No matter who wins, there’s still a healthcare cost crisis

By Reihan Salam
October 1, 2012

One of the strangest aspects of the 2012 presidential campaign is that President Obama has barely bothered to make the case for the Affordable Care Act (ACA) and Mitt Romney has only rarely summoned the will to make the case against it. This is despite the fact that ACA is arguably the most consequential domestic policy legislation since 1965, when President Johnson presided over the creation of Medicare and Medicaid.

The usual explanation for why we haven’t had a serious debate over ACA is that Democrats recognize that the law is not wildly popular and that Romney is boxed in by his continued support for the universal coverage law he backed as governor of Massachusetts. All of this may well be true. But the foundations of America’s patchwork health system are unraveling before our eyes, and conservatives need to make the case for a more cost-effective reform sooner rather than later.

It is commonly understood that the United States spends an incredibly large amount of money on personal healthcare – the number was $2.19 trillion in 2010 – and that health spending is increasing rapidly as a share of GDP. A high level of health spending isn’t necessarily a bad thing. It makes perfect sense that an affluent country will spend a great deal of money to keep its citizens healthy, and medical care is a complex service that demands a lot of skilled labor.

What is worrisome is that the cost of medical care seems to be outstripping our ability, and more to the point our willingness, to pay for it. We tend to think about this in the context of the dramatic growth of Medicare and Medicaid spending, and understandably so. There is virtually no elected official, Democrat or Republican, willing to support the tax increases we would need to pay for these programs at their current growth rates, which is why the Obama White House and congressional Republicans alike have called for aggressive, and some would say unrealistic, cost controls.

Yet the clearest indication of our unwillingness to pay for rising health costs is the slow-motion collapse of employer-sponsored health insurance (ESI).

Though we tend to think of ESI as “private” coverage, the chief reason it is so prevalent is that it is subsidized by a tax exclusion that was worth $260 billion in 2010 – a tax exclusion that individuals buying their own health insurance do not enjoy. Even with this tax subsidy, however, a growing number of employers are deciding that sponsoring health insurance coverage is a bad bet.

In 2000, 69.2 percent of Americans under 65 were covered by ESI. By 2010, that number had fallen to 58.6 percent. To put that in raw numbers, we went from 169 million Americans with ESI to 157 million. The decline of ESI has been particularly pronounced among low-income workers, for whom the tax exclusion is not nearly as valuable as it is for high-income workers.

One of the main reasons for ESI’s decline is that the rising cost to employers of sponsoring health insurance coverage is crowding out wages and other benefits. Some big companies, like Sears and Darden Restaurants, are trying to salvage ESI by shifting to a strategy of offering workers a fixed sum of money to purchase insurance on an exchange, and this might make a difference.

But ESI is clearly in trouble, and an increasing number of Americans have been forced to seek health insurance from outside its protective umbrella. Some low-income workers have turned to Medicaid, which has seen enrollment increase from 33.3 million in 2000 to 54.6 million in 2010. This expansion may in turn have encouraged at least some low-wage employers to drop coverage. A small but growing number of non-elderly Americans have turned to Medicare. While Medicare is generally understood to be a program for the old, it also provides medical care for the disabled. In 2010, Medicare spent $59 billion – well over a tenth of its total budget of $525 billion – to provide medical care for Social Security Disability Insurance (SSDI) beneficiaries. SSDI enrollment has skyrocketed, going from 5 million in 2000 to 8.2 million in 2010. As the MIT economist David Autor has argued, at least some of this increase can be attributed to the shriveling up of labor market opportunities for less-skilled workers.

The many Americans who don’t qualify for Medicaid or Medicare, meanwhile, have been forced to navigate the often confusing and intimidating individual insurance market, where subsidies are scarce and people with pre-existing conditions can face frighteningly high insurance premiums. And so ESI’s decline has created a tremendous demand for health insurance options that offer all the benefits of job-based coverage, like the low premiums that come from being part of a big risk pool, without keeping workers shackled to a particular job.

Health reformers on the right and left have spent decades puzzling through how to address this extremely tricky problem. The main advantage of job-sponsored coverage is that a large business enterprise is relatively easy to hold together, and it’s a fair bet that it will include the relatively young and healthy as well as the relatively old and sick. Although some firms vary premiums by age or income, most ESI is community-rated, requiring the younger, healthier and generally poorer employees to subsidize their older, sicker and generally wealthier co-workers. However, healthy employees are unlikely to leave a job just to get a lower health insurance premium.

Holding together a pool that is not united by employment at a single company is much harder, as the young and healthy aren’t likely to want to subsidize the cost of insuring the relatively old and sick. If the government nevertheless wants to hold together such a pool, it must either offer generous subsidies, impose an individual mandate, or both.

And that, in essence, is what the architects of the Affordable Care Act decided to do. As Douglas Holtz-Eakin, president of the right-of-center American Action Forum, explained in an interview, the ACA has in essence created “a second Medicaid-style program” in the form of its state-based insurance exchanges. These exchanges will allow individuals and families who do not have access to job-sponsored coverage to purchase insurance policies that will cost no more than a tenth of their income. As with Medicaid, state governments are meant to set the terms and conditions of the insurance policies offered on the exchanges, subject to various federal mandates and restrictions.

In theory, this new exchange-based system will exist alongside ESI and Medicaid. Indeed, under ACA, Medicaid is meant to expand dramatically, as the federal government has promised to pick up the full cost of expanding state Medicaid programs to cover all households earning less than 133 percent of the poverty level.

But as Eugene Steuerle of the Urban Institute has observed, people who are covered via the exchanges will receive much higher subsidies from the federal government than those with job-sponsored coverage or Medicaid. This will create a strong incentive for employers to drop coverage, even in the face of the employer penalties established under ACA. Thus, the slow-motion collapse of ESI is very likely to pick up speed. And as more non-elderly Americans flood the exchanges, ACA’s commitment to keeping family medical expenditures below a tenth of household income will become cripplingly expensive – far more so, in all likelihood, than the Congressional Budget Office has assumed.

ACA aims to contain healthcare cost growth by encouraging medical providers to consolidate into larger Accountable Care Organizations (ACOs). Given that Medicare’s “fee-for-service” structure has been the main barrier to the emergence of higher-quality, lower-cost networks of medical providers, this should be a very positive development. Yet so far at least, these ACOs are quite unlike successful integrated providers such as Kaiser Permanente and Intermountain Healthcare, which are renowned for offering cost-effective care. Rather, they appear to have increased the market power of local hospitals, which have been shielded from antitrust regulations and from more specialized competitors. Some, including Holtz-Eakin, suggest that the new ACOs are bending the cost curve up instead of down.

There is a more sustainable alternative to the Affordable Care Act. Back in 2008, Senator John McCain’s presidential campaign called for a comprehensive overhaul of the tax treatment of health insurance. The tax exclusion for employer-provided health insurance would be scrapped in favor of a universal tax credit, a move that would, in one fell swoop, curb tax subsidies for the rich while increasing them for low- and middle-income households. All households would receive a stable and predictable amount of premium support that they could then use to purchase coverage. Insurers and medical providers would have a strong financial incentive to contain costs, as they wouldn’t be able to game ACA’s unlimited subsidies. While the McCain plan would not have solved every problem facing America’s health system, it would have allowed for more state-level experimentation with high-risk pools and organized care delivery models.

The political problem with the McCain plan, which the Democrats exploited masterfully, is that it acknowledged that the tax subsidies for high-income and middle-income households had to be curbed to move the country to a fairer and saner health system. That, alas, cut against the instinctive conservatism of voters who liked their job-sponsored coverage, and who much preferred Barack Obama’s wildly unrealistic promise to keep ESI as we know it intact.

But as this promise comes undone, voters will be faced with a choice. We can either embrace something like the McCain plan, which will pave the way toward a more market-oriented health system, or we will wind up with stringent bureaucratic price controls as ACA’s subsidies prove unaffordable. In light of the conservative failure to actually make the case for a market-friendly solution, the latter outcome is looking ever more likely.

PHOTO: Patient Sharon Dawson Coates (L) has her knee examined by Dr. Nikhil Narang at University of Chicago Medicine Urgent Care Clinic in Chicago, June 28, 2012. REUTERS/Jim Young

19 comments

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The solution for US healthcare costs is simple indeed. LEGISLATE to Benchmark all healthcare costs against average and equivalent European costs. This way, all Doctors should be paid about half of their present remuneration and drugs and medicines sold for half the costs. Insurance premium should be halved too… And this will have no bearing with the service quality, as the European counterparts are doing quite well with what they get, and there is no reason to believe that the US doctors are going to run away or drug companies are going to close shop if they earn half of what they do. Presently they are earning at least twice of what they deserve, against a fair benchmark. Now why is healthcare remuneration such a holy cow??? They do not have enough votes and they do not contribute all that much to campaigns. It is just because there is no good presidential candidate who can target the deserving greedy industry …and win…

Posted by vasantjoshi | Report as abusive

The simple reason the cost of medical care is outstripping both the government’s AND individual’s ability to pay for it is that “necessary coverage” is no longer definable. In the “old days”, things were simpler. You got checkups, operations for removal of tonsils, or an appendix. Very few had comprehensive dental, vision or hearing coverage because these were almost universally necessary (eventually) for everyone who could afford them and those that couldn’t did without, just as today.

Computers have made research and collaboration possible beyond man’s wildest dreams, and the result is an ever-increasing flood of new medicines, treatments, procedures and even specialties…none of them cheap. But Medicare and Medicaid have rushed forwarded to “cover” a great many of these advances even as the bean counters ignore the fact that incoming revenues have actually decreased from which these must be paid.

Those who would “cover everyone” in pursuit of an “equitable society” have their heads in the sand. Even America does not yet have an economy productive enough to pay for such.

One “solution” is more training to produce more “Nurse Practitioners” to serve as a “first line” of medical defense. Put them in care centers open 24/7 in Walmarts, etc. and price services at nominal cost. That’s a lot easier than increasing the number of available doctors in the short term (necessary when you suddenly “cover” more people). The “basics” of care for normal pregnancies and minor “emergencies” of cut fingers, colds, nose bleeds, colic, etc. and routine flu/viruses and urinary infections aren’t all that difficult to effectively render.

This would “free up” the schedules of our relatively limited supply of general practitioner doctors once”normal” office visits” are filtered through these lower cost alternatives. They would themselves likely be sick less ofter and handle less routine challenges more expeditiously and thoroughly. It should also equiitably reduce the costs of “necessary” health care while increasing the effectiveness of the dollars thus spent.

I would like to see a “basic medical allowance” which employers, small business or individuals could fund. This would be a “universal single benefit” for individuals, one that is government-subsidized or incentivised, applicable to one and all from the Presidend down through Congress, federal, state and local governments, CEOs, etc. as well as “we, the people”. It could be used for everything from aspirins to cancer care and renew annually. Those who desire more coverage could purchase it, but premiums and/or co-pays for the higher coverage would not be tax favored (deductible).

Would that solve all present problems? No, but it would be a good first step and reduce the remainder to something more easily contemplated and addressed as time and revenues permit.

Posted by OneOfTheSheep | Report as abusive

The minute they made car insurance mandatory, it ceased to be insurance and became a tax. The same with health insurance. It isn’t insurance anymore, it is a mandatory tax. As long as care is compulsory, both by the patient being forced to go through “channels” and rack up huge costs for a cold when antibiotics and such should be over the counter, and also for the providers who cannot turn anyone away, you will have the continued “welfare syndrome” we see today being applied to health care. Ask any nurse what would alleviate their hospitals of patients and they’ll say “just put a bowl of pain killers and antibiotics outside and no one would come inside”. Better yet, make it over the counter like 3/4 of the modern world does.

Posted by LysanderTucker | Report as abusive

@vasantjoshi,

America isn’t Europe and doesn’t want to be. Socialism is not the panacea you suggest.

It is possible to fine tune the profit motive on which Capitalism is based to achieve ANY desired result simply by the incentives and disincentives of the adopted tax system. That’s the “way” America should “solve” this “problem”.

Who are YOU to presume to judge what is “appropriate” compensation for professionals. Are you one? These people invest incredibly greater dollars and academic talent and effort on the way to certification.

Even America does not yet produce enough to provide of them to treat our present population. The rest of the world, including Europe, has longer waits for more abbreviated attention to human needs. That’s not a goal to move towards.

Whether it is acknowledged or not, extended waits for routine and for complicated procedures (if approved) is but a substitute for the economic semi-rationing of medical services apparent in America today.

Posted by OneOfTheSheep | Report as abusive

There will continue to be a healthcare “crisis” as long as we have to obtain care through purchasing insurance from profit-making companies. The health care itself is expensive enough without having the profit-making merchant between the patient and the medical provider.

Posted by bcrawf | Report as abusive

@bcrawf,

I disagree. Profit is not a dirty word in a society whose success has substantially arisen from and remains attributable to Capitalism. Can the process be abused? Yes, like any other. Is it perfect? No, but no other has proven superior as a working and available choice.

There are non-profit insurance companies. I believe they are called “Mutuals”. I don’t see large differences in rates, perhaps because smarter or more efficient management gravitates to the “for profits”. Who knows?

There are “for profit” hospitals/chains and “non-profit” ones. It’s just about impossible to do an “apples and apples” comparison of anything medical because of the perverted interpretation bureaucrats use to deny individuals, journalists and competitors access to existing data already collected and squirreled away by their government at taxpayer expense.

Release the information, let genuine competition and innovation, American strengths, sift out the inefficient and the incompetent and quality will go up even as costs go down given wise and appropriate incentives.

Posted by OneOfTheSheep | Report as abusive

Isn’t it very obvious that the ACA mandates that all those who can afford to pay must have health insurance without any attempt by the government to control the costs of services or premiums that the costs will rise like a balloon. The country is now a captive market to the private insurers.

Massachusetts had/has mandatory auto insurance since I lived there over 30 years ago. The statehouse also controlled the rate of increase in premiums.

The only reason there is an ACA is that Congress didn’t really want to try to deal with the problematic future issues because they knew it would die in committee.

@OOTS – Carl Jung had a line I always remember. He said: in Communism the individual suffers; In Socialism the state suffers. I will complete the line with, in capitalism everyone suffers. But it is a very interconnected and vocal world today. If the pain of the sufferers becomes too obvious and too loud, the country turns into a living bolgia of hell. The world is no longer large enough or vacant enough either to seek an escape from the din or to try to ignore the screams. And all the screamers are voters. And the future might well mean the death of all three classic economic systems.

I think you are wrong about the stress on Doctors but that depends on where you live. I had an operation recently for a benign tumor that seemed to me a model of cost effectiveness and efficiency. It was out-patient surgery and I wasn’t in the hospital for more than about four or five hours. I spend about 30 days recuperating at home until the wound had completely drained and closed. I had the no frills approach for those who can’t pay for insurance. I liked it and had the help of a visiting nurse who came to my house to change my dressing every few days. Otherwise – after the wound had cleaned up enough I could stand to look at it because it was a shock looking at a five inch slit in my side and about a square foot of bruise discoloration (but Oxycodone can make anything bearable) I was able to clean the wound and dress it myself with gauze and bandages from the doctor and the local pharmacy. I just had to overcome a little squeamishness.

I talked to someone recently who had a hospital stay too and it sounded like she felt she was entitled to first class service. I have another friend who heard about my experience and automatically said – “but I like hospital care – it’s like a vacation”. They both have insurance.

Because I stayed at home and was very happy to be able to do that – I saved the system about $1200/day for the room. It may have been the kind of operation that would have required two weeks until the drainage tube had to be removed – something I asked for earlier – actually because it drove me nuts with the itch – and possible another week until most of the drainage stopped enough to allow only gauze pads. It could have been a two or three week stay if I had private insurance. But I’m a big boy and don’t need constant doting care that many think they deserve. To be real – beggars can’t be choosers either. But would I have had the option to go home if I had private insurance?

Some people can be spoiled brats and are never satisfied. And they can treat themselves to hypochondriacal fears. They also have a tendency to treat everyone around them like they were their personal servants.

BTW – Warfare is a socialized system. If the government intends to devote about 60% of its budget to military related expenditures, how does one draw the line at socialism in every other sphere of its life? If it’s life depends on socialized warfare shouldn’t it also socialize it’s peace as well?

Another BTW: Don’t ever try to pull a tube from under your skin in a fit of aggravation like I did. It was stitched in place. It didn’t hurt but I almost passed out from something the body senses even if the nerves can’t feel much of anything. It’s very odd. But gauze was a lot more comfortable than a ¼ inch plastic tube with hard stitch ends sticking into the skin. It was also more discrete than wearing a little bottle to collect my own drippings.

Posted by paintcan | Report as abusive

@paintcan,

I’m impressed, and glad to hear of your successful outcome. With some of the “superbugs” that threaten today, it’s disconcerting to know that many of us already carry these within us kept in check only by our immune system.

Several years ago my wife was admitted to the hospital following an Emergency Room visit for a gastrointestinal problem. She had Medicare, but I always put on the admission forms that we are to be specifically consulted before anything is done that Medicare does not “cover”.

It is also necessary to request a “semiprivate room”, as that is all that is covered by Medicare…very few hospitals today have such rooms, so one gets a private one anyway without the surcharge. Best also to take your own meds too…saves “the system” a LOT of money.

Patients are supposed to have the right to sufficient information to make such decisions as you made. While I made repeated cost inquiries from admission until discharge some four days later, no one explained that just going from “outpatient” (Part B Medicare) to “inpatient” (Part A Medicare) status instantly incurred a $1,000 deductible.

Since her admission was a voluntary one, precautionary at best, I was able to ultimately get that deductible resolved as “Charity care”. One does have to be one’s own advocate!

Posted by OneOfTheSheep | Report as abusive

Just as roads and bridges and airports are a necessity for our economic health and economic growth, so is healthcare. Unlike all the other “infrastructure” that is paid for from the taxes we ALL pay, healthcare is left to stand, not only on its own, but in the hands of private sector enterprises.

I am not espousing nationalization of health care. From what has happened in countless other countries we all believe that will not work. What I do think is a better solution is having everyone pay something for health care, as is mandated in the Affordable Health Care Act, BUT, instead of turning that money over to the insurance companies, put it into an account like Social Security, and manage the payouts to doctors and hospitals and pharmacies with better computer software AND as part of Medicaid/Medicare.

THIRTY PERCENT of every dollar currently paid FOR health insurance TO health insurance companies is taken BY those insurance companies. We need to eliminate those health insurance companies to be able to control costs and provide coverage to everyone.

Health insurance is a national security issue. It is an economic competitiveness issue. It is an imperative for the survival and growth of our country. In order for it to be cost effective insurance companies with their bloated executive suites (with HUGE bonuses) need to be eliminated. THEN we will see a rebirth of manufacturing and the middle class.

Posted by jswain23 | Report as abusive

@OneOfTheSheep in response to @vasantjoshi asks “Who are YOU to presume to judge what is “appropriate” compensation for professionals” and in the very same post this individual proclaims that “America isn’t Europe and doesn’t want to be”. To paraphrase your very own scolding of @vasantjoshi, who are YOU to proclaim what America wants? Let me be the first to inform you that you do not speak for America. This is completely apart from the fact that your attacks on others here are pure strawmen. @vasantjoshi did not suggest that America was Europe nor that it wanted to be Europe, rather this person merely suggested their own opinion that the American healthcare system use the European systems, systems widely recognized by healthcare experts throughout the world to be significantly more efficient and effective than the American system, as a benchmark to control costs. You then proclaim that “Socialism is not the panacea you suggest” which offers a glimpse into your true, underlying purpose here. I see nothing in @vasantjoshi’s post that suggests that socialism is a panacea, however, you evidently felt strongly enough about the subject to bring it up. Rational, thinking people recognize that neither socialism nor capitalism is a panacea, but that one or the other might offer a superior solution for specific issues and neither should be ruled out based simply on ideological beliefs. You do the same in your response to @bcrawf with your assertion that “Profit is not a dirty word” a claim that was not made anywhere in their comment. Reading @bcrawf’s comment without the rabid ideological bias presents a much more reasonable perspective that health insurance is a major contributor to the excessive cost of healthcare in America. This perspective is supported by the 2008 McKinsey & Company report “Accounting for the cost of US health care: A new look at why Americans spend more” in which health administration and insurance costs accounted for the highest percentage of excess cost (nearly 170% higher than expected) of any of the seven major components of health care.

Then you make completely unsupportable statements such as “Those who would “cover everyone” in pursuit of an “equitable society” have their heads in the sand. Even America does not yet have an economy productive enough to pay for such.” How do you account for the undeniable fact that essentially every other developed country in the world does exactly that?

You state that “The rest of the world, including Europe, has longer waits for more abbreviated attention to human needs.” yet the OECD report “Health at a glance 2011″ concludes that Americans have the highest level of unmet care due to costs of any of the eleven countries measured. Forever is a very long time to wait. According to the report 39% of Americans with below average incomes reported that they were unable to get necessary medical attention due to costs. Not only that, 20% of Americans with above average income reported the same issue. The next highest rate in the report was Germany where 27% of below average income people and 17% of above average income weren’t able to obtain care due to cost and the numbers drop off significantly from there, down to just 4% for both groups in the UK. The same report indicates that more patients in the US (20%) spent four weeks or more waiting to see a specialist than in either Germany (17%) or Switzerland (18%). More Americans (7%) waited four months or more for elective surgery than residents of Germany (5%) or the Netherlands (5%) and France and Switzerland had the same rates as the US. The US also ranks fifth from last in the number of doctor consultations per capita and seventh from last in the average length of stay in hospital of the 33 countries monitored by the OECD. The US provides neither more care nor less abbreviated attention than other developed countries, it simply provides far more expensive care. Do you have any data to support your claims?

Then you go on to state that “There are “for profit” hospitals/chains and “non-profit” ones. It’s just about impossible to do an “apples and apples” comparison of anything medical because of the [insert standard free market/capitalist rant here]“. Perhaps you failed to notice the two organizations mentioned in the article as “renowned for offering cost-effective care” by none other than Reihan Salam, contributor to National Review and co-author of “Grand New Party”. It so happens that both of these, Kaiser Permanente (the largest managed care organization in the US) and Intermountain Healthcare are non-profits. The other hospital system widely cited for cost effectiveness is the Mayo Clinic, also a non-profit. But no need to fret, the free market system has it’s distinctions as well. Columbia/HCA, the largest private operator of health care facilities in the world, under the leadership of current Florida governor Rick Scott committed the greatest healthcare fraud in US history by fleecing US taxpayers for hundreds of millions of dollars, a crime that eventually cost their customers and shareholders over $2B to settle. Scott of course walked away from the whole thing with over $300M. Not perfect indeed.

While I’m not arrogant enough to claim that I speak for America, I at least value the health and well being of Americans and the economic viability of America above my own petty ideological beliefs. Strict adherence to an ideology, whether it be capitalism or socialism, nearly always leads one to ignore facts and dismiss potentially superior solutions in order to support the ideology. I believe America deserves better and I believe Americans deserve what works best regardless of the underlying ideology. The rest of the developed countries in the world manage to deliver decent basic healthcare to all of their citizens and Americans deserve at least this much.

Posted by jtfane | Report as abusive

One of the Sheep,
I did not suggest profit is undesirable (or “dirty”), but do you claim an insurance company can provide coverage with an overhead–including profit–of about 3percent as the Medicare system does?

Posted by bcrawf | Report as abusive

@jtfane,

I am an American with the right to share my observations of those who contribute to American productivity. It is upon these that America’s future rests…not those who are an economic drag. I exempt from the latter all who have led productive lives and are enjoying (or attempting to enjoy) their “golden years”.

You are entitled to your love of Europe and it’s substantive embrace of the fundamentals of Socialism, just as I am entitled to my love of America and it’s traditional Capitalistic fundamentals. I certainly agree neither is “pure” or ever likely to be. I also agree that “…health administration and insurance costs [account] for the highest percentage of excess cost…”.

That must end, and so such unjustified costs should be set aside and ignored in any meaningful comparison of “systems” such as McKinsey & Company and OECD purport to do. I, too, am aghast at the pervasive medical fraud that goes on and on which our clueless public servants seem powerless to identify and reduce or eliminate. I believe available statistics show that insurance companies are much more efficient at eliminating fraudulent claims than Medicare and Medicaid are.

I have championed the idea of a “government mandate” (did I say that?) that would require individuals put aside a certain amount of money before taxes (to be pooled, or “spread the risk”). “available funds” could accumulate (that not used) from year to year from which personal out-of-pocket health care expenditures up to a certain level could be reimbursed. I have championed the idea of a “government mandate” (did I say that?) that would require individuals put aside a certain amount of money before taxes (to be pooled, or “spread the risk”) that would accumulate if not used from year to year from which personal out-of-pocket health care expenditures up to a certain level could be reimbursed. One could purchase more annual “coverage” on a year-to-year basis,, but the cost would not be paid with before-tax dollars.

When you excuse our own government collecting mountains of medical treatment monitoring information and then preventing access to same by the public that pays for it’s collection by the knee-jerk “[insert standard free market/capitalist rant here]” you reveal your own “agenda” of economic hate and loathing. The very IDEA that the public should expect anything USEFUL from a government that is the “best that money can buy!

I have championed the idea of a “government mandate” (did I say that?) that would require individuals put aside yearly a certain amount of pre-tax money from which personal out-of-pocket health care expenditures up to a certain level could be reimbursed. The amount not used from year to year would accumulate, with untaxed interest, to encourage frugality. Thoose interested could purchase more annual “coverage” on a year-to-year basis, but the additional cost would not be paid with before-tax dollars.

When you excuse our own government collecting mountains of medical treatment monitoring information and then preventing access to same by the public that pays for it’s collection by the knee-jerk “[insert standard free market/capitalist rant here]” you reveal your own “agenda” of economic hate and loathing. The very IDEA that the public should expect anything USEFUL from a government that is the “best that money can buy!

When you excuse our own government collecting mountains of medical treatment monitoring information and then preventing access to same by the public that pays for it’s collection by the knee-jerk “[insert standard free market/capitalist rant here]” you reveal your own “agenda” of economic hate and loathing. The very IDEA that the public should expect anything USEFUL from a government that is the “best that money can buy!

We each “…value the health and well being of Americans and the economic viability of America…” but your big tent accepts everyone that breathes. Access to my smaller one is limited like John Smith’s philosophy that “only those who contribute to the community larder may eat from it”.

I am always fascinated by liberal presumptions as to what citizens DESERVE. When I started my business, did I work hard for long hours? Yes. Did I deserve more pay than I had earned as an employee? Most definitely. So what did I receive? NOTHING for over a year. My suppliers got paid, my people got paid, my taxes got paid. After them, there wasn’t enough to pay me for my “sweat equity”. Eventually, it all worked out.

No society can, in the long run, pass out more social service “goodies” than their economic productivity can pay for. No tickee, no washee. It does not require advanced math skills to comprehend that no country has yet demonstrated the long term ability to provide complete “state of the art in America” health care coverage to everyone within their borders.

You claim as “undeniable fact that essentially every other developed country in the world” does exactly that”. Not so. The “rest of the developed countries in the world” are learning that lesson, among others, the hard way via the unfolding collapse of the Euro”system”. The fundamental problem is that many of these countries have passed out lavish social service “goodies” that are inconsistent with their acual economic productivity.

Posted by OneOfTheSheep | Report as abusive

Sorry…what a mess. Please substitute this for the above:

@jtfane,

I am an American with the right to share my observations of those who contribute to American productivity. It is upon these that America’s future rests…not those who are an economic drag. I exempt from the latter all who have led productive lives and are enjoying (or attempting to enjoy) their “golden years”.

You are entitled to your love of Europe and it’s substantive embrace of the fundamentals of Socialism, just as I am entitled to my love of America and it’s traditional Capitalistic fundamentals. I certainly agree neither is “pure” or ever likely to be. I also agree that “…health administration and insurance costs [account] for the highest percentage of excess cost…”.

That must end, and so such unjustified costs should be set aside and ignored in any meaningful comparison of “systems” such as McKinsey & Company and OECD purport to do. I, too, am aghast at the pervasive medical fraud that goes on and on which our clueless public servants seem powerless to identify and reduce or eliminate. I believe available statistics show that insurance companies are much more efficient at eliminating fraudulent claims than Medicare and Medicaid are.

I have championed the idea of a “government mandate” (did I say that?) that would require individuals put aside a certain amount of money before taxes (to be pooled, or “spread the risk”). “available funds” could accumulate (that not used) from year to year from which personal out-of-pocket health care expenditures could be reimbursed.. One could purchase more annual “coverage” on a year-to-year basis,, but the cost would not be paid with before-tax dollars.

You excuse any government collecting mountains of medical treatment monitoring information that limits meaningful access to same by the public that pays for it’s collection with a knee-jerk “[insert standard free market/capitalist rant here]“. That reveals your own “hidden agenda” of economic hate and loathing. The very IDEA that the public should expect anything USEFUL from their government…please.

We each “…value the health and well being of Americans and the economic viability of America…” but your big tent accepts everyone that breathes. Access to my smaller one is limited like John Smith’s philosophy that “only those who contribute to the community larder may eat from it”.

I am always fascinated by liberal presumptions as to what citizens DESERVE. When I started my business, did I work hard for long hours? Yes. Did I deserve more pay than I had earned as an employee? Most definitely. So what did I receive? NOTHING for over a year. My suppliers got paid, my people got paid, my taxes got paid. After them, there wasn’t enough to pay me for my “sweat equity”. Eventually, it all worked out.

No society can, in the long run, pass out more social service “goodies” than their economic productivity can pay for. No tickee, no washee. It does not require advanced math skills to comprehend that no country has yet demonstrated the long term ability to provide complete “state of the art in America” health care coverage to everyone within their borders.

You claim as “undeniable fact that essentially every other developed country in the world” does exactly that”. Not so. The “rest of the developed countries in the world” are learning that lesson, among others, the hard way via the unfolding collapse of the Euro”system”. The fundamental problem is that many of these countries have passed out lavish social service “goodies” that are inconsistent with their acual economic productivity.

Posted by OneOfTheSheep | Report as abusive

@LysanderTucker

If the antibiotics were a miracle cure-all, they would be used as such. But they are not. For example, if everyone started to treat common cold with antibiotics, in the long run this would render all the antibiotics quite useless, leading to much more fatalities. And it would be useless too, as Common Cold is a viral infection, not bacterial. Antibiotics only work against bacteria.

So they are quite rightly kept as a prescription-only.

Posted by EsaMikkola | Report as abusive

The writer mis-states terminology and perpetuates a misconception. The money withheld from an employee’s pay that goes toward part of the cost of the company-provided health insurance is the “employee contribution,” the money the company pays the insurer for the insurance is the “rate,” or by extension the “premium.” It is hard to believe, but many employees think their contribution is the total cost of the insurance, just as many think the co-pay in the doctor’s office is what it costs to visit the doctor.

Posted by RichardNYC | Report as abusive

Reihan, I am surprised you went for the intellectually lazy jab at fee-for-service medicine. Canada has FFS medicine with zero degrees of separation (the private practice physician bills Medicare directly), yet manages to control spending. The Mayo Clinic practices FFS medicine with one degree of separation (the physician is employed by the clinic, the clinic bills for each service it’s physicians perform, and the physician is informed at each semi-annual performance review how well they are hitting their volume targets), yet manages to be considered a cost effective provider. FFS medicine does not not necessarily lead to inflationary abusive consumption, but is contingent in a cultural environment which has also produced factory farming, mountaintop removal mining, fracking, and overfishing of the oceans.

Posted by poppyloon8 | Report as abusive

@paintcan

I can agree with your comments. I recently was in the hospital for a situation that required surgery. They had to delay the surgery for a week because I requested a second opinion and I had to wait for the surgeon to have the time to do it. As a result, I spent an additional week in the hospital that I did not need to (one of the nurses actually inquired as to whether I could be discharged for the time I did not really need to be there). Personally, I very much dislike hospitals and would much rather have been at home. Also I know what you mean about pulling out a tube as they had one from my ankle into the middle of my foot and that was a strange feeling when they pulled it out

Posted by texan5555 | Report as abusive

@texan5555 – Thanks. I think there is a tendency for hospitals to milk insurance too. My operation was performed at the nearest hospital that is required to treat regardless of ability to pay. I wasn’t going to get huffy. But it is more relaxing to be home,I think, and to know that my house is secure and I have my books, music, my own food and this screen at hand. OOTS reminded me of mirsa and that slipped my mind entirely. I would get homesick. Hospitals are a lot noisier generally than I am used to now.

I just did some research of some articles about RomneyCare in MA and it appears that costs have risen in the state but more people are insured.

I think the country is going into a period of declining standards of living. One could vote for either or neither Presidential Candidate and the results will be the same. They are not being voted as Commander in Chief of the World. They will not be able to have their way with the world as they were able to do so successfully during the last century.

It bothers me that Romney would like to deregulate insurance companies and I think that means they know the ACA will cost them big and will have to spread the costs over all types of insurance.

I think many more people will find themselves in my position of having to economize, do-it-yourself, try not to travel much or spend for superfluous items and shop Good Will etc. That will not do the economy any favors – ours or anyone else’s.

In other words, I’m probably going to see a long and boring road till I drop dead and the prospect of life extending surgery or increases in human life span doesn’t look nearly as attractive to me as it looks to some.

The trouble with feeling old and having to act like one is, is that it is self reinforcing and the costs of one’s life seem to go up. I try to walk or carry out needed repairs around here and find, like my 88 year old father, that moving around keeps one alive and I was even feeling fit again. But by the time the winter has ended I will have to start to regain strength again just to move around.

I cans see now why Chinese seniors go to public parks for group Tai Chi exercises. I always thought they were being brainwashed to be group minded and now I see that they reinforce themselves by trying to stay limber and reduce their need for medical care. They are actually comforting each other and encourging each other to stay alive. Someone in the group acts as leader and sets the routine and they may not actually be some party official or other but more like a club captain that they chose. I don’t know? But I do know that the world I’ve known most of my life is bathed in misinformation and rumor.

All propaganda is aimed at our own preconceptions and ignorance. It’s too bad one gets wiser when one gets older because I can’t use it now. But it isn’t the same wisdom one needs when one is young. It isn’t strong enough and can’t remember what hormones feel like. How delicious they are.

Posted by paintcan | Report as abusive

I think people would vote for Romney if at all they only care for Health Policies as the policies mentioned by him are Best compare with that of Obama !
Medicare

Posted by Samanthaa | Report as abusive