. . . we don't really have a federal spending problem or a long-term structural deficit problem in this country. Well yeah, we have a ridiculously bloated military and rich people don't pay enough taxes, but getting past those obvious facts, what we really have is a health care spending problem. Medicaid is the biggest problem for state budgets right now, and Medicare + Medicaid is the long-term problem for the federal budget. Get our health care spending down to that of the rest of the civilized world and everything else is much more tractable.
And, as I have also said, the Affordable Care Act is not the solution, but it's a start -- it gives us a framework to build on. The Urban Institute agrees with me. The problem is, this won't fit on a bumper sticker. In fact, the prospects of actually getting more than 5% of voters to understand anything about this, or even to want to, are dismal.
Basically, the Act lays down the following foundations:
It restrains growth in Medicare payment to providers, mostly hospitals and nursing homes. Republicans, of course, portray this as "cuts" to Medicare, but it doesn't cut benefits at all. The idea is that the providers will become more efficient, reduce useless and unnecessary services -- and that can indeed happen. There's plenty of room for it and they've already started. (BTW, yesterday a provision kicked in that essentially fines hospitals for excessive short-term readmissions for people with heart failure and some other conditions. We'll see how it goes but they aren't really complaining -- they're already figuring out how to do this.)
It sets up greater competition among insurance companies and makes it easier for consumers to comparison shop through the "exchanges." And it already requires them to return more of their premiums for actual health care and spend less on marketing and profits. Soon, it will eliminate medical underwriting. All this cuts administrative expenses.
It taxes "Cadillac" health plans, correcting one of the perverse incentives resulting from the tax exemption for employer-provided health insurance.
It sets up the Patient Centered Outcomes Research Institute. Even though Medicare isn't allowed to actually use the information for coverage decisions (death panels and all that) one hopes that doctors will use it to deliver care more wisely.
How much will all this save? It remains to be seen, but growth in health care spending has already slowed. And as I say, it's just a start. Like all new legislation, it will require fixing and improving down the road. Hey, maybe we can even add a public option!
But it all depends on the election. Yes, it really matters.
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also on the politics on Nowhere Land,
yeah, the political discourse and political action is so disconnected it appears other-worldly. End times!
(OECD, big countries) The two that look the worst to me are the USA and France. These countries are in fact in many crucial ways quite similar. They provide strong arguments for the position that representative democracy in a Republic no longer work and should be abandoned.
Re, health care, the topic of the blog, the two systems, F and USA, are often presented as a ‘major contrasting example.’ Sure it all depends on if you seek similarities or differences.
1) F health care is paid for about 65-70 % by Gvmt controlled and Gvmt funded - they don’t have self-management responsibility - organisms. (Tax payer.)
The rest comes from obligatory co-pays within the State system and private insurance. And for the private part, I’m not talking frills likes spas and psychotherapy.
‘All’ upperish middle and higher ppl have private insurance of some kind, and many others do as well. (Private = non gov, may be for ex. a co-op thru professional association, thus basically non-profit.) There are plenty of private clinics in France that make a bundle of money. Plenty of ppl in F struggle to pay meds, health care, etc. They are often mired in bureaucracy / admin and have transport problems.
I don’t know how much health care is paid for by the tax payer in the US. 40%? 50%? Medicare, Medicaid, vets, Indians..? Special pediatric programs or other paid by individual states? How does one figure charitable donations?
Anyway, the structure is similar, with State Orgs, on the one hand, and private insurers (for sure more for profit in the US), on the other, with a myriad of complications (price of meds. controlled by the Gov or not, etc.)
Essential differences: in F all those legal on the territory have the right to the State package, and are covered by it. (That is the ‘universal’ part. It is RECENT though, Jospin was the one who got it through. Spain is the only EU country afaik that covers illegals.) So the F system is not based on groups - children, vets, the poor, etc. Second, the State system will pay for long lasting / catastrophic illness 100%. There is no going in and out of different statuses or situations, no pre-existing conditions, etc.
Ana
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