Saturday night I went to my 25 highschool reunion and bumped into a friend who is a physician's assistant in an emergency room in Maine. I asked him what he thought about all the healthcare stuff that is either happening or not happening, depending on how you view it.
So remember he works an an ER, he said there has to be coverage for everyone, it is crazy that there is not, "every other country" has it he said. Then he tried to close me with "don't you think?"
I did not want to turn it into a political discussion so I stuck to my perception of the economics which is that the bottom line, regardless of the morals of the issue, is that the numbers will not work. The inputs being used to figure out what should be done are either suspect or incorrect which likely leads to the wrong solution.
But then I realized, maybe the last one to realize this, no politician, perhaps this is a tad hyperbolic, cares about a solution. They care about creating the appearance of having done something and having done something that won't blow up for a while--like until after they are gone. To the extent there is some truth there how does this ever get fixed? Ouch.
Before going to the reunion a reader braced me for the idea of there being a few grandparents there. Well I did not stumble into any grandparents but there was one guy who was somewhat obsessed with who had died. My buddy Martin and I bumped into this guy early and ran from him screaming. We found it odd that he lead with this as opposed to, you know, waiting a little while until everyone had loosened up some.
Short post, Joellyn is going to put down a wood floor in the bedroom today (she can do anything) and I have to move the furniture.
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19 comments:
Roger. A couple thoughts on the health care debate. Your friend who works in an ER obviously has an economic stake in how health care turns out; ergo, anything he says must be discounted for this reality. I have never met anyone in any profession who does not think more money/resources are needed to correct the problems of the profession. Continuing that line of thought; yes, the American people do want health care reform. They want to keep or improve the current system and for it to cost less (or, at a minimum, no more). As I understand it, we already have a system that treats everybody; i.e., no one can be denied treatment at an emergency room, regardless of their insurance status or ability to pay.
I can't imagine why those under age 65 wouldn't want government run health care when those of us over 65 find it works quite nicely.
Re: 07:20, yes everyone can get treatment at an emergency room but it is the most expensive and least efficient kind of treatment that could be provided.
The fuss is about the insurance companies profits and nothing else.
Come on 7:39. It's not about insurance company profits, which I understand to be below the average of all American companies. It's about insurance premiums and taxes, both of which will go up for the 80%-90% who have coverage they are happy with, if the democrats plan goes through.
The numbers that don't add up are leaving the US health care system as is; e.g., http://tinyurl.com/yc5fe5w
Other than that I have to assume the nominally bipartisan CBO is on some kind of rational ground w/ requisite expertise when they state as a preliminary analysis that the House health reform package should reduce the deficit over 10 years; e.g., http://tinyurl.com/yhjgsjx
If the Financial Times wants to run an analysis I might pay attention to that too but can't think of anyone else WRT a topic this loaded; just about any think tank or corporate media outlet I can think of reflects some fat cats POV.
As far as politicians go some probably do just want the problem to go away but most probably want to use problems to stay in and/or acquire more power: If they can do that by giving gifts, fine, if they can do that by pissing people off or scaring them, that's obviously fine too (a lot of them seem to indulge in the latter, maybe because it's cheaper).
to be clear I am not making a case for status quo, i just think we will get something that will not be viable and geared to the wrong set of numbers
to be clear I am not making a case for status quo, i just think we will get something that will not be viable and geared to the wrong set of numbers
Didn't seem like you were making a case for much of anything but perhaps you read the CBO analyses of the various bills and didn't buy their numbers for some reason. Whatever.
IAC I don't think we'll get a very good bill either but that's mainly because the compromises and pork necessary to get each bill passed and then reconciled between the Senate and House will likely weaken or distort even the better features. That problem has more to do with a damaged civil society and corrupted political culture than anything else though.
I don't see how they're going to insure everybody, and I don't see that they're going to insure everybody.
I see them a) requiring everyone to buy insurance, need it or not, and b) taxing insurance benefits as income. Somehow this whole thing will wind up hurting my bottom line, not helping.
It will help the government and it will help certain companies.
It's the Senate’s bill that has an excise tax on high-value insurance plans, the House bill has a surtax on the upper 1% of income earners, but yeah, different revenue mechanisms will almost certainly be among the chips played during reconciliation. Ugh.
OT: It was twenty years ago today, Sgt. Pepper taught the band to play ...
1989: The fall of the Berlin Wall
Lest we forget.
The entire healthcare debate has avoided the big question - who rations healthcare and how do they do it?
If I am poor I don't get to drive a Mercedes Benz, I drive a second-hand Toyota Corolla. If I am poor, who decides which treatments I can have, and which are withheld?
The details of who pays for it and how are exactly that - details.
And if the conclusion is really that everyone deserves everything, then we have some big expenses coming up...
Anonymous (first comment) said "As I understand it, we already have a system that treats everybody; i.e., no one can be denied treatment at an emergency room, regardless of their insurance status or ability to pay." So if we have already decided that everyone gets everything, then let's discuss the cheapest way to give it. I have been in a few emergency rooms for real emergencies and seen these expensive facilities tied up by cases that should have spent 5 minutes at a community clinic with a less-qualified (cheaper but good enough) practitioner. Let's remember who pays for those emergency room visits - WE DO. The poor, suffering middle-class pays through our higher payments to these same institutions (via our insurers) subsidizing the free cases.
Many people criticize the quality of nationalized care in other countries, but in fact it is working as it should - it gives basic care, makes you wait for surgeries, declines to treat those who don't qualify. This is available to everyone. Those who want more are free to go to private practice doctors, and get better, quicker care. Isn't that in fact quite a good way to deliver "universal healthcare"?
I have recent experience with both uninsured ER trips and also processing hospital bills that might offer additional info on this topic.
2 years ago I had strep throat and went to the ER. I never had it before so didn't know. Breathing became difficult and my throat was swelling shut so I played it safe.
All that was done was they took my vitals, took a throat swab test, and wrote me 3 prescriptions.
In the end I walked out of there 20 minutes after I walked in.
Final bill was $930.
I previously worked with a medical billing company that would review the medical records of hospitals and then prepare them to be sent to individuals without insurance, insurance companies, and medicare so the hospitals could get paid.
Some crazy number like 25% (I dont recall exactly but thats close) of all visits never get paid by anyone.
I guess my point is that the public is ALREADY paying for the nation's healthcare in a round about way. The hospitals like any industry will pass on their losses and costs to those that pay.
It appears the group that does not want to see any changes in health care, have adequate insurance coverage.
By the way, if you have cancer, you cannot go to the ER for treatment. We just want those individuals to go away...it costs too much.
A key question that is almost entirely left out of the national debate is "does more health care spending make people more healthy?"
It is convenient to think disease "just happens", but this is clearly only a partial truth. If you are a large bank you can consume any type of questionable security, and refrain from showing any discipline wrt lending practices. If anything goes wrong after years of such indulgence the government will just bail you out and make sure that you can pay your bonuses on time.
If you are a US citizen you have a right to hedonistically pursue sloth and gluttony your whole life. If anything goes wrong after years of such indulgence the government will just bail you out by paying for technological heroics to keep you cancer riddled, hardened-artery, arthritic, diabetic body from expiring for a few additional drug-induced years. Rock on ;>
What people want is universal top-notch high-tech healthcare even if theyze eaten/drank/smoked/slothed themselves into a very unhealthy state.
They want it to be paid for by that great philanthropic marvel known as 'someone else'
I would like to meet and shake the hand of 'someone else' for all that they give.
We have great health care for those that are insured and we are going to steal their benefits and replace it with rather mediocre health care for everybody. 20% more people covered 0% increase in doctors and nurses although I am sure the drug makers can spit out a few more pills.
I plan on retiring in my 50's so I am really not against this. The current system only lets you play if you continue to work for a large corporation.
Roger,
You went to high school in the people's republic of Massachusetts and you are surprised by your comrades points of view????
OT (sort of): Significant melt up in equities on relatively weak volume today w/ not much agreement from FX and bonds but not a strong head-shake either. Liquidity continues to rule the day it appears and I confess to an abiding fascination concerning what will happen when it doesn't: Will it be total collapse, a shrug, or something in between?
Don't have a clue: Haven't seen a market this perverse in my 36-year investing lifetime but I've read about a couple (and the end was never good) but, hey, it could be different this time.
Making a freaking fortune in tactical accounts: I'd brag about how much if I was confident the first 800% would hold but it could all reverse tomorrow so better not.
Capital preservation continues to rule the strategic roost regardless so, shall we say, the message is mixed.
Strange days: Oh yes, very.
What was the question?
Let's keep the status quo then, shall we? The US has the most expensive health care, the largest disparities between the rich and poor, the greatest number of bankruptcies because of doctors' bills but at least YOU get better care because you can afford it.
Just like you drive on better roads, use better electricity and breath better air, am I right?
I believe that Congress can learn something from the medical profession's Hippocratic oath: Physician do not harm.
In attempting to fix some problems Congress will kill the patient.
10:09 Mark said
"So if we have already decided that everyone gets everything, then let's discuss the cheapest way to give it."
I agree 100%.
Present system is not the lease expensive. As another post said - 20 minutes ER visit and a $900+ bill. Been there - done that. For many uninsured the local ER is their primary care physician who can not turn them away. They go to ER when their health problem has become severe. A problem if treated earlier, could have been taken care of by a family physician if they had insurance. Many uninsured pay $0.00 and walk away because they do not have the means. If todays Uninsured could walk into a clinic and be treated timely the cost of that treatment would be a small fraction of the cost of a ER visit.
This is of little concern to a great number of people who have insurance from an current employer or pre-retirement employer. It should be because they are paying for it indirectly with local taxes. Private ER quickly transport non-insured patients to county hospitals. County hospitals most often run in the RED and the County subsidizes the costs with local taxes.
Those enjoying paid up health insurance may soon get a rude wake up call when Companies and the gov't start requiring the insured to pay a portion of the insurance premium. I pay for our insurance and I have watch it increase between 10 and 14 % for the last 6 years. At this rate the insurance premium will equal our mortgage payment in less than 10 years. How many families can afford to mortgage payments?
I know a person who pays for his health care and has a large deductible insurance policy. The Doctor billed him and he paid over $10,000 for a recent treatment. He found out later, via inside source, that the Doctor bills insured and cash customers the same amount and accepts 60% of billed amt from insurance company. This apparently is common practice.
Let's improve our health care system with electronic records, volume purchase of drugs, ... we will all benefit. The current Health care bill in congress is a start. It may have many short comings but if enacted it then can be modified as we discovery its deficiencies.
Cost of Health care impacts the bottom line and encourages companies to downsize number of employees living USA.
Richard
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