Senate Rejects House 2012 Budget

[Ben]

Five so-called Republicans joined the Democrats to defeat it, apparently mostly based on Ryan's Medicare fix. Just shows these people have zero interest in fixing Medicare. Ryan's "voucher" system makes great sense.

http://www.foxnews.com/politics/2011/05/25/senate-votes-house-budget-plan/

[AZRedhawk44]

To be fair to those 5...

The voucher system still allows for private insurance to decline to accept senior citizens with particularly costly medical issues... or charge them a significantly higher rate.

Frankly, I have no problem with that.

But the Nation has not had that debate yet.  Or many others.

Is heath care a right, or not?
Should health care be an entitlement?
To what age is perfect health care a right?
To what age should a person work, then, if indefinite health care (and an extra 20-30 years of associated longevity compared to when the system was designed) is a right or entitlement?
Does 65 still cut it for Social Security?  70?  75?  90?
What is the point of private wealth if you can't buy the "best" care for yourself?


There's a big, fat fight we need to have before enacting anything.  We don't want to ping-pong legislation like we're likely to do with Obamacare.  The industry has spent hundreds of millions or even billions of dollars to comply with the anticipation of Obamacare, and we're probably going to whack it before it is enacted.  We will then spend millions/billions going to a different system.  Only to watch the Democrats re-rally and enact something similar again.

Because we haven't had The Debate.

What are you ENTITLED to, and at what age, and how do we pay for it without selling 3-4-5-6 generations later into debt bondage?

I loathe the last two generations for selling me and my future children into slavery.  In exchange for frippery.

[SteveT]

Five so-called Republicans joined the Democrats to defeat it, apparently mostly based on Ryan's Medicare fix. Just shows these people have zero interest in fixing Medicare. Ryan's "voucher" system makes great sense.

http://www.foxnews.com/politics/2011/05/25/senate-votes-house-budget-plan/

You know the vote was forced by Harry Reid to put the GOP Senators on record due to the extreme unpopularity of the Ryan Budget right?

[De Selby]

The voucher system is a good way to leave old people with no coverage. 

The problem here is cost - medicine is more expensive, procedure for procedure, than in any other country in the world.  The reason is that insurance companies introduce extreme inefficiencies, like multiple layers of review for every trivial decision.

America's choice is to either bust the insurance companies or do without on this one.  There is no way to maintain the current private insurance system whilst providing healthcare to most of the population.

With current levels of spending, we could easily pay for universal healthcare.  One of the features of az's debate should be to consider whether we should refuse to have universal healthcare on grounds of fairness.

[stevelyn]

I apologize for the actions of our Spoiled Princess.

[RocketMan]

Despite ShootinStudent's basic misunderstanding of why health care costs are increasing, he is correct to an extent that health insurance companies are a causitive factor in those increases.  But so is the Medicare program that he is so in love with.  As is Medicaid.
There is a very fundamental reason for the excessive yearly inflation in health care costs.  ShootinStudent's hatred for insurance companies, and big business in general, has blinded him to that reason.
Health care costs are increasing at such a great rate because Medicare, Medicaid, and the health insurance companies, through their very existence, make available to the health care industry a huge pool of dollars to pay for care.  Naturally, health care costs will increase to absorb that pool of dollars.  The larger the available pool of dollars, the more costs will increase to absorb that pool.
It is the same in any economic exchange.  Costs increase to absorb the available dollars.  There is nothing evil going on there.  Stupidity maybe, because of people's basic lack of knowledge as to why costs increase, but nothing evil.

[Jamie B]

The real issue will never be addressed - the unjustifiable rise in health care costs.

I see our local hospital that has continually increased in size, breadth, and cost over the years.

They went from 1 building to now several city blocks, parking garages, etc.

Their occupancy rate seems low, but their costs continue to rise at rapid rates.

Consumers are footing the bills via their insurance, and do not question costs as their insurance is paying most of the ride.

[dogmush]

America's choice is to either bust the insurance companies or do without on this one.  There is no way to maintain the current private insurance system whilst providing healthcare to most of the population.

 

Without starting the health care cost arguement again, I have to point out that MOST of the population has healthcare under the current system.

[De Selby]

Without starting the health care cost arguement again, I have to point out that MOST of the population has healthcare under the current system.

Rocketman, your model precludes the notion that more money can actually buy more services - it doesn't do so because the money is absorbed by things that do not deliver care, like insurance administration and professional billing coders.  In other systems, when they add dollars, they get more product.

Dogmush, most people will not be covered in the next few decades at current increases.  And at current spending, we could cover a lot more than the 30 million or so who do without.  We could also have a system that doesnt bankrupt so many.  But that would require a socialist benefit scheme, and many people would rather keep our more inefficient system instead on principle.  That's something we ought to have a national discussion about.

[Ben]

Health care costs are increasing at such a great rate because Medicare, Medicaid, and the health insurance companies, through their very existence, make available to the health care industry a huge pool of dollars to pay for care.  Naturally, health care costs will increase to absorb that pool of dollars.  The larger the available pool of dollars, the more costs will increase to absorb that pool.
It is the same in any economic exchange.  Costs increase to absorb the available dollars.  There is nothing evil going on there.  Stupidity maybe, because of people's basic lack of knowledge as to why costs increase, but nothing evil.

This is how I understand health care costs as well. Which is why I think vouchers are a good idea. Maybe I don't have all the facts on Ryan's definition of voucher, but if it's "Here's "X" value of dollars for health care. Use it wherever you want, and supplement it or not. Your Choice". I don't see how that's bad. It seems like taking away the Medicare trough is a good way to get insurance companies and associated businesses to cut the bloat and compete.

[zxcvbob]

The real issue will never be addressed - the unjustifiable rise in health care costs.

I see our local hospital that has continually increased in size, breadth, and cost over the years.

They went from 1 building to now several city blocks, parking garages, etc.

Their occupancy rate seems low, but their costs continue to rise at rapid rates.

Consumers are footing the bills via their insurance, and do not question costs as their insurance is paying most of the ride.

Medical costs are rising without bounds because they are paid with other people's money -- so normal market forces do not work.  The problem is more on the supply side than demand; the hospitals charge whatever they can get away with.  For example, 10 or 12 years ago I had a colonoscopy and it cost about $800.  Now the same procedure is over $4000.  I called both local clinic/hospitals and they each gave me the same price.  I asked why such an increase, "Oh, we bill it through the hospital now instead of the clinic. So you have to pay for the procedure room, the recovery room, anesthesiology,..."  Of course I paid all that before, they just didn't itemize it and fluff up the bill.

[HankB]

Despite ShootinStudent's basic misunderstanding of why health care costs are increasing, he is correct to an extent that health insurance companies are a causitive factor in those increases.  But so is the Medicare program that he is so in love with.  As is Medicaid.

Medicare is nominally paid for by contributions from senior citizens, both during their working lives and as a deduction from their earned Social Security benefits. Future senior citizens also pay into Medicare today, with the presumption that they, too, will eventually get benefits.

We can debate and examine the cost of benefits vs. contributions, Fed "borrowing" from the trust funds, Ponzi schemes, negative cash flow and looming insolvency, etc., but the fact remains that Medicare benefits are paid for, at least partially, by the benficiaries. So as an "entitlement" at least a plausible argument can be made that SOME level of coverage has been EARNED.

How does Medicaid work? Do those receiving Medicaid contribute the way Medicare recipients do, and have? 

[AZRedhawk44]

Rocketman, your model precludes the notion that more money can actually buy more services - it doesn't do so because the money is absorbed by things that do not deliver care, like insurance administration and professional billing coders.  In other systems, when they add dollars, they get more product.

Or, in the case of Government getting their tentacles into it... "Meaningful Use" and the exact same kind of Medicare audits to prevent fraud as insurance companies use.

If medicine actually became a cash-n-carry industry again, EVERYONE could afford medical care.  We need to get rid of all the administration and billing coders and IT jockeys that feed the unnecessary bloat of the machine.

[makattak]

Or, in the case of Government getting their tentacles into it... "Meaningful Use" and the exact same kind of Medicare audits to prevent fraud as insurance companies use.

If medicine actually became a cash-n-carry industry again, EVERYONE could afford medical care.  We need to get rid of all the administration and billing coders and IT jockeys that feed the unnecessary bloat of the machine.

You mean like something with insurance for catastrophic care and healthcare savings accounts for more mundane care!??

That could never work!!! (Why, I'm not sure. I just know the Democrats tell me that would be making grannie eat dog food and dumping the poor into the gutter.)

[MechAg94]

You mean like something with insurance for catastrophic care and healthcare savings accounts for more mundane care!??

That could never work!!! (Why, I'm not sure. I just know the Democrats tell me that would be making grannie eat dog food and dumping the poor into the gutter.)

Of course, they don't explain the dog food thing when people food is cheaper.

[AZRedhawk44]

I like this Ryan fellow:

http://abcnews.go.com/Politics/abc-news-exclusive-rep-ryan-stands-ground-medicare/story?id=13689568

House Republicans overwhelmingly voted in favor of Ryan's plan and now may pay a political price. I asked Ryan if he thought their support of his budget plan would cost Republicans the House. He said he felt confident voters would in fact reward, not punish the Republicans.

"I think we were elected in this last election to take a stand on fixing this country's fiscal problems, to go after spending, to solve this debt crisis, to stop spending money we don't have," Ryan said.

Says he doesn't care if he gets re-elected in WI.  He'd rather solve the financial problems and face any negative voter feedback (if any) than allow the system to crash into insolvency.

[Monkeyleg]

Says he doesn't care if he gets re-elected in WI.

Ryan is very popular in his district. Of course, it didn't hurt when the district was re-drawn in 2001 (IIRC), extending it up into more conservative parts of Milwaukee county and Waukesha county. I don't think he'd have a problem come election time.

[RocketMan]

Medicare is nominally paid for by contributions from senior citizens, both during their working lives and as a deduction from their earned Social Security benefits. Future senior citizens also pay into Medicare today, with the presumption that they, too, will eventually get benefits.

We can debate and examine the cost of benefits vs. contributions, Fed "borrowing" from the trust funds, Ponzi schemes, negative cash flow and looming insolvency, etc., but the fact remains that Medicare benefits are paid for, at least partially, by the benficiaries. So as an "entitlement" at least a plausible argument can be made that SOME level of coverage has been EARNED.

How does Medicaid work? Do those receiving Medicaid contribute the way Medicare recipients do, and have? 

HankB, the source of the Medicare funds is irrelevant.  That it is an entitlement, earned or not, is irrelevant.  That Medicare is a large source of available dollars for the health care industry to absorb, thereby driving health care costs upwards, is the point.  The source of those dollars matters not.
ShootinStudent missed the point as well with, veering into his argument about insurance companies administrative costs.  Sure, the insurance companies have administrative costs.  An argument can even be made that they are excessive in some cases.  But that does not address the chief reason for escalating health care costs, the price for health care goods and services charged by the actual providers of care.

[De Selby]

Rocketman, your theory about polls of money would mean that increasing services by buyin more would be impossible, since any additional dollar would just be "absorbed.". Money is only absorbed without increasing services where there is some fundamental inefficiency, or a ceiling on the available resource has been reached. 

"Absorbing money" is exactly what the insurers do; that's the problem.  It does not have to be that way - there are plenty of systems where more spending yields more service, like, for example, here in Australia. Its hard to imagine why you'd want to keep the American model when it is, on your theory, capable of absorbing all money thrown at it through increasing prices as opposed to increased service delivery.

[TommyGunn]

Rocketman, your theory about polls of money would mean that increasing services by buyin more would be impossible, since any additional dollar would just be "absorbed.". Money is only absorbed without increasing services where there is some fundamental inefficiency, or a ceiling on the available resource has been reached. 

"Absorbing money" is exactly what the insurers do; that's the problem.  It does not have to be that way - there are plenty of systems where more spending yields more service, like, for example, here in Australia. Its hard to imagine why you'd want to keep the American model when it is, on your theory, capable of absorbing all money thrown at it through increasing prices as opposed to increased service delivery.

Given the tendency of American politicians to raid "cookiejars" I have very little faith in the ability of American government to run programs and do so in an efficient and profitable manner.  Take Social Security for example; the trust fund was raided decades ago (by politicians of both parties) and the politicians have left it with "I.O.U.s"  --- which means bankrupt, essentially.  And that is not the only program where this has happened.

...here in Australia...

  Oh, I think I get it now.
Maybe the politicians "down under" are actually honest politicians (I rather doubt this but am willing to stretch my imagination) or.... maybe it's just that there are fewer of them. 
I am willing to concede they may not be honest, per se, but simply more honest than the American criminal ----er, politician.  It wouldn't take much. 
The older I get the less respect I have for America's political class.  I hope the situation in Australia is not as bad, but it has become one of my central principles that the Federal Government here should do as little as possible and political power should be kept as close to home as possible.   Yes, this is a "pipe dream" given the situation as it is, but I am obstinant enough to maintain this conceit inspite of all evidence mitigating against it.