Without the pain, swells can’t be glad: Various atrocities occurred on last Sunday’s This Week.
We’re going to wait until next week to record the way Senator Johnson lectured the world about the Social Security trust fund. As it turns out, the fund is a mere accounting fiction! Poor Krugman was forced to look on.
For today, here’s what Julianna Goldman had to say about a potential Grand Bargain:
GOLDMAN (3/10/13): Look, both sides understand what a Grand Bargain is going to look like. Republicans are going to have to give on revenues. Democrats are going to have to give on entitlements.Goldman, who was born on third base, thinks she hit a homer. She never fails to mention the need for regular folks to feel some pain as we adjust our social insurance programs.
And so there is some case for optimism now that, if the president, in trying to build trust, wants these lunches, these dinners—don't become news events that we're covering [sic]. But if Republicans see the president moving forward, putting Medicare savings on the table that doesn't just hit providers but also hits beneficiaries as well—and also, going out and selling it to give Republicans some cover—then there could be a sense that you could get some Senate Republicans to help bring the House along as well.
In terms of health care, those spending cuts shouldn’t just hit the providers! They should hit beneficiaries too!
As a matter of policy, does that make sense? As everyone knows but no one says, we spend two to three times as much on health care, per person, as other developed nations. Presumably, a lot of that massive over-spending is looting of various kinds.
Why can’t we simply eliminate the overspending without making beneficiaries feel some pain? We don’t know, and people like Goldman never get that far.
Neither does anyone else, of course. Typically, network discussions of this topic run about sixty seconds. But Goldman makes a point of calling for pain for those average blokes.
We don’t think it’s smart. In fairness, This Week's roundtable segment was a fake—an imitation of life.
Bloomberg News? What do you expect?
ReplyDeletewe spend two to three times as much on health care, per person, as other developed nations. Presumably, a lot of that massive over-spending is looting of various kinds.
ReplyDeleteWhy can’t we simply eliminate the overspending without making beneficiaries feel some pain? We don’t know..?
This differential has existed for decades. Whatever its cause, the fact remains that the problem wasn't fixed by any President. Not by Jimmy Carter. Not even by the brilliant duo of Bill Clinton and Barack Obama. Realistically, I don't think the federal government is going to find a way to maintain the same quality of care but at substantially lower cost.
Until the national dialogue starts detailed coverage of the causes of our high health costs, there will be little change.
ReplyDeleteAlmost everything reported today says the fix is to cut MEDICARE cost, not healthcare costs.
A bit of the talk centers on unneeded tests, liability insurance, technology, etc.
Little of the reporting goes to covering Big Pharma profits, insurance company profits (both healthcare and malpractice), billing company profits, hospital overcharges for virtually everything, and outright fraud.
Why doesn't the government underwrite medical school tuition and require a few year of designated service in exchange for a license, as they do for the military doctors?
A small percentage of doctors are responsible for the majority of malpractice suits. Why aren't they required to go back to a medical school to learn more?
Teachers are required to continue their education, so are auto dealership mechanics.
Eliminate malpractice insurance altogether. Fix the patient AND the doctor.
Instead of waiting until a doctor maims three or four people so lawyers can make their retirement on a few cases, retrain them. If they still kill their patients, send them out to patch potholes in roads.
Don't punish all doctors for the sins of a few, and don't allow quacks to keep their license.
(If we had a GI bill for doctors, they couldn't squawk that they owe hundreds of thousands in loans.)
The problem is not information or ideas, it is inertia. The information is all over Europe. We send Congressmen to Finland to look at their schools, why not send a few to look at their healthcare as well?
We lack the will, not the means.
gravymeister, you present an interesting bunch of ideas. Having been in the malpractice business, I can speak to your thoughts in that area.
DeleteI like the idea of eliminating malpractice suits altogether. Before 1960, medical malporactice suits were just about non-existant. In order to bring suit, one would have to have a doctor testify that another doctor had committed malpractice. But, doctors simply refused to testify against each other.
Did the lack of malpractice suits mean that doctors behaved carelessly? Of course not. Doctors then and now behave professionally. They're in the profession of healing and they take their work seriously.
Unfortunately, there's no chance at all that Congress and state legislatures will abolish medical malpractice suits. And, if they somehow did so, I'm sure the courts would find that action unconstitutional.
It's true that there are a few absolute butchers who get sued a lot, e.g., the notorious Dr. Nork. However, lots of doctors get sued a lot because of the type of medicine they practice or because they're in a litigious area. John Edwards made a fortune in "bad baby" cases where the doctor and hospital really had done nothing wrong, but the jury was sympathetic to a baby who was damaged in some way. Dr. Michael DeBakey, one of our greatest surgeons, was often sued because he took on the most difficult, challenging cases.
David.
DeleteAs usual, you miss the point completely.
A board of DOCTORS will be established to review botched cases and help the patient, and determine if the doctor was responsible.
If he is incompetent, he will be given the choice of going to school or losing his license.
It works in other countries. It works in countries we sneer at, but that get better results at half the cost. It has been working for DECADES.
Practicing medicine is like driving a car. It is a privilege, not a RIGHT.
If the federal Government is paying the piper, it gets to call the tunes.
Your examples only demonstrate why our system is irrational and why it is failing.
I completely agree. My examples demonstrate why our system is irrational and why it is failing. I wish our system could be fixed along the lines suggested by gravymeister. Sadly, the plaintiff's attorneys have too much political clout for that to ever happen IMHO.
Delete"John Edwards made a fortune in "bad baby" cases where the doctor and hospital really had done nothing wrong, but the jury was sympathetic to a baby who was damaged in some way."
DeletePlease back this fantastic statement up with some evidence, David. In those cases you so callously refer to as "bad baby," how many that have gone to trial have resulted in jury verdicts in favor of the plantiff, and how many in favor of the defendant?
And be prepared for a huge shock. That is, if the truth matters to you at all.
First, most discussion calling for austerity (cut benefits, the Grand Bargain) are responses to political created problems, not economic one. In a sovereign, fiat monetary system, government debt is, except under extreme conditions, not a problem. If there is a problem it is the escalation of private (consumer and corporate) debt.
ReplyDeleteThe observed relationship is that when the private sector in aggregate “saves,” it is the government that is a rough compensating system through spending. When the private sector spends, classically by borrowing, the government’s deficits decline as taxes can be used to slow inflation. On what government money is spent, the focus of political decisions, entails decisions about who benefits and the kinds of benefits that are available.
The kitchen table analogy for the federal debt is misspecified.
Second, on the malpractice item, Public Citizen’s report, Medical Malpractice Payments Sunk to Record Low in 2011 (July 2012), notes that malpractice costs in terms of payments and insurance premiums have been declining, many the lowest since 1991. “Total costs for medical malpractice litigation, as measured by liability insurance premiums paid by doctors and hospitals . . . [in 2010, the latest available data at the time] was 0.36 percent of total national healthcare expenditures.:”
Third, Social Security policies and the Social Security Trust Fund have been variously used in governmental operations. Fairly early in the program rising costs were anticipated and policies suggested to meet future payout needs. In the late 1960s when the U.S. began its march to be a major debtor nation, just prior to President Nixon subsequently taking the country off the gold standard, Social Security was folded into the unified budget to mask the precarious budget in an era in which both “guns and butters” were the Johnson Administration’s policy. In the 1990s the Boskin Commission recalibrated the cost-of-living index with the aim to slow down rising expenditures for Social Security. Now the austerians who haven’t looked around the world nor the Great Bargainer are again moving to deal with Social Security that isn’t even by conventional Trust Fund accounting a system that’s in imminent danger unless the political consensus is that the U.S. economy has no prospects to “grow.” Such talk is hampered by a number of things, including measurement, but that’s for another day.
Arthur Wilke
In a sovereign, fiat monetary system, government debt is, except under extreme conditions, not a problem.
ReplyDeleteArthur Wilke, what are the extreme conditions when government debt IS a problem in a sovereign, fiat monetary system? The National Debt has passed GNP (although some of that is money owed by government to other arms of the goverment.) The annual deficit is running at 6% of GNP with a good chance of never falling below that figure. New money is being created at 6% of GNP per year. Are these extreme enough to be a problem?
At the rate we're going, in four years, National Debt will be 125% of GNP. Is that extreme enough to be a problem?
"Is that exterme enough to be a problem."
DeleteYou and the economic minds you follow said it would be a huge problem -- already, years ago, in fact.
You, and the economics minds you follow said huge inflation and rejection by our creditors of any new debt issuance were inevitable, immediately around the corner.
You were dead wrong. You won't let that stop you giving your advice and telling us your dear concerns.
But we will ignore them as the ramblings of an ideologue, which is what they are.
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