MEDICARE MUDDLE: Miller keeps getting it right!


Interlude—Medicare muddle no more: The Post’s Matt Miller has been on fire since Romney selected Ryan.

This morning, he offers a deconstruction of our Medicare mess. His headline: “The real Medicare villain.”

We’re sorry to be unpleasant today. But the liberal world, such as it is, has long been too clueless to say this:
MILLER (8/25/12): The beginning of wisdom on Medicare’s future starts with two things both parties say but which can’t simultaneously be true.

The first is that we spend much more on health care than any other advanced nation yet get no better results. The second claim—implicit in the attacks on Obama’s $716 billion in “cuts” or on Romney/Ryan’s heartless vouchers—is that, if we do much to slow the growth of health-care spending, we’d hurt seniors’ access and quality of care.

As I’ve argued before, no matter how often and how loudly interest groups and politicians scream this second claim, it can’t be true if the first claim is a fact. And U.S. health care’s inefficiency is indisputable.
Duh. As everyone knows, we spend massively more per person on health care than other developed nations. At the same time, we act as if there’s no earthly way to cut back our spending on health care (read, to cut back our Medicare speanding).

As Miller notes, this simply doesn’t make sense.

As Miller continues, he describes a “progressive catastrophe.” He does make one factual error:
MILLER (continuing directly): The United States spends twice per person on health care what most other advanced nations spend without better outcomes to show for it. As a share of the economy, this now translates to an eye-popping 18 percent of GDP; the next closest nations spend 12 or 13 percent, while the OECD average is in the 8s. Mighty Singapore, with comparable results, spends just 4 percent! And these nations perform better under every model—from single-payer (Canada, England) to mandated private insurance (Switzerland, Holland) to creative public/private hybrids (Singapore).

These aren’t just dry numbers. They represent a progressive catastrophe. If we could run our health-care system as cost-effectively as other rich nations—which also manage to insure everyone, while we shamefully still leave 50 million people without basic coverage—we’d free up hundreds of billions of dollars each year to pay for infrastructure, R&D, universal preschool, great teachers for poor kids, a mega-earned income tax credit for the working poor, and higher wages (that’s my starter list, at least).

After Republican intransigence, in other words—and even after we eventually raise taxes to help fund the boomers’ retirement—it’s not an exaggeration to say that health-sector inefficiency is the biggest obstacle to progressive goals in America.
Duh. Within our profligate health care system, every consumer is being looted by powerful interests. The drug manufacturers, the medical device makers—it’s obvious that every player is taking a large extra slice.

This leads to our complaint about Miller. As people constantly do, he understates the extent to which we overpay for health care. On a per person basis, we pay two to three times as much as other developed nations.

Obviously, large sums are being looted.

The liberal world has tolerated this situation for a very long time. In 2009, our nation spent a year pretending to have a discussion of health care. Again and again, we noted the way the major news organs refused to examine that basic question: Why do we spend so much more on health care than other developed nations?

The New York Times took an obvious dive; so did the Washington Post. The NewsHour refused to conduct a discussion of this blindingly obvious question.

When T. R. Reid published his much-discussed book about international health care, he too presented a bogus discussion of our massive over-spending. Where is all our money going? The big news orgs refuse to say. And as this groaning silence persists, the liberal world stares into air.

Be sure to read Miller’s whole column. Truly, he has been on fire since Romney selected Ryan.

That said, has there ever been a dumber people than we modern-day liberals? The historians could probably answer that.

But wouldn’t you know it? They’re on sabbatical! The historians are lounging in France!


  1. While there is some truth in Miller's column, his claim that "we...get no better results" is bogus, at least as applied to Americans over 65. The claim that American medical care is no better than other countries is based on studies of overall mortality. However, there are many factors affect mortality. One cannot measure the quality of medical care for American's over 65 by just looking at overall mortality.

    In fact, Americans on Medicare do get better care than in other countries. Other countries have longer waits and more excluded treatments.

    However, Medicare is much too expensive to maintain as it is. Miller is right that something will have to be done.

    AFAIK Ryan's plan is the only serious approach to long-term affordability currently on the table. Obama and the Dems are wickedly irresponsible when they demonize Ryan's proposal without offering one of their own and without even acknowledging that Medicare benefits will need to be substantially reduced.

    1. D in C, Medicare's soaring costs are a result of the rise of health care costs in general. In fact, the cost of private health insurance has been rising faster than medicare. Medicare is a symptom, not the problem.

      The real problem is that America's health care system in general is aggressively wasteful. And if Obamacare (which has been our only serious attempt to date to remove some of the waste) is overturned, the burden of healthcare costs on American corporations as well as all levels of government will only grow. It is amazing that America has remained competitive despite being shackled by its healthcare system.

  2. DinC
    You perpetuate the myths.
    Some Americans, wealthy ones, get the best medical care in the world.

    Most get good medical care, but it is mostly treatment rather than preventive medicine which is far superior (and free) in other OECD nations.

    The line about longer waits and excluded treatments is pure mythology.

    A typical case:
    A European walks into his doctors office without an appointment, complaining that shoulder pain wakes him up every night.
    After an examination the doctor sends him to an orthopedic surgeon who diagnosis tendonitis in what we call the rotator cuff.
    The surgeon schedules an MRI and sets aside time in an OR for surgery. With the MRI in hand the surgeon schedules the procedure in an OR.
    Elapsed time 3-4 weeks.
    The patient receives physical therapy, intensive at first, and declining for up to a year, and is pain free after 20 weeks.

    Back in the USA, a patient with health insurance schedules an appointment with his primary care physician with the same complaint.
    The doctor prescribes painkillers. The patient comes back. The doctor prescribes stronger painkillers. The patient comes back.
    The doctor orders an x-ray. Since the problem is soft tissue, the x-ray is inconclusive.
    The doctor prescribes physical therapy. After six weeks, the patient is still suffering.
    The doctor refers him to an orthopedic surgeon, who gives the patient a corticosteroid/lidocaine injection.
    The patient feels relief for three months, then the pain returns.
    Back to the orthopedic surgeon, who orders an MRI.
    After seeing the MRI, (and getting permission from the insurance company) the surgeon schedules surgery.
    After 30 weeks, the patient gets 3-4 months physical therapy.
    About a year later the patient is pain free.
    Every visit, including PT, requires a co-pay.
    Questions: Which takes longer, which costs more, and which provides a better result for the patient?

  3. Quaker in a BasementAugust 25, 2012 at 6:41 PM

    Bob, your complaint that Miller understates is weak. In the very same paragraph, he tells readers that we spend 18 percent of GDP and compares that amount to several other countries that achieve similar outcomes.

    Are you just congenitally unable to cite any other writer without finding something the pick at?

    1. Quaker In Mother's BasementAugust 26, 2012 at 7:38 AM

      Isn't it amazing that I think any praise should be unvarnished? That if it's good, we shouldn't say how it could have been better.

      Am I congenitally stupid?

    2. You're right.
      Miller deserves credit for explaining the real costs.

      Ryan proposes nothing to fix the real problems.
      His is the same old cold-war argument that social programs are socialism.

      There is an Iron law in economics: Whenever the government starts to pay for something, the prices skyrocket.

      The reasons are waste, corruption, and plain old profiteering.

      Several commenters have recommended Rachel Maddow's book on the military budget.
      I haven't read it, but I have lived through it.

      I was a military dependent overseas while Kennedy was President. His gold flow program had a dramatic impact on prices in the PX and commissaries.
      Up til then, the overseas military referred to our government as "Uncle Sugar."

    3. gravymeister says:

      >>>>>There is an Iron law in economics: Whenever the government starts to pay for something, the prices skyrocket.<<<<<

      Er, how come that law is all rusted throughout the rest of the advanced industrial world where governments take a larger role paying for the health care systems in their societies than does the U.S. government in ours, yet those other societies are getting nearly comparable health care services at a much lower cost than we are paying here?

  4. It's not just 50 million uninsured, it's the hundreds of thousands of people, over years, who go bankrupt from medical expenses. That does not happen in the other developed democracies. For example, in Austria, Israel, New Zealand, Taiwan and Norway, everyone is covered and no one goes bankrupt from medical bills as they do in the US. Medicare could save billions if it were allowed to bargain for lower drug prices or if it were allowed to buy drugs in bulk. There's another thing, medications are much cheaper in countries like Canada, Germany and Sweden. Michael Moore's film, SiCKO, illustrated that even people with insurance can go bankrupt from medical expenses.

  5. ALL the other advanced industrialized democracies have some form or version of universal health care except the US. What the hell is the matter with this country? Teddy Roosevelt had national health care as a part of his 1912 campaign platform. Harry Truman tried to institute a national health care system throughout his presidency but was stymied by the GOP and the AMA. We do have universal health care for seniors 65 and older but the yahoos and the GOP are determined to fix that. We do have socialized medicine for veterans, the VA which does negotiate with the drug companies for lower drug costs. We also have Medicaid for the desperately poor, CHIPS for kids and Social Security disability insurance. But all these programs are under threat by the deficit vampires who only care about deficits when a D is in office. The UK really has socialized medicine while Canada does not, its doctors and hospitals are private. The best we could come up with in this country is Obamacare, just pathetic. Single payer was not even allowed at the bargaining table, the single payer advocates were ousted from the hearing chamber. What a dense country when it comes to health care coverage.

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  7. First claim is that we spend more than other countries on health care, second is that Obama's so-called "$716 billion cut" to Medicare will reduce care for seniors, and he says that "this second claim, it can’t be true if the first claim is a fact."

    Actually, I don't believe the second claim is true, but that quoted statement is simply incorrect and is false logic. The first claim is not that we overspend specifically on seniors, merely that we overspend overall. If a budget has several areas and overspending is an overall condition, then that says nothing about spending in any one area of that budget, and it is perfectly possible that any one area might have little or no overspending and that cutting in that area of the budget can be harmful to your ability to function in that area.

    The two claims, one of which he says contradicts the other, do not provide sufficient context to say whether they actually do so in reality or not. Of the overall overspending, what portion is on seniors, and what is the amount of that overspending? Is it more or less than $716 billion?

    It's called "jumping to conclusions."