Krugman: It’s Health Care Costs, Stupid

[ProSense]

It’s Health Care Costs, Stupid

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In today’s column, I tried to emphasize a point that is weirdly absent from public discourse, at least among VSPs: the favorite VSP “solution” to the long-run budget deficit, raising the Medicare eligibility age, actually yields only minor savings. The point is that if you want to control Medicare costs, you can’t do it by kicking a small number of relatively young seniors off the program; to control costs, you have to, you know, control costs.

And the truth is that we know a lot about how to do that — after all, every other advanced country has much lower health costs than we do, and even within the US, the VHA and even Medicaid are much better at controlling costs than Medicare, and even more so relative to private insurance.

The key is having a health insurance system that can say no — no, we won’t pay premium prices for drugs that are little if any better, we won’t pay for medical procedures that yield little or no benefit

But even as Republicans demand “entitlement reform”, they are dead set against anything like that. Bargaining over drug prices? Horrors! The Independent Payment Advisory Board? Death panels! They refuse to contemplate using approaches that have worked around the world; the only solution they will countenance is the solution that has never worked anywhere, namely, converting Medicare into an underfunded voucher system.

- more -

http://krugman.blogs.nytimes.com/2012/12/03/its-health-care-costs-stupid/

What Defines A Serious Deficit Proposal?
http://www.democraticunderground.com/10021914963

[Warpy]

1. Not only are their stupid vouchers inadequate

no insurance company with a cadre of bean counters worth their name is going to write policies for anyone over 65.

That's why we got Medicare in the first place. Retirees couldn't find private plans anywhere at any cost.

[WCGreen]

13. Ice Flows and Eskimos time...

[jody]

2. Krugman avoids answering whether competition should be allowed to set prices or govt. will take over

such things as research and ultimately production of drugs.

He also skirts the implication that "The key is having a health insurance system that can say no" means some form of health care rationing.

[ProSense]

3. Who exactly

"Krugman avoids answering whether competition should be allowed to set prices or govt. will take over such things as research and ultimately production of drugs. "

...asked Krugman a question?

As for your point on rationing, I think it's utterly bogus.

[jody]

4. Krugman addresses cost of health care. That becomes an issue under socialism when the state is

unable to pay for all health care procedures, hence rationing is necessary.

Please identify one government that is socialist that does not face rationing.

For that matter please identify any government that does not face rationing.

IMO there are none and that's why cutting costs are essential.

That leads to the other question I posed, does Krugman expect competition to reduce drug costs or a government monopoly drug department?

[ProSense]

5. You mean

That becomes an issue under socialism when the state is unable to pay for all health care procedures, hence rationing is necessary.

Please identify one government that is socialist that does not face rationing.

For that matter please identify any government that does not face rationing.

...as opposed to paying 17 percent of GDP in health care costs and having 50 million (expected to climb to 70 million pre-reform) citizens without insurance?

Oh, and the rationing debate happened leading up to the health care reform bill being signed into law. On one hand were the single-payer advocates and on the other were the RW nuts screaming about long lines and rationing in Canada. Look up some of the posts addressing the issue.

[jody]

6. Interesting. Still rationing of health care is necessary and fraught with moral subtleties. I'm not

sure anyone will be remotely happy with the outcome.

[ProSense]

8. Here:

"Moral Hazard:" The Myth of the Need for Rationing
http://www.pnhp.org/resources/moral-hazard-the-myth-of-the-need-for-rationing

[jody]

10. Thanks, I had already read that. nt

[Skittles]

14. you think healthcare is not "rationed" now?

please

[jody]

16. I never said that but so what? nt

[mucifer]

7. We need to ration more. Not every 80 year old with metastatic endstage cancer should be offered a

ventilator and months in the ICU for their final days. That's what's happening in our system now and that's NOT what happens in a lot of single payer countries.

Sorry, we need some rationing. Doctors and patients and families need lots of education on end of life care. That in the long run (and maybe the short run) would save us billions.

A bigger issue is it could save a lot of suffering.

[stopwastingmymoney]

9. Yes

[frostfern]

11. I agree.

The real moral dilemma here is whether it rationed fairly or have it totally based the profit motive rather than actual efficacy. I'm sick of the "I paid into the system all my life" argument when the truth is due to the ridiculous rise in costs a lot of people are taking out far more than they put in. Medicare and Medicaid are social safety nets and we need to be reasonable and fair about it, not have this stupid "me first, screw the future generation" attitude the baby-boom generation has. The only real savings is to lower overall healthcare costs and get the rent-seeking private sector leeches off the government tit. Doctors and practitioners should be compensated fairly for their valuable skill and expertise, but the profiteering middle-men need to get the hell out.

[ProSense]

12. I really don't like your argument. n/t

[Skittles]

15. nice generalization of baby boomers

you do realize we are getting screwed too, right?

[mucifer]

17. I think the end of life discussion should be brought up as soon as the prognosis is known.

Then while people can still make their own decisions, or their relatives have more time to think about it. It should be explained what spending final weeks or months in an ICU is like and what CPR vs dying at home with family is like. The other thing some people are proposing that I like is changing the term DNR do not resuscitate to AND A Natural Death. This might make it easier for people to think about it as a natural process as opposed to withholding important treatments.

You don't even have to discuss the money aspect.

[ProSense]

18. It should be between people and their doctors

This notion that government should decide is ludicrous, and that's evident because of the ageism aspect. It's one of those idiotic slippery slopes that people tend to push in age discrimination. What about a younger person, or a child, in a similar situation?

[mucifer]

19. Kids can live on and on unresponsive in the ICU also. It's the same thing.

Many parents when given the choice chose to take their children home to die with family and the help of hospice care.

[ProSense]

20. "when given the choice"

As it should be. I still say that's between a family and their doctor.

[mucifer]

21. I don't really believe that is true in all cases.

We shouldn't force a body to stay alive for months or years when there truly is no hope and the person is unresponsive. In EXTREME CASES I don't think doctors should have to give the families a choice.

[ProSense]

22. You're

"In EXTREME CASES I don't think doctors should have to give the families a choice."

...advocating that the decision be left to the family (choice) and in the most "extreme cases" the family's doctor.

That's not the same as letting the government decide.

[mucifer]

23. I've seen some cases where I really don't care who it is, but someone should say "no".

It's an ethical question. I know not everyone agrees with me. I do believe many single payer European medical systems couldn't thrive the way they do if the government didn't say "no" sometimes.