Posts Tagged ‘Medicare’

Obamacare Fans Going Mad?

November 29, 2013

Be free. Within bounds. Belong. But stay critical. Do not forget. And first of all, do not forget to learn, and do not forget to forgive.
Sage principles one ought to give thanks to. Just the opposite of Krugman proclaiming “Obamacare’s Secret Success”, namely the slowdown in health costs has been dramatic”.
I have a different explanation for the slowdown in the rise of health care cost in the USA. Trees don’t grow up to the sky
Limits to Growth: Exponential Up Mutates Into Exponential Asymptotically Bounded

Limits to Growth: Exponential Up Mutates Into Exponential Asymptotically Bounded

Secret Success?”, Krugman? Millions of health insurance contracts have been cancelled, millions of people have seen their premiums and co-pays skyrocket. Krugman calls this a “secret success“?

Obama delayed for Thanksgiving, another piece of Obamacare called “SHOP”. (A telling name: Obama feels everything is for sale; not just himself, but also Americans’ health). See New York Times: Small Firms’ Offer of Plan Choices Under Health Law Delayed.

The drama of the Obama presidency was that, after He was elected, all too many of his supporters felt like they belonged, and reveled with tribal relish. They put the little critical sense that the reign of Satan Bush had fostered, in deep freeze. In other words, they were back to their old goose stepping of 2003.

Instead of forcing Obama to improve Medicare by executive orders, right away, they let him, and the plutocratic leaders of the Democratic Party, embark on a bizarre effort to save the for-giant-profit health system in the USA.

Obama and the democrats had acquired full control of the USA (I know they deny this, a telling Freudian slip, per se). They sang and played like little children, knowing the masters would reward them well for their mindlessness. Masters such as the Koch brothers, or the Waltons (see below).

There was also blatant dishonesty: Obama had promised to crack down on the revolving door between giant profits and government. Instead he opened it fully, allowing Well Point, a health insurer, to draft Obamacare. Everybody at the top was hushed with money: the debt of the USA is doubling.

Krugman: The law establishing Obamacare was officially titled the Patient Protection and Affordable Care Act…— slowing the seemingly inexorable rise in health costs… Has the curve been bent? The answer, amazingly, is yes. In fact, the slowdown in health costs has been dramatic.

O.K., the obligatory caveats. First of all, we don’t know how long the good news will last. …Second, we don’t know for sure how much of the good news is because of the Affordable Care Act. Still, the facts are striking.”

My name is Paul Krugman, and I am incoherent! Krugman: ” Since 2010, when the act was passed, real health spending per capita — that is, total spending adjusted for overall inflation and population growth — has risen less than a third as rapidly as its long-term average.

What could account for this good news? One obvious answer is the still-depressed economy, which might be causing people to forgo expensive medical care… there’s evidence that Medicare savings “spill over” to the rest of the health care system… The news on health costs is, in short, remarkably good. … health reform is starting to look like a bigger success than even its most ardent advocates expected.”

Notice that all what Krugman found was Medicare “bending costs”. In truth, this has noting to do with the ACA. Obama could have done more on Day One, by an executive order, if he had given Medicare full negotiating powers, as its homologues have all over the world. For example, in Canada. But Obama, too happy to hide behind occupied by his “SHOP” program on the “health marketplace” with its (stock?)”exchange”  for “consumers” still refuses to do so to this day.

Va de retro, Krugman delirium! The obvious explanation for the bending in health cost rise is that people simply don’t have the money for a health care system costing 20% of GDP.

So there could be just a limit to growth (“Malthusian”) curve at work: people cannot afford to spend more, so they cut down, because they have to.

The cost of health care is completely out of control in the USA. Top health administrators in the USA are paid ten to twenty times more than their homologues in Europe. And it’s worse at the level of insurers.

This madness at the top does not just cost more, it creates a corrupt system where underlings are paid more than they should be, just to make them accomplices of the outrageous gouging at the top.

If I am correct, the quality of health care in the USA ought to be going down, as patients see doctors less, and get treated less. And what is observed? Exactly this. The USA slipped from 37th in health care quality down to 46th rank (latest evaluation).

A new born in the USA has a probability of dying twice that of the European Union, with its 500 million people (including 100 million poor Eastern Europe still recently enslaved by the Red Plutocrats of Stalinian ilk).

How did that deliquescence develop? Because people such as Paul Krugman, instead of insisting stridently on a public insurance system developed the human relations that told them that private for profit insurance was the American way.

Hence Obamacare, an experience unique in the world. For (huge) profit corporations that claim, as USA style philanthropists do, to care for the little guy, while filling up their pockets ever more. For reference, the first public universal health care system opened in Germany, more than 150 years ago. Obamacare is nothing of the sort. Obamacare is more like universal gouging rather than universal health care.

Yet, denying blatant evidence, many democrats have stridently claimed that Obamacare is the exact opposite of what it is. The difference between their fanatical cult and the unfolding reality is apparently driving them mad (analyze Krugman above admitting “we don’t know for sure”, and then proving it’s not about the ACA, as he claims, but Medicare!).

Instead top democrats should relax. They are rotten, they should admit that to themselves.

They should do like Wal-Mart. Wal-Mart is the largest employer in the USA. It makes enormous profits: 17 billion dollars last year. Wal-Mart’s CEO, Mike Duke, earns 11,000 dollars, an hour; its retirement is worth 113 million. And he is not even the owner.

Wal-Mart treats most of its employees like dirt. Still Wal-Mart organized a “food drive” among its employees, for those of its own employees who can’t feed themselves. that’ s philanthropy at its best, and most revealing.

Six individuals of the Walton family have a combined “worth” of more than 110 billion dollars. When it was only 89 billions, a few years ago, it was already more than the total wealth of the bottom 40% of the population of the USA (145 million people).

As Ralph Nader explains in the link above, the profits of Wal-Mart are made possible by government assistance. It’ s the same for the fast food industry: 52% of workers there use public assistance.

In a country where plutocrats get much, if not all, of their profits from the government, Obamacare is a natural.

***

Patrice Ayme

MEDICARE FOR MORE.

September 19, 2009

Abstract: If my "Medicare For All" cannot be had now, because of greedy critters in the way, "Medicare For More" will nevertheless put the USA on the same road to the (French) heaven of the best health care in the world, in the fullness of time. There is no reason whatsoever to obstruct and deny this more modest reform, except from debasing and outrageous respect for the religion of greed of the few as ultimate good for all, forever and ever, Amen.

Even Obama cannot bipartisan his way out of that one, which is to put Medicare on the road of becoming a universal public insurance plan. As proposed below, it’s self financing, and autonomous. In particular, as explained below, it would be public, but independent of the executive branch and elected officials’ direct interference.

***

The democrats are controlling Congress, the Senate and the Presidency. Thus, they are under big pressure to show that they can make the country progress towards better outcomes by taking some significant positive action somewhat, somewhere, somehow, that can seem to benefit the People, and not just their beloved hyper wealthy bankers.

Killing Afghans more efficiently may not be good enough, so those crafty dems are trying to tinker with the health care system, since, after all, they campaigned on making it much better. At the same time, those professional politicians and would be higher elements of society have to satisfy the BIPARTISAN PARTY, the party of the plutocrats, the only way they seem to know to elevate themselves.

The Swiss system is often touted as a template of what leftist American politicians want to do. But, as we will show, they can’t use it as a template. Nor do they want to, come to think of it.

In Switzerland, those who can afford to buy insurance are required to do so by law (as individuals, this has nothing to do with employment). For those who can’t, the government provides subsidies. About a third of the population receives subsidies (40% of households).

Nevertheless, the core reason that Switzerland has universal coverage, and good private health insurance, is that the Swiss people demanded that the Swiss government heavily regulate the health insurance industry and the Swiss people decided to pay more taxes so that the government would provide subsidies. In Switzerland, basic coverage components, very good by American standards, must be included in all plans. Basic health insurance is provided by nonprofit insurers — though some are affiliated with for-profit companies that offer supplemental policies (private rooms, super teeth, etc., similar to Medigap in the United States). The basic benefit package is defined by law and is quite generous. Maximum drug prices are regulated.

Still, Switzerland is trying to push its health care system in the French direction. The reason is that the Swiss system underperforms the French one, it costs more, and ever more so. In frontier areas, the French and Swiss systems are imbricated for practical reasons

It is not easy to go from Swiss to French health cares, although the basic structures are both non-profit: there are fierce debates on how to get the Swiss system more like the French (which is itself a work in progress, with major changes on how to make foreigners pay, and also a new, extremely expensive cardiac care system, to save more lives). That is why it’s important that US health care reform takes the right road, even if it cannot get to its destination now.

The French insurance system looks complicated, to the foreign observer. In truth it is simple in its value system, the dominant value being that LIFE IS A RIGHT. In contrast, Obama recently explained to us that Greed Is Good. Or that a person is never bad as long as profit is the motive.

At this point it’s important to keep in mind the liberal president Obama’s famous quote: "Insurance executives don’t do this [kill people] because they are bad people. They do it because it’s profitable." That’s where Liberal America is at: way out in the twilight zone of smoldering fundamental values, set on fire by bankers and greedsters. Very far from Europe.

Thus, in France, as in Switzerland, basic health insurance is non profit. Just it does not masquerade in France as a herd of private outfits. The main French public insurer is gigantic: the giant public French BASIC HEALTH CARE insurer is ‘Assurance Maladie’. Per its bulk, ‘Assurance Maladie’ has enormous negotiating power, and medical drugs from the USA, purchased as is, without any insurance, cost less in France than the co-pays in the USA with an excellent private insurance plan.

Superb care is given by the French health professional themselves, who are completely detached, physically separated, from the compensation system. Although some doctors, mostly the surgeons and professors in the hospitals are partly paid by the public system, paradoxically, most French doctors are in private practice (but paid by the public insurer(s) and complementary private insurance(s) if need be, for non essential care such as age spots).

Economies are made by endowing personnel with examining and curative powers. For example, midwives run in minutes exams that take many visits to many different specialists in the USA. The French midwives, in their offices (thrice bigger than a doctor office in the USA) have all the machinery, and know how to use it. Results come in seconds. There are also private labs for sophisticated ultrasounds (completely for profits, owned by the local doctors operating them), but the fees are much less than in the USA, although the electronics is much more advanced (straight from Japan, with lower prices negotiated in bulk). The system saves by making no mistakes (decisions are taken collegially, and from protocols), so there are no lawsuits: there is nothing to sue about.

The one and essential part of health care reform as proposed in Obama’s electoral platform is a PUBLIC OPTION.

If the Public Option does not happen, as Obama himself more or less admits, there is no reform in the direction of progress, and forcing everybody to pay private insurers would be making the later in a functional equivalent of the French Fermiers Generaux under the Ancient Regime. Those were private individuals in charge of gathering taxes (they paid themselves in passing).

The Fermiers Generaux’ motto was: ‘your money, or your freedom’. By law, everybody had to pay them. In turn, they paid the king. Many Fermiers Generaux were judged and executed during the revolution. Modern American life insurers have assuredly a similar motto: ‘your money, or your life’. If Obama makes paying them mandatory by law, and they, in turn, as they already do, pay the king, the USA would have gone back full circle to the France of the Ancient Regime. (After that maybe we can organize a revolution too? Just an idea.)

Indeed when your private insurer refuses to treat your cancer, that is what he does; take your life (that was a precise example used by Obama). In theory, people could divorce, give up all their belongings, then apply for Medicaid, but, by the time they get to that, they will be dead. Anyway, what is the difference between giving all you have to save your life, while getting half dead in the process, and the worst abuses of slavery?

There is only one way to save the public option: free Medicare from its constraints. Allow people to pay for it before the age of 65, on a sustainable basis (namely allow Medicare to charge as much as it wants: it will always be less than the Wall Street health care insurance plans, because Medicare does not have the necessity to make a profit to stay interested, whereas Wall Street does). The important point is to accept that Medicare (or the somewhat related Medicaid) will grow.

After launching the "Medicare For All" slogan, I propose that the best that can be hoped for now is "MEDICARE FOR MORE". As Medicare grows, it will be able to squeeze out the profiteers, if it is given full authority to negotiate costs with providers. Then, in the fullness of time, it will become "Medicare For All".

Patrice Ayme

https://patriceayme.wordpress.com/


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because all (Western) philosophy consists of a series of footnotes to Plato

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