Medicare does “NOT PAY FOR ITSELF”
In the comments section of an earlier post (1/3 of Medicare is Wasted), Maggie Mahar had stated to everyone; “Medicare Does Not Pay for Itself.” This is what I meant by that comment:
“For more than a decade the federal government has borrowed to pay for the rising cost of Medicare. Debt-financing of Medicare will increase sharply as the population over 65 doubles from 2010 to 2030 and the number of beneficiaries over 85—with the greatest medical needs—triple.”
Note, using borrowed money to finance Medicare is not something happening in the future as it began more than a decade ago. Yet, as the article notes: “Members of Congress are reluctant to argue with constituents who sincerely believe that they have ‘paid for’ Medicare with payroll taxes and premiums. Most find it more convenient to tiptoe around the minefield of Medicare financings.” So the charade continues even today.
People who believe that they have paid for their Medicare with payroll taxes and premiums are terribly naïve and do not realize how much Medicare actually costs or how much “Medicare for all” would cost.
The article goes on to explain the history of how we arrived where we are today and why I make the comment on Medicare:
“In the mid-1990s, Democrats proposed to balance the Medicare budget by limiting fees paid to physicians for services, while Republicans sought to contain the costs by transferring the program to managed care insurers and capping the annual per capita rise in premium subsidies.
In 1997 the leadership in both parties agreed to a plan that would eliminate borrowing for Medicare, principally by limiting the growth in the level of fees paid to physicians. That Medicare reform, along with increasing general revenues paid by taxpayers in the highest bracket, led to a federal budget that balanced in fiscal year 2000.
The balance turned out to be short-lived. In 2001 and 2003 Congress passed debt-financed reductions in income tax rates. And in 2003 it also suspended the application of ceilings on fees set in 1997. Later that year Congress used debt to finance a new Medicare prescription drug benefit and higher payments to Medicare managed care plans.
As a result, the portion of Medicare paid for with dedicated taxes dropped from 73 percent in 2000 to 53 percent in 2010, the year that the first of the Baby Boom generation became eligible for Medicare.”
“After the 2008 election of President Obama, Democrats sought Medicare ‘savings’ for the purpose of expanding other medical services rather than balancing the budget for Medicare. In order to offset the cost of expanded PPACA medical services for families with low incomes; they placed restrictions on reimbursement rates, provided incentives for more efficient delivery of medical care, raised the Medicare tax paid by taxpayers with high-earned incomes, and applied Medicare taxation to gains from investment.”
On the other side of the political spectrum, “Republican House Budget Chairman Paul Ryan exemplifies his party’s ambivalence toward Medicare reform. He ran as the vice presidential candidate on a ticket in 2012 that attacked the Affordable Care Act’s limits on Medicare reimbursements. Yet before and after that election, he incorporated those very cost-saving measures into his own budget plans.”
Incumbents from “both parties find it awkward to even talk about the practice of borrowing to pay for Medicare. Obviously, an extra layer of interest on debt simply increases the program’s long-term cost. Any attempt to highlight that issue naturally invites the question of whether to cut Medicare costs or raise tax revenue dedicated to the program. No mainstream politician seeks to cut benefits by almost half and down to the level payable by revenues from premiums and payroll taxes. Democrats condemn any increase in payroll taxation as ‘regressive,’ while most congressional Republicans have signed a pledge to oppose any tax increase.”
Both sides of the aisle feint a reluctance to either cut Medicare benefits or increase Medicare withholding taxes and an honest discussion with their constituents regarding Medicare financing knowing full well something must be done. Indeed, it is politically expedient to kick the can or the bucket into the next decade avoiding the third rail of Medicare.
What can we do? I will answer that question in my next post.
Notes and References:
1. “Pay As You Go Medicare” Washington Monthly, Bill White, June 23, 2014
2. Maggie Mahar writes the Health Beat Blog Maggie is also the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006). Mahar also served as the co-writer of the documentary, Money-Driven Medicine (2009), directed by Andrew Fredericks and produced by Alex Gibney. Before she began writing about health care, Mahar was a financial journalist and wrote for Barron’s, Time Inc., The New York Times, and other publications. Her first book, Bull: A History of the Boom and Bust 1982-2003 (Harper Collins, 2003) was recommended by Warren Buffet in Berkshire Hathaway’s annual report.
I propose we begin by finding out exacatly what medicare would cost the workers if they paid for it all themselves with a “flat” tax that was capped.
I suspect the amount would look shocking at first. But if the 1/3 that is wasted could be fixed by better, honest control of prices and unecessary procedures, the final tax rate looks like… based on your statements above… twice the present level …it looks like 4% should do the job.
only when the “left” thinks it is reasonable for those who can to pay for their ordinary costs of living is there any hope the “rich” can be persuaded to pay for those who can’t.
moreover since insurance companies were proposing charging the elderly 5 times as much as the young i suspect a “medicare for all” could be paid for (as a first guess) at about 6%.
i think this is pretty close to what people already pay for their medical insurance from private insurers, so they might be willing to pay the same amount as a “tax” with the understanding that their care would be guaranteed and someone big enough would be looking out for the prices and usefulness of “services.”
this is not meant to pick a fight. but it has not been obvious to me that any of the commenters here have tried to address the “facts” before falling into something like rage that their opinions… or not-clearly-expressed “facts… are being argued with.
i am not at all sure i have expressed myself clearly. but i’d like to see someone try.
if we find that the people cannot afford the cost of their own expected medical care, at least we will know that. and if we find that the congress cannot be trusted to oversee health insurance, we will have to ask quite serious then “who can?” and what do we expect congress would do about that.
Paul Ryan is suggesting:
– The elderly pay 500% of the lowest cost insured.
– Those with pre-existing conditions or serious illness/disorders be placed in risk pools.
As I explained and LT wishes to conflate, two tiered systems do exist in greater abundance than single payor or socialized healthcare. And they exist in the lower cost healthcare countries.
The limit on the PPACA premiums is ~9% of 400% FPL. If you could reduce the service for fee present healthcare environment and also provide evidence based care, it is possible to reduce the cost. Maggie does elude to such happening as well as Klein, Gawande, Berwick, etc.
So far you are one of the few who appears to have caught the idea. If you have not noticed each of the posts feeds into the next one. They below together. I did Maggie’s editing at the time for AB while she was here. She has since retired and is unable to come back. We do talk from time to time. Thank you coberly.
Give Maggie my best.
If only more people would listen to her.
Run, I eagerly await your “what can be done” next post.
But I can’t figure out what your saying what it can be done for. Done for what about Medicare? Costs of health care? or Paying for it?
I’m interested in your “what can be done” post simply because we already know what it costs under the present (and past) political system, we know what it could cost by changing the political system and how to pay for it by following the European examples., but those require the US change its political system, so I’m really wondering what you will come up with for answers to “what can be done”?
Here’s where the Costs are:
CMS is the acronym for Centers for Medicare and Medicaid Services
NHE is the acronym for National Health Expenditure
Note that the $9,990/person number is the entire population of the US in 2015 = 320.32 million, from infants to people on their death beds and institutionalized or not.
— Federal, State, Local Gov’t tax revenues pay for 48.5% of total costs or $4845/person.
— Private Business pays for 19.9% (and falling) or $1990/person although it applies to a much smaller population that business’s pay health insurance for, so business outlay per person they cover is much higher… on the order of 10x or more.
— Households pay 27.7% or $2767/person. To put that in perspective, Medicare deducted $1260/person in 2015 from SS income.
–But Medicare costs were 20% of total NHE or $1998/person in the population. In 2015 the annual average Medicare enrollment population was ~38.5 million with spending of $646.2 billion or cost per Medicare person was $16,785/person / year over age 65ep. Basically that’s what it costs for Healthcare/person at less than European care levels for the age 65 and over population.
Population of Medicare enrollment, 2015:
So it should be pretty clear that the elderly (>65 until death) can’t possibly pay their own costs of health care. If you figure the actuarial average age is 80, then 15 years of health care from age 65 to average age at death costs on the order of $252k per person in that age bracket… at least.
However, if that price, call it $300k/person over age 65 is amortized over life to age 80, then it’s still $3750/year for 80 years from birth to death… and that just covers their costs from age 65 to death… the other 65 years of life from birth to age 65 cost 80% of the total NHE or at least (with lousy benefits) or $2.56 trillion, divided by the population < age 65 (281.82 million) or $9084/person/year under age 65… and that's not full health care coverage.
Another way to say this is that it costs 1.84 times as much for health care after age 65 as it does before age 65 on average… call it double just for round figures.
Now round up the per person costs for age 65 to $19k/year for full coverage and the average annual lifetime cost per person for health care is $780k/person from birth to age 65 and another $285k until death, for $13,312 per person / year from birth to death, in 2015 prices and dollars.
That’s the very least it costs in reality for health care in the US’s system… e.g. political system. And don’t try to get away with saying 1/3 of it’s “waste” when in reality it’s the political system that allows it in the form of profits to providers ,drug companies, health equipment providers, and insurance overhead and profits.
Historical NHE, 2015:
•NHE grew 5.8% to $3.2 trillion in 2015, or $9,990 per person, and accounted for 17.8% of Gross Domestic Product (GDP).
•Medicare spending grew 4.5% to $646.2 billion in 2015, or 20 percent of total NHE.
•Medicaid spending grew 9.7% to $545.1 billion in 2015, or 17 percent of total NHE.
•Private health insurance spending grew 7.2% to $1,072.1 billion in 2015, or 33 percent of total NHE.
•Out of pocket spending grew 2.6% to $338.1 billion in 2015, or 11 percent of total NHE.
•Hospital expenditures grew 5.6% to $1,036.1 billion in 2015, faster than the 4.6% growth in 2014.
•Physician and clinical services expenditures grew 6.3% to $634.9 billion in 2015, a faster growth than the 4.8% in 2014.
•Prescription drug spending increased 9.0% to $324.6 billion in 2015, slower than the 12.4% growth in 2014.
•The largest shares of total health spending were sponsored by the federal government (28.7 percent) and the households (27.7 percent). The private business share of health spending accounted for 19.9 percent of total health care spending, state and local governments accounted for 17.1 percent, and other private revenues accounted for 6.7 percent.
•For further detail see NHE Tables in downloads below.
Here’s a real (e.g. actual) breakdown of what the actual costs are based on a $15k/person in population total cost of health care, using 2016 population sizes and breakdowns by age.
Say the real average annual per person health care cost, birth to death is $15k/person per year (not households but per person infant to death)
Now if you can change the political system (which nobody’s addressing at all) then by gov’t setting the prices, the $15k annual per person cost can be cut to 60% of $15k or to $9k based on the fact that Europeans from the advanced nations pay ~60% or less of what the per capita cost is in the U.S.
So the bill/person is $9k/year if we can change the political system to get the same cost advantage the Europeans can do by gov’t deciding what we’ll pay for profits for full health care from birth to death.
From that $9k/person basis:
But the lower 20% can’t afford to pay anything so the upper 80% of incomes have to pay for those that brings cost per person to $11.2k (=$9k/0.8) per year. Then you have to consider that those over age 65 can’t afford to pay either, or only a small part of the per person cost. The >65 age population is presently ~ 40 million our of 324.1 million or 12.5%.
If the > 65 age population pays $1300/year (current $110/month for Medicare) then that leaves $9.9k x 12.5% of the population that has to be paid by the other 80% who are able to pay. Thus 67.7% of the population pays for the costs of the lower 20% of incomes and all but $1.3k of the 12.5% of the population > age 65.
That comes to $13.065k per person/year who has to foot the bill (which is total population x $9k per person if the political system is changed)
That $13.065k per person /year has to be paid by a progressive tax system according to income levels.
But of the total population only 169.4 million are age 25 to 64 or 52.4% (per US census in 2016) which can pay for the health care because they are of working age and ability. That means that the paying population age 25 to 64 for the $13,085k/person after eliminating paying for the lower 20% of the population and all but $1.3k of the >65 age group comes to $16,912 per person / year for those age 25 to 64.
That’s the real per person bill ($16.9K/year for those that are of any significant income producing ages.
Clearly that has to be paid by a progressive tax system on incomes such that those at the lower 21% – 30% pay ~ $500/year on income, and those at the upper 80% – 90% income levels pay ~ half or $8.5k/year, and those at the top 5% pay full price and those in the top 1% pay 3 times full price, and those in the top 0.1% pay 4x the full price .. that’s just a w.a.g. but at those levels the rate of income paid for health care would be a small fraction of income…. such that
for the upper 0.1% even paying 4x or 8x the full price would be chump change.
But no matter how you cut it, the bill has to be paid by those in the working age brackets and affordable for families with only one adult wage/salary earner in a family of 4 or 6 or 8 or just 2.
If the European’s can figure out how to make the costs per income earner and family size fair and affordable then so can we.. provided we modify the political system to get off the “individualism” god worshipping kick we’ve been on since inception and figure out how to keep representatives representing the vast bulk of their constituents (90% of them).
For starts healthcare is almost 18% of US GDP — so it will take a bit more than a blog to get to the bottom of all this. There are three battles here: (1) providing health care to Americans and (2) ideology; where government should have nothing to do with providing healthcare and (3) vested interests.
Part of the problem is that policy wonks address problem (1) and ignore (3) there’s not much to be done about (2) — but (2) represents the GOP’s current “real” view of healthcare (plus a bit of (3) because they are big donors.
Universal healthcare (which is by far the cheapest — administration cost are in the single digits) are impossible in the US because of (2) and (3) — the GOP’s position on healthcare is like the Saudi’s position on women — makes no economics sense; its a question of philosophy. Vested interest (hospital/doctors/insurance companies/ etc etc) have a good and very profitable business model.
Within these constraints healthcare has to be provided — America in 10 years may look very different than it does today. My gut feeling is that religious organizations will be reeling under the burden of providing healthcare — cause the GOP is not going away!
9k per person (counting all 300 million of us) seems a bit high. when i read statistics like these some years ago the “cost of health care” included the cost of research institutions and perhaps some other things i would not expect to show up on the bill to the average citizen.
i’m not sure i have the chops any more to analyze your cost figures, or any i might find on my own, so I only ask you to look more skeptically at what you read and at least tie it down to progressively lower levels of abstraction.
i don’t think i am a typical person… i run away from doctors who want to examine or treat me more than i think i need…. but so far my visible health costs are my Medicare part B (hundred dollars a month), my former Medicare (HI) tax (2.9% combined employee and employer?) (about a hundred dollars per month present value) and my employer contribution to my (his) health plan… about another hundred dollars a month (then. maybe 200 dollars present value)
So at a very rough estimate my costs to be insured come out to be (have been) about 200 dollars per month (counting former Medicare tax as paying for present insurance). Call it 2000 dollars per year or about 4%. Again, this is extremely rough and meant only as a place to begin. But “obviously” not 9k per year per person.
I’ll try to look more carefully at your numbers, but may not succeed soon.
it did not quite escape my attention that the above described only what i paid. my costs (billed costs) were essentially nothing for the first 68 years or so, then 4000 dollars for ten stitches, which Medicare paid half of and I paid 20% of that out of pocket. I don’t know how that is accounted in the national accounting. Nor do I know what it would have cost if I had agreed to have the operation the “providers” insisted I needed.
I suspect that leaves me among the very, very fortunate. I am like most people willing enough to pay (insurance) for those less fortunate (which would have included me if my luck ran out).
But I am not sure how long any of us will be glad to pay for the less fortunate if that payment begins to look like it is taking mortal bites out of our own income.
From what I have seen from even “the left”, who demand “the rich” pay for everything… without limit, and without realizing that most of us (the left) are ‘”rich” compared to the less fortunate.
just something to think about.
According to the 2016 Trustees Report, Medicare taxes are within one tenth of one percent of costs for the next five years.
income rate is about 3.4% of payroll and expected to rise to about 4.4% of payroll by 2090. Cost rate is about 3.4% and expected to rise to about 5% of payroll by 2090.
So “Medicare does not pay for itself” but the difference is not huge.
Moreover, the tax rate for workers is one and a half percent of payroll, or 3% if you count the employer contribution as “really the employees money.” Raising that rate by one percent (combined) would eliminate the “deficit.” And this would be without raising the extra “tax on the rich” which is now about 1% on those making more than 200k.
I don’t think paying 4% of your income to pay for your medical care when you are no longer able to work is a huge burden. You may have a different opinion, but think about what you are paying for, and about what you really need that money for if not health care when you are old. There are details in this that might change even my mind, so they are worth thinking about. [Left as an exercise for the reader.]
The next step for “Medicare for all” would be to determine what the additional cost of insurning “the young” would be. As a first guess I note that insurance companies think they should be allowed to charge “the old” five times as much as the young. I would guess (very much a guess) that means that an increase in the payroll tax of 20% of 4% projected tax for “the old”) would pay for “all.” Call it 5% total. Again, I don’t think this is huge, given that current “private” rates are in that ballbark and these would be eliminated by “Medicare for all.”
But note that 5% of payroll is not 9k per person, so where does the other 7k go?
Again, this is all very much subject to correction by those who know more than I do.
In the beginning the basic part B premium was 50% of the cost of providing part B services. The congress over time allowed this to be reduced to 25%, and the IRRMA was introduced for higher income taxpayers. who pay up to 80% of the total cost of part b.
One idea to reduce the outlay is to increase the percentage of the costs covered by the premium back to the 50% over say 10 years by setting the premiums for those turning 65 each year such that for folks in the first year they would pay 27.5% etc.
That would help, but raising taxes and making the economy less reliant on consumption is the real key.
i can’t understand your idea. if you reduce the outlay, who pays the costs?
if you raise taxes, personal consumption would go down while government consumption would go up. But in the case of SS and Medicare is it really “government” consumption, or just the government providing an efficient way for the people to pay for their own consumption of medical services and future living expenses?
That is, if the taxes are reasonably proportioned to the consumption of any given taxpayer. This is not a recommendation that the very poor be ignored, but it is a recommendation that the rich” not be expected to pay for the ordinary costs of living of the people who can afford to pay for them. It’s not that I love the rich, but I do fear them, and I do have a more old fashioned sense of “fair” that seems current among some circles.
“THAN” seems current. Not “that” seems current.
Oh, and I guess I left out Part B and D as part of the “medicare pays for itself” equation. I didn’t see any mention of those in the Trustees Report.
I would follow Nicholas Forget to some extent and say that focusing on fixing Medicare all by itself is not all that useful. The real problem is the cost problem of the US health care system in general, which PPACA only marginally addressed, with its supposed GOP replacement getting rid of even that smidgen. Obviously the problem of vested interests is serious, and they all ended up signing off on PPACA, which is why its cost controls were only mild at best.
I would point to the long repeated proposals by Dean Baker such as allowing foreign physicians to practice in the US even if they have not done a residency here, as well as loosening substantially various patent monopolies, especially for drugs, the latter probably calling for some subsidies for research. Needless to say, the former has never been mentioned by any member of Congress from either party, but would do more to resolve cost problems of Medicare than anything anybody here has been talking about specifically so far.
What I was proposing raising the part b premium back to what it was when medicare started and doing it gradually so as to not shock folks. I.E the premium for folks on medicare today would stay the same, but folks turning 65 in 2019 would pay 27.5% of the average per person part b cost, Folks turning 65 in 2020 would pay 30% etc. Thus more cost would be passed back to the beneficiaries. over time. Already today higher income folks pay more thru the increased premiums for medicare due to higher incomes.
I guess I don’t really see what this fixes. It transfers costs back to the retiree, saving “the rich” that much money.
While I don’t like plans that start out by saying “make the rich pay”, I don’t like plans that say “make the old pay.” Part B would be better folded into the general Medicare tax and paid for over a life time.
The hundred bucks a month i pay now, over a life expectancy of about 20 years in retirement, would have been better paid at 50 bucks a month over 40 years of working. And this is without considering the benefit from “interest” over all those years.
And there remains the problem that costs are too high, and providers “provide” more services than the patient needs.
I like Dean Baker too, but I’m not sure this plan will lower costs. No doubt more competition would lower costs if the market in health care was like the market in wheat.
But I did have a doctor once (forgot about this one) who was an immigrant, and I guess he needed money so he ordered some tests I didn’t need. But it was okay because my insurance paid for it. (that’s a joke.)
I think what you’ll get is the same number of rich doctors thinking of ways to game the system and a bunch of poor doctors wondering why people don’t come to them when their prices are so low. (we used to have a frequent commenter on AB who was convinced that the most expensive doctor in down was the one he wanted to to his operation. i think that may be a widely held superstition.)
The problem with health care in America is that it is too expensive. And the main reason for that is the asymmetry between what the doctor knows and what the patient knows. That, and the “your money or your life” aspect of the Medical market.
Only hope I see for controlling costs is if the people get together and form their own insurance company that is honest and also big enough to oversee costs and procedures. Maybe I am missing something.
That “people’s insurance company” idea seems to have caught on in one form or another in the civilized world.
When politicians talk about lowering the cost of healthcare, they mean lowering the cost to government whereas it should mean lowering the out of pocket cost to people. Government, through taxes, should pay the vast majority of the cost. Governments efforts should be directed to lowering the cost of healthcare itself, not the proportion it pays.
Jerry, I agree whole-heartedly with you (see Jerry’s post May 19, 11:19 am). But that means gov’t has to change the political system which is controlled by gov’t through its constitution, legislative, executive, and judicial separate but equal branches, each of which has a vested interest in maintaining or increasing their own branch’s relative power, which is thus countered by each of the others.
So gov’t cannot change its own political system upon which it’s own existence depends. Therefore, while I hate to say this your statement is pie-in-the-sky utopian idealism …. a fantasy. Fantasies are fun to contemplate but only so far as they are of entertainment value only.
The American Revolution was a fantasy, and freeing the slaves was pie in the sky.
We can change anything. All it takes is effort and good sense.
as long as you understand that “government should pay…” means WE should pay. and that means you and me, not the other guy.
Yes, I understand that. The first step towards fulfilling the fantasy is public financing of elections. No more corporate money. No more wealthy money. Elections are financed by taxes. Return the power to the people…or have another revolution where the people seize the power.
I agree that medical care markets work very imperfectly in the US. But it is a hard fact that we have a low quantity of physicians compared to other high income nations. We are 52nd in physicians per capita, at 2.3 per 1,000, compared to a European average of 3.05. This is ridiculous. There are nations in Europe where doctors actually visit patients in their homes. Ours do not because they are so scarce and their time is “too valuable,” so all the sick people have to get out of bed and go sit in a waiting room for hours with a lot of other sick people, making each other even sicker.
Sorry, I think Dean is right, loosening immigration restrictions on physicians would both lower costs and improve health care in the US.b
I was hoping you would have more to say on this. According to WHO, there are 2.554 doctors per 1,000 patients (2017) in the US. This compares to 3 to 4 in western Europe with the exception of Poland. Even Russia has 3.3 doctors per 1000 patients. Just some thoughts http://www.who.int/gho/health_workforce/physicians_density/en/
– Why is there a shortage of doctors? Is it because there are not enough openings at universities? Is the entry to a Medical Education controlled? Maybe the AMA has something to do with this even though <20% of all doctors are members.
– If those doctors in the US make more than what they do in Europe, why can Europe keep developing a greater supply of doctors?
– Why is there a shortage in some fields and not others and how do we encourage more people to go into that field experiencing the shortage. Does the US need more Endocrinologists, Hematologists, Cardiologists (to take care of our old a**es), Urologists, etc. or is the shortage in Primary Care which is the lowest paid of the fields.
– To supplement the brain-drain from other countries, Dean said this too:“two or three doctors for every one that came to the United States”. If we are willing to do this for other countries, why can’t we do it for ourselves the same as we did for the race to space to beat the Russians and without taking from countries such as Algeria with 1.192 doctors per 1000 or Turkey with 1.749 doctors per 1000. More than likely doctors will come from these countries where conditions are harsh than from Germany. My German friends like the US; but, they are always happy to go home too.
– Why do we need a certified doctor when a PA or an NP could handle an appointment? This would supplement shortages and at a faster rate. I do not know about you; but after my appointment with “Sears Best” to crack my chest, the surgeon showed up once, and the PAs and Nurses watched over me.
– Why aren’t we questioning some of the services we get today. Are stents the best option when meds may work better? The US is a service for fees healthcare system. Why aren’t we looking at the services provided by our doctors and the results of those services with regard to patient outcome? Medicare is just starting to do this. Maybe eliminating some of these services which have questionable value may allow doctors to spend more time with patients.
I have a lot of respect for Dean Baker; but, I think his solution is a band aid on the issues with US healthcare.
a former contributor to AB told me privately about her experience in hospital for a broken shoulder:
doctor would walk past room, poke head in door, and keep on going.
showed up on bill as “consultation.”
the problem is not “not enough doctors” but dishonest doctors.
i agree that a great deal of “medical care” could be accomplished by ordinary people with reasonable training, including knowing when to refer the patient to a “real” doctor.
i also think there may be “real” doctors who would be willing to work for a salary in a government clinic (including repayment of school loans) and not have to worry about being a “businessman.”
i also think the government could find a way to run hospitals and clinics as fee for service, but not taxpayer supplement, in direct competition with “private” providers. no doubt the customers of the government providers would be glad to buy government insurance.
but we will never see these things, not so much because there are too few doctors in America, but because the current “providers” control the Congress.
and that far I agree with Maggie. but I still don’t see how you change anything if you can’t trust Congress. the Free Market in medical care never worked even half as well as “the free market” with government oversight, such as it is.
government oversight, bad as it is, is the only way to introduce a player with the power and resources to “compete” with the private providers who occupy a monopoly on an essential, money or your life, service.
There is a lack of Primary Care Doctors and they are amongst the lowest paid of the healthcare industry. What do you mean by ordinary people doing medical care? NPs and PAs have Masters Degrees and are well trained beyond that of a registered nurse. They are supervised by doctors and spend more time with patients than doctors might. I was pretty happy with mine while I wanted to punch my arrogant Cleveland Clinic Heart Surgeon in the nose.
There is a lot of anecdotal information out there. I could tell you stories of my care also. The article Dan posted from Naked Capitalism, I disputed the three cases they cited. Lambert claimed they were failures. When you dive into the detail, they are not failures. Maybe people need more; but to blame it on system failure is a bit of a stretch on NC’s part.
i don’t think we are disagreeing with each other, but we may be talking past each other a bit. By “ordinary person” I mean something like this: back in the day I was told that doctors had IQ’s of about 150. Back then I thought that was “high” and meant something. 50 years later I am not so sure. An ordinary person, without much “higher education” can get very good at something he does often if he is honest and cares about it. Some doctors are not honest, some don’t care very much, many are “smart” about book learning but not so smart about what is in front of their face. In any case I think… don’t really know… that some countries have pretty good results from “barefoot physicians.” Not necessarily brain surgeons, but folks who can tell a cold from a fever, and worms from bug bites.
I don’t think this country needs more highly educated Doctor’s who are in it for the money. Though a Masters Degree represents a degree of knowledge and training and commitment, I suspect an “ordinary person” could pick up the knowledge and training from something like an apprenticeship… or school if that is considered more efficient and better certification. The point here is just that importing more highly educated doctors might not be the best way to lower costs, not to say actually improve care.
I am not familiar with the Naked Capitalism article, but “system failure” might just mean the general situation that allows bad medicine at high cost. I could tell anecdotes too, maybe best over a beer, but the fact is that anecdotes don’t DO anything, and what we need is at least a starting plan, subject to modification as we go, and then get busy.
Maybe a better way to put it is that if there were not enough doctors, there wouldn’t be so many of them running around ordering unnecessary procedures.
Bringing in more doctors would just aggravate the problem: Too many doctors running around ordering unnecessary procedures to make an extra buck and pursue the American Dream.
You are not seriously suggesting that the way to reduce medical costs is to get rid of all the doctors, are you?
only those who charge for unneeded services, or services not actually performed.