OP-ED

Why Medicare Isn’t the Problem, It’s the Solution

I hope when he tells America how he aims to tame future budget deficits the President doesn’t accept conventional Wasington wisdom that the biggest problem in the federal budget is Medicare (and its poor cousin Medicaid).

Medicare isn’t the problem. It’s the solution.

The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up. Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.

Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)

Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

Let me say it again: Medicare isn’t the problem. It’s the solution.

Robert Reich served as the 22nd United States Secretary of Labor under President William Jefferson Clinton from 1992 to 1997.  He blogs regularly at Robert Reich, where this post first appeared.

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  99. yes, most medical studies are, who ever pays the bills has an agenda and majority of the time it shines through.

    Not big on the Donald for Pres, I think he’s better on TV, 4 yours without the apprentice sounds like hell.

    Yes I have done considerable business with “The Poor”

    Racial disparities exist is a meaningless statement. If there is unequal opportunity based on race that is a serious problem, if there are unequal results based on poor personal decisions that is a different argument.

    “Most people who tote “look at all the alcohol and fast food sold in low income areas” have never even set foot in those neighborhoods and if they had would know that fast food chains directly target low income areas because they know that they can make a profit with their dollar menu which every fast food chain has.”

    So your not saying those people are wrong, in fact your proving they are correct, you just rather blame the fast food company for holding a gun to the poor and forcing them to eat there?

    “Do you really think big corporations have the little man’s heart in their best interest?? ”

    If the little man doesn’t worry about his heart why should the big evil corporation? If people are going to seek out and find this food why is the corporation wrong for giving it to them. There are fast food joints that go out of business every day in poor neighboorhoods so obviously the poor are able to exercise choice, why do you place all the blame on the corporations, besides that beng what your told to do? People should be allowed to eat what they want, if once a week I want to break my vegan tofu diet and have some roach coach tacos that is my right, your saying poor people are to stupid and weak to be allowed to have those choices so your going to take them all away from them. Why don’t you just lock them all up in towers and tell them how to live….oh thats right you already tried that.

    ” Instead of sitting in your office reading audits you should take to the street and actually talk to some poor people.”

    I have spent more time in the streets and housing developements then you will ever see. Peering out your ivory tower doesn’t mean you have seen poverty.

    I rather spend my time helping people come up not just sustain, I’ll continue spending time working on music and real estate, feed them for a day or a lifetime difference. Apparently you rather have them dependent on you for life, best way to keep their vote right?

  100. Really, the institute of medicine is a propaganda study?? Interesting…you must also be a supporter for Trump as president too..
    Do I weep* at every poor welfare story out there? No, I know there is welfare fraud committed on a daily basis, but I also have worked with the poor directly (which I don’t think you have). From the outpatient clinics to the ER (and, yes, racial disparities exist), so forgive me if I take what you say with a grain of salt. Most people who tote “look at all the alcohol and fast food sold in low income areas” have never even set foot in those neighborhoods and if they had would know that fast food chains directly target low income areas because they know that they can make a profit with their dollar menu which every fast food chain has. Do you really think big corporations have the little man’s heart in their best interest?? Instead of sitting in your office reading audits you should take to the street and actually talk to some poor people. Hey, maybe you should volunteer at a soup kitchen or at a homeless shelter? What do you say? Really get out there and see how the lower half live (I’m betting you won’t).

  101. you are the problem Vanessa, apologist that wheep at every sob story and propoganda study that crosses your path.

    ” it is cheaper to buy high fat content and high calorie food for their family (actually I should say that is all they can afford) than fruits and vegetables.”

    BS, only an idiot would believe this. Look at all the alcohol and soda sold in low income areas, compare that to the price of water. Look at all the fast food sold in those same neighborhoods, a trip to KFC is more expensive then some fresh pruduce.

    Yes I am such a great guy I pay taxes so entire armies of people can do nothing 8 hours a day but sign people up to take more of my taxes. Speaking of facts, you wouldn’t know one if it hit you upside your head, our public assistance programs have a problem of to many ineligibile people signing up and getting benefits they are not entitled to becuase the process has been made so easy. Medicaid alone has over 10% of its enrollees covered without propoer documentation because the rules are so lax. Ready any of the GAO audits.

    Its people like you that enslave these people to their welfare.

  102. Please review the Institute of Medicine report on Unequal Treatment in America and maybe you will bite your tongue the next time you feel like speaking of “society’s supposedly neglected” as well as racial disparities in America.
    It’s not a hidden fact that certain races receive sub-optimal care.
    For the poor, and I’m talking poor Nate….less than $18,000/yr (for some reason I think your views of the poor are very clouded) it is cheaper to buy high fat content and high calorie food for their family (actually I should say that is all they can afford) than fruits and vegetables. If you had $20/wk to buy food with what would you buy Nate?
    You comment that there are all these wonderful programs for the poor and all they have to do is sign up for them, right? How many poor do you think are literate, Nate? How many applications do they have to read and sign? How many multiple times must they be denied by medicaid before they finally give up? But let me guess….you are such a great guy that you will personally take the time to help all these people fill out those applications….

    Institute of Medicine (2003). Unequal Treatment. Washington, DC: National Academy Press. http://www.nap.edu/openbook.php?record_id=10260

  103. Dr. Reich– I love your blog and have been reading it for years. Americans need the type of clear-headed economic information that you provide.

    Regarding Ryan’s Road to Ruin, what about the issue of medical bankruptcy? Americans are more likely to go bankrupt because they can’t pay their medical bills — than for any other reason. The American Journal of Medicine posted a story about this recently.
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  104. I am in the MEDICARE FOR ALL camp. But it must be a modified Medicare from the present with-1) Much more emphasis on jail for fraud (fines don’t work) 2) Much more emphasis on individual and institutional prevention. 3) Much more emphasis on death with dignity – not profiteering off the prolongation of death

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  105. Paolo –

    One important factor that I didn’t mention is that the average annual claims cost per Medicare member is far higher than the average claims cost for the under 65 population. Any comparative analysis of administrative costs needs to adjust for that. Alternatively, one would need to look at administrative costs per insured person instead of as a percentage of premiums. It’s also hard to assign a cost of capital charge to Medicare. I believe the Council for Affordable Health Insurance (CAHI) has also written on this topic.

  106. “Office rent, I believe, is part of the General Services Administration budget. The list goes on. If you factor in all the costs associated with running Medicare that are handled by other government agencies, Medicare’s fully allocated administrative costs are more like 7%-8% of spending than 3%.”

    Barry – do you have any source for these numbers? An additional 5% to Medicare’s budget is about $25 billion. That’s a lot of billions. Given that the entire General Adminstration budget is only about $30 billion, it is pretty hard to believe that most of it is going to assisting Medicare.

  107. I only step in here to laud the accuracy of Godwin’s Law: “As an online discussion grows longer, the probability of a comparison involving Nazis or Hitler approaches 1.” But it takes special cleverness to bring in the Eichmann trial: I’ve not seen “the banality of evil” used to describe those who disagree with universal health coverage, until now. Give this thread one more day, and we’ll have images of gas chambers and ovens.

    Health is in indissoluble unity with wider culture. The ” we spend more for health care but get less for it” sound bite, useful as it is for growing the Democratic voter base of government employees, is a classic instance of assigning causation to the loosest of correlations.
    The “health care system” is only to blame for poorer health in the US if the material human behaviors are under the control of the health care system. If that’s your premise, then the entire culture will need to be managed by the government. This vision seems deeply satisfying to some.

  108. What I always found funny is those that society supposedly neglicted, those that can’t be expected to take responsibility for their healthcare or diet, are always able to figure out how to qualify for assistance. Be it EITC, food stamps, SS disability, etc etc, they can nail that just right, make as much as possible but not to much, or do what ever is needed, but ask that they count calories or follow up on an office visit your racist and suppress them.

  109. Steve –

    This quote is from the IRS website:

    “The Earned Income Tax Credit or the EITC is a refundable federal income tax credit for low to moderate income working individuals and families. Congress originally approved the tax credit legislation in 1975 in part to offset the burden of social security taxes and to provide an incentive to work. When EITC exceeds the amount of taxes owed, it results in a tax refund to those who claim and qualify for the credit.”

  110. “If you have insurance. Without insurance follow up is poor. I am aware of at least one study of pediatric trauma patients showing that the uninsured have worse outcomes, presumably because of worse follow up care.”

    Do you think a study paints a true picture? Studies are done with purpose, they are also paid for by someone with an agenda. That is why we have studies saying Medicare is more efficient and we have lower life expatancy becuase of our healthcare system. With a little thought and research its clear the studies are worthless but its still noise out there.

    Why do uninsured have worse follow up care in the first place. Before you can answer that though why do they not have insurance in the first place? There are only 5 million people that can not get insurance. All the rest either already have access to free insurance programs like Medicaid or they make enough to buy insurance and choose not to buy it.

    Should we be surprised that someone that has access to insurance but doesn’t take it also makes poor health decisions? Is the problem our insurance system or people that make bad decisions? Follow up is poor becuase the people are bad at follow up.

    How do you solve problems directly and solely related to poor decison making by the minority? The left wants to destory a system that works great for 80% of the nation because 15% make bad decisions. Its the same thing they do with education, the crashed education to accomodate the lowest level. Why not let the 80% enjoy an incredible system like they have instead of creating a terrible system that benefits no one?

    Payroll taxes are 7.? lets say 8%. Someone making $20,000 would have $1600 of payroll taxes? All the tax credits far exceed the small amount of payroll taxes.

  111. First I didn’t say it I cut and pasted it. Second its a fact supported by endless studies and statistics. Third its a valid rebuttal to the argument that other nations have higher life expectancy.

    Nice selective quoting by the way, would the extra line have taken to much space.

    “but comparing nearly all-white Europeans to the United States which has a substantial black minority, a race known for its lower life expectancy, then ”

    Pointing out the statistical fact that blacks in all nations have shorter life expecatancy is not racist no matter how badly simple minded liberals want it to be. Typical of the left, you can’t deal with the fact so you just try to distract.

    “Why dont payroll taxes count?”

    Steve you mkust be one of those people that don’t file taxes. If you pay no taxes and get a tax credit back which is payment over and above any payments made what part of zero aren’t yopu getting? If your sole income earner with a spouse and couple kids the government pays you to exist. With earned income child tax credit and everything else they have a negative tax bill. ZERO

  112. “See as how 40%+ aren’t paying federal taxes in the first place your Robin Hood Analogy doesn’t really work.”

    Why dont payroll taxes count? Revenue received by the federal government from payroll taxes is now about the same as received from income taxes.

    “Indeed, the U.S. system probably is the best at what Don Berwick calls rescue care.”

    If you have insurance. Without insurance follow up is poor. I am aware of at least one study of pediatric trauma patients showing that the uninsured have worse outcomes, presumably because of worse follow up care.

    Steve

  113. Margalit –

    It’s a fact that poverty is correlated with lower life expectancy whether we’re talking about low income white people, African Americans, Native Americans or Hispanics. I don’t think it’s legitimate, though, to attribute that lower life expectancy to the quality of the U.S. healthcare system. It’s also a fact that Americans have the highest obesity rate in the world by a considerable margin at over 30%. Only the UK and Mexico are within shouting distance in the low 20’s. For most of the rest of Europe, it’s between 10% and 15% while in Asia, it’s generally in the low to mid single digits. Even within the U.S., this varies quite a bit among the states as diets and cultures are different and diverse in different regions. On the positive side, the murder rate has declined a lot in the last 15-20 years and, as auto safety improves, traffic deaths are down sharply as well. Both are making a positive contribution to the decline in premature deaths and neither has much to do with the quality of the healthcare system.

    The bottom line is that it’s bogus to use life expectancy and infant mortality statistics as indicators of healthcare system quality. Indeed, the U.S. system probably is the best at what Don Berwick calls rescue care. Other countries do a better job in primary care. The two biggest problems with our system are that it costs way too much and we don’t cover everyone (yet). I’m quite sure that fear of litigation among physicians is a much bigger issue in the U.S. than it is elsewhere and, I suspect but can’t prove, that patient expectations are higher here (meaning more expensive to fulfill) especially as it relates to end of life care, diagnostic imaging and, possibly, prescription drugs. We also have the problem of paying much higher prices for most services, tests and procedures than payers in other systems do. Brand name drugs cost more here too though generics are actually cheaper.

  114. Nate, sorry buddy, but you are not getting away with this one.
    You initiated discussion on the race issue here: “black minority, a race known for its lower life expectancy”. I have not the slightest idea what made you say that, and even less of an idea why Barry agreed. So I asked if life expectancy in a continent mired in violence and poverty is your indicator for people’s life expectancy in the US.
    If you think race is not pertinent to your arguments, than you shouldn’t bring it up with clockwork regularity.

    I would also suggest that you look up the definition of “fruits of one’s labor”. It implies actual labor.
    I suggest you check out some actual fruits too, like apples and oranges and how they get to your table.
    Then we can talk about contributions to society, which involves a bit more than paying whatever taxes are left after all the loopholes have been successfully employed.

  115. Liberals envision cadilliac private plan coverage, coverage for everything with little to no out of pocket, for everyone, they just never bother to envison how it would be paid for. This is the exact same thing they did with Medicare. First dollar coverage for every senior even though that isn’t what they needed and don’t worry about paying for it, let someone 50-60 years figure it out.

    Liberals should be required to fix medicare before they are allowed to pass any more insurance reforms.

  116. Medicare for all might be a solution, but as rates are paid now it would mean that most doctor visits would be in VA-like settings. Right now, most doctors’ offices cannot pay the overhead on Medicare and Medicaid fees. If fee structures under non-government (“commercial”) insurance dropped that far, there would be nowhere to get the money to make up for the big financial holes left by Medicare and Medicaid. No doctors outside of large multispecialty or hospital systems would stay in business, other than certain procedure-heavy specialists (who make a great deal more money). Everyone would be cared for by large institutional clinics.

    Some people may be satisfied with this, but many wouldn’t. It would be better for those who currently cannot afford insurance, and that would be good. It would be worse for many who are currently under Medicare/Medicaid, because their doctors get much of their pay for the services they perform for those Medicare/Medicaid patients by other, commercially-insured patients. This is cost-shifting.

    What would that medical world look like? I suspect that under that system the government would allow Medicare patients to see private doctors outside of the large clinics if they could afford the extra fees. Current law does not allow doctors to receive Medicare fees and simultaneously bill patients the balance of the office/service fees. So patients who want to buy more time or service from the doctor cannot do so if the doctor takes Medicare fees. The doctor has to “opt out” of Medicare entirely, and the patient is unable to recoup any of that doctor’s fees from Medicare. I think there would be enough backlash from a VA-like Medicare-for-all system that the government would have to allow balance billing. So doctors would have a financial incentive to open practices catering to those who could afford the supplemental fees. You would have a two-tiered system, with a very evident division between the haves and the have-nots.

    I am not suggesting that this is a bad thing. It’s a matter of opinion. It could end up meaning that there is universal health insurance. I don’t think that’s what Progressives envision, however. I think Progressives picture everyone going to the same sorts of doctors and hospitals, and that being affordable under a government program. I don’t think that would happen without a bottom-up rebuilding of our system with a Swedish or similar model. Just expanding Medicare to everybody won’t accomplish that.

  117. rbar, you must be from a different generation then me, the three or four versions of Robin Hood I remember all entailed Robin Hood stealing the tax collections back from the king’s men and returning them to the common folk. See as how 40%+ aren’t paying federal taxes in the first place your Robin Hood Analogy doesn’t really work. A more correct comparison would be barbarians raiding the civilized working people and stealing the fruits of their labor. If 40% of our population would contribute to society we wouldn’t have these problems.

    “But I do know this – when I reach eligibility it can’t turn me away.”

    Actually Mike you don’t know. Try being covered by your employers plan and see what they tell you. It use to be as soon as you hit 65 you got full Medicare, then the government couldn’t afford that promise so they changed the rules and now employer coverage is primary. 20 years from now you think they won’t change the rules more? It took only 5-7 years after passage before Medicare broke its promise to providers to pay them a fair price for services. The reason Medicare’s 40+ trillion in debt is not on the books is becuase you are not promised Medicare, there is no commentment to anyone beyound today that Medicare will be there, otherwise all that liability would be on the books.

    “Meanwhile some 50 million people in the US are SOOL if they need care.”

    Again no idea what your talking about. 50 million are uninsured for some part of the year, at any one time there is not 50 million uninsured. After that around 15-20 million are already eligible for coverage and just haven’t enrolled, once they need coverage they just need to sign up. Why is it you liberals can never get your facts strait?

    “So, Barry, Americans of African descent ought to see whatever life expectancy they have in the US as a major success for our health care system, when compared to life expectancy in Africa?”

    So white people are suppose to do what? Its not white people shooting them in gang wars and force feeding them junk food. Their health is their issue, if you race baiting liberals have a problem with that then round them all up into gated towers and control their lives…oh thats right you already tried that.

    Like Barry showed with Liberals its never about actually fixing problems or caring for people its all about money and control with them, disgusting, all of them.

  118. “This has been disproven so many time you have to know your lying when you type this. ”

    Nope. It just depends on whether you want to look at expenditures per capita or by total expenditures. If private insurance takes over Medicare and has increased expenditures, we might find those more important.

    “Medicare skimps on admin and because of that they have a 10%+ fraud rate, that is $700+ per year, where is that factored in Robert?”

    You always forget the extra expense incurred by providers from having to comply with private insurance paperwork and changes in billing. Additionally, most of that fraud and waste seems to come through the private contractors hired by CMS. Perhaps the govt should run this directly.

    http://www.gao.gov/new.items/d10844t.pdf

    “Private insurance already delivers Medicare benefits cheaper then Medicare can,”

    My broker will not even give me a price quote for someone of Medicare age. What would you charge to insure a 68 y/o with diabetes, hypertension and obesity, one of my typical patients? Given that private insurance pays 20% to 300% more than Medicare, note all of the docs who come here and say that they have stopped taking Medicare patients, how does private insurance pay less?

    Steve

  119. There is no doubt that the current “system” produces a large, confusing bureaucracy that is rather counterproductive to patient care. Just go into any US hospital and look at the amount of paperwork and, yes, billing clerks. Canada has proven that one can do private delivery of healthcare with a single payor.

    I am not sure whether Barry Carrols analysis is correct, but adjustments to improve medicare could be easily made if there is enough political traction to work against interest groups and “death panel” demagogues (i.e. consevatives incl. , by his own admission, Nate). In particular, the fee schedule need to be looked at. There are studies indicating that certain complex surgeries are overused because they are better paid (including medicare, which is not such a bad payor gor hospital care). but it will not happen with a pseudoliberal centrist and corporate interest peddler in the white house, and republicans who, as a whole, moved towards market libertarianism (without any social libertarianism) and now barely hide their reverse Robin Hood schemes.

  120. Medicare might be more efficient, or maybe it is even no better than private insurance, as an insurance company.

    But I do know this – when I reach eligibility it can’t turn me away. Meanwhile some 50 million people in the US are SOOL if they need care.

    Reich makes some economic arguments for Medicare, but he never really states the most important one, the ethical argument.

    You can argue the economics of insurance systems all day long, but the bottom line is if you defend a system that allows 50 million people (or one person) to remain shut out of the system you have crossed a moral and ethical line and elected to wage class warfare.

    There is a war being waged against the lower half of US society, and the insurance system is one component of that war.

    We get a glimpse in these comments of the minds of good soldiers and bureaucrats in the war against the lower and middle classes. We see people who no doubt sleep well at night in the tight security of their circular arguments, oblivious to the death and misery that they cause, or justify, every day.

    To read the comments here is to witness the banality of evil.

    Former Secretary of Labor Robert Reich is hardly a flaming leftist, but he was as left as was allowed to be part of the Clinton administration, and compared to the right wing Obama administration, he is a breath of fresh air and public ethics.

  121. Government is the problem. It terrorizes people into believing survival is impossible without the government.

    Government is the problem.

  122. “The correct analysis, as you suggest, would compare Asians in the U.S. with Asians in Asia, Scandinavians in the U.S. with those in Scandinavia, Germans in the U.S. vs. Germans in Germany.”

    So, Barry, Americans of African descent ought to see whatever life expectancy they have in the US as a major success for our health care system, when compared to life expectancy in Africa?
    Not to mention that we don’t really have American Germans or American Scandinavians anymore.

    I do agree that the health care system is not the sole reason, and perhaps not even the main reason, for the US life expectancy, or infant mortality numbers.
    I suggest factoring in the large disparities in American society as opposed to, say, European societies (US Gini is in high 40s and Europe is around 30).
    So the problem is, was, and will continue to be, poverty (whichever color you want). Fix that and you fixed health care.

  123. Nate –

    To add to your comments about Medicare’s administrative costs, when people first apply for Medicare, they do so through the Social Security Administration, not CMS. CMS only has about 4,600 employees while SSA has more than 60,000. The revenue to fund CMS is collected or borrowed by the Department of the Treasury. Office rent, I believe, is part of the General Services Administration budget. The list goes on. If you factor in all the costs associated with running Medicare that are handled by other government agencies, Medicare’s fully allocated administrative costs are more like 7%-8% of spending than 3%. Add in the fraud rate which you peg at 10% and you’re up to at least 17% for administration and fraud. Throw in below cost payment rates for many services, tests and procedures which get shifted to a still viable private insurance market and overall costs growing faster than GDP, and it doesn’t look like a sustainable model to me.

    As many times as you and others point out the flaws in the analysis around life expectancy and infant mortality in the U.S. vs. other countries, we still hear the same BS over and over. The correct analysis, as you suggest, would compare Asians in the U.S. with Asians in Asia, Scandinavians in the U.S. with those in Scandinavia, Germans in the U.S. vs. Germans in Germany. The fact is that a given person’s health status is determined 40% by personal behavior, 30% by genetics, 20% by socioeconomic status and environmental factors, and only 10% by the quality of healthcare than one can access.

  124. I have to call out nate for his admittedly relevant, but spectacularly racist dismissal of the issue of health disparities in the US.

    Another way to say what he’s saying is, “sure, if you look at the whole population we’re not taking care of them, but the only ones who COUNT are the white folks, and they’re just fine.”

    Seriously, you can write that blacks are “a race known for its lower life expectancy” without comment? Yes, there are many many social determinants of health that impact non-whites in this country disproportionately and thus impact life expectancy, but that’s PART OF THE PROBLEM, not an exception to be dismissed. This post makes me sick to my stomach.

  125. This one needed its own post so Robert doesn’t miss it;

    http://www.nytimes.com/2009/09/22/science/22tier.html?adxnnl=1&adxnnlx=1302710847-rbuCAF2H0dKLCY/sz3xtKA

    But a prominent researcher, Samuel H. Preston, has taken a closer look at the growing body of international data, and he finds no evidence that America’s health care system is to blame for the longevity gap between it and other industrialized countries. In fact, he concludes, the American system in many ways provides superior treatment even when uninsured Americans are included in the analysis.

    Americans pay more for health care partly because they get more thorough treatment for some diseases, and partly because they get sick more often than people in Europe and other industrialized countries.

    An American’s life expectancy at birth is about 78 years, which is lower than in most other affluent countries. Life expectancy is about 80 in the United Kingdom, 81 in Canada and France, and 83 in Japan, according to the World Health Organization.

    This longevity gap, Dr. Preston says, is primarily due to the relatively high rates of sickness and death among middle-aged Americans, chiefly from heart disease and cancer. Many of those deaths have been attributed to the health care system, an especially convenient target for those who favor a European alternative.

    But there are many more differences between Europe and the United States than just the health care system. Americans are more ethnically diverse. They eat different food. They are fatter. Perhaps most important, they used to be exceptionally heavy smokers. For four decades, until the mid-1980s, per-capita cigarette consumption was higher in the United States (particularly among women) than anywhere else in the developed world. Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries.

    Like the say read the whole article, as it completly tears apart your argument. When I have time I’ll educate you on your other numerous errors. In the mean time could you explain where in your 3% admin cost for Medicare the budget of CMS is included. Also staff time of Congress when working on healthcare related bills. printing and research. Medicare cost is spread all throughout the federal budget, the 3% refers to a minute portion directly linked to Medicare but leaves out all oversight and management, expenses that are included in the private insurance numbers.

  126. Another difference in life expectancy relates to race/ethnicity. For example, in the United States, the expectation of life at birth for whites is six years higher than for African Americans. However, the difference in life expectancy at age sixty-five is less than two years.

    Read more: Life Expectancy – world, body, cause, time, human, The Measurement of Life Expectancy, Life Expectancy at Birth, Circa 2001 http://www.deathreference.com/Ke-Ma/Life-Expectancy.html#ixzz1JQ5x024q

    Ethnic diversity causes lower life expectancy
    European countries have longer average life expectancy than the United States, but comparing nearly all-white Europeans to the United States which has a substantial black minority, a race known for its lower life expectancy, then you are comparing apples to a mixture of apples and oranges. It’s a meaningless comparision.

  127. All the more reason to not listen to Labor Secrataries and journlist and listen to people that actually work in the field and know what they are talking about.

  128. maybe I shouldn’t have used we in such a general sense.

    people that do insurance for a living and work with this stuff day in and day out instead of writing and pontificating about it know the cost.

  129. you have to go to the CMS data and look it up. First thing you need is the bill broken down by revenue codes

  130. We do?
    What is the audited, direct cost incurred by, say, Mass General for a hip replacement, itemized for technical component, professional component and facility, with no margins built in?

  131. ” we should first know what the real costs are to deliver that care. And we don’t. We know what we are charged,”

    Margalit we do some cost plus reimbursement for hospitals now, not nearly as much as I would like but the numbers are known.

  132. I somehow don’t believe it’s a good idea to counteract fiction with more wishful thinking.
    Yes, Mr. Ryan’s plan is not even remotely attached to reality, but if we are serious about fixing this mess, we first need to understand it.

    Medicare, and its poor cousin Medicaid, are indeed not negotiating prices with hospitals and doctors. They are dictating those prices. There could be savings associated with negotiations between Medicare and drug manufacturers, but that’s about it.
    As long as hospitals and doctors have a release valve by which to shift their desire to make profits from Medicare to a private insurance market, we will achieve very little other than miserable care for the elderly and the poor by having Medicare, and its poor cousin Medicaid, reduce reimbursements. I don’t even know if any reductions in Medicaid fees are even possible without getting into negative numbers.

    Medicare for all, including those currently relegated to its poor cousin Medicaid, may very well be a good suggestion, but it has to be for all, from day one. And that is not going to happen any time soon.

    I do agree that there are savings possible from administrative simplifications and reductions in medication prices paid, but in order to reduce what we pay for all other care, which is the bulk of the expenditures, we should first know what the real costs are to deliver that care. And we don’t. We know what we are charged, but we have no idea what the costs are to the provider, excluding embedded profit margins, arboretum constructions, enormous salaries for the few and miscellaneous bloat built in for a rainy day.

  133. What a bunch of BS, pure partisan BS.

    “And we have the highest rate of infant mortality of all advanced nations.”

    Might this have ANYTHING to do with the way infant mortaility is measured? The NHS lets them die under 22 weeks, we spend millions to save them. That skews both your per capita spending and infant mortality rate.

    How many unhealthy illegal South American immigrants are breaking into these other countries to have babies, again skewing both numbers.

    “Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations.”

    Why don’t you break down how an asian American life expectancy compares to an Asian, a black to a black and so on? Because when you do the difference disappears.

    “It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.”

    This has been disproven so many time you have to know your lying when you type this. Medicare is no where close to private insurance on administrative cost, if you had any idea what you where talking about you would know they are considerably higher. Then again this isn’t about facts its about politics.

    “Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure.”

    Do you not understand math or just that dishonest? Robert you’re comparing 3%, which is low, your leaving out half their expenses, of $7000+ to 5% of $3500. Let me help you out there, $210 is more than $175. Even using your bogus numbers you’re wrong. You don’t buy stamp, pay salaries, or office space as a percent of premium so why does the left always compare admin efficiency as a %, because it’s the only way they look close. Incredibly dishonest but effective. Medicare skimps on admin and because of that they have a 10%+ fraud rate, that is $700+ per year, where is that factored in Robert? That alone is 400% of the total cost of private admin. Funny how you always forget that piece of the equation.

    “allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors,”

    ??? What country do you live in, Medicare and Medicaid don’t need to negotiate they just tell doctors and hospitals what they will be paid and this is already done. You want to cut Medicaid reimbursements even lower?

    “Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year.”

    When done by far left liberal propagandist that don’t know anything about healthcare. When done with even a token effort at accuracy fraud alone increases your cost 10%. Private insurance already delivers Medicare benefits cheaper then Medicare can, that is as true of an apple to apple comparison you can get.

  134. Thanks for sharing this. Reich is right on. The system needs to start small with the docs, hospitals and other health care professionals. Trying to fix this nationally is going to leave out the ones who need the Medi programs the most. Looking forward to what Obama has to say about the topic later this afternoon. Reich always gives great insight – a follow-up from him would be superb.

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