because of The Patriarchy.
It's all so tedious.
(I am a woman. My name doesn't make it clear and earlier today I was mistaken for male, which under pretty much any other circumstances doesn't matter to me in the least, but with regard to this particular issue, I feel a need to make my sex explicit so no one here can claim that I'm exercising my, what, male rage or something. Not only am I a woman, but I'm a woman who has made choices about how to use my time and talents, in concert with a husband who has done the same. To our mutual happiness, our choices have been by and large complementary, which is not to say we haven't given up material benefits because of our choices.)
they work less (fewer hours per week, fewer years per career)
women physicians work 26% fewer hours than men month to month.
true for many (most?) fields..
something to think about, next time you hear that women made 83 cents for every dollar earned by men
A big change in 2010 was the beginning of wellness programs being 100 percent covered by Medicare. Correlation is not causation, but if I was investigating, I would start reviewing the records and see if perhaps earlier diagnosis was leading to better outcomes. It is also around that time that the mass exodus to Medicare Advantage began, which gave the insurance companies a lot of bargaining power with the healthcare providers. The answer is out there, but no one seems to be invested in finding the cause.
Tim makes a point that it might be wellness programs under Obama care that caused this decline in Medicare costs.
But here's what happened to life expectancy at age 65. -- Big drop under Covid.
year life expectancy at age 65
2009 17.7
2010 17.1
2011 17.8
2012 17.9
2013 17.9
2014 18
2015 18
2016 18.1
2017 18
2018 18.1
2019 18.2
2020 17
It's obviously the huge influx of relatively healthy Boomers in their late 60s, plus the dying out of the large, old, and expensive pre-Depression cohort. In a few more years, costs/person will explode and stay high until the govt goes bust.
gilbar said...
they work less (fewer hours per week, fewer years per career)
women physicians work 26% fewer hours than men month to month.
true for many (most?) fields..
Those data are from the agencies that arrange the Gig work that so many young docs do. Lots of GPs, ER docs and those who work in walkin clinics or "Urgent Care" offices.
I know my personal share of insurance + expenses continues to go up up up every year.
My wife and I are, of course, on Medicare. I did pay both halves of the Social Security tax until I stopped working at 80. Now our "Medigap" premiums are about one thousand a month. For both of us.
Obamacare didn't pass until 2010 and most provisions in the law were not in force until years later, so it can't explain an immediate change in growth in per beneficiary spending in 2010. Furthermore, a reduction in HC spending growth is observable across OECD nations beginning in 2008, also before Obamacare. There is something larger going on and I have not seen a good explanation (and I pay attention to this stuff as part of my job).
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