Jared Bernstein takes a look. Basically, it involves giant cuts in Social Security and Medicare under guise of terms like "reform," "rethink," and "making tough choices."
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McCainonomics
19 Mar 2008 12:42 pm
Comments (19)
Shorter Fred: I don't know if Obama does anything and am too lazy to look but I know McCain made the hard choice to help out the wealthy!
Seriously, conservatives need to move on from this bamboozle. Social security and Medicare ain't broken and the American people know it.
Shorter Rob: I am too lazy to try to refute anything Fred said, but I can't resist typing something.
How Insane:
Being willfully innumerate will only take you so far.
Fred-
I don't know, willful innumeracy has taken the Republicans very far in the last 8 years. We're living the effects.
Here's a "tough choice" with some wonderful fiscal benefits: ending the war.
Actually, most of us are just waiting for Petey to come along and blast you for suggesting Obama wants universal health care.
Also, leaving Iraq and raising Rafael Yglesias' taxes do count as tough choices.
Regarding social security, if the program were simply eliminated today, the deficit would increase. (This is part of the "problem" -- as more of SS's revenues are actually used for SS, the budget deficit, using the numbers that are typically reported to us grows. The fallacy is assigning this as SS's problem.) Of course, there is a day when this is projected to be not true. At this time, you can do any or all of raise taxes, raise the retirement age, and cut benefits. "What we need is more market risk!" doesn't really sound... numerate? right now.
And, if there were some sort of universal health insurance available through the government (which, again, Obama isn't proposing) I'd have $2500 a year, and my employer several thousand more, to kick in towards offsetting the new costs in terms of taxes.
Anyway, it would sure have been nice to have paid the bills for the last 27 years.
Matt,
Why doesn't cutting Medicare count as "making tough choices?" We cannot afford to pay what Medicare has promised. We can either raise more revenue, spend less than we promised, or replace Medicare with some other program. Broadly speaking, those are our only options.
Are tax hikes the only solution that would count as "making a tough choice" in your book?
Note about Obama and "free" health care. Why don't Fred and Petey get together and hash it out. Both of them can't be right. Why don't you two exchange emails and report back when you've reached agreement?
As for affording "free" health care (by which I presume Fred means something akin to single payer), it costs other countries ~50-60% of what ours costs us. I'll take a 40% reduction in health care costs without too much complaint.
So, it finally dawned on me-- you know why conservatives don't trust McCain? Because he can't be trusted.
How big are these "deep" "cuts", and how measured? Relative to GDP growth? To inflation? To someone's prior projections of future expenditures? Whose? Are the models being used to estimate expenditures under McCain's proposals sincere, or are they just based on the standard election game of plugging absurdly realistic (and possibly inconsistent) assumptions into your model until you get the least favorable result for your opponent? And if we reduce medical expenses and therefore reduce Medicare costs, is that a "cut"?
Whatever McCain's plan is, I'm sure it's something I oppose. But if there's anything I know, it's that election-cycle claims about how things like how many jobs your economic plan will create, how much your opponent's budget proposal will cost, etc., are bullshit until proven legitimate beyond a reasonable doubt. If Matt and Bernstein aren't even willing to give us numbers, just weasel words like "deep", this goes in the bullshit heap too.
But if there's anything I know, it's that election-cycle claims about how things like how many jobs your economic plan will create, how much your opponent's budget proposal will cost, etc., are bullshit until proven legitimate beyond a reasonable doubt.
That's undeniably true. Still, "healthcare for everyone" is at least the kind of bullshit that--unlike the bullshit about a cheap-and-quick Iraq war or tax-cuts-for-the-rich-that-benefit-everyone--might possibly have a positive effect on my life in the next few years.
In-the-ballpark-bullshit is still a marked improvement over what we've been served up for the last eight years.
Jeffrey Davis,
As for affording "free" health care (by which I presume Fred means something akin to single payer), it costs other countries ~50-60% of what ours costs us
This isn't the only factor in the skyrocketing cost of care, but it might be worth pointing out that other countries' nurses, doctors, orderlies, paramedics, etc. are compensated at roughly 50% of what US counterparts make.
I'm not trying to be coy, obstructionist or patronizing; I'm genuinely interested in how progressives will reconcile the fact that getting US single-payer down to the affordability levels of foreign, socialized systems (which, unlike the Clinton or Obama plans would address the Health Care Cost elephant) will include the requirement that every nurse and every doctor take a 50% pay cut?
Also, many doctors operate personal practices, which, as private, entrepreneurial businesses, are worth quite a bit of money. Will they be bought out or confiscated? If bought out, how much will that cost, and how many years before the federal savings in overall health care costs catches up with those lump sum payments, including the interests on the loans the federal government has to take out to make the payments? If confiscated, well, what do you say to the public when they catch wind of the fact that the family Doctor had hundreds of thousands of dollars stolen from him or her by Congress?
Insane,
Social security and Medicare ain't broken and the American people know it.
Social Security is breaking, but it's a simple problem of demographics and an easy fix: raise the retirement age, cut benefits or raise taxes. In the proper magnitudes any, or a lower magnitude combination of the three, are sufficient to fix it.
To say Medicaire is something other than very, very broken is to put your head in the sand. The total cost of Iraq, wasteful as that war has been, is insignificant compared to the coming Medicaire annual shortfall. Even worse, raising taxes is insufficient (regardless of how much taxes are raised), cutting benefits is insufficient (by any measure of what could be cut without riots), and raising eligibility age will have no meaningful effect, whatsoever. Doing all three, without rethinking the way the program, or our entire medical system itself, is structured probably wouldn't even fix Medicaire.
what do you say to the public when they catch wind of the fact that the family Doctor had hundreds of thousands of dollars stolen from him or her by Congress?
Oh, I'm sure they'll be taking to the barricades to protest such injustice. After all, working folk have been sucking it up and accepting their stagnant wages for thirty years, but the manifest unfairness of asking doctors to take a pay cut is sure to precipitate massive social unrest.
Oh, I'm sure they'll be taking to the barricades to protest such injustice.
All I'm saying is Bush's argument about limiting medical damages because they were unfair to Doctors, didn't exactly hurt him. Doctors are admired figures in a lot of cases.
Also, many doctors operate personal practices, which, as private, entrepreneurial businesses, are worth quite a bit of money. Will they be bought out or confiscated?
Under what theory does anyone hold a property interest in who pays for medical care?
Under what theory does anyone hold a property interest in who pays for medical care?
I was under the impression you were suggesting a socialized system in which hospitals are publicly owned and Doctors were public employees. If that's not the case, then I've misunderstood.
Shinyk,
I agree with you that fundamental reforms in Medicare are needed. However, in my opinion, the factors driving soaring costs in Medicare are very similar to the factors drivng soaring health care costs in general: (1) an overabundance of specialists, who are much more expensive than primary care physicans (2) the tendency of health care supply to drive demand, without resulting in better health care outcomes & (3) the lack of effective price & utilization controls. I would recommend this article by Maggie Mahar on Medicare reform in the American Prospect, which addresses some of these issues. However, controlling Medicare costs should be seen as part of a broader initiative to reform health care in the United States.
In regards to physican salaries, it's true that physicans do make a lot more in the United Statse than other countries (I'm not sure about nurses & orderlies). It should be pointed out that, unlike the United States, doctors in other developed countries don't have to pay for medical school, which might account for at least part of the gap. But I think the bigger issue is the overabundance of specialists. The physician workforce of the United States has the highest ratio of specialists to generalists of any developed western nation. There are studies showing that not only are specialists far more expensive, but also that an increase in supply of specialists has no positive effect on health care outcomes.
By the way, Shinyk, you also might be interested in the landmark Dartmouth study of regional variations in Medicare spending. It's the best piece of evidence that more health care spending does not result in better care or health care outcomes:
http://content.healthaffairs.org/cgi/content/full/hlthaff.w2.96v1/DC1
In regards to physican salaries, it's true that physicans do make a lot more in the United Statse than other countries (I'm not sure about nurses & orderlies). It should be pointed out that, unlike the United States, doctors in other developed countries don't have to pay for medical school, which might account for at least part of the gap.
...
It's the best piece of evidence that more health care spending does not result in better care or health care outcomes:
...
I don't know if I think overspecialization is as big a driving force in cost of Health Care Cost as you've suggested it is, but I'll be sure and read this literature, which seems interesting on first glance. Other than that, though I'm not particularly warm to the idea of socialized medicine or single-payer systems, I basically agree with everything you've said.
Especially this: However, controlling Medicare costs should be seen as part of a broader initiative to reform health care in the United States. .
Controlling Medicaire Costs can only be achieved through Medicaire-affecting, non-Medicaire-specific measures such as those you've suggested (forcing down Med School Prices, forcing down doctor/nurse compensation, price controls on hospitals) or a scaling back in benefits that would be politically impossible and possibly heartless (such as a maximum of, say, 5 thousand dollars per year, per eligible citizen).
It's a lot nicer to see someone admit that How Insane's notions that
1) Medicaire "ain't broke (sic)" or
2) is fixable through the simple raising of taxes
are both fairy tales and discuss the problem in a concrete way.
Comments closed April 02, 2008.
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Heads in the Sand
Matt,
Just out of curiosity: Do Obama's economic proposals include making any tough choices? If so, please fill us in. From what I've heard, he has proposed nothing to slow the growth in spending of our current entitlements, some of which are growing three times as fast as our long-term economic growth rate, and on top of that, he wants to add brand new entitlements such as universal free health care. Will raising taxes on people like your father be enough to pay for all this? If not, than what "tough choices" is Obama prepared to make?
Posted by Fred | March 19, 2008 1:03 PM