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The Problem With Seniors

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Sadly, it's not only conservative economists who fear that government will get its hands on Medicare. It's seniors. Seniors are by far the least supportive group for health-care reform. Barack Obama jokes about the little old ladies warning the government to "keep its hands off my Medicare," but they were around in 1994, too. The elderly have long been skeptical of health-care reform.

But this is a funny type of skepticism. Seniors don't oppose government-run health insurance. They like it too much. Americans over 65 live in a welfare state that most Europeans could only dream about. They have single-payer health care and government-run pensions. Most of their political activity is either an effort to expand those programs or a defense against anything that could in any way harm them. That includes not only direct changes, like cuts to Medicare, but indirect changes, like health-care reform that would focus new resources on the uninsured.

This is a reversal of the normal politics of opposition. Generally speaking, people who oppose health-care reform are worried we're going to end up with something like what Canada has. Not seniors. They have something like what Canada has (Canada, in fact, also calls their health insurance program "Medicare"). And they like it. They report higher rates of satisfaction with their health care than do people in employer-sponsored insurance. They're worried, rather, that they might end up with something like what the rest of America has. And having spent time in both Medicare and private health insurance, they don't want that. They don't want that at all.

This means, of course, that they oppose health-care reform in uncommonly high numbers because they're concerned about changes to their situation. But for the rest of us, it should serve as a pretty good argument for heath-care reform, and particularly for something like Medicare-for-All.

By Ezra Klein  |  August 4, 2009; 4:57 PM ET
Categories:  Health Reform  
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People on wellfare like being on wellfare so why don't we have wellfare for all?

Posted by: fallsmeadjc | August 4, 2009 5:07 PM | Report abuse

I'm pretty sure that people on welfare don't like being on welfare, and would prefer to make a million dollars, or at least a livable wage.

Posted by: Ezra Klein | August 4, 2009 5:09 PM | Report abuse

How can you claim that a program that is bankrupting the Government is worthy of expansion? It is so poorly run that it loses hundreds of billions of dollars to fraud every year.

Posted by: fallsmeadjc | August 4, 2009 5:11 PM | Report abuse

I disagree a lot here.

Seniors have something no one else in the world has. Unfettered access to almost any medical intervention, with little cost borne by themselves. That's not what Canada has. Or Europe. Or the rest of us in US. So there's little wonder that they oppose any changes-- they've got a better deal than any group out there.

But Medicare-for-all is a misnomer. TODAY's Medicare cannot be given to all. Its simply not affordable. Something more like Medicaid-for-all? Sure. But the sugar daddy (Medicare) is running up credit card debt, and the gig is almost up.

Posted by: wisewon | August 4, 2009 5:14 PM | Report abuse

I'm not terribly impressed with the significance of these numbers. First, seniors in general tend to resist change so you would EXPECT to see that upward curve. Second, the percentage of those who believe there would be no change or an improvement (47%) is substantially greater than the naysayers for every age group. This looks like a really poor argument for doing nothing.

Posted by: adagio847 | August 4, 2009 5:16 PM | Report abuse

They like the checks just as much as people like their Medicare benefits.

Posted by: fallsmeadjc | August 4, 2009 5:18 PM | Report abuse

I'm pretty sure this is another case of "I've got mine" and screw everybody else. A lot of people with job security and relatively affordable medical insurance premiums feel the same way as those already covered by government programs. Mind you, unless they are independently wealthy, they may find cause to see the real need for change if they lose their jobs and face any significant medical issues themselves. It's amazing how quickly those medical bills piles up and how many end up going bankrupt solely due to an unexpected medical crisis.

Posted by: olcranky | August 4, 2009 5:19 PM | Report abuse

Can't you think of a way to improve access to medical services that doesn't involve bankrupting the Government? Is that really the best all of the wise experts can do?

Posted by: fallsmeadjc | August 4, 2009 5:22 PM | Report abuse

Seniors are right to worry about what "reform" will do to Medicare, but only because Republicans' idea of reforming Medicare is getting rid of it. So if all you say is "reform" without telling them what that reform actually constitutes, then of course they're going to be worried.

Posted by: bluegrass1 | August 4, 2009 5:27 PM | Report abuse

"Can't you think of a way to improve access to medical services that doesn't involve bankrupting the Government?"

Yes. Raise taxes on the wealthy.

Anything else you'd like help with?

Posted by: bluegrass1 | August 4, 2009 5:30 PM | Report abuse

It's amazing that Democrats are on the defensive about "changing medicare" when Republicans are the ones constantly railing against "government run health care."

Why the hell can't the Dems put the Republicans on the defensive over opposing a wildly popular government program?

Posted by: SteveCA1 | August 4, 2009 5:31 PM | Report abuse

Let's heighten the contradictions: Medicare for all or Medicare for none!

Posted by: chrismealy | August 4, 2009 5:39 PM | Report abuse

"How can you claim that a program that is bankrupting the Government is worthy of expansion? It is so poorly run that it loses hundreds of billions of dollars to fraud every year."

Hundreds of billions each year? Medicare only costs us $4-500 billion each year. Are you saying half of that is fraudulent? And what about the $1.2 trillion a year we spend on private health insurance, whose cost is growing at an even faster rate than that of Medicare?

Posted by: bluegrass1 | August 4, 2009 5:43 PM | Report abuse

Medicare for some, tiny American flags for all!

Posted by: JEinATL | August 4, 2009 5:43 PM | Report abuse

"Why the hell can't the Dems put the Republicans on the defensive over opposing a wildly popular government program?"

Seriously, it should be pretty easy to get soundbytes of some prominent Republicans talking about getting rid of Medicare.

Posted by: bluegrass1 | August 4, 2009 5:45 PM | Report abuse

Is there any data on satisfaction rates post Medicare Part D? Perhaps the negative attitude is reflecting those changes.

Posted by: elainelinc | August 4, 2009 6:24 PM | Report abuse

fallsmeadjc: produce some medicare stats that show anything close to the level of fraud you claim (with links!) put up or shut up.

I'd think that the Medicare recipients could be easily appealed to with a few key changes to make Medicare better:

- fill in the donut hole on Medicare Part D that has the retiree paying a big chunk of money on drugs between the mimimal coverage and the major annual expense. This is a few thousand bucks for part of the covered, but it is often a few thousand that either makes them eat their pet's food for more time than they can handle (or starves the pet), or they go without the drugs (or take part dosage, which is dangerous).

- Medicare pays zero for vision, hearing or dental care. Add a new Part E to provide these items for a shared premium between the retired folks and the gov't - with the government negotiating the rates. Can anyone honestly say that vision, hearing and dental care are not vital to being healthy?

- Move assisted living (and end of life care) from Medicaid (where states play with your life by budget tricks) to Medicare under uniform rules/payments. (Creating a nationwide new market for workers to care for the very elderly).

Posted by: JimPortlandOR | August 4, 2009 6:29 PM | Report abuse

Let's clear up some "misconceptions" and outright falsehoods by considering an actual senior I know. His SS check is $1150 after the Medicare Part B ($70) is deducted. So, all he has to pay then for health care is $70 (Medicare Part D) and $80 (doctor's copay) and $40 (oxygen) and $120 (copay on three medications), for a total of $310- about a third of his income.

That leaves him a generous $840 for rent, utilities, phone, transportation, and such incidental medical expenses as may occur if his health doesn't stay as "good" as it is.

And this is not some unusual case. The average SS payment is a little under $1000 per month. The average American at age 65 is taking more than three medications on a regular basis.

And the idea that people on Medicare can have any treatment or care they want is total baloney. In reality, you have to find a clinic that will accept Medicare patients at all, be prepared to pay the entire cost of the visit before you see the doctor (they'll give you back some money when Medicare pays them), and accept what you're given in the way of treatment or prescription. The care ordinary people get is nothing like the care rich people get, who actually do get whatever they want.

As usual, I'm left to wonder about some of the characters you meet on the internets, who actually do go around kicking the elderly and disabled with their words and lies. Pretty low, if you ask me.

Posted by: serialcatowner | August 4, 2009 6:52 PM | Report abuse

D'oh! They're scared of healthcare reform because they're scared of their taxes being raised! It's as simple as that. Seniors on fixed incomes are historically as antitax as they come.

Of course, since Medicare is funded through a payroll tax, it's working people who are paying for the healthcare of (mostly) retired people.

Generationally speaking, they're getting a pretty good deal. Snarkically speaking, I guess they don't want to pay their fair share of healthcare for everyone else.

Posted by: rosswords | August 4, 2009 6:52 PM | Report abuse

I'd like to see Obama and the Dems to first bend the Medicare and Medicaid cost curves as proof of concept(s). If they are successful they can use the savings to restore the program's solvency and expand Medicaid coverage for the uninsured without raising taxes or further inflating the national debt.

Having achieved this their political successors would be in a much better position to obtain the single payer which, denials notwithstanding, is clearly their ultimate goal.

Posted by: tbass1 | August 4, 2009 7:27 PM | Report abuse

Ezra - This post is misleading (at a minimum) on a couple things. Medicare is not much like the Canadian system. It's like Canada only in that it is government sponsored. Medicare has no rationing, only modest cost sharing and access to innovations that Canadians can only dream about. US Seniors would not be happy with canadian wait times for hip replacements, MRIs, stents, etc.

Second, I don't think Seniors are worried about having something like the rest of us have. By your own admission, Americans with emplyers sponsored coverage are happy with their coverage. I imagine that Seniors would be quite happy with similar coverage. I agree Senoirs would not be happy with Medicaid. Seniors are rightly worried about health care reform because they know that their level of coverage can't possibly be extended to the general population. Expansion of Medicare would equal reduction in Medicare benefits.

Posted by: mbp3 | August 4, 2009 8:00 PM | Report abuse

"I'd like to see Obama and the Dems to first bend the Medicare and Medicaid cost curves as proof of concept(s)."

That's a BS demand. Right now, you have people in their late 50s and early 60s forgoing treatment from their private insurers (if they have them) in the hope that they can make it to Medicare age.

The fact that Medicare runs as efficiently as it does, when it's the place where all the deferred middle-age health maintenance gets done, is frankly remarkable.

Want to bend the curve of Medicare? A crude but simple way to do it would be to allow people to sign up at 55 and have those conditions treated earlier.

Posted by: pseudonymousinnc | August 4, 2009 8:07 PM | Report abuse

"you have people in their late 50s and early 60s forgoing treatment from their private insurers (if they have them) in the hope that they can make it to Medicare age."

I don't think this is true. Do you have any evidence that people who have employer sponsored health care (which is the vast majority of people under 65) forego health care until they reach 65? If this was the case you would see people join Medicare at a certain health status and then become more healthy as they release their pent up demand for health care. But this isnt the case, the spending per member goes up every year as they age - as you would expect (in other words the avg spending on 65 yr olds is less than 66 which is less than 67, etc).

It might make for a compelling talking point, but Medicare data doesn't back it up.

Posted by: mbp3 | August 4, 2009 9:12 PM | Report abuse

BTW in answer to the question about fraud in Medicare, the GAO estimates fraud in Medicare in 2008 at over $17 B and even higher in Medicaid (about 10.5% of federal spending, not counting state spending).

Also another GAO report found the following: Medicare's loss of billions of dollars to fraud and abuse could be curbed by adopting such private sector techniques as competitive bidding, use of advanced software to detect gross overpayments, and preferred networks to better control costs. Medicare's losses stem from inappropriate pricing and inadequate scrutiny of claims for payments. Further, abusive and poorly qualified providers of medical services and supplies continue to participate in the program. These problems are not unique to Medicare. However, private payers are often able to react quickly, through a variety of management approaches, whereas Medicare's pricing methods and controls over utilization, which were consistent with health care financing and delivery when the program started, have not been adapted to today's environment.

Posted by: mbp3 | August 4, 2009 9:19 PM | Report abuse

The estimate of $17 Billion of fraud in Medicare is 3.4% which I think is pretty darn good. Remember Medicare is required by law to investigate fraud and publishes the result. We have no idea of how much there is in private insurance (not counting the fraud perpetrated by the insurance companies).

Posted by: lensch | August 4, 2009 10:29 PM | Report abuse

To those who keep saying that it is too expensive to extend Medicare to every one, I will keep posting the following:

Myth - "It will be very expensive to get good health to everyone."

Fact - Actually there's a way we can have better universal health care at no more than we are now paying (see 5. below). Here are the facts (cf.

1. We waste $100 - $200 Billion a year on the high overhead of insurance companies.
2. We waste $200 - $300 Billion a year on doctors filling out forms for insurance companies.
3. I don't know the compliance cost of patients fighting with insurance companies, but it must also be in the 100's of Billions.
4. We pay the highest drug cost in the world to drug companies that spend twice as much on profit and three times as much on "marketing" as they spend on research. This is about another $100 Billion each year.
5. Because of the above, we could give Super Medicare (few limitations, no co-pays, no deductibles and complete drug, dental & mental coverage) to everyone at no more cost per person than we are now paying.

Other countries with single payer systems get better health care as measured by all the basic public health statistics and they do it at less than half the cost per person. If we build on our rotten system, we will get a health care system with rotten foundations.

Posted by: lensch | August 4, 2009 10:33 PM | Report abuse

Just for fun, here are some statistics that show how badly treated the poor Canadians are by their terrible health care system: (see the Basic Indicators 2008)

Percent of GDP spent on health care (public/private/total)
USA 8.1/4.6/12.7 Canada 7.4/1.4/8.8
Infant mortality rates (per 100 000)
USA 6.9 Canada 5.4
Maternal mortality rates (per 100 000)
USA 15.1 Canada 5.9
Communicable Disease mortality rates (per 100 000)
USA 44.1 Canada 28.6
Ischemic Heart Disease mortality rates (per 100 000)
USA 156.8 Canada 128.8

Posted by: lensch | August 4, 2009 10:36 PM | Report abuse

Selfishness is a common element in the human condition. "I've got mine so screw everyone else."
I've seen it time and time again with seniors. ( I'm four years from Medicare myself.) They don't want to pay taxes for schools because their children are grown up. Well, guess who's paying for their Medicare, and their Soc. Sec.??? And guess who will be paying for their Medicaid when they end up in nursing care?

Most Americans want what seniors have. That's what scares the insurance companies and the Republicans.

Posted by: cmpnwtr | August 4, 2009 10:37 PM | Report abuse

Medicare pays less than market rates (about 80 percent of) thru transferring cost to the working ages who pay higher premiums to make up for that loss. Make the whole system like Medicare you just cut market rates by 20 percent without lowering demand from 16 percent of GDP. Another little known fact is that Medicare contracts out for help with billing and such to the multiple provider/private insurers so costs may not be as low as some suggest were the government to replace them entirely. Your choosing underfunding/disconnection where supply meets demand a huge mistake. And despite low administrative costs existing Medicare goes broke in 2017 as the boomers retiree? Seniors have more common sense than we credit them. Look at both Canada and Australia they have high health care inflation in single payer settings (inflation is something built in like growth it can't be stopped by pruning). Go Wyden/Bennett (pays for itself at market rates/creates surpluses) for the working ages and you might be able to save over 65 Medicare as we know it simply by asking wealthier retirees to pay more plus adopting salaried care guided by cost effective reimbursement rules.

Posted by: DougHuffman | August 4, 2009 10:58 PM | Report abuse

So what you are saying is ... that you and "the rest of us" should express our self interest and support "Health Reform" ... but we should chastise Seniors for opposing "Health Reform" because they feel it may not be in their self interest?

Sounds like a double standard to me.

Posted by: cautious | August 5, 2009 2:16 AM | Report abuse

If the President said he was going to pay two thirds of the cost of "Health Reform" and universal coverage by finding "savings" and cutting "waste" in Washington Post bloggers salaries ... I wonder how you would feel about his proposal :-)

Posted by: cautious | August 5, 2009 2:43 AM | Report abuse

The Problem With Seniors?

Ezra, you write:

"Seniors are by far the least supportive group for health-care reform...The elderly have long been skeptical of health-care reform. They oppose health-care reform in uncommonly high numbers because they're concerned about changes to their situation."

What do Seniors know that we don't?

TODAY's Medicare cannot be given to all. Its simply not affordable or financially sustainable. Something more like Medicaid-for-all? Sure.

The health security that seniors now enjoy gives them something no one else in the world has. Unfettered access to almost any medical intervention, with little cost borne by themselves.

Now, if everyone wants this same deal there IS NO WAY that government-run health care will be LESS stingy with treatments and procedures than private insurers.

Mickey Kaus writes:

"The problem is that...if the government won't second guess your doctor in the name of saving money, then how is it going to "bend the cost curve" as Obama promises it will? Won't more treatments cost, you know, more?"

At the very least, "Medicare for All" is in conflict with Obama's cost-cutting rationale. And in even GREATER conflict with Obama's concrete proposal to establish a commission of cost-cutting bureaucrats-- government bureaucrats rather than private ones--whose purpose is precisely to "decide what's reimbursable" even if your doctor might disagree.

Seniors KNOW that the health security they enjoy DOES NOT SAVE MONEY. They KNOW that Medicare is the Rolls Royce of health Insurance coverage.

Seniors also know that this country DOES NOT HAVE THE MONEY to buy everyone in the US a Rolls Royce too. Even IF the government roots out fraud and waste, even IF the government raises taxes on the 'rich'.

If we ALL want MEDICARE, we will ALL have to pay for it. The young and healthy, who may not want or need a Rolls Royce, when a Fusion or Focus is all they want or need, will now have to pay for one any way. The middle class will pay too, as the federal government will need to find more 'revenue streams', read TAXES to pay for all the Rolls Royces they just purchased. Here come Value added taxes (VAT) like they have in Europe. Taxes on 'soda and other 'unhealthy' foods, taxes on EVERYTHING we buy. These taxes are coming because the President has promised a "deficit neutral plan' BUT he has also promised that if you make under $250,000 a year you will not see you taxes increase "one dime." He said, "Not your payroll tax, not your income tax, not you capital gains tax." Hidden taxes will be the only taxes available.

Are the American people willing to pay these taxes in exchange for "Medicare for All"? If not, get ready for rationing.

Posted by: ST1235 | August 5, 2009 10:11 AM | Report abuse

"That's a BS demand."

Obama himself says that reform should be judged, first and foremost, on its ability to control costs. I agree. Unfortunately the CBO has said that none of the Dem's plans will achieve his stated goal. This is partly because the CBO will not score unproven cost control measures.

Since the government *already* controls almost 50% of the our national health expenditure, it has the means to demonstrate the effectiveness of the Dem's cost control theories in the public insurance plans. Let's see if these theories work in practice before we turn our health industry upside down and risk a ballooning national debt.

The Medicare program itself overshot its backers' original cost projections by 900% in the plan's first twenty-five years of existance. IMO, indebted as we already are, our nation cannot afford another error of such magnitude.

Posted by: tbass1 | August 5, 2009 10:22 AM | Report abuse

Well, a thread like this never goes long without the need for some debunking.

First of all, Medicaid is Medicare, with the state paying the premiums for means-tested recipients. If you're on Medicaid, you're actually enrolled in Medicare Part A and B.

Second, there is no reason to think that Medicare-for-all would be as expensive, per person, as Medicare for the elderly. Apparently somebody didn't get the memo about aches and pains as you age- boy, are they in for a surprise!

Most of us go for long periods of middle life with no reason at all to see a doctor. (Stop thinking that there is some treasure trove of info about you called a 'medical record' and see how motivated you are to keep going in for that 'annual checkup'.) It won't cost us any more to insure those who don't have coverage today, because, guess what, WE'RE ALREADY PAYING FOR THEM.

Yes, amazing as this may sound, if you need care and you don't have insurance or money, you will be declared 'medically indigent' so the state can enroll you in Medicaid and the hospital you end up in won't go broke.

As for the idea that 'seniors get whatever they want', they 'don't have to wait for hip replacements' etc etc, what a bunch of crap. Most people wait much longer to even ask for a joint replacement than a Canadian does to get one.

Maybe we have some mentally ill commenters here, who actually want to go to the doctor every chance they get. Most old people, like most young people, don't particularly like going to the doctor. Most of us delay seeking treatment as long as we can stand the pain. In fact, about a third of the people who die from heart attacks would have survived if they had just called 911 or gone to an ER. But they didn't because they don't like going to the doctor.

Sheesh, take a CPR class someday why dontcha. You might learn something.

You can also read about these things on the internetz. Ezra Klein, for example, has covered a lot of this already.

Posted by: serialcatowner | August 5, 2009 11:07 AM | Report abuse

@ serialtowner

What happens when we bring the 47 million uninsured into the system? You think that the demands they place on our system will be LESS or equal to what they place on it now? That is wishful thinking.

And if you think seniors have to wait already...what makes you believe they will not have to WAIT longer?

How can you truly claim that adding 47 uninsured to the ranks of the insured will be 'deficit neutral' either in terms of dollars or quality of care. It is a utopian pipe dream.

Posted by: ST1235 | August 5, 2009 11:39 AM | Report abuse

commenter serialcatowner. You're absolutely wrong - Medicaid is not Medicare. Low income people in Medicaid are not enrolled in Medicare Parts A and B. Only low income SENIORS who qualify for Medicaid are enrolled in both programs. Seniors represent about 6 MM of the 40-45 MM people on Medicaid.

You're also glossing over (or ignoring) the fact that Medicare and Medicaid are subsidized by the private sector. Without the private sector Medicare's payment rates would be unsustainable. They simply can't be applied to everyone unless: you come up with a viable way to cut physicians salaries by at least 20% (and much higher for specialists). Politcally impossible, i think.

Again, i ask you for any evidence that people under 65 who have employer sponsored health insurance delay getting services until they're 65. I don't think you have any.

On fraud. Again, the GAO estimates that fraud is much higher in Medicare and Medicaid than in pvte sector health insurance. And they likely under report fraud in Medicaid since they dont have good data on how much of state spending is fraudulent.

Posted by: mbp3 | August 5, 2009 1:32 PM | Report abuse

"Since the government *already* controls almost 50% of the our national health expenditure, it has the means to demonstrate the effectiveness of the Dem's cost control theories in the public insurance plans."

Again, that's a dishonest argument. If that 50% were evenly distributed, you might have a point, but Medicare and Medicaid and other government-administered pools clearly don't represent an even distribution of healthcare dollars. As such, their costs are directly affected by the failings of the private sector, which makes the idea that it can be some kind of laboratory for cost control absurd.

mbp3: that's a non-sequitur. Look at the Commonwealth Fund's studies on healthcare decisions by those 55 and older.

Posted by: pseudonymousinnc | August 5, 2009 1:51 PM | Report abuse

Well just back up the damn cart, Mr. ST1235- I've spent the whole week hearing rightwingers say that there aren't really 47 million uninsured. And you know what, you're both wrong. In any given year about 47 million (roughly) are at some time without insurance. If they end up in the hospital then, we pay, but not all of them do or will. There is simply no "47 million" bridge we have to cross before we ever come to it. In fact, there could be a considerable upside to enrolling young freeriders who think THEY will never need insurance and don't pay premiums now.

As for MBP3, to start with, I never said people will wait until age 65 to seek care. Maybe you're responding to some other comment there.

All of the young disabled people I've known in Washington state have had Medicaid provided and billed by Medicare as part A & B coverage. Maybe this varies from state to state.

As for cutting physicians bills by 20%, that's easy enough- cut the paperwork and uncertainty about payment. The doctors I've known providing care to disabled people with Medicare payment rates have been reimbursed (adjusted approximately to 2009 $) about $200 an hour, which should be perfectly adequate to an office practice with almost no billing costs and a full appointment book.

As for your big point about fraud, I would consider it more likely that the GAO doesn't know the real rate of fraud for the private insurance companies. In my experience, companies don't go around telling people how easily they were swindled, or opening their books to the government in the absence of a subpoena.

Of course, the real reason we're seeing all these bogus talking points raised is to distract us from the fact that people very much like us, in Europe, are saving money and caring for everyone at the same time. Amazing what you can do when you're not determined to spend more than the rest of the world combined on armaments.

Posted by: serialcatowner | August 5, 2009 2:22 PM | Report abuse

"As such, their costs are directly affected by the failings of the private sector..."

Medicare costs exist because the government offered to insure all adults over a certain age. They are high and rising rapidly because the government's cost-control efforts have been limited and mostly ineffective. If anything, the Medicare and Medicaid programs benefit from the existance of private insurance through their ability to shift costs.

Although the US system is noteworthy in an international context for the sizable role played by private insurers, the government is the dominant force. Thee government even exerts a massive influence over the 50% of the health care market which is doesn't control outright through regulation and example. Much of the credit and blame for our current health care system, such as it is, belongs to the government, not the private sector.

"..which makes the idea that it can be some kind of laboratory for cost control absurd."

On the contrary, it is ridiculous to assert that the public programs cannot be reformed unless control of the entire health insurance market is ceded to the goverment. For, in fact, the Medicare and Medicaid programs have been setting up pilot projects at the behest of politicians and bureaucrats to try to "bend the cost curve" for decades. Some of these have borne fruit and been spread program-wide and have been voluntarily adopted by private sector insurers.

That's what I want to see now: experimentation on a small scale to prove the effectiveness of the proposed reforms. If they are effective, they can be propogated and we can use the savings to expand coverage. The alternative you propose - act on faith now - seems reckless to me.

The US government's share of the health care expenditure (roughly half of the total) is, as a percentage of GDP, higher than the UK government's expenditure to cover their country's *entire populuation*. But to achieve that level of savings, American Medicare beneficiaries would have to accept UK-style coverage and care. And American clinicians would have to agree to work for UK-level wages. I don't see that happening.

The bottom line for me is I'm not willing to surrender greater control of health care to the government on a leap of faith that, this time, they'll get it right. IMO, their record of delivering cost-effective, high quality service is lamentable. And I think the Dem leadership is banking on the fact that, as with Medicare and Medicaid, if they can just get another public plan established it will never go away, however inflated the costs. I think they are right to believe so as history has shown it is nigh impossible to eliminate or scale back entitlement programs - once created they grow remorselessly.

Posted by: tbass1 | August 5, 2009 2:55 PM | Report abuse

To wisewon--Seniors have unlimited access to almost any medical intervention? I just wound up owing $359 to an oral surgeon I had to drive a 300-mile round trip to get to for a minor procedure that took five minutes. (I think he may take a painting in trade, since I'm on Medicaid which doesn't cover the procedure) and Food Stamps. Why? Because there isn't a single oral surgeon I can get to in my state who takes Medicare! And the procedure wasn't even dental, it was removing a suspicious growth inside my right cheek, which is medical!

Posted by: cloudwoman | August 5, 2009 3:59 PM | Report abuse

Obama's gonna kill Grandma?


Posted by: MikeLicht | August 8, 2009 12:28 AM | Report abuse

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