The Minnesota State Fair is going on right now. Unlike many state fairs, Minnesota’s is located in the heart of the metropolitan area, just north of St. Paul, just south of the University of Minnesota. And so the fair becomes a huge magnet, not just for people coming out to eat pronto pups, but for politics. If you’re a Minnesota politician, you’re going to have to put in time at the fair. Indeed, former Sen. Rudy Boschwitz, R-Minn., best known nationally as the guy Wellstone beat, built a huge following based on the fact that he had a booth at the state fair where you could get root-beer-flavored milk. I am not making this up.
Anyhow, because the state fair is a magnet for politicians, it’s also a magnet for political activists. And here in the silly season, that means that there are roving bands of teabaggers looking to challenge DFL elected officials on health care.
One of these roving bands decided to take on freshman Sen. Al Franken, DFL-Minn. And the discussion that followed was exactly the sort of discussion that we should be having.
I have expressed concern about Al Franken being too partisan as a senator; I’m not opposed to him being liberal, but by the same token, I know that successful politicians are able to fight their opponents with a smile.
This discussion is Franken at his best. Franken doesn’t talk down or attack people who want to attack him, lays out a sensible case for health care reform, stresses points of agreement between everyone, and generally disarms people who see this as a socialist plot to steal sick people’s bodily fluids.
The reason, though, that Franken is successful here is that he knows what the hell he’s talking about. He’s not rattled by the hokum; he’s interested in countering it and refuting it, and trying to bring along as many conservatives as he can.
I understand the argument that Democrats should give up on seeking GOP votes for health care reform, that we can water down the bill so far that it only realistically allows the poor access to high-deductible plans, which they then are required to purchase. There are health care bills that are a cure worse than the disease. And while I am not in the camp that thinks jettisoning the public option is the point of no return (I’m far more concerned about making sure subsidies are robust), I am decidedly in the camp that thinks that progressives are right to push hard for as good a bill as possible.
But that doesn’t mean we should stop talking to Republicans. Yes, GOP politicians are going to spew bile, and GOP talk show hosts are going to spread conspiracy theories, and there’s a big chunk of GOP activists who really believe that Barack Obama is going to use mind control powers to steal their children. But there are also Republicans out there who are Republican because they haven’t been engaged by anyone who knows what they’re talking about. Republicans who might not agree with the health care reform bill that’s passed, but who could at least be persuaded that it isn’t a Trojan horse for Stalinism.
Part of a politician’s job is to engage with people that disagree with him or her. To show those people respect. To listen to them, and to attempt to persuade them. One can do that the way the Republican party does, by endlessly looping a few basic talking points. Or one can actually try to, you know, engage adults like adults, talk to grown-ups like grown-ups, and explain what one believes. In the end, the Democratic Party needs its leaders, including the President, to start emulating Al Franken here. To fight opponents of health care reform, not with anger, but with truth. To accept that we may disagree with each other, but to believe that disagreement is no reason for bitterness. Yes, it sucks that Democrats have to be the grown-ups — for it is more fun just to shout back at the shouters. But someone has to be the grown-ups. It might as well be us.
(Via Dusty Trice.)
Now compare Franken with Barney Frank comparing protesters to furniture without attempting to give the appearance of addressing their pretended concerns. Not that Rep. Frank could have won the encounter, but I can easily imagine someone who was honestly confused seeing Rep. Frank refusing to engage. But Sen. Franken engaged.
He’s got some experience dealing with hecklers, I’d guess. It obviously helps.
I’ll give points to Sen. Franken for how he handled this. But note that he left unanswered (honestly, because he said he had no answer) the question of how this is all going to be paid for. That’s especially important because people keep holding up Medicare as an example of “Look, Medicare works, so what’s wrong with govenrment-run healthcare programs” when in fact it’s NOT working. Sure, you pay a lot less for care if you’re a Medicare patient. But the facts are that it’s not working for the people paying for it; it spends more than it takes in now and with no changes in either health care costs or tax levies it’s projected to run out of money completely in 2017 or earlier. Someone who retires then after paying money into Medicare all their lives will get nothing for all the money they paid. Nothing.
Saying Medicare works is like saying your household works because you can pay the rent and the grocery bill while ignoring the fact that you’re using your credit card to do so.
So – did he handle the crowd well? Sure. Can he answer a basic question? No. Will he vote for a healthcare plan backed by the Obama administration even if it leaves that basic question unanswered? Unknown. If not, then he’s doing his job. If so, then he’s a political hack.
Ron, the Democrats have instituted paygo rules.
Unless they change the rules — and I’ve been watching the debate closely, and I’ve seen absolutely zero support for that among elected Democrats — it is literally impossible for them to pass a health care bill that doesn’t pay for itself somehow.
However, so far there is no agreement in Congress (even among Dems) of how to pay for it, among several competing mechanisms. The debate isn’t over whether to pay for it; it’s over how to pay for it.
Senator Franken glosses past a point which I think is a very strong argument, and one which you would think would be persuasive for free-marketeers of all stripes:
Because health care is tied to employers, and usually to full-time employment:
People are scared to start businesses, because they have pre-existing conditions, or children with pre-existing conditions; and
People are scared to take a part-time business to a full-time level, because they are worried that they can’t afford healthcare for themselves, or they can’t provide it to employees; and
People don’t want to work a 3/4 job, because it doesn’t come with health care. So the people who work multiple jobs often work a full-time job, and then part-time jobs on top of that. (I myself have one full-time job, which includes overtime, and two part-time jobs. Someday I’d love to take one of the part-time jobs full-time, but I have a pre-existing condition, so the system is going to have to change, or I’ll have to have retirement income, to make that at all worthwhile.)
I think that if we eliminated the spectre of loss of coverage, such that everyone had access to an essentially level playing field for their healthcare, we would see a tremendous boom in entrepreneurial activity.
We would also see tremendously more worker mobility, with a consequently more dynamic labor market. Supply-and-demand could operate much more freely if people could take a 3/4 job which paid as much as their full-time job, and not worry about leaving their family with health insurance.
Leave aside healthcare, and we would simplify the playing field tremendously, forcing employers to compete much more transparently on such things as wages, retirement benefits, location, opportunity, and so on.
There are a number of ways we could do this, but however we do it, we have to eliminate the ability to deny coverage or charge significantly more for pre-existing conditions, and we have to end the practice of recision.
Grace
From The Atlantic: How American Health Care Killed My Father
Thank you for posting this. And yes, just because some members of the GOP are throwing sand in our eyes does not mean we should leave the sandbox.
Well Amp, if they have, how is it that a Democratic Senator that is being held up as an example of how to handle questions on healthcare changes seems to not be able to articulate them but instead says he doesn’t know how this is going to be paid for?
Grace, I second your question of why should health insurance be tied to employment. I have no ready answer myself, but it’s the kind of question that needs to be asked and explored. What other systems for this are you aware of?
Ron, as I said, we don’t yet know how it’ll be paid for. There are a number of competing proposals, and no one proposal (or combination of proposals) has yet captured the support of a large majority of Democrats in the Senate.
But there isn’t any actual doubt that the bill will be paid for. There are several competing proposals on the table, but none of them are “just add it to the deficit.” That would be unacceptable to too many Democrats to be politically viable; it simply wouldn’t be passable if it added anything significant to the deficit.
The big danger I’m worried about is that the Democrats, in an attempt to make this bill much less expensive (and thus get the extra 1-3 votes they need to get up to 60 votes), are going to cut too deeply into subsidies for low-income people, and make the insurance available cheaper (and thus not as good). Forcing people to buy lousy insurance they can’t afford, is the worst of all possible worlds; but it’s looking like a real possibility right now.
(By the way, is there any right-wing equivalent of that? Was there a group of Republicans in congress who refused to vote for right-wing priorities — Bush’s tax cuts, say, or invading Iraq — unless they could be made deficit neutral? Because as far as I can tell, the Republicans have never cared about the deficit when caring about the deficit would impede their own priorities.)
Whether or not this bill passes, there’s also the fact that health care as a whole — not just the government portion of it — has been rising very fast as a percentage of GPD, and over the long term that’s not sustainable. That problem is neither caused by nor solved by this bill, although there are a few things in this bill which might begin to chip at that problem.
Whether or not this bill passes, there’s also the fact that health care as a whole — not just the government portion of it — has been rising very fast as a percentage of GPD, and over the long term that’s not sustainable.
Why not?
Imagine the comics industry produces 1000 titles each year, all of which sell more or less well. Total spending on these 1000 titles is $100 billion a year. The industry is stable, sales are flat but steady.
On Jan 1, 2010, Barry Deutsch announces his new MegaComic line of annual books. Each book is 1000 pages and costs $500 and is totally awesome. Demand surges, and another $20 billion worth of MegaComics are sold in 2010, bringing the total market to $120 billion. Nobody gives up any of their previous titles; this is all new business.
This happens year after year. In 2011, the market is $140 billion. In 2012, $160 billion. And so on.
Is the 20% annual growth rate in comics a sign that the industry’s growth is unsustainable? Or is it just a sign that new products have come out, stirring demand?
Is the 20% annual growth rate in comics a sign that the industry’s growth is unsustainable? Or is it just a sign that new products have come out, stirring demand?
Answer: it’s an apples-to-ostriches comparison. Comic books, while entertaining and enjoyable, are not life-sustaining, except for those who draw them. Health care is. I have a choice whether or not I want to buy Barry’s comic; I suppose I have a choice whether to get bypass surgery, too, but the latter leaves me dead in two years if I don’t get it, which makes it the kind of decision that’s not really a decision at all. Bypassing Barry’s comic merely leaves me less entertained than I would have been.
Right now, the American system is geared to reward doctors who order expensive tests, and reward drug companies for creating new, expensive drugs. There are ways to remedy both without sacrificing care; the Mayo Clinic, which at last report was a pretty good hospital, determines compensation for doctors based on the illness and their success at treating it, not based on the number of tests run. That makes the incentive for doctors to search for the proverbial horses rather than the proverbial zebras, and, to mix metaphors even more, to focus on four-yard-runs rather than Hail Marys. Given that my ex-wife’s mom and dad are both alive thanks to Mayo, I tend to give them a bit of respect.
I agree with that critique of the system.
But the point of my example is that “unsustainable” growth rates may (in some measure) be the result of people being able to choose new things rather than the result of existing things costing more or too much.
To put it back into medical terms and let our tortured metaphors rest for a bit, I am pretty sure that the medical care I could get in 1970 on a cash basis would cost me significantly less today on a cash basis, corrected for inflation and economic growth. By that I mean that if a broken arm in 1970 would have cost me fifteen hours of labor at my job as a file clerk, in 2009 I could get the same setting and cast for thirteen hours of labor as a file clerk.
The difference is that now there are all these awesome procedures and tests and drugs that the doctors of 1970 dreamed about, and naturally they cost a lot. Open-heart surgery was new and cutting edge in 1970, and super expensive, to boot – today it’s much cheaper.
I don’t dispute that there is some cost growth associated with bad practice, but I suspect that the vast majority of cost growth is associated with good practice of new (and expensive) medicine. In other words, we’re not so much paying more because things have gotten more expensive, we’re paying more because we have more money than we used to and there’s more to buy.
That kind of growth is “unsustainable” in the sense that it doesn’t go on forever, but not unsustainable in the sense of being the result of something about to break.
And, if you do get it, how much more life does it give you? One month? Six months? One year? Five years? Do you know how big the benefit actually is?
Well, I don’t know the answer, but, since this is the Internet age, I can probably find out just what kinds of benefits coronary artery bypass grafts have been proven to have.
::does some research::
Ah, here’s some relevant data.
The (indeed real) benefits of bypass surgery seem to be more long-term than short term, So, if you’re going to die in two years without it, it probably won’t postpone your death very much, but differences in mortality rates do start to become apparent after five years. And it tends to reduce angina symptoms, as well. (It still might make a person wish that he or she had gotten more exercise in the past, though.)
Considering that 46% of medical treatments are of unknown effectiveness, it kind of makes you wonder just what people are getting for their health care dollar…
My understanding is that healthcare’s link to employment is an historical artifact: during World War II, wages were frozen, and so employers could only compete for employees by offering benefits. After that, the system stuck.
As I understand it, pretty much no other country does it that way. So there are, at least, tens of other ways of doing it. For further details, I defer to others who know more about these other systems, and more about the proposed legislation.
Grace
That kind of growth is “unsustainable” in the sense that it doesn’t go on forever,
Certainly technically correct since it’s not clear that the universe will go on forever and humanity certainly won’t. However, why shouldn’t the rapid growth of medicine and the associated industry be thought of in the same way as the rapid growth of the computer industry or the service economy? We don’t need all that many people to produce food or goods any more, people need to do something. Why shouldn’t they spend their time finding and implementing newer and cleverer ways to keep each other alive and healthy? With that framing, the real problem is not the “runaway growth” but the fact that our stupid economists haven’t come up with a way to make it work economically yet. Any economists reading…?
As I think about this, I keep on coming back to the “it’s a matter of life and death!” concern, that works like this:
1) We decide to provide basic health care to everyone, somehow.
2) We draw a line–somewhere, anywhere–based on what we think we can afford. (Even if we actually want to provide more, we can only provide for what we can afford.)
3) Someone ends up on the other side of that line.
4) That someone raises a holy fucking shitstorm.
5) The government responds. The line gets moved. The special drug gets provided to some woman even though it costs $400,000 per year; the much-loved and TV-famous 7 year old boy gets the expensive surgery to prolong his life by 7 months; the old man gets a bypass.
6) Because government is bound b6 precedent in a way that corporations are not, the exceptions result in moving the line.
7) Now there’s a new line.
8) Which brings us back to #3.
How exactly do y’all think that this is to be avoided? All the pro-healthcare writing I see seems to sort of conveniently step aside from the question of exactly where that boundary is. Or exactly how it is to be determined.
And that’s a damn important boundary.
I think that the system will rapidly crumple under pressure from people wanting more care.
Sailorman, you hate the poor and are a racist.
Forgot to say:
I think Medicare is different, because generally speaking the people who are on Medicare view it as a benefit, not an entitlement. IOW, they are quite well aware that many people in the U.S. don’t get health care, so although it doesn’t mean everyone on Medicare will roll over on their backs, it serves as a psychological incentive to accept it. It’s always good to be better off than someone else, at least mentally.
Universal care is being presented as an entitlement. And people feel very differently about their entitlements.
Your experience is very different than mine. I view it to be precisely the opposite of what you think.
Thank God someone is saying this.
I don’t know how many Liberals/Progressives I’ve run into that don’t seem to believe this. It’s really depressing how quick people whose causes I might support are to demonize anyone who fails to toe their political line, and to demonize even people who do toe the line but treat those who don’t like human beings.
One of my favorite quotes is from Barney Frank (from Wait, Wait, don’t Tell Me), where he says (more or less) that an essential skill in politics is the ability to work with people whose political positions you despise.
Sailorman: this the kind of thing you meant? She didn’t get the care in this instance but the situation puts pressure on to expand the benefit.
Sailorman, that concept is at the center of this whole conversation. Right now healthcare is a right. Just like guns and printing presses you can buy as much of it as you can afford. No one has the legal ability to stop you from buying it because you are black/gay/Catholic/Martian, or because someone else can’t afford as much as you can.
What people are talking about is turning a right into an entitlement, the most expensive entitlement that this country has ever considered. That, with what is right now an inadequate model for how it’ll be paid for (and Robert’s scenario will only expand that cost) and the rather frightening idea of expanding government control over healthcare, is what’s got everyone excited.
Add to that the fact that government’s record in running the current largest healthcare entitlement – Medicare – isn’t exactly stellar, what with the billions of dollars of debt, the failure of taking in as much money as is going out, the liklihood of going completely bankrupt in 2017 (about when I retire) and reimbursement rates well below market such that numerous doctors (like my mother’s) refuse to take Medicare patients – thus rather falsifying the concept of “choose any doctor you want”. It doesn’t engender confidence of giving government MORE control, or money.
I am actually in favor of some sort of universal health care system. But I bet you can’t tell what I mean! From my perspective, the very language that people are speaking is based on assumptions that are so widely diverse to make communication ineffective.
Words like “reasonable” or “basic” or “affordable” surely mean very different things to me than they do to you. Or to Obama, or Al Franken, or anyone else.
So even if two people agree that folks should have basic health care with reasonable limits at a price that they can realistically afford, it’s meaningless.
Roy and Louise agree on basic universal health care…. but Louise Liberal walks away from the conversation thinking that everyone will get very low cost health care, including everything from psychological services on up, without regard to citizenship. Roy Republican walks away from the conversation thinking that we’re going to provide only emergency care, treatment of communicable disease, and immunizations; and that only to citizens.
So where is that line?
Do we need to provide mental health care at all, for example? If so, what’s the cutoff? Do we provide care for people who are miserable but still functioning? Do we get to push chemical treatment (often both worse and cheaper) over long term therapy? If it includes dental, do we go cheap and pull bad teeth, do we pull teeth but pay for false teeth, or do we spring for the gold crown? And so on.
I say this because this is a HUGE HUGE cost issue. Basic care–and in this context right now I mean really basic care, i.e. “that care which can be performed by a primary care physician in a quick office visit” is relatively cheap. Care requiring specialists is more expensive (gotta pay for those extra years of residency and/or training.) Care requiring hospitals, more so. And so on. Between each level of care it can be a nearly exponential increase.
There are millions of issues, each with its own lobbying group (informal or no.) To use an example group which has been the subject of the last few posts: What would someone be entitled who felt like they were in the wrong body, gender-wise? Therapy, Zoloft, hormone prescriptions, minor surgery, full surgery, etc.? Does it matter how miserable they are; does it matter how much it costs?
Surely there are some folks who think only full treatment is ethical; surely there are some folks who think that giving antidepressants satisfies all our moral obligations. Each of them thinks the other one is insane.
Or, to quote my mother: Anyone driving faster than I am is a maniac; anyone driving slower than I am is an idiot.
Ron, please try to confine yourself to the facts. What’s being proposed is far, far from as expensive as the most expensive entitlements.
The Health Care bill is projected to cost approximately $100 billion a year (or a trillion over ten years), give or take. Not all of that is the entitlement portion, but for the sake of argument, let’s say $100 billion a year.
Social Security, in contrast, costs a little over $600 billion a year.
In fact, the health care bill wouldn’t even be the most expensive health care entitlement program. Because there’s Medicare, which costs over $460 billion a year. (Source).
And let’s not forget the employer health insurance tax deduction.. This subsidy costs $250 billion a year.
So no, this wouldn’t be anywhere NEAR the most expensive entitlement.
As entitlements go, the health care bill is actually comparable to the homeowner mortgage deduction, which costs the federal government around $100 billion a year. (Source.)
(The health care bill also costs much less than making the Bush tax cuts permanent would, btw.)
Something that seems to get lost on the whole criticism of “how is this immense program going to be paid for” is this:
How does everyone think insurance companies pay for it?
Supporters of UHC are talking about creating a government-run alternative and adding it to the mix, which will, hopefully, force insurance companies to be more competitive and cut out the whole “we’re going to cancel your policy retroactively” crap that we know for a fact the insurance industry engages in wholesale.
And though it will be “government run”, it’s still going to cost those who have it money. And if they don’t like the way the government runs it (maybe because they believe all the b.s. about death-panels), they’re free to choose another non-government option.
Why do you think the Medicare system (with all it’s potential for crashing by 2017 and leaving you without health care once you retire) or a Universal Health Care alternative is somehow worse than paying into a for-profit health insurance policy for 55 years only to have it cancelled when you need it most, just because you started actually… you know… needing it? Now that the insurance company has 55 years worth of your cash and has been investing it to make millions of dollars and you need a couple hundred thou back and they can say “No. Sorry. In fact, we’re firing you as a client.” How is that better or even comparable?
Don’t get me wrong. I’d love for the government to get it right on the first shot. But even if they don’t, I know that I have some kind of legal recourse to fix it.
But the way it’s done now, the only recourse I have is to die and hope my kids can recoup some costs when the litigation is settled.
That is a critical question, with no easy answer. There is, and will be, much societal debate about it, and a lot of that debate will be hot.
Expecting that question to be completely settled before we change the system, though, is putting the cart before the horse. That question is always with us.
The distinction is that right now, that battle is being fought in ten thousand little skirmishes, where society doesn’t have to pay much attention, and where the insurance companies can stick it to individuals within the comfort of a huge power disparity. If there were basic (whatever that turns out to mean) coverage for everyone, then that debate would be out in the open, where enough people would feel the impacts (of both coverage and cost) that they could advocate more effectively as a group.
In my mind, the real question is one of equity. Are we all going to be in the same boat, however we construct and maintain that boat, or are we going to be in a thousand smaller boats, where the captain of each boat has much more power relative to the passengers, and can pitch a paying passenger overboard (recission)?
Right now, we have a lot of people in the water, and a lot of boats motoring past them. “Can I come aboard?” the people in the water yell. “How much can you pay?” the captains yell back, “and how much do you weigh?” [pre-existing conditions]
And the boats motor on, riding high and confident. And why not? If they start to ride lower in the water, they can always throw the heaviest passengers overboard.
Maybe if we make a berth for the rail-thin passengers, and the captains, contingent on a berth for the people in the water, they’ll start to care about the people in the water.
What gets covered, and how, is by far a secondary question. Critical, but not the most critical.
Grace
By
1) picking and choosing their patients, to get primarily healthy ones;
2) dropping people who look like they’ll be expensive;
3) negotiating extraordinarily low-cost deals with physicians, forcing the physicians to pass off the added expense to other parties; and
4) limiting coverage of issues.
Only one of those can be expanded to apply to everyone, and it’s #4.
It’s not. Medicare is way better. (and I’m not sure, if you’re responding to me, how you come up with what I purportedly think.)
I *also* think that not everything is expandable. Medicare reimbursements, for example, are incredibly low. Many doctors don’t take them. Many of those that do take them limit their number, so that they can make enough money elsewhere. Medicare can work because there are other ways to pad the budget (private pay, some insurers, etc.) But it doesn’t seem feasible to ask every single doctor and hospital to take only medicare rates, for example.
And therein lies both the solution and the problem.
Maybe you’re reasonable. But whether or not you are, there are plenty of unreasonable people getting their legal recourse ready, if you know what i mean.
Is this meant to be an empirical claim that doctors and hospitals could not survive if they got paid for every patient, but got paid on Medicare rates? I find that implausible. The majority of my dad’s patients are on Medicare (he’s in cardiology, a somewhat geriatric field), and they impose a much lower administrative burden on him than the private insurance patients do. Medicare always pays. If everyone is on Medicare, you don’t have to have a half dozen non-medical employees whose sole purpose is to argue with insurance companies and have to go after the patient for what the insurer refuses to cover, or just eat the cost.
Dad doubtlessly would miss sometimes getting paid in catfish or deer meat by patients trying to make good on the debt, but I’m pretty sure having everyone on Medicare would make his life easier without decreasing his income by much.
And of course even if we went to a single-payer system, providers wouldn’t have “to take only medicare rates.” As they have done in the UK, private insurers would offer to “top up” the basic level of care provided by the state (interestingly, even though the standard claim is that employer-provided health care is merely an anachronism of WWII price controls and tax benefits, the Brits I know who have private insurance get it through their jobs as well). Providers would offer nicer treatment for those on private insurance, which would pay more than just the basic Medicare level insurance: private rooms, jump to the head of the queue for lab testing, etc.
It is entirely possible for private insurance to co-exist with public insurance even in the British NHS system, which is the most socialist version, with many doctors directly employed by the government and many hospitals directly owned by the government (something Medicare for all doesn’t entail). What about the U.S. makes people think that private insurers would disappear here, when they haven’t done so elsewhere?
Faith.
Change. (Not that i think they’d disappear, but to answer the question…)
We are farther away from a single payer system now than we were before. We have an ever more capitalist health care system than we did before, and we have working conditions and economic conditions that make it more difficult to adopt single payer than in, say, 1970.
Doesn’t mean we can’t do it, but there’s been a cost IMO of waiting. The worse we get, and the farther away from ideal we are, the greater change that will be required.
And it is perfectly reasonable to think that different levels of change will breed different results.
Sailorman,
Sure, but “change” is an issue for any comparison (I think we went over this with Robert in another health care thread). It’s pointless to look at states as “laboratories of experimentation” for policy if every time someone suggests expanding a successful policy to other states, there’s the objection “But what works in Wisconsin can’t work in Florida because they’re so different.” What most moderates and conservatives consider the biggest success of the Clinton Administration, welfare reform, was an expansion of programs pioneered in a few states. If you can’t describe the mechanism by which something will happen, dismissing the examples of where it didn’t happen simply by saying “they’re different” doesn’t help.
There are a fairly decent number of physicians who feel that medicare reimbursement does not cover their expenses. I believe that’s much worse with medicaid, which is of course a different program.
You save on administration. But that doesn’t necessarily mean you save overall: If you see 10 patients at $5000 each and spend an additional $5000 in administrative costs to end up collecting from 7 of them, you end up with $30,000. If you see 10 patients at $2500 each and spend $0 to end up collecting from all of them, you end up with $25,000. Obviously those are made-up numbers, but they serve to work as an example.
Sailorman,
There are a fairly decent number of physicians who feel that medicare reimbursement does not cover their expenses.
Then they can refuse to participate in Medicare. Most physicians choose to participate. Why participate unless you can make money off it? Masochism?
The Health Care bill is projected to cost approximately $100 billion a year (or a trillion over ten years), give or take.
And when Medicare was formulated in the 1960s, it was expected to cost $67 billion a year in 2009 – a difference of a factor of ten from reality.
We don’t trust the administration’s predictions or projections. Leaving aside the thorny question of “will these people lie about the feasibility of something over the long term, knowing that they won’t be around to take the heat in ten years when it turns out to have been a lie”, happy-talk cost projections from ANYONE who wants a government program tend to have the ironclad reliability of a British sports car.