We Americans seem to live in a dream world ! There is no such things as "preventable death".
In the real world, the operative phrases are "inevitable death" and "prolonged life".
In the real world, those who insist on prolonging life need to be ready to pay for it too. If they think they can impose life syles on others, then they should be ready to foot the bill for those others as well.
It is simple, in the dream world, immortality comes free. In the real world longevity cost more.
Many people state health care costs as 2.2 trillion, and 16% of GDP, including the Kaiser Foundation. However, when I go to Table 3A of http://www.bea.gov/newsreleases/national/gdp/gdpnewsrelease.htm
health care in 2008 accounts for 1.5 trillion out of a GDP 14.4 trillion or about 11% (not too far off from other nations).
Where do people get their data from?
I went to the http://www.cms.hhs.gov/NationalHealthExpendData/ web site, and while I can reconstruct the popular numbers from their site, they leave me even more puzzled. The GDP numbers for 2007 do not match the BEA. Off by at least a trillion, depending on Net or Gross DP. In addition, the BEA makes it clear that it is not counting Social Security or Medicare/Medicaid under Government consumption. So they must include it all under personal consumption.
The BEA percentage of health care over GDP has been pretty constant over the last decade, around 11%. The HHS data shows it jumping 3 point, to 16% during the same stretch. What's more, it made me realize that 50 years ago it supposedly was at 5% mark(HHS). Made me wonder why we don't hear an explanation of how we did it back then (forget the Canadians).
In other words, it seems very much like whoever counts gets whatever results they desire. Now I have double the evidence that all the numbers are suspect.
Disappointing. Especially since I used Kaiser Foundation numbers from an age stratified cost per year chart, and figured out that "prevention" was bullshit. Excuse my language. Healthy living adds costs to the flat part of the bathtub curve, merely deferring the end-of-life costs. So "whole life cost" goes up with longer lives. There will be no bending of the cost curve as long as longevity increases.
I suppose politicizing numbers shouldn't surprise me. But better orchestration would help.
Congress and the Administration are busy tweaking the existing system, and calling it reform. They are crowing about 47 million uninsured as evidence of a crisis, when a huge number of them are prime of life people who do not need health care. Republicans are attacking costs, increased taxes proposed by Democrats, while claiming that the for profit insurance system is great, begging the question if they’ve woken up from the Bush years yet. All of it is in a crisis mode – must be reformed this summer. Or what? I think we’ll just have another summer next year.
Now I do have some ideas for real health care reform. It starts with the simple premise of a single payer. I don’t care if it is the Social Security Administration or Halliburton. Stop wasting billions on multiple billings, useless accountants, claim processors, rate negotiators, and of course, CBO, GAO and untold other studies. The Government should simply open it up for bids. Companies could partner, agencies and companies could partner, agencies and agencies could partner. I would not care. Just two basic criteria: single payer, meaning single book-keeping, and lowest operating bid. Health insurance is not brain surgery – it is just moving money from the left hand to the right hand. So the winner should do it cheaply. That would take care of my health insurance claim processing reform.
Now for actual health care reform? Well we are in a pickle, one that neither Democrats, Republicans, AMA or BCBS want to admit. The baby boomers are going to clog the are demographics arteries. The number of Americans over the age 64 will double for the next 40 years, and these old codgers consume 6 times the health care that a young person does. Our infrastructure, you know the one with Indian immigrant doctors, Philipino immigrant nurses, and hundreds of closed hospitals, cannot serve their numbers. So we will have metered health care. The rich will go to through the side doors while the rest of America will queue up at the front desk. Inevitable. How can Congress ignore this? Perhaps because most will be dead and gone by the time it becomes obvious.
The way to get out of the pickle is to resort to the great American ideal of self determination and self reliance. My suggestion is that every American be endowed with a voucher of $1,000,000, for life time health care. Each time they go to a doctor, the single payer will pay the doc, and reduce the balance of the voucher. Once a person runs out, they are on their own. If they live right, maybe the voucher can last a long time. If they live smart, they won’t rush to the doctor for every sprain and strain, much less for Viagra. If at the end of life, they only have enough for a hospice, rather than the inhuman cruelty of being kept alive on tubes for months, who is to judge which represents better quality of care. How do I suppose to pay for this. Well, the startup cost is minimal. Even old people only average $8-10,000 in annual costs. That’s the only part of the voucher that has to be covered initially. The full million is like life insurance – you pay, perhaps into Medicaid (what a novel idea) to build up the “future value” of you endowment. The younger you are when you start, the lower your monthly payments. I think it is doable.
Now to complete my tour de reform, I would allow the unused balance of a voucher to be transferred to heirs, as part of the estate. I know, it sounds odd, but it really makes sense. The genetics will ensure that in the long run, the healthiest of the breed will end up getting the best of care.
Sorry folks, but when one is looking to reform reform, one has to strain the gene pool to achieve real savings in health care.
The President finally called the reform by its proper name: Insurance reform!
Let's be honest. The entire discussion has very little to do with health care reform for 250 million Americans. It consists of Medicaid offering wall-to-wall coverage for families making under $29,000 per year, and about $2 grand in government subsidies to those making less than $88,000 per year (with yet to be stated levels of coverage. The rest of Americans will retain the same crappy insurance, but pay more in taxes.
The likely beneficiaries will be the insurance companies, who will get another 40-50 million subscribers.
That is not something I want to help with!
Senate will delay action on bonuses tax , not to mention Geithner and the President himself are backtracking on the House action.
The arguments about breaking contracts between employers and employees is bogus. If it had meaning, my real estate tax increases could not cut my raise in half. The retroactive tax argument is bogus. A bonus paid in 2009 is current year taxable earning. The argument that it is not constitutional is the biggest crock of them all. Cigarette taxes, liquor taxes, skims from lotteries are all punitive taxes, and legit. And lets just wait until carbon credits roll, which will be the biggest social engineering tax of them all. These are all Wall Street arguments floated to save their bonuses!
Are we finally seeing tranparency? Is it transparent now the Congress and the Administration listen to and work for Wall Street, first and foremost? If they work for all Americans, then they should act on all our behalf. The House did, this time!
Mr. President, your call for fiscal responsibility in spending the Recovery Act tax dollars has the agreement of every American. It won't be an easy job. But, it would seem to me, there is at least one, simple driving function that you can use, namely the performance standards of every Government manager.
Performing the mission under budget is NOT, and never has been a job standard in government. In fact, the whole Executive Branch operates on the premise that turning money back to the Treasury is a sin. "Year End Obligations" is what the annual September ritual is known as. I believe you can issue and Executive Order that makes "fiscal performance against budget" a mandatory performance standard for all Government managers. A standard that clearly states that coming in under budget will be rewarded. In fact, I think, it needs to be the standard with the most weight, to motivate the behavior you are expecting from your workforce.
Congress, historically, also sees the appropriations as "must spend" amounts, where wasting tax dollars to meet obligation goals is inherent. Perhaps you'd need bi-Partisan agreement and support for the Executive Order to change their mindset. But which representative of the tax payers will oppose budgets as maximums, and instead, publicly support fiscal irresponsibility? I think you can drive this through.
Mr. President, you promised us change. Turning the Federal Government into an organization that puts primary value on conserving the tax payer's money would be a huge , and welcome change. One that perhaps all levels of government could adopt.
Start Fiscal Responsibility in Government - all it would take is your Executive Order !
I really would like to see two rules implemented in the Administration's Homeowner Stability Initiative procedures, in addition to payments lowered to 31% of income.
First, no tax deductions for interest on bailed out mortgages. That would make the rest of us cover the sin twice.
Second, if and when a bailed out property gets sold for more than the mortgage principal, the "profit" gets taxed at 100%, until the incentives are paid back. Those incentives, of a thousand dollars here and there, are our tax dollars! They need to be paid back to the Treasury, not end up as "somebody's slick move".
The implementation rules must contain assurances that the $75 billion gets paid back by those who got bailed out, not by our children.
Mr. Geithner has several months for developing the implementation rules. The money comes out of TARP, which means he can do pretty much whatever he wants. Such rules should not be a problem for him, and it would be very reassuring, and FAIR, for those of us with the "responsible gene".
There is no constitutional right to homeownership! If you borrowed above your means, you've got no right to stability of ownership! The fact that the value of a house dropped below your purchase price is not relevant unless you want to sell - and if you can't afford to sell, then stay put - that is stability!
If you want rules for dealing with this mess, and keep 4 million families from being thrown out on the street (who, by the way, are not all hopelessly helpless to start with), here is a suggestion to Mr. Geithner:
Make the banks take their houses back (let them foreclose) and make them rent to the occupants (for minimum of 1 year, or pick your time frame)!
Then the dumb bankers will have their "fair market equity" and the dumb buyers will have a roof over their heads at "fair market rates"
I do not want my children to pay for all these gifts!
I had worked for nearly 50 years, starting with pumping gas when I was 14. I paid my way through engineering school. Worked my way up to what you'd call middle management, before I semi-retired this year. My wife and I raised our children, put them through college, and they are productive, good citizens now. While we scrimped early on, going pay check to paycheck, other than a mortgage, we never carried debt. Paying off the mortgage was one of my pre-retirement goals, and we managed to do so. Mind you, we've lived in our house since 1980, the only thing flipping since then were hamburgers on the backyard barbeque. My pension is reasonable, we have no debts, we've done all the right and responsible things, and now I am starting to feel like a sucker! You might ask why?
Because I will be paying off the debts of irresponsible consumers and the salaries of high paid financiers. I will be getting no tax breaks, while Washington is creating them for those who want to borrow, and live beyond their means once again. My biggest uncertainty is not about the Dow Jones, not about housing prices. It is about taxes and inflation.
What is currently going on is eventually going to have to be paid for, either by more taxes or by inflation. Maybe it will be creatively deferred until past my time. But we have also gifted our children with the "responsible gene". If Washington doesn't get me, then it will make suckers of our children. Social conscience is OK by me. Helping those in need is also. But throwing my tax dollars at greedy crooks, greedy idiots (lenders and borrowers) and adding more pork to wasteful programs and pet rocks is not.
President Obama, perhaps this is not the story you wanted to hear, but it is a real, true, and American story. Thank you for your time.
