WatchYears ago members of the elite showed their courage by leading troops into battle. They risked their own lives for the greater good. (Never mind that the wars being fought often did not serve anything resembling the “greater good.”)
Things are different today. In the land of the 1 percent, the way you show your courage is by demonstrating your willingness to beat up on the elderly. That gets you bucket loads of campaign contributions, high praise from the Washington Post in both its news and opinion pages, and could even get you named Person of the Year by TIME.
Last week, Senator Ron Wyden of Oregon stood up to do the big kick. He decided to join ranks with Representative Paul Ryan on a proposal to replace Medicare with a voucher-type system. The claim was that with increased competition, we will be able to lower costs.
Using competition to lower costs; that seems like such a great idea! If only someone had thought of this sooner.
Of course this has been thought of sooner and tried again and again. Remember Medicare Plus Choice in the 90s? How about Medicare Advantage, the more recent incarnation of the program which still exists? In both cases, analyses from the
Congressional Budget Office and others have consistently found that they raise costs. And we have been experimenting with competition between insurers in the private sector for decades, and it has not succeeded in holding down costs.
But in Washington, just because something has failed repeatedly is no reason not to do it again; especially if it protects the interests of the 1 percent.
The basic story on health care is not hard even if we can devise plans that make it very complicated. We spend more than twice as much per person as the average for other wealthy countries. This gap is projected to grow even larger in the decades ahead. If these projections prove accurate then health care costs will devastate the economy. The huge projected budget deficits are one part of this devastation because we pay for more than half of our health care through public sector programs such as Medicare and Medicaid.
It is indisputable that we need to get off this health care cost growth path. There are two ways to do it. One is to give people less care, the other is to reduce the amount of money that we pay providers.
If we look to other countries, what makes costs in the United States so much higher is not that we get more care than people in Canada, Germany, the United Kingdom and elsewhere. The difference is that we pay much more for our care. We pay more to the pharmaceutical industry for our drugs, more to the medical supply industry for medical equipment, more to doctors and especially highly paid specialists and we pay way more to our insurance industry.
A genuinely courageous senator from Oregon might stand up and suggest ways to get our payments more in line with the rest of the world. But some of the main beneficiaries of these overpayments are in the 1 percent. They are not interested in a solution to our health care cost problem that will reduce their income.
Therefore if Senator Wyden had gotten up and proposed to reform our system in a way that is likely to bring down costs he would have been either ridiculed by the media or ignored. Proposing a Canadian-style universal Medicare system is not the way to get on the front page of the Washington Post or to fill campaign coffers, a fact that Mr. Wyden understands very well.
If Senator Wyden was really interested in holding down costs instead of denying care he didn’t even have to make the big leap to a whole new system. He could have followed the suggestions that Columbia University economist Jagdeesh Bhagwati and I put forward for opening up the U.S. health care system to international competition.
Wyden likes vouchers; why not give people a Medicare voucher that would let them buy into the health care systems of Canada or England and split the tens of thousands of dollars of projected savings with the government? Why not make it easier for people to get expensive medical procedures at world-class facilities in the developing world that charge a fraction of the price – and let the patient share in the tens or hundreds of thousands of dollars in savings? Why not make it easier for qualified foreign physicians to practice in the United States, bringing down our payments to doctors and health care costs?
That is what someone who really cared about lowering our health care costs would be proposing. But Senator Wyden doesn’t have that sort of courage. Of course if he did, the Washington Post types would do their best to make sure that no one ever heard of the senator from Oregon.
Originally published at http://www.cepr.net/index.php/op-eds-&-columns/op-eds-&-columns/the-cowardly-senator-wyden
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You make some great points. Why do doctors make so much more than teachers, it is not that hard of a job.
http://benbrownmd.wordpress.com/
Probably, with some more administrators we could have much more efficient health care system.
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I am in primary care and finished medical school with a 100k scholarship. Without other debt i still owe 180k back. I spent 11 years between undergraduate school and medical school working 80 hour weeks and 30 hour shifts. I now make $8000 per month and owe $2500 per month in student loans. Had I spent those same 80hour work weeks starting 11 years working minimum wage the math works out that I will have to have done this job for 25 years in order to break even. Does it seem that I am overpaid now? I might as well have been flipping hamburgers than gone into primary care, less stress anyway. The math is crude, but I can show anyone how it works out if they want.
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La Jolla, CA
make medicine not for profit.
Yes, we should have higher subsidies for medical education, both doctors and nurses. There should be be a huge discrepancy between medical specialties incomes, where primaries make 100-200k, and specialists can make 1 million+ (based on UC doctors)
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make medicine not for profit says
Many of the proposals that come forward for medical reform include a discharge for student loan payments. You might only bring home $5500 a month with competition, but if you didn't have that student loan repayment, you'd be taking home the same amount of income. You are right, the cost of higher education has to come down for something like this to work.
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Anchorage, AK
"It is indisputable that we need to get off this health care cost growth path. There are two ways to do it. One is to give people less care, the other is to reduce the amount of money that we pay providers."
There is a third way: decrease the overhead costs of health care and make it more efficient. Administrators, CEOs and attorneys don't provide care: doctors, nurses and allied professions do.
Why leave out the other side of the story about the unbelievable growth of the administrative burden of medicine, Patrick??
NO country has a federal law like HIPAA that increases costs substantially by creating a mountain of paperwork for everyone in the health industry. (HIPPA was passed in the early 90's...look at Joebo's chart above to see how administrative costs have exploded as a result, but patients aren't any better off, of course).
NO country has as many malpractice lawyers, who increase costs by making doctors practice defensive medicine, not preventive medicine. No one criticized John Edwards about how he got wealthy, and he lives much better than any physician.
NO country has so many redundant licensing and credentialing bureaucracies that raise the cost of business for everyone in health care. This cost HAS to be passed on to consumers, and our taxes pay for even more bureaucrats.
NO country has such high medical education requirements. Even in Canada many residencies and pre-med requirements are shorter and less burdensome financially than in the US. Medical education debt is nowhere near as high as in the USA in any country.
Even Canada does not allow drug company ads, which raises the cost of R&D tremendously because marketing to the public costs much more than marketing to doctors. Also, there is no sense of entitlement which means Canadians, etc. don't need an MRI or an expensive pill for everything. Turning health care into a dog and pony show has only raised costs for everyone.
There are many other factors not mentioned, but the health care debate on this website loses legitimacy when it only looks at one side of the formula.
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Menlo Park, CA
NoSingleOne says
I didn't write that article, Dean Baker did.
And you're helping to fill in the story about administrative costs. Please say more.
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Anchorage, AK
Sorry, Patrick. I should have known. You don't even live in Oregon.
I work in health care. I just get frustrated because I often see that special interests put a lot of effort into ignoring what I think are the worst issues driving up health care costs.
However, railing against administrative burdens means railing against the government, and many progressive people who ought to know better shut down because they think you are a partisan. They don't realize how government financed health care is mismanaged...especially health care regulation and transfer payment programs. The private sector has its abuses too, which are much better documented by Mr. Baker's article.
Many private industries (particularly the legal and marketing industries) also parasitize off of health care, which raises costs even more while providing biased information about what constitutes good care, and unrealistic expectations.
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Santa Cruz, CA
There are several reasons why health care is more expensive in the USA but one is it's BETTER.
Sorry folks, but you have probably not been to a hospital in England or Canada or Mexico.
Medical Doctors are a bit more expensive here in the USA and they are worth it. But, it's true that the burden of debt for their education makes doctors expensive compared to other labor. Are doctors as well educated as the average MBA? Are people complaining that MBAs are overpaid? Do people know how little education a lawyer has compared to a doctor? Do people complain about the price of lawyer's labor?
The surgeon in the USA is far more capable and educated than other labor in the USA and around the world. This costs money, if you want the best in any field, it costs money.
Actually, doctors are paid very little if the patient is on medicare. I saw that my mother's nationally recognized oncologist was paid about $50 for an appointment. That's peanuts and an insult to the doctor. This is the reason that they see you for just long enough to get the job done. There is no time for chitchat when you are being paid poorly to see patients.
We have a unique situation in the USA with ambulance chasing lawyers. These guys cannot shine an average surgeon's shoes.
All of the efforts of the insurance industry to become efficient are prevented by Goverment.
All of the efforts of doctors using high technology like MRI, CT scan, etc. to bring down costs are ruined by ambulance chasers making doctors perform a lot of extra "defensive medicine".
All of the efforts of Americans to pay for health care are ruined by the deadbeat illegal aliens who rip the system off and get everything for FREE. I lived in Mexico for a few years before California and I know a bunch of them. They pay zero for health care. Their employers pay zero. The taxpayers are all on the hook.
The vast majority of surgical procedures and wonder drugs have come from the USA because there is a profit motive to do so. The DaVinci surgical robot was NOT invented in England or Canada. Amazing drugs like Neulasta were not invented overseas, but here in the USA.
Usually scumbag lawyers who also often become politicians want to get over on doctors, they have not gotten over the envy of their betters.
My blood was boiling when I heard Obama speaking without his teleprompter saying that doctors did unnecessary procedures to make money. What a lying prick.
If you think American doctors are overpaid, I suggest you take a trip to Mexico, or perhaps Cuba. See how that works out for you. I am not talking about lasik, dentistry, or plastic surgery. I mean go there when you are very SICK. Oh, no American wonder drugs, MRI, or CT scans allowed.
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Get healthy, stay healthy and have a low monthly policy with a super high deductible, just in case. Don't pay a high monthly premium, if you can help it.
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We pay $283 for a family of 4 and a $5000 deduct per person. If they raise my rates i am going back to esurance and filing for a new plan. $283 imo is still way too much for nothing. We never use insurance cards even when once a year or less one of us visits the doctor. One time i needed a procedure done, i had 2 choices for how to pay:
1. Use insurance and be billed 4750.00 to insurance. I would have ultimately paid $2750 after the then $2000.00 deductable. $2750.00
Or
2. No insurance card and be billed $1570.00 out of pocket. $1570.00
I saved about $1200 not using the ins. Card.
I find this a lot when we use a doctor. 2 prices. 1 for the insured and 1 for the unisured . They tell me its because the ins. Co has predetermined rates etc.
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If you don't like pigeons pooping on your patio, don't put the seed out for them. Same for insurance, avoid high premiums if you can.
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elliemae's website
KILLERJANE says
A couple of years ago was diagnosed with a serious chronic health condition that's not lifestyle related and there's no cure; just sayin' that not everyone is blessed to be able to obtain cheap insurance. If I didn't have it through my employer it would be beyond my financial capability to buy it.
So far as make medicine not for profit says
I believe that any profession that requires a huge amount of time and effort should be reimbursed at a higher rate. Once they graduate and start practicing, there are hours of on-call and malpractice insurance... they should make more than an engineer or other professions.
I don't begrudge physicians for being overpaid (although some do make huge amounts), they devote their lives to their craft. I do have a problem with hospitals making huge profits, etc.
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elliemae says
Wow really awwwwww i thought we were all exact duplicate fuckin robots!!!!!!!
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46 male
Menlo Park, CA
KILLERJANE says
Why so low? I can't find anything close to that. Our family of 4 payment is more than $700/month with an $8,000 deductible per person. What state are you in?
And more importantly, does that policy really cover anything at all?
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clambo says
Uh, not true. US health care is not objectively better by any measure you pick. It's worse by pretty much all measures than any of the European systems, or Japan, or Taiwan. Or Australia.
I've used the medical system in Germany and the Netherlands and I don't think the US is at all better, and the European systems cost half as much as ours, or less.
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Buffalo, NY
KILLERJANE says
And what if you're not born healthy? Not everyone who is disabled can't work. Many can but choose not to because they would never be able to get care for the conditions they do have, or pay for the medicine they need to continue working.
What about accidents or infectious disease or diseases that can strike anyone, no matter how well you care for yourself?
What about those who are too poor to afford healthy food and end up fat but malnourished because the food they can afford has little nutritional value?
I could go on and on, but this idea that only the lazy with unhealthy lifestyles that they chose need reliable healthcare beyond a catestrophic plan is wishful libertarian thinking. Bad things happen to good people that are outside the market's influence, and market forces that promote freedom for one set of individuals can limit the freedom of poorer or weaker individuals. Reality doesn't fit your 'get healthy, stay healthy' quick fix.
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Patrick says
I am currently in los angeles...but bicoastal between here and florida. Go to esurance. Does not cover maternity well i believe. This insurance covers one you have 5000 in medical expenses. The way i figure it, because we are healthy, worst case scenario is an emergency.
Esurance. Our carrier is humana PPO. The deal when i signed up with them is that they cannot raise the rate for one year.
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futuresmc says
That is why i said, "if you can". But for my family, we can. I am thankful we are all in decent health.
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futuresmc says
That is just an excuse. The fact is their is great nutrition to be drank if only doctors, schools etc. were really educated about nutrition. I have good and bad habits. But my good green juice really helps allow my body to have enough nutrition to help repair it. The body is suppose to heal itself, most of the time it can't get around to doing that when it is busy digesting all the crap we dump into it.
It costs 1.50 bunch for organic kale at the farmers market. Traders sells a bag of organic apples for under 2-3 bucks...
I am not trying to argue with anyone here, just offer up what i have come accross and learned.
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Buffalo, NY
KILLERJANE says
Nope, not an excuse. The people who work two or three jobs can't dash about farmers markets to find cheap kale or organic apples, not to mention spend the time to prepare it. Low nutrient, pre-prepared food, is cheap and you don't have to put in all that extra effort after a 12 hour work day on your feet, helping your kid with their homework, doing a load or two of laundry, etc. Face it, when you are poor you often don't have time or money, as all of it is eaten up in survival. That farmer's market lifestyle is a professional class thing.
What we need is subsidization of healthy foods, or at very least, a removal of subsidies for garbage. We need healthier foods in public schools, not pizza sause as a vegitable. The larger society sets the tone. What the larger society is saying is that a poor child's health is not worth the extra taxes to pay for fresh fruit and vegitables in cafeterias, or provide daily physical education, or free preventative medical care. We tell poor parents its their responsibility, yet do nothing to protect the wages of low skilled workers, so that they have the time and energy and health to provide those lessons, and the nutrient rich, low fat, salt, and sugar, diet for their kids and themselves.
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Yes. All must die. Health is the last thing needed. Brilliant.
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The US system is better than any other country if you are very SICK.
Want proof? If they can afford it, ALL rich people from ALL foreign countries come to the USA for their medical treatment. That's a fact.
When your life is on the line, you come to the USA.
If you want snake oil, incompetence, people who bought their diplomas, dirty hospitals, and free care, by all means go overseas.
I wrote before, I am NOT talking about plastic, dental, Lasik, etc.
If you get PROSTATE cancer, and you want them to do surgery using the DaVinci robot, will you have it done in the country where it was invented? Or, will you take a plane down to Costa Rica to save money? Bullshit you will have it here.
If you have kidney cancer and you want a "partial nephrectomy" using that same Da Vinci surgical robot, will you have it done here or will you fly over to the Philippines?
You sure can't go up to CANADA and have it done, they 1. don't have davinci 2. don't think you need the surgery 3. a pakistani doctor will remove your entire kidney for you however.
I am tired of the ignorance and foolish nonsense from people who have 1. no experience in medicine. 2. no experience living in England to see their health system 3. no experience living in Japan 4. no living experience in Mexico.
I do have this experience and their health care SUCKS when you are very SICK.
Are we even going to mention China? Something hurts? Take two seahorses and call me in the morning.
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clambo says
ALL rich people from ALL foreign countries?? That's a FACT. Really?? Even if that were so, which it isn't even close, where else are they going to go? The rest of the first world has public medicine. You have to be a resident to use the health care system anywhere else in the first world unless you have an emergency while traveling. The USA is the only first world country you can just fly into and have medical treatment. So much for proof or being tired of ignorance and foolish nonsense. For what it's worth New Zealand is trying to set up medical tourism within the private system, but the issues of who pays if it goes wrong and a patient must be moved to the public system are not resolved yet.
How long exactly were you a resident in England, Mexico, and Japan by the way? What medical care did you and your family receive there and at what hospital? Was that in the actual public system or some tourist clinic.
Wow the da vinci surgical robot. That's impressive. You know the research for da vinci was originally funded by the NIH (that's in England by the way). You can't get Divinci surgery in Canada. That's really odd, the Intuitive Surgery (they make the DaVinci) website says there are 12 installed in Canada. What do you suppose those silly Canadians are doing with them?
The DaVinci robot is actually in 42 countries (providing Intuitive knows what they are talking about) around the world. Places like China, Chile, Bulgaria, India, Mexico, Turkey, etc., etc.. Do you suppose Intuitive is lying about all this?
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Prince Phillip just had a blocked coronary artery procedure.
An American invented angioplasty of the coronary artery.
An American invented the coronary artery stent.
American medicine is saving the life of a guy in Britain.
I lived in England for a year, two years in Mexico, half a year in Japan.
My friend cut his finger badly in London, we took him to a London hospital in the fancy neighborhood where he lived.
The repair of his finger was botched because there was no capable surgeon. He waited a bit and flew back to the USA to see a microsurgeon to repair the nerve damage so he would have the use of his finger.
My horror stories about medical care in Mexico are too many to start about. I was lucky and was only sick twice but was cured by antibiotics. My friend's younger sister died of a simple problem in the local hospital. My friend fell and dislocated his elbow once which is scary to see and hurts like hell. I drove him all over because it was Christmas day and there was no one present in the local hospital. I drove him to a hospital in the next town over and luckily there were a few guys hanging around who could fix him.
My point is that the Davinci robot was invented HERE because this is where medicine is rewarded with profit. If you remove profit and reward, you get mediocre medicine.
So, for all of Canada there are 12 davincis. Boy they must do a lot of sugical procedures up there with all 12 of them.
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Japanese medicine is interesting by the way. If you have cancer, the doctors will NOT tell you but rather they'll tell your family. They think this quaint custom will help your treatment. I think if I'm the one sick, I want to hear the truth from my doctor, but I guess that's because I just don't understand the cultural nuances of being Japanese.
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clambo says
You lived in England for a year and didn't have private insurance? That is bold, you are a far braver man than I Gunga Din. The NIH is a perpetually underfunded horror show, always has been. I lived in France and had excellent care. WFT did you expect in Mexico, it's a poor third world country.
clambo says
You most emphatically stated that the ONLY place in the world to get DaVInci surgery was the USA. The manufacturer disagrees. Canada probably does get a lot of use out of their machines. Canada has a small population concentrated in a very limited geographical area. They use regional centers heavily for expensive equipment.
You are aware that almost half of research is done with government funding and profit isn't a factor? Angioplasty and coronary artery stent? University of Oregon, Charles Dotter. The DaVinci robot you are so enthralled with. Phillip Green at SRI (used to be Stanford Research Institute of Stanford University) a non profit organization.
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I like how the cost skyrocketed long about the time the "Clintons" were "FIXING" healthcare.
It's just like the way Obama fixed it.
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Ehealthinsurance. Big deductable
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Baltimore, MD
t costs so much because of all the Medicare fraud.
http://news.heartland.org/newspaper-article/2011/12/06/quarter-billion-taxpayer-dollars-spent-penis-pumps
Quarter-Billion Taxpayer Dollars Spent on Penis Pumps
According to data collected by the Centers for Medicare and Medicaid Services (CMS), Medicare has spent more than $240 million of taxpayer money on penis pumps for elderly men over the past decade, and will surpass a quarter of a billion dollars this year for costs since 2001.
One area of concern for CMS is the rise in fraud in relation to the pump devices. Earlier this year an Illinois man pled guilty to collecting more than $2 million from Medicare in a fraudulent operation where he repackaged $26 items from adult websites and sold them to seniors as medical devices, charging Medicare $284 apiece.