That magic number of 15%. Hillary Nation or Obama Land will never be able to promise universal anything if you don't have a solid foundation of primary care doctors willing and able to take the reigns of chronic disease and spend time with the disease and the patient. Extenders will never be able (nor will they ever want to) be the leaders of this most difficult profession. It is, in so many ways, much harder to be a primary care doctor than a specialist.
Many in the lay public believe that doctors make too much. That they are greedy for wanting more. The correct word is not greed. It is opportunity cost. Can I make more money doing something else than I am as a primary care doctor? For many, the answer is a resounding yes. Become a specialist. Become Wall Street. Become a lawyer. A businessman.
The greed factor is farthest from the truth. It is the obstructionist system in place creating havoc to the physician patient relationship.
Senior citizens. There. I said it. The biggest, fattest, richest and greediest group that ever lived. And they are going to bankrupt this country beyond any imaginable stretch.
And because of their strength in numbers and wealth in numbers, there ain't a politician in this country who is willing to take them on.
Comptroller General of the United States David Walker recently gave a speech titled A Call For Stewardship
word for word:
Candidly, our current deficit and debt levels are not unduly troubling as a percentage of our national economy. However, these deficit levels and related debt burdens are set to escalate dramatically in the near future due to the retirement of the "baby boomers" and rising health care costs. The fact is, absent meaningful reforms, America faces escalating deficit levels and debt burdens that could swamp our ship of state!
This brings me to the longer-range picture. Believe it or not, the federal government’s total liabilities and unfunded commitments for future benefits payments promised under the current Social Security and Medicare programs are now estimated at $53 trillion, in current dollar terms, up from about $20 trillion in 2000. This translates into a defacto mortgage of about $455,000 for every American household and there’s no house to back this mortgage! In other words, our government has made a whole lot of promises that, in the long run, it cannot possibly keep without huge tax increases.
The Medicare program alone represents about $34 trillion of our current $53 trillion fiscal gap. If there is one thing in particular that could bankrupt America, it’s runaway health care costs. And don’t forget, the first "baby boomers" will begin to draw their early retirement benefits under Social Security in a couple of weeks! And, just three years later, they will be eligible for Medicare. When "baby boomers" begin to retire in big numbers, it will bring a tsunami of spending that, unlike most tsunamis, will never recede.
The prescription drug benefit alone represents about $8 trillion of Medicare’s $34 trillion gap. Incredibly, this number was not disclosed or discussed until after the Congress had voted on the bill and the President had signed it into law. Generations of Americans will be paying the price—with compound interest—for this new entitlement benefit. In many ways, the 2003 Medicare prescription drug episode arguably represents government "truth" and "transparency" at its worst. Unfortunately, based on adding the prescription drug benefit and other spending and tax actions, the federal government seems to be ignoring the first rule of holes in connection with its fiscal affairs. Namely, when you’re in a hole, stop digging!
If trillions of dollars aren't big enough to get your attention, believe it or not, in fiscal 2007 over 62 percent of the federal budget was on "auto-pilot" and this percentage is on the rise! Shockingly, the major functions expressly envisioned by our Founding Fathers as a proper role for the federal government—things like national defense, homeland security, foreign policy, the treasury function, the federal judiciary, the Congress and the Executive Office of the President—are in the remaining 38 percent of the federal budget! And this portion of the budget is set to get squeezed.
These benefits aren't means tested either. So a poor 30 year old with 5 children is paying taxes to support a 66 year old multi millionaire's Viagra prescription courtesy of our dysfunctional welfare state.
Doctors aren't greedy. America is.
Instead of reining in the Greed of America, they have tried to rein in the "Greed" of the doctors. They have destroyed the primary care profession and made the greedy Americans move to a system of expensive free ER visits and expensive specialists with lots of xrays and procedures.
It is politically incorrect to call your constituents greedy. But that's what they are.
Quit destroying the profession that provides a valuable service to this country and start destroying the me mentality. And do it proudly.
When Congress finally gets their heads out of their assess and realizes FREE=MORE will eventually become MORE=BANKRUPT, only then will real reform happen.
Talk of universal government paid single payer system is ridiculous if you can't even pay for what you have now. And you don't have a primary care system in place to handle it.
It's fantasy land economics.
The US dollar is plummeting in relation to many other currencies through out the world. Because we keep printing our way out of consumptive debt. And everyone knows that the more money you print, the less it becomes worth. That's inflation for you. It makes our buying power plummet. The value of our money continues to plummet in relation to other currencies in this world. And as other countries realize that buying our debt (who do you think is paying for it) is less secure and more risky and worth less in relation to their money they will demand higher interest payments for that extra risk.
And there you have it. Inflation. America's debt is no longer as appetizing as it used to be.
And our government's response?
Cut doctors fees. Destroy the hands that can save you. Not cut the benefits. That would be the right answer. But it would also be political suicide.
"i'm avoiding other responsibilities by responding here"
ReplyDeletethat's great! lol
just wanted to say great post. as a society we really need to adjust our expectations. i wonder if we can adjust those expectations from a medical liability standpoint to allow for less testing and such to really try and save costs, as in england? doubt it. maybe someday we will have to ration treatment oregon style-create a list of covered items. if off the list, you have to figure it out on your own.
So much of this right on the mark.
ReplyDeleteWealthy medicare patients (with vacation homes and annual Hawaii trips) are asking for an Rx for prescritption version of the prilosec and antihistamines that they had been buying over the counter, so as to get part D to pick up the cost.
I don't want my children buried in tax because we can't get our politicians to stop handing out entitlements. The lack of means testing is particularly galling to me.
This problem will require something more complex than cutting benefits. To some extent it will require a set of solutions in which everyone shares some of the burden.
ReplyDeleteIt's easy to look at the costs collectively and create scary numbers. Many retirees, whether deemed "wealthy" or not, are looking at their expected lifespan, the rising cost of living, and wondering if their money is going to last. Cuts in benefits are likely to be spread across the board, not focused on some group said to be able to afford to pay their own way.
Perhaps if the President and Congress got their healthcare through the Medicare system they would be in a better position to decide what the country can afford.
Excellent and definitely informative post, George.
ReplyDeleteI'd rather have a bunch of clones of you in Congress, any day! :-)
If politicians balanced their own checkbooks the way they balance the taxpayers', they'd be conducting the business of state from rescue missions.
The baby boom debacle was glaringly obvious years ago (and I recall that the Social Security Administration was several trillion dollars in debt over 20 years ago), yet Congress did nothing but expand entitlements they had to know they couldn't pay for, but what the heck: The funding didn't come out of their own checking accounts, anyway, and their irresponsible disbursements got them votes.
"Don't tell my mother I'm a politician, she thinks I play the piano in a whorehouse."