Town Hall, And the beat goes on . . . .

A short answer, yes, I resist any type of government health care program. Simply because they have no business being in it.

To expand:

Two programs, Medicare and Medicaid, were started in 1965 as part of President Johnson’s “Great Society” program. Over the years the programs changed in operation and in scope into what we have today. Medicaid and Medicare are two parallel health programs. Medicaid is an entitlement program whereas Medicare is solely a federal program funded through employment taxes (FICA). Both are administered by the Social Security Administration.

Medicare is in trouble.

“A MESSAGE TO THE PUBLIC:

Each year the Trustees of the Social Security and Medicare trust funds report on the current and projected financial status of the two programs. This message summarizes our 2009 Annual Reports.

The financial condition of the Social Security and Medicare programs remains challenging. Projected long run program costs are not sustainable under current program parameters. Social Security's annual surpluses of tax income over expenditures are expected to fall sharply this year and to stay about constant in 2010 because of the economic recession, and to rise only briefly before declining and turning to cash flow deficits beginning in 2016 that grow as the baby boom generation retires. The deficits will be made up by redeeming trust fund assets until reserves are exhausted in 2037, at which point tax income would be sufficient to pay about three fourths of scheduled benefits through 2083. Medicare's financial status is much worse. As was true in 2008, Medicare's Hospital Insurance (HI) Trust Fund is expected to pay out more in hospital benefits and other expenditures this year than it receives in taxes and other dedicated revenues. The difference will be made up by redeeming trust fund assets. Growing annual deficits are projected to exhaust HI reserves in 2017, after which the percentage of scheduled benefits payable from tax income would decline from 81 percent in 2017 to about 50 percent in 2035 and 30 percent in 2080. In addition, the Medicare Supplementary Medical Insurance (SMI) Trust Fund that pays for physician services and the prescription drug benefit will continue to require general revenue financing and charges on beneficiaries that grow substantially faster than the economy and beneficiary incomes over time.

The drawdown of Social Security and HI Trust Fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the third consecutive year, a "Medicare funding warning" is being triggered, signaling that non-dedicated sources of revenues—primarily general revenues—will soon account for more than 45 percent of Medicare's outlays. A Presidential proposal will be needed in response to the latest warning.
The financial challenges facing Social Security and especially Medicare need to be addressed soon. If action is taken sooner rather than later, more options will be available, with more time to phase in changes and for those affected to plan for changes.”

Medicare Cite

Can we blame the current administration for this? I don’t think so. But I can oppose more of the same. It would be next to impossible to abolish these two programs outright. It would expose too many to needless suffering. Everyone’s planning has been to include Medicaid/Medicare in their retirement plans.

One solution would be to allow more freedom to plan for retirement and by extension, health care outside of government control not more of it. Slowly over time, as the population grows, wean the public off of government assistance. This is where I think people have the biggest disagreement and it all depends on one’s outlook on life. I am an eternal optimist and believe in individualism. I can take care of myself and my family. And on occasion I do help those less fortunate or unable to help themselves. But I make the decision, not the government.

Give a man a fish and you feed him for a day. Teach a man to fish and feed him for life.

Let’s take each, one at a time.

“There need to be subsidized programs to keep making world-class doctors out of any kids that have the brains and the dedication, and it should be a priority;”

Why subsidized? It is quite apparent that future doctors do whatever is necessary to become one. The problem is that health care has become so complex when it comes to health care delivery as to keep some from even thinking about becoming a doctor. Simplify it. Cut the red tape. Make it easier for the doctors to do their job. A definite priority as I have been seeing reports that there will not be enough doctors to go around.

“There needs to be serious malpractice tort reform and a cap on settlements;”

This point alone would take care of much of what is wrong. Generally, I would like to see a loser-pays-all type of system along with a simple formula for damages. Such a formula could be up to twice actual damages for punitive damages. These outrageous awards have made everyone so paranoid about liability that appropriate decisions can not or will not be made.

“and there needs to be much stiffer regulation of the entire insurance industry.”

In what way? And why? Could it be that they are responding to an outside influence, i.e. government regulation? Could it be that current regulations prevent new therapies from being readily accepted? Could tort reform relieve some of the pressure too?

“Everybody's assumptions about what's normal have to change -- what doctors expect to make yearly would be substantially lower, but so would their education and malpractice costs, hopefully an approximately fair offset if it were regulated intelligently;”

I do not believe the people get into the medical profession to become rich. My experience is that that get into it to help people. Do you believe that they put themselves through 8 to 12 years of medical training on the hope that they can become rich? What is there to intelligently regulate? And by whom?

“and what insurance companies expect as reasonable profit would be radically changed.

And who gets to determine what a reasonable profit is? The government? What are the criteria for the definition of “reasonable profit?”

“When medicine and the peripheral industries of malpractice law and insurance are ALL essentially for profit, there's no way to assure continuity of the best, world-class care that we know we are capable of.”

No way to assure continuity of the best, world-class care that we know we are capable of? Do we not have the best care in the world now? Isn’t the United States one of the leading creators of cutting edge medicine already? If you are referring to service delivery, I do think there is room for improvement. Our current system was created by profits and what is wrong with that?

If you take the incentive of profit out of the business model what do you think would happen? You have previously stated, “Everybody's assumptions about what's normal have to change -- what doctors expect to make yearly would be substantially lower.” And this is going to motivate who? Health care quality/quantity will increase in what way?

“If you can think of another way to downramp all these excesses, which have long since spiralled out of control, other than government regulation, I would be all for hearing about it.”

What excesses? Malpractice insurance will be reduced through tort reform. Our quality of care is currently very high, what is there to change? Education costs are more reflective of required education for current technologies. We have advanced more in medicine in the last 20 years more than any earlier time. Where would you like to cut educational requirements? Or do you expect the medical faculty to take a pay cut? Or both? Last I was at school, they were considered non-profit.

I contend that the profit motive is a very strong one and can motivate people to do extraordinary things better than any regulation can. But they need the opportunity to take the chances and sink or swim by those decisions. Further, the current state of affairs is more the result of governmental intervention than not.

One aspect that has not been looked at is the illegal immigration question. This plays a large role in all of this as well. What impact do you think this has on the health care equation?