So I suppose being an internist gives me an unfair advantage over even most physicians for knowing how to pursue evaluation for even simple complaints. For that, I am grateful. I am grateful I have the knowledge to make informed decisions everyday about illness that will certainly affect me or my wife or my family in years to come. I am grateful I know which questions to ask. Which tests to deny. Which tests are being done just for the money.
Medicare's Hospital Insurance Trust Fund is going bankrupt. Fast. You know, the one you pay 1.45% of all your income on every paycheck, as does your employer. It is now cash flow negative and will be insolvent in 10 short years. Then what? What the hell do you do? I'm glad I know what I know. I see no possible way to slow the cost of health care as long as we continue to spend other peoples money. The third party model. That pays for everything, every time, with a few medically necessary words placed in the appropriate spot. The growth in spending cannot be sustained.
The 2.3 trillion dollar behemoth that is American health care is being milked for every possible dollar on the back of the tax payers and premium paying customers every where. Every player looking for their piece of the pie. Hospitals. Doctors. Lawyers. Drug companies, Device manufacturers, IT specialists, technology experts. They are all looking for their pay day.
Take for example Happy's insurance premiums. Our small group of about 20 docs and nurses. We learned our insurance company wants to increase 2009 premiums by almost 30%. Thirty percent. Unbelievable. I learned that another group of docs in town is experiencing a 50% increase. Irrational by any and all measurements. The laws of mathematics say these kinds of increases simply are not sustainable.
Insurance has become a currency. The expenditures are out of control. Especially on the backs of the 5% who spend 50% of all dollars. They have ruined it for everyone else. We have a system in place, both public and privately financed that treats everyone equally. And leaves those with no insurance out to pasture.
You only have to ask yourself one question. With the financial world collapsing around us. With millions of global jobs being lost on the backs of capitalism's boom and bust cycles, why is health care a perpetual growth industry with highly inflated prices and no competitive forces? It's the demand that is guaranteed by you and I. By corporations which pay for the health care as currency for all their employees. By guaranteed revenue streams of third party economics. It simply cannot last. The question is, what part will buckle first? And I don't have an answer for that. But what ever it is, and whenever it is I'm just glad I'm an internist, not only for me, but also for my family and extended family as well.
Dr. Val has a pertinent post on her site that has a segment which goes hand-in-hand with your post. An excerpt:
ReplyDeleteCharlie Rose asked Atul the million dollar question at the end of the interview, “How do we fix healthcare?” His response was well-reasoned:
First we must accept that any attempt to fix healthcare will fail. That’s why I believe that we should try implementing Obama’s plan in a narrow segment of the population, say for children under 18, or for laid off autoworkers, or for veterans returning from Iraq. We must apply universal coverage to this subgroup and then watch how it fails. We can then learn from the mistakes and improve the system before applying it to America as a whole. There is no perfect, 2000 page healthcare solution for America. I learned that when I was working with Hillary Clinton in 1992. Instead of trying to fix our system all at once, we should start small and start now. That’s the best way to learn from our mistakes.
If the Medicare Hospital Insurance Trust Fund is like the Social Security Trust Fund, then there is no fund.
ReplyDeleteFor Social Security, all collections go into the Treasury, and accountants note how much went in. When Social Security payments are made from the Treasury, the accountants note how much was paid out. The difference at any time is how "solvent" the trust fund is. For example, as of now, more has been collected under the name Social Security than has been paid out, so the fund is "solvent" and has a surplus.
This means that there is a piece of paper with a positive total written on it.
More importantly, more is collected in current years than is paid out, so the "fund" (the total on that piece of paper) is growing. The problem is that current liabilities are huge, about $15 trillion ($15 million million), and the "fund" will run out in about 20 years.
I say there is no fund, because no cash or investment is set aside according to the surplus amount. Actually, all of the money has been spent from the Treasury, and more. That is the meaning of a yearly budget deficit. The government spends all of the money it collects each year, including the Social Security receipts, and borrows about $400 billion more, all spent.
So, when current Social Security payments begin to exceed current Social Security receipts in about 8 years, the only cash available will have to be raised as then current taxes. There is no fund, just the tax increases that people will have to pay in, so that the promised payments can go out.
Soon after is when the Ponzi scheme comes apart. The increase in taxes will be huge, and people will finally realize how they have been fooled. All of the current promises about later retirement and medical care is merely a promise to raise taxes in the future. All of the current receipts are spent, along with huge borrowings.
I don't know for sure that the Medicare fund is like the Social Security fund, but I think it is. Promised Medicare benefits are estimated to be a current (unfunded) liability of $60 trillion, about 3.3 times our current total GDP (Gross Domestic Product) of $18 Trillion.
Agree with everything except that you internists aren't unique. Us family physicians also have broad knowledge about how to handle the common problems and enough training to pick out the exceptions who will be missed in the coming PA and NP based primary care system.
ReplyDeleteThe pediatricians have similar skills for a portion of the population but I wouldn't want to be them right now. The first likely change from Obama will be to expand SCHIP, putting much of the pediatric population under a Medicaid like system. With those payment rates, you can say goodbye to any pediatrics practices that aren't heavily subsidized.