Wednesday, August 15, 2012

Change is Coming to Medicare and All Other Aspects of Health Care ... The Doctor Shortage

In managing our future fiscal affairs, including health care entitlements, necessary change is coming to America and the rest of the world. Fundamental change is coming, too.

We're going to have to find a way to live within our means, and that means effectively resolving our health care affordability and accessibility issues. And that means vouchers, premium support and individual choice all have to be a big part of the solution. We the People have to have more of our own skin in the game, if only the right to choose how the money will best be spent, and less of the third party payer government knows best formula.

401(k) plans are replacing pension plans in the private sector. They will be replacing pension plans in the public sector as well sometime soon.  And the exact same thing will happen with respect to health care as well. Public schools, too. Free choice and personal responsibility lie ahead.

Giving free people the right to make free choices isn't giving us anything. It's simply restoring our natural rights and taking power away from too many power hungry government knows best bureaucrats and elitists, aka our elected officials and "public servants."

Vouchers are a big part of the answer. So is means testing. And so is all of us taking care of those individuals who need our help. Thus, many of us shouldn't be taking from the young in order to prosper as the old. If we can, we should pay our own way. Period. For Medicare, Social Security and education, too. But government needs to get out of the way first.

So today we'll limit our discussion to health care, the biggest elephant in the unaffordable entitlements room. Simply stated, to the extent feasible, we must start paying our own way in our own generation instead of recklessly passing this responsibility on to succeeding generations of taxpayers and citizens.

As background reading for our careful reflection, we'll begin with how an Englishman assessed the political problems in 1924. Notable & Quotable provides a compelling explanation of the stuck in the mud, stand your ground stances of both political Progressives and Conservatives:

"English writer G.K. Chesterton in Illustrated London News, 1924:

The whole modern world has divided itself into Conservatives and Progressives. The business of Progressives is to go on making mistakes. The business of Conservatives is to prevent mistakes from being corrected. Even when the revolutionist might himself repent of his revolution, the traditionalist is already defending it as part of his tradition. Thus we have two great types—the advanced person who rushes us into ruin, and the retrospective person who admires the ruins. He admires them especially by moonlight, not to say moonshine. Each new blunder of the progressive or prig becomes instantly a legend of immemorial antiquity for the snob. This is called the balance, or mutual check, in our Constitution."

Now let's bring Chesterton's quote straight into a discussion of today's biggest and most fundamental political and financial issue facing the U.S. It's the Medicare, Medicaid and ObamaCare health care affordability and accessibility problem.

Romney's Pick Puts Medicare in Bulls-Eye describes the situation perfectly:

"In selecting Rep. Paul Ryan as his running mate, Mitt Romney has also made the fight over the future of Medicare a focal point of the election, raising opportunities and challenges for both parties, particularly in battleground states such as Florida.

Many Democrats and liberal groups said immediately that they'd use the sweeping plan to overhaul Medicare authored by Mr. Ryan as a cudgel against Republicans in the presidential race, as well as in down-ballot elections.

Democrats have had mixed results using Mr. Ryan's Medicare plan on the campaign trail in recent House races. Now, a central question of the presidential election will be how the public reacts to the Ryan Medicare plan . . . .

Mr. Ryan has staunchly defended his plan for more than a year, refining his argument for it, and he isn't likely to buckle now that the debate is again taking the national stage.

"Medicare is the issue," Mr. Ryan, of Wisconsin, told reporters in February. "This is the big budget issue."

Few federal programs touch the lives of as many voters as Medicare, the government-run health plan for seniors. It is both one of the most costly and popular federal programs, covering 48.7 million Americans last year.

In proposing his overhaul, Mr. Ryan has pointed to the program's rapidly accelerating costs, driven by the aging U.S. population and the rising cost of health care. . . .

Medicare was created by the federal government in 1965, and its rapid growth in recent years has made it one of the government's most expensive programs. Combined with Social Security, it accounted for 36% of all federal spending in 2011.

Medicare has several components, financed by separate trust funds. The largest trust fund - which primarily covers health needs and hospital care - is on a path to exhaust its reserves in 2024. Since 2008, it has paid out more in benefits than it has brought in through revenue. Last year, Medicare's primary trust fund paid $256.7 billion in benefits, compared with the $228.9 billion it brought in through revenue.

As the Baby Boomer generation ages, roughly 10,000 Americans turn 65 every day and qualify for Medicare benefits."


Medicare has been a fundamental part of the American entitlements system since the 1960s. Now we've added ObamaCare to the unaffordability mix. In all cases, benefits are guaranteed but the costs aren't covered. Health care is now a heavily subsidized federal program, primarily for the elderly.

Why should old people who have the means to take care of themselves take from young workers who are just starting out? In other words, why should young people subsidize the old? I can think of no good reason. So why not change that requirement and achieve more "fairness?"

And why should anyone have to participate in Medicare or ObamaCare? Why isn't it voluntary? Again, I can think of no good reason. Why not change it?

And what makes us think a third party payer program will effectively monitor and control costs? Are government workers and doctors possessed with some kind of special knowledge about human nature and free markets which is not available to the rest of us? Why won't free choice exercised by free individuals and their families work in health care? It works elsewhere. Again, I can think of no good reason.

The fact is that these Medicare and Medicaid government programs were seriously flawed at the outset and remain so today. With today's financial catastrophe, they are in critical need of a new look, revision and refresh, to say the very least.Which brings us back to the Englishman's quote about Progressives and Conservatives almost a century ago.

Once an entitlements or welfare program is in place, it's virtually impossible for politicians to successfully address and resolve the ongoing problems, including financing, associated therewith. They get worse and worse as time goes along.

Progressives fight to introduce new programs and conservatives fight to maintain the status quo. It's death by a thousand cuts. Meanwhile, they're all scared to face facts and propose and proceed to do what's right for all of We the People.

All that said, change with respect to our seriously flawed healthcare system is going to happen.We simply can no longer afford, morally or financially, to burden future generations with the mistakes of the past just because "what's done is done." What's been done can and must be undone if it has to be done. And it does.

Finally, Let's Consider the Role of the World's Most Powerful Union ... The American Medical Assoication

There's a shortage of doctors in the U.S. It's only going to get worse.

The most powerful labor union in the nation is the American Medical Association. Doctors are able to restrict the number of doctors who enter their profession and thereby control compensation and who practices medicine.

Now let's Consider what Why the Doctor Can't See You adds to the health care affordability and accessibility discussion:

"Are you having trouble finding a doctor who will see you? If not, give it another year and a half. A doctor shortage is on its way.

Most provisions of the Obama health law kick in on Jan. 1, 2014. Within the decade after that, an additional 30 million people are expected to acquire health plans—and if the economic studies are correct, they will try to double their use of the health-care system.

Meanwhile, the administration never seems to tire of reminding seniors that they are entitled to a free annual checkup. Its new campaign is focused on women. Thanks to health reform, they are being told, they will have access to free breast and pelvic exams and even free contraceptives. Once ObamaCare fully takes effect, all of us will be entitled to a long list of preventive services—with no deductible or copayment.

Here is the problem: The health-care system can't possibly deliver on the huge increase in demand for primary-care services. The original ObamaCare bill actually had a line item for increased doctor training. But this provision was zeroed out before passage, probably to keep down the cost of health reform. The result will be gridlock.

Take preventive care. ObamaCare says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health (2003), scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary-care physician's time each year, or 7.4 hours per working day. . . .

In the meantime, the most vulnerable populations will have less access to care than they had before ObamaCare became law."


While I'm certainly no expert in health care matters, I do know that there are lots of serious questions about our health care system that desperately need answering. Such things as how much quasi-doctors, allowing more foreign trained doctors, adding "doctor like" responsibilities to nurse practitioners and such would alleviate the coming doctor shortage issue.

And to be able to afford all this, stop subsidizing those who can afford to pay for their own health care, no matter what their age.

Also on the financial side, why are employee health care contributions not treated as taxable income to employees of large employers while others receive no such equal treatment, to take just one example? Make none of it tax deductible and raise the contributions and co-pays or whatever else puts the overall system on a sustainable track.

And why are the reimbursement rates for Medicare and Medicaid different? Why wouldn't vouchers and market based competition work in U.S. health care? And so on.

Wouldn't it be nice if the politicians and the rest of us, including the oldsters, began discussing and addressing these affordability and accessibility issues in a serious manner, and while we still have ample time to do so in a non-crisis atmosphere?

Regarding our unaffordable and government mandated entitlements, and especially health care, it's time for us as a nation to grow up, face facts, engage in some straighttalk, make decisions and then all move forward --- together.

Summing Up

It's time we discussed this rationally --- and nationally --- and seriously --- and holistically.

Our kids and grandkids are counting on us to do the right thing.

Thanks. Bob.

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