The CMS released a staggering estimate for Medicare spending a decade from now– $2Trillion. And yes, on Medicare alone (not counting SCHIP, Medicaid, or any semblance of “universal healthcare”).
Are we willing to sacrifice the solvency of the taxpaying public so that the elderly can eat freely at the “free” table of medical expenditures? In my mind, this figure alone highlights the insanity of a defined benefit for medical care– and knocks any thoughts around expansion of government “insurance” programs out of the water.
Its a paradoxical situation– government control of medical costs per visit (via the RVUs and billing through CPT based claims coding) has systematically swapped out thought-driven primary care for technology driven specialty care. As overall cost increases, government hits cost/ time units harder and harder, incenting physicians to dispense with talking to patients at all, while freely paying for diagnostics and expensive specialty procedures. We’re now at a point where the strong controls on primary care time have made that practice virtually unaffordable and the specialists are driving us faster and faster to bankruptcy.
Is this the system we should bolt all future health expenditures through? Seems the low administrative costs of this pass-through system have allowed the wolves to raid the henhouse. Were it not for taxpayers being forced to pay into the system, it would have been tossed on the scrapheap long before, with something better at managing overall spend (likely through enhanced access to primary care and increased controls on specialty medicine) in its place.
We appear to be entering an era of uncertainty, where once again we realize that the practice of medicine is an art, not a science.
While doctors may carry scientific tomes in their heads and engineering marvels on and around their persons (although surprisingly few computers to date), the clinical practice of medicine is being rediscovered as an art, not a cookbook science. As new studies challenge the existing metrics evaluating risk through a black/ white approach dedicated to lowering intermediate clinical markers (see cholesterol for the otherwise low risk patient, glucose for Type 2 diabetics, BMI for the overweight, quantity of bloodborn “humors” to be released by lancet, etc)
Big lesson: Lower does not mean better
So, as we find out that cookbook medicine may actually be harmful in addition to being expensive, we have the same issue that is currently cracking the mortgage industry: evaluating and managing risk is hard and replacing underwriting with automation and customer service reps leads to problems when real judgment is required.
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Interesting op-ed from the WSJ on the unfairness of employer-only deductions for health insurance.
If the purpose of health-care reform is to decrease the ranks of the uninsured, these job-related tax breaks are poorly targeted, even regressive. The more generous the employer health plan, the more the subsidies increase. On average, lower-wage workers have more limited coverage as part of their compensation, usually from small- or medium-sized businesses. Estimates show that the subsidy is worth more than $3,000 for upper-income families (with higher marginal tax rates), and less than $1,000 for those on the lower income rungs.
This does bring up interesting questions on why Democrats are pushing for increasing amounts of insurance instead of increasing the equity of the insurance subsidy.
If these losses were converted to the equivalent of direct spending, the tax exemption would have cost more than $208 billion in 2006. The only federal programs that cost more are Social Security, Medicare and national defense. But all that money props up only employer-provided insurance. Individuals who buy policies don’t get any tax breaks and pay with after-tax dollars.
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