Of course, it’s part of the structure of social security as well. We have a culture that accepts passing the buck to our kids as normal.
I don’t think there’s any way the Reps can “win” with taking control of it. About the UK system. It’s also faltering under increased healthcare costs.
Completely agreed, and you asked earlier what my main concerns, and this is another one. 
The debt is a moral issue, a fiscal issue, and a national security issue. And it is essentially a kind of treason against our posterity. We spend their money lavishing ourselves with the things we want.
Republicans - laughably describing themselves as fiscal conservatives - don’t care about deficits or debt. Well, they pay lip service to it when a Democrat is in the White House, but they simply don’t care.
Democrats don’t either. Managing and getting rid of debt means having to choose to leave some things on the cutting room floor.
I’m generalizing, of course - there are some in both parties that take it seriously. But they are distinct minorities.
Your post is right on target.
Hard to imagine - the Greatest Generation (mostly) grew up without and then sacrificed much of what they had, to gain victory over evil. Then turned around and raised a self centered generation that not only had to have it all, but has gotten more than their input by taking from generations before and after them. Disclosure boomer born in 1960.
Morals, globalization, automation, whatever. In the end, this is a mathematical issue than will only be solved by using less than we earn as individuals and as a nation. If we can’t do this, natural laws will force a reset. IE the world economic system will collapse.
If you guys want to talk problem solving, that Economist article I put up is really very good. It has quite a bit of detail about a system that has been tried, if you want to think about what you would do if you were in congress right now. @Mufasa, getting back on track talking ACA policy.
Our system is newer, but we already have many of the same problems here in the US with the high costs of aging, and the high costs of caring for sickest people. Under the ACA, two-thirds of the spending goes to the sickest 10 percent, according to a recent Kasier Foundation survey. It’s not an acute care shortfall.
A similar problem has emerged in the UK, “About 25% of all hospital inpatient spending during a person’s lifetime occurs in the final three months. The second is caring for those with more than one chronic condition. About 70% of NHS spending goes on long-term illnesses.” The costs have continued to outstrip funding, and the NHS is set to fail. Although they’ve attempted to overhaul it repeatedly, they have yet to figure out a fix.
Since 1948, spending on the NHS has grown by an average of 3.7% per year. From 2010-11 to 2020-21 growth is set to average 0.9%. On a per person basis the budget will hardly budge—a big departure from the 2000s, when it shot up by 70%. NHS finances are “in a much worse position than they have ever been”, says Chris Ham of the King’s Fund think-tank.
@thunderbolt23, and @treco - Simpatico. Great posts, both. I’ve made the joke, “I don’t vote for people who hate my children.” Of course, that leaves very few choices, if we’re talking seriously about the debt we’re leaving behind, and our expectation of laying greater burdens on their shoulders.
And they were given an extra 10bn for the next 6 years and the head of the NHS is before parliament saying that won’t make a dent. The issue we have in the UK is that it IS a black hole, we know it is a black hole, but it is politically impossible to do anything that even smacks of pruning it.
A fascinating experiment conducted in Camden NJ to address this very problem:
This is why rationing–‘death panels,’ if you’d like–is critical to controlling government healthcare expenditures. We should not be disbursing tax money for futile end-of-life care. (Note that I am talking about rationing government-funded care only–not care obtained via private insurance or self-pay.)
I feel like people wouldn’t go for palliative care then…their goals of care…code status…would all likely remain in an “inappropriate” state longer.
Maybe I don’t understand your point, but in a rationed system, things like the ‘code status’ of a pt whose medical care is being paid for via the govt would be subject to rationing as well. No more Grandma with Stage 4 lung cancer and brain mets lying comatose in the ICU while her family requests that ‘everything possible’ be done for her, including insisting she remain a full code.
Nope that clears it up. Thanks.
That New Yorker article was really nice. In some ways it’s taking things back to a family doctor who makes house calls for these sickest patients, or in today’s world more like adding a social work component (sense of community) to these often socially isolated patients who are considered hot spots for care.
I don’t know how many of you are familiar with the large (mostly CA) HMO, Kaiser Permanente, but I think they are a model for what a better healthcare system could look like. Kaiser is a large regional HMO. They own their own hospitals and imaging equipment, and have many specialists, so you typically have choices of many physicians within the system. There is less of a motive for them to not send you over to the MRI machine, because they own it and are already paying people to run it.
Maybe more importantly, they are a nonprofit, so any money they make goes back into building clinics, buying equipment, or providing services. They don’t have the same profit motive of other insurance companies. The nightmare of billing is also streamlined so these really sick people are less likely to be hit with an avalanche of paperwork that they are unable to cope with.
For women like the chronic migraine sufferer in The New Yorker article, Kaiser has all patient records computerized, so if she showed up to an ER with a migraine, it would trigger a notice to her neurologist or GP and the ER would have immediate access to her meds, and patient history. I think it’s much less likely that you’d get someone in that situation, repeatedly headed to the ER, because care is so coordinated.
I have a friend who is a CFO for a large nursing home chain. I was surprised to learn that we have many elderly people in skilled nursing facilities who remain on life support for many months or years, because families won’t consent to letting them go. I thought those people were in the ICU. Note to my kids: Please unplug me.
Easily the worst part about working in healthcare. When I used to work at the VA it was even worse, cause the families were collecting checks off the vets 
That’s an interesting model, but wouldn’t it lead to insurance companies acquiring multiple hospitals and colluding/price fixing in that manner?
Indeed. And to be clear, I’m not passing a moral judgment on those who keep grandma alive indefinitely, nor am I saying they’re wrong for wanting to do so–for all I know, they had a long talk with g’ma who told them in no uncertain terms to keep her alive by any means necessary. What I am saying is, given the finite resource that is the tax receipts we can dedicate to healthcare, someone can’t decide to keep their persistent-vegetative-state g’ma alive forever, and expect the rest of us to pay for it. On the other hand, if they want to pay for it out of their pocket, have at it. Likewise, if the family is fortunate enough to have Cadillac health insurance that covers this sort of care, more power to 'em. But we as a nation can no longer afford to provide any and all care to everyone. Medical care is simply too expensive.
In this regard, we are indeed the victims of our own success. Back when Medicare was enacted, there were ~300 FDA-approved pharmaceuticals. Today there are ~3000. There were no CT scans, no MRIs, and no such thing as percutaneous transluminal coronary angioplasty (heart stents). Organ transplantation and CABG were in their infancy. There were a handful (at most) of ICUs in the country. The list goes on and on. And while these advances have been a blessing in terms of health care, they have been a curse in terms of health care costs.
It’s hard for many people to appreciate just how far we’ve come in terms of the quality and sophistication of what can be done healthcare-wise. An example: When President Eisenhower suffered a heart attack in 1955, his doctor prescribed bed rest, and told Eisenhower’s wife to get in bed with him to help keep him warm. (It was only the next day that they decided to take him to the hospital, where his care plan was essentially the same.) If the likes of bed rest with one’s spouse for ACS were still the standard of care, we could easily provide universal health care. But both fortunately and unfortunately, those days are gone forever.
Durable power of attorney is your friend in this regard.
I’m not sure I understand how that would work. Please tell me if I’m not understanding the question.
I’m making up numbers here, but let’s say that as a member of Kaiser, you pay $1000 per month for a healthcare package. Let’s say it includes a $20 co-pay for doctor’s visits, up to $20 for a prescription, and a $100 co-pay for a hospitalization. Kaiser is both insurance company and provider, so your ACL repair is going to cost you $100 at a Kaiser run hospital. If at the end of a contract period, they notify you that they are raising your monthly cost of membership, or raising your co-pay for services, you can decide to jump to another provider if you’re unhappy with the new terms. I’m not sure how they would engage in price fixing.
Hypothetically speaking, what if Kaiser acquires all of the hospitals in Southern CA from LA County down?
What would prevent them from charging whatever they want in those areas because you have to go to a hospital they run? Obviously you could travel north of LA County or to Nevada but what if that isn’t an option?
Because they own the hospital, if you don’t have their insurance you pay whatever rate they want.
If you have their insurance, you may pay a cheaper rate, but it’s still whatever rate they desire…does that make sense?
Yes. Got it. A problem if the ACA created monopolies, which is effectively what we now have in some markets, right? I don’t read sites like Breitbart, but I just googled and came across this article related to monopolies under the ACA. It mentions Kaiser specifically. My experience has been overwhelmingly positive, and I think HMO’s when run well can be a great way to go. I think Kaiser is unique in that it’s a non-profit but it does have market competition.
I think this article gets to your concern? I don’t know enough about the industry to know if this is an accurate picture. An example of government intervention creating some big winners?
Interesting article. I was trying to understand the arguements it was making.
I guess it’s saying that the premium increase requests are the driving cause behind mergers due to increased regulation? It says a lot about hospitals and medicaid that makes sense for hospital acquisitions, but I’m not understanding the insurance part.
Yes. A focus on the huge rate hikes in some markets, and the consolidation of insurance companies.
If you read any right-leaning source, you’re hearing about huge rate hikes, less choice, and how the ACA is just too expansive to ever be affordable. That it’s already a mess that is about to collapse on itself anyway, had zero support from Reps from the beginning, and deserves to die.
From left-leaning sources you hear this kind of thing, to quote Paul Krugman, economist at the NY TImes. “Wait until those working-class Trump voters feel the devastation of loosing their healthcare. Repealing Obamacare will inflict huge harm on precisely the people who were most enthusiastic Trump supporters — people who somehow believed that their benefits would be left intact. What happens when they realize their mistake?.. But there is certainly an opportunity for Democrats coming. And the indicated political strategy is clear: make Trump and company own all the hardship they’re about to inflict. No cooperation in devising an Obamacare replacement; no votes for Medicare privatization and increasing the retirement age.”
The legislation was never a bi-partisan effort, so it’s particularly ugly. Was it destined to fail anyway in it’s current form? “Make Trump and the Reps own all the hardship they’re about to inflict” implies that things were going well with the ACA under Obama.
With respect to the ACA, things were going well–at least for Trump voters:
Not a single Republican in either the House or Senate voted for the ACA. Once enacted, the GOP-controlled House voted over 60 times to repeal, defund or delay it in some form or fashion. In other words, I think it’s fair to say the GOP hung the ACA around the necks of the Dems. Seems to me it’s only fair to let the GOP own the repeal, and whatever results therefrom–for better or for worse. (But hey, if the ACA is as awful as Trump and the GOP made it out to be, its repeal should produce nothing but sunshine and lollipops, right?)
Seems like the NYT would catch losing and loosing mistake. Grammar nazi - I know, but my resistance is worn down by the use of apostrophe’s (sic) for plural on this site.
It’s mixed really. Some of the people have been forced in to it, but they aren’t happy with it.
Quote from the WSJ article you put up.
"At the same time, some people who gained insurance coverage may nevertheless dislike the law—among other reasons, because coverage was mandated. In other words, just because people follow a mandate doesn’t mean they necessarily support it.
Gallup’s data show that nationally, 53% disapprove of the law, while 42% approve of it. That’s despite the fact that the uninsured rate in the U.S. sank to 10.9% in the third quarter of 2016, according to Gallup. That’s the lowest since Gallup began tracking the figure nine years ago.
And there is the question of the law’s cost.
The Gallup survey data show that people living in some places that favored Mr. Trump’s election are likely to say there have been times in the last year when they did not have enough money for health care or medicine their family needed.
That was particularly true for those living in the African American South, Evangelical Hubs, Working Class County and Hispanic Centers, where 19% or more said that statement applied to them. Mr. Trump won three of those county types. Nationally, that figure was 15.6%."
And it’s a huge piece of legislation with enormous economic impact. Healthcare is something like 17% of GDP, I believe. Huge. Even before the ACA, we weren’t exactly talking about a newborn baby. We already had soaring costs, and a complicated cobbled together system with public services like medicare, and insurance company middle men.
When you say the Reps “hung it around the necks of the Dems,” the inverse would be “the Dems shoved down the Reps throats.” Part of the legacy. Ugly all around in terms of partisan politics. Try to phase something in more slowly with bi-partisan support? It seems like we don’t know how to do that anymore. It’s really discouraging.
I think you’re right in your assessment that we’re victims of our own success, and that any successful healthcare plan/reform will have to include looking seriously at the hot spots for care, big costs. It’s something nobody seems to want to do.
US health care spending grew 5.8 percent in 2015. Imagine being successful at taking control of that! That’s one reason I don’t think the Reps can win.