Often, when discussing our need to lower our deficit through controlling entitlements costs, I'll see or hear the argument that Social Security is insolvent and that our younger generations will never see their share of it.

Yes, projected spending for Medicaid and Medicare is out of control; however, Social Security doesn't appear to fluctuate too much from the spending baseline.

I can understand why someone who makes a living through investing retirement accounts would wish to see Social Security dismantled, but I feel that it's in the best interest of most Americans to continue to fund the program.

There are only two ways that we will not receive our Social Security benefits:
1) We allow them to take it away from us.
2) We spend so much on programs other than Social Security that our country is too bankrupt to fund it.

Those of us who are serious about reducing the deficit would benefit from investing less time and energy into railing against Social Security and focusing more on spending programs that are far less solvent.

Every argument spent demagoguing Social Security's impact on our deficit distracts us from the urgency of resolving our rising health costs problem.

9/6/2011 2:50:37 PM

How can you not see that health care inflation and entitlements are interconnected? As health care costs continue to explode, so will the unfunded liabilities resulting from our entitlement system.

Before I offer my explanation of why health care costs might be increasing at an abnormally high rate, I'd like to hear yours.

9/6/2011 3:17:23 PM

how is medicare not an entitlement? DOH

AND, that SS projection is woefully inadequate. Baby Boomers retiring is going to massively increase outlays

[Edited on September 6, 2011 at 6:29 PM. Reason : ]

9/6/2011 6:28:41 PM

The options for price increase are

1. Too little supply - It's not lucrative to be a doctor -- too many years of school for too little reward. There are seemingly more lucrative (but unproductive) professions such as finance, business, and lawyering
2. Too much demand - Baby boomers
3. Too much inflation - Out of control financial sector pumping too many dollars into the real economy.

I'd rank them as 3, 1, 2 in explanatory importance.

[Edited on September 6, 2011 at 8:33 PM. Reason : .]

9/6/2011 8:32:29 PM

healthcare providers can basically charge whatever they want because they know either medicare or insurance will take the heat

9/6/2011 9:21:00 PM

single payer could've fixed all of this

9/6/2011 9:23:54 PM

lol no it wouldnt

9/6/2011 9:24:15 PM

they arent paying attention to cost now they wouldnt do it in a single payer system either.

identifying the causes of healthcare cost increases and putting a stop to them is independent of the payment system. but no ones gonna touch that shit because healthcare is defense 2.0

9/6/2011 9:29:43 PM

Quote :

"It's Not Entitlements; It's Health Care Inflation "

Quote :

"healthcare providers can basically charge whatever they want because they know either medicare or insurance will take the heat "

Quote :

"single payer could've fixed all of this "

hahaha. Honest question to you guys. When you say stuff like this around your friends do they just nod their heads?

9/6/2011 9:33:03 PM

what's so wrong with just saving/investing your own money for retirement?

(besides the fact that most americans are too fucking stupid to do so, of course)

9/6/2011 10:14:11 PM

because the gov't can't control your life as easily and garner votes for Democrats that way. duh

9/6/2011 10:15:46 PM

Quote :

"(besides the fact that most americans are too fucking stupid not paid enough to do so, of course)"

Its much easier for the government to pay for healthcare than to force fair wages and benefits

9/6/2011 10:19:08 PM

haahahahahahaha. actually, it's much easier to make it affordable if you get the government the fuck out of it in the first place. is it any surprise that costs skyrocketed after Medicare was created?

9/6/2011 10:31:46 PM

Generally, it costs more money to take care of people than to let them suffer.

9/6/2011 10:48:33 PM

because the only two solutions are "gov't runs everything" and "nobody gets healthcare"

9/6/2011 10:54:51 PM

ITs not "nobody" its the vulnerable. The only two options are private companies provide workers with jobs and healthcare because they are decent or the government steps in and

a. forces companies to be decent or
b. provides what the companies don't provide.

9/6/2011 11:02:33 PM

Quote :

"The only two options are private companies provide workers with jobs and healthcare because they are decent"

and there is your first problem: assuming that healthcare should in any way be tied to your employer

9/6/2011 11:03:28 PM

i didn't assume that. i just said it was the only alternative to government healthcare.

9/6/2011 11:04:55 PM

which is still totally retarded. employment sponsored healthcare is also part of the problem. and yet you hark it as one of the only "solutions".

and, yes, that's a fucking assumption. to say "it's A or B" and B specifically is not allowed in A, is to assume that B is a viable solution

[Edited on September 6, 2011 at 11:08 PM. Reason : ]

9/6/2011 11:08:07 PM

your solution is healthcare only for the rich

show me a high paying job that doesnt include healthcare as a benefit

[Edited on September 6, 2011 at 11:12 PM. Reason : k]

9/6/2011 11:11:51 PM

hahaha. again, you are assuming that it has to be tied to a job. it would be much better if it weren't, in so many fucking ways. yet, being the troll you are, you will give us the false dilemma of employer-sponsored versus gov't provided

9/6/2011 11:15:55 PM

if employer nor government provides the means of healthcare, who the hell does? Is there a health fairy that will visit people who leave their cancerous cells under the pillow?

If employer sponsored is so bad, why do all high paying jobs offer it?

9/6/2011 11:19:25 PM

Quote :

"which is still totally retarded. employment sponsored healthcare is also part of the problem. and yet you hark it as one of the only "solutions". "

+1

Almost as ridiculous as the guy who said doctors charge whatever they want and medicare/insurance pays it.

E Man, the employer provided healthcare started as a direct result of the govt forcing wage controls on the private sector. Once it was ruled that health insurance would not count towards wages, employers started offering health insurance to get quality hires bc they were not allowed to offer more money.

In order to keep prices down you have to engage the consumer with the cost. Putting even more barriers between the two will only result is VASTLY more demand and increased cost. Eventually the govt will step in and just start limiting what can be provided (already do in some ways)

9/6/2011 11:24:24 PM

Quote :

"if employer nor government provides the means of healthcare, who the hell does?"

1) insurance is not "the means of healthcare". that;s the other fatal flaw in your thinking.
2) neither the government nor the employer provides my car insurance. neither the government nor the employer provides my homeowner's insurance. it's wholly possible that people could buy insurance without either entity providing it. take away the tax credit to companies for providing health insurance and they'll stop doing it. instead, they'll give people more money in salaries thay the people will then use to purchase insurance, if they so desire it

Quote :

"If employer sponsored is so bad, why do all high paying jobs offer it?"

are you this fucking stupid? BECAUSE THEY GET A TAX BREAK FROM THE GOVERNMENT IF THEY DO!!!

9/6/2011 11:32:56 PM

Wells Fargo is getting rid of their HMO and PPO plans due to "rising healthcare costs and increased healthcare regulations".

Coming soon to a company near you.


They will still offer HSA/HRA but that means you pay in full up to your deductible (Say, $1,000) and then you have 80% co-insurance (you pay the other 20% out of pocket, no more $20 co-pays).

I for one think this is a great way to control healthcare costs as it's bullshit that people can just go to the doctor for $25 once a week while I get stuck paying for them.

I'm for changes like this that control the cost of healthcare, but there are going to be a lot of families freaking out about this.

I think it's funny that everyone thought free healthcare was a good idea until they realized someone has to pay for it.

9/6/2011 11:45:53 PM

Quote :

"Almost as ridiculous as the guy who said doctors charge whatever they want and medicare/insurance pays it."

I think you're both making the same point. The consumer is not facing the direct cost - there's a third party payer, whether it's your employer purchasing your health insurance or entitlement related. That's really the central problem of this whole mess: price discovery is offloaded onto another person or organization, rather than the consumer and providers negotiating prices.

Another note about the OP. "Other spending (Excluding debt service)" is projected to be completely flat. What the hell? Does this mean we're going to have 0% interest rates for the next century?

When you factor in that the bottom layer of that graph is completely bogus, it makes it clear how bad things really are.

9/7/2011 12:00:32 AM

Quote :

" 1. Too little supply - It's not lucrative to be a doctor -- too many years of school for too little reward. There are seemingly more lucrative (but unproductive) professions"

My fiancee specializes in auditing doctors offices. Most of the cost of the practices come from salary. All of her doctors make 1 million to 2 million a year. I don't know a world where that isn't lucrative.

Some of them are specialists and work 3 days a week. Not all of them are specialists and some still hit near the million a year mark.

[Edited on September 7, 2011 at 7:42 AM. Reason : a]

9/7/2011 7:41:12 AM

Quote :

"I think it's funny that everyone thought free healthcare was a good idea until they realized someone has to pay for it."

Quite frankly, fuck those people. Got your wallet ready?

9/7/2011 7:52:08 AM

You got a gun?

9/7/2011 8:43:37 AM

^^^

http://www.medscape.com/features/slideshow/compensation/2011

Is there any reason your wife's "sample" of salaries is way more than this survey's medians and averages? $150-$350k seems like the right range.

[Edited on September 7, 2011 at 8:49 AM. Reason : .]

9/7/2011 8:48:58 AM

^hahah. Yeah, ALL doctors make 1M to 2M and work 3 days a week. Good lord. Maybe she audits Dr. Oz and Dr. Phil

btw, I do know an ophthalmologist that I believe makes around 1M, but he busts his ass. (sees 40+ patients in a morning) They own their own surgery suite, that is where the money is.

[Edited on September 7, 2011 at 8:59 AM. Reason : .]

9/7/2011 8:56:48 AM

Quote :

"You got a gun?"

Nope but Uncle Sam does

[Edited on September 7, 2011 at 9:17 AM. Reason : You got an airforce?]

9/7/2011 9:10:38 AM

So, the reasons presented appear to be multiple and of unclear magnitudes.

A. Lack of price seeking behavior on the part of consumers due to 3rd party payer systems (insurance/medicare/medicaid)
B. Lack of supply of new doctors due to artificial restrictions upon medical schools by the AMA
C. Wasted effort on protective medicine to avoid lawsuits

Any others I missed?

The solutions are quite easy, we just need to adopt the regulatory regime of any other industrialized country. First we need to crush the AMA and allow an increased supply of doctors.
Second, we need to first make medicare means tested and give those that remain a high deductible with a low lifetime cap of, say, $200k.

9/7/2011 9:20:11 AM

Quote :

"All of her doctors make 1 million to 2 million a year. "

Exactly what kind of Doctors are these?

Are you trying to imply that this is anywhere remotely near typical for a doctor?

9/7/2011 12:50:06 PM

there just needs to be a restored relation between only DOCTOR and PATIENT. NO GOVERMENT.

9/7/2011 12:50:33 PM

rabble rabble rabble rabble All doctor's drive mercedes and don't care about me and are millionares and are bankrupting america.

I will be leaving medical school with over 250000 in debt with interest that will amount to well over 1.5 mil to pay off, I have been working over 65 hrs a week for free (actually i've been paying through student loans to work that) for the past two years, and I will work greater than 70 hrs a week for 40,000 grand a year starting next year. when I leave residency in 3 years I will be lucky to pull in 65 grand a yr once you factor in my student loans and malpractice. So next time you see your primary care doc you should thank him cuz he sure as shit is doing it for the money.

9/7/2011 4:44:02 PM

kinda fumbled on your closing statement there, doc

9/7/2011 4:54:23 PM

I pretty much agree with the OP.

Nothing other than that to contribute.

9/7/2011 6:33:47 PM

^^^ You mean NO INSURANCE COMPANY. At least that's my experience -- insurance companies are shitty, and the interaction between me, doctors, and insurance companies is a bureaucratic nightmare. No government involved.

9/7/2011 6:35:10 PM

Quote :

"I will be leaving medical school with over 250000 in debt with interest that will amount to well over 1.5 mil to pay off, I have been working over 65 hrs a week for free (actually i've been paying through student loans to work that) for the past two years, and I will work greater than 70 hrs a week for 40,000 grand a year starting next year. when I leave residency in 3 years I will be lucky to pull in 65 grand a yr once you factor in my student loans and malpractice. So next time you see your primary care doc you should thank him cuz he sure as shit is doing it for the money."

Had a friend doing his residency and complaining about the hours and money - Granted, it sucked. It's 5 years later and his shit is paid off, and though he works his ass off 2 weeks out of the month, he goes on international vacations every 2 weeks. I hate him.

[Edited on September 7, 2011 at 7:38 PM. Reason : ]

9/7/2011 7:37:50 PM

^lets punish him then. We should make it that noone wants to be doctors. That way they wont earn as much as they do. Make everyone feel better.

9/7/2011 10:36:17 PM

That is not how a stable system works. Doctors should be paid enough for the supply and quality of doctors to satisfy demand, which is not what we have now, with the AMA artificially restricting the supply of doctors.

9/8/2011 12:48:47 AM

^^

Read the chapter in Predictably Irrational on the effects of money on motivation. It's pretty insightful.

9/8/2011 1:22:15 AM

^^^ im not for shitting on doctors, but considering he doesn't live extravagantly and manages his money he'll be a multi millionaire by his mid 30s...doubt he'd argue doctors don't make enough

9/8/2011 8:02:37 PM

Quote :

"My fiancee specializes in auditing doctors offices. Most of the cost of the practices come from salary. All of her doctors make 1 million to 2 million a year."

Does your fiancee understand the concepts of net and gross?

Quote :

"Lack of supply of new doctors due to artificial restrictions upon medical schools by the AMA"

This is a commonly cited fallacy - easy to say, rolls off the tongue, it's a conspiracy! - but absolutely asinine. Take a look at all the new MD and DO schools that have opened in the last ten years. This will continue... and it won't matter. The population increase and aging will outpace any ability to open new schools. Opening new schools takes money and time that there is no will to invest. Not to mention the equal need for new residency positions for all those new students. I'm sure taxpayers are just tickled pink to fund more training positions for all those money-hungry, egomaniacal, sociopath doctors.

It takes 7+ years to make a physician. There isn't a lack of supply of physicians. There is a lack of supply of people with the ability to become a physician who are also willing to go through all it takes to become a physician and then work under the current set of circumstances of the average primary care physician.

9/8/2011 8:27:35 PM

Quote :

"In order to keep prices down you have to engage the consumer with the cost. "

you cannot apply basic economic principles to healthcare. that is where you go wrong. people cannot control their healthcare consumption.

Quote :

" neither the government nor the employer provides my homeowner's insurance. "

completely different. Everyone already knows the max that could be needed from home insurance and it is not required to survive either.

Quote :

"That's really the central problem of this whole mess: price discovery is offloaded onto another person or organization, rather than the consumer and providers negotiating prices."

This would be ideal but could only work if the consumers could afford the prices which we know they can't so theres no need to play this game.

Quote :

"there just needs to be a restored relation between only DOCTOR and PATIENT. NO GOVERMENT."

doctors have to be paid. they cannot simply take what the patient can give them. procedures can be very expensive.

9/8/2011 8:55:47 PM

Quote :

"you cannot apply basic economic principles to healthcare. that is where you go wrong. people cannot control their healthcare consumption. "

Most of the time you can. Barring emergencies, there's no reason why you couldn't shop around for a lower cost for medical procedures. It's why lasik and other non covered elective procedures are the only health care costs that are decreasing. Even end of life long term care could be shopped around for.

Of course for that to work, you'd need to be able to shop around for prices, unfortunately the insurance system we have makes that more or less impossible. It's absolutely insane that I can go to my vet and get a quote for stated services (and a quote that's good for a week) but I can't do the same for my own doctor. Hell it took me almost 2 years to just get an itemized bill from UNC for my wife's ankle break.

[Edited on September 8, 2011 at 9:10 PM. Reason : lkjl]

9/8/2011 9:07:37 PM

Quote :

"This is a commonly cited fallacy - easy to say, rolls off the tongue, it's a conspiracy! - but absolutely asinine"

and yet, the number of internships is the same. ergo, supply restricted. and who is pushing for this? THe AMA. his point is proven.

Quote :

"Not to mention the equal need for new residency positions for all those new students."

which is kept the same via AMA lobbying in Congress. DOH.

Quote :

"completely different. Everyone already knows the max that could be needed from home insurance and it is not required to survive either. "

no, it's not. they are both insurance. moreover, health insurance isn't required to survive. damn luck helps, but insurance aint required. Food is required. Insurance, not so much.

Quote :

"This would be ideal but could only work if the consumers could afford the prices which we know they can't so theres no need to play this game."

They only can't afford the prices because the prices have to be jacked up so the doctor can get what he wants after insurance makes its payment of far less than what the doctor asked for. Look at your EOB one day. You'll then see how much the doctor really wants. He has to charge higher, though, because insurance and medicare agree to pay x% of reasonable and customary. and he can't charge cash payments less, because that lowers R&C or he gets sued by the insurance company.

Quote :

"doctors have to be paid. they cannot simply take what the patient can give them. "

funny you say that, because that's kind of how it used to work.

9/8/2011 10:48:13 PM

^ Point is proven? That is a low logic bar. You provide no backing for your claims. Google is your friend. The AMA at least talks like it wants to increase residency spots, and as all they actually can do is talk and lobby ... the ball is in Congress' court.

http://www.ama-assn.org/amednews/2009/05/25/prse0528.htm

Quote :

"Bills have been introduced in the Senate and House of Representatives to reduce current and projected physician shortages by increasing the number of Medicare-supported residency positions. The measures, both called the Resident Physician Shortage Reduction Act of 2009, would expand the number of positions by 15%. The increase would amount to about 15,000 additional residency slots, bringing the total to approximately 115,000, the bills' sponsors said. Preference for the positions would be given to primary care, general surgery, nonhospital community-based settings and other areas of need, according to the legislation. The measures also would change regulations to let residents train in nonhospital settings. And they would allow residency slots from closed hospitals to be used by nearby teaching hospitals so the slots are not lost, as is currently the case. The bills lift a cap placed by the Balanced Budget Act of 1997 on the number of resident physicians each teaching hospital can claim for reimbursement under Medicare. Medicare does not generally reimburse such hospitals for training residents beyond the capped number of slots. The AMA supports the bills. "Although medical schools are increasing their class sizes and several new allopathic medical schools and colleges of osteopathic medicine are scheduled to open within the next few years, Medicare-funded GME residency positions have not increased," AMA Executive Vice President and CEO Michael D. Maves, MD, MBA, wrote in a letter to Senate and House bill sponsors."

9/9/2011 7:14:54 AM

Why is residency a requirement requiring federal funding? the AMA says so. Why did we go decades without a single new medical school? The AMA said so.

This is a government enforced cartel and should be broken up.

[Edited on September 9, 2011 at 8:14 AM. Reason : .,.]

9/9/2011 8:10:59 AM