Right Thinking From The Left Coast
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Krugman Consumes His Own Tail

Paul Krugman has written a bizarre op-ed in opposition to the GOP Medicare plan.  Let’s have some fun with it.

Here’s my question: How did it become normal, or for that matter even acceptable, to refer to medical patients as “consumers”? The relationship between patient and doctor used to be considered something special, almost sacred. Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough.

It’s acceptable to call them consumers and providers because that’s what they are.  The only reason this language strikes Krugman as odd is because he, like many liberals, has becomes used to thinking of healthcare as a “right”—something akin to Freedom of Speech. But any time there is a voluntary exchange of services, the relationship is one of consumer to provider.  There’s nothing repulsive or sinister about this.  Teachers, fireman, cops, doctors, clergy—none of these people work for free.  All of them provide services that we consume.

Note also that Krugman is engaging in the “I’m On Your Side” tactic.  He praises the doctor-patient relationship as something sacred.  But, as we will see, he does this on the way to severing and controlling that bond.

We have to do something about health care costs, which means that we have to find a way to start saying no. In particular, given continuing medical innovation, we can’t maintain a system in which Medicare essentially pays for anything a doctor recommends. And that’s especially true when that blank-check approach is combined with a system that gives doctors and hospitals — who aren’t saints — a strong financial incentive to engage in excessive care.

I agree.  One way we can do this is to put more responsibility on the consumers who have shown the ability to make complex and difficult decisions about homes, cars, schooling, computers and other supposedly opaque disciplines.  We could, for example, adopt David Goldhill’s proposal of moving back to a major medical system where the first few thousand dollars of healthcare—the most discretionary part—is controlled by the consumer and either the employers or the government provide a voucher for a $5000 deductible.  It’s difficult to imagine such a system now because we’ve gotten so used to first dollar coverage.  But that’s what we used to have when our healthcare spending wasn’t so out of line.  That’s what we have in non-insured regions like lasik surgery or fertility treatments, where price guarantees are normal.

Alternatively, we could move toward something like the Australian system.  In Australia, there is a socialized insurance system that provides basic care and pays a basic fee.  If you’re poor, you can go to lower-tier hospitals that accept those fees.  If you have more money, you can buy additional insurance or pay out of your own pocket to get better care.  But the key is that you pay the bills and are then reimbursed.  So the consumer is decidedly in the loop.  (My understanding of the Aussie system is based on talking to my wife and her family; blame any errors on them.)

So certainly Krugman, an economist, is going to suggest something along ... oh.

Hence the advisory board, whose creation was mandated by last year’s health reform. The board, composed of health-care experts, would be given a target rate of growth in Medicare spending. To keep spending at or below this target, the board would submit “fast-track” recommendations for cost control that would go into effect automatically unless overruled by Congress.

Dr. Krugman, please send a nice package of whatever it is your smoking to my house.  Have you been watching the budget debate?  We endured weeks of rending of garments and gnashing of teeth over the cutting of unspent budget authority.  Do you think Congress is going to stand up to seniors and tell them they can’t get care?  Even assuming this board makes some tough choices—do you really think Congress will let unpopular ones stand?

We don’t even need to ask these questions—we’ve already seen what will happen.  When PPACA was being debated, a study came out claiming routine mammography should start at 50, not 40.  Congress immediately moved to prevent this from being acted on, whether the result was valid or not. Their previous mandate on unproven CAD technology led to a huge surge in this expensive procedure. One of the reasons Republicans want insurance sold across state lines is that state governments have become incredibly pliable in mandating coverage, including “alternative medicine”.  During the PPACA debate, several senators tried to get alternative medicine like therapeutic touch and prayer therapy into the bill (these being fringe guys like um, ... the 2004 Democratic nominee for President).  Any government board is going to be controlled by special interests (who are solidly behind the idea) and overridden by a spineless Congress.

Where is this sudden surge of political courage going to come from?  This seems like an inverse of the “starve the beast” theory.  I’ll call it “gorge the beast”.  The idea is to let government healthcare spending get so out of control that Congress will have to act.

Now, what House Republicans propose is that the government simply push the problem of rising health care costs on to seniors; that is, that we replace Medicare with vouchers that can be applied to private insurance, and that we count on seniors and insurance companies to work it out somehow. This, they claim, would be superior to expert review because it would open health care to the wonders of “consumer choice.”

Notice the two-step here.  Krugman has spent his time running down consumer-controlled healthcare.  But now he’s running down a very different proposal on privatizing Medicare.  These are not the same things, unfortunately.

“Consumer-based” medicine has been a bust everywhere it has been tried. To take the most directly relevant example, Medicare Advantage, which was originally called Medicare + Choice, was supposed to save money; it ended up costing substantially more than traditional Medicare. America has the most “consumer-driven” health care system in the advanced world. It also has by far the highest costs yet provides a quality of care no better than far cheaper systems in other countries.

You know, it must be nice to be a Nobel Prize Winner.  It apparently means you never have to bother with facts anymore and can just pull things out of your ass.

Because this is pulled out of Krugman’s ass.  RAND has studied consumer-controlled healthcare and shown considerable savings, a result that has held up under some scrutiny.  And we are most decisively not the most “consumer-driven” healthcare system in the world.  According to the OECD’s 2008 data, out of pocket spending accounts for 12.1% of healthcare spending in the US. That’s less than Switzerland (30.8), Sweden (15.6), Japan (14.6 in 2007), Australia (18% in 2007), Canada (14.7% in 2007) and just about every country except France (7.1%).  Decisions might be consumer controlled; spending is not.  And any economist—any economist not talking out of his ass that is—can tell you what happens when consumers have no restrictions on spending other people’s money. The Kaiser Foundation has specifically identified the decline in patient responsibility (from 40 to 10%) as one of the reason for rising healthcare costs.

Medical care, after all, is an area in which crucial decisions — life and death decisions — must be made. Yet making such decisions intelligently requires a vast amount of specialized knowledge. Furthermore, those decisions often must be made under conditions in which the patient is incapacitated, under severe stress, or needs action immediately, with no time for discussion, let alone comparison shopping.

This is a straw man made of red herrings.  Under consumer-controlled plans, no one would be comparison shopping when they are incapacitated, under sever stress or need action immediately.  Such situations would be well into the insurance-controlled regime.  Additionally, the idea that healthcare spending is “involuntary” or that patients are incapable of making difficult choices is ridiculous and arrogant.  Two thirds of healthcare spending occurs in non-emergency situations.  Patients make decisions about healthcare every God-damned day, including about the most expensive and wasteful of care—end of life management. Medical procedures, by law, have to be explained to the patient who then has to be told of his prospects and alternatives.  They almost always do everything the provider says.  But is that, at least in part, because they’re not paying the bills?

The idea that all this can be reduced to money — that doctors are just “providers” selling services to health care “consumers” — is, well, sickening. And the prevalence of this kind of language is a sign that something has gone very wrong not just with this discussion, but with our society’s values.

No.  This is reality.  It’s not repulsive to describe patients and doctors and consumers and providers.  That’s precisely what they are.  We’ve just forgotten because of our diseased system.  All economic transactions—all movements of goods and services—take place between consumers and providers.  Describing that relationship as “sickening” is like the describing the Law of Gravity as “sickening”.

Posted by Hal_10000 on 04/23/11 at 07:03 AM (Discuss this in the forums)

Comments


Posted by TheEvilCapitalist on 04/23/11 at 03:14 PM from Australia

Excellent post Hal. One of the best I’ve read in quite some time.

Posted by AlexinCT on 04/23/11 at 07:49 PM from United States

I have concluded that most of the Nobel prizes these days are handed out based on political qualifications, usually to some of the nastiest or stupidest people possible. Case in point people like Obama, Arafat, and Krugman. The list of idiots given a prize for nothing but saying what the leftist intelligentsia likes to pretend is truth is long and distinguished by those that are undistinguishedly stupid.

You know, it must be nice to be a Nobel Prize Winner.  It apparently means you never have to bother with facts anymore and can just pull things out of your ass.

Nah man. That sort of stupid and reality challenged behavior’s not exclusive to these Noble prize winners: it is the way the lefty intelligentsia all operate. Facts, logic, and truth should never get in the way of the narrative.

Posted by on 04/24/11 at 04:09 PM from United States

You guys really deserve the world as you want it. You really really do.

http://www.kff.org/medicare/upload/8179.pdf

“The CBO projects that out-of-pocket costs for the typical 65-year old would be more than twice as large under the (Ryan) proposal than under traditional Medicare ($5,630) in 2022, because the cost of providing benefits is greater under private plans than under traditional Medicare.”

So you guys are asking to pay $7,000 a year more for care provided by the care denying health insurance companies?  And you are also hoping that they will cut your social security checks by about a $1000 or more a month. Careful boys you just may get what you ask for.

Posted by on 04/24/11 at 05:17 PM from United States

I suppose, Murgey, that most of the people here would rather pay more for our own care when the alternative is have our children and grandchildren pay for it.

Posted by AlexinCT on 04/24/11 at 05:22 PM from United States

“The CBO projects that out-of-pocket costs for the typical 65-year old would be more than twice as large under the (Ryan) proposal than under traditional Medicare ($5,630) in 2022, because the cost of providing benefits is greater under private plans than under traditional Medicare.”

So what Moogoo? Here is a question for you: if there isn’t enough money to keep the current massive debt and social spending obligation of the US government going, how much will the cost be for seniors once Medicare implodes along with the rest of our government? Ask seniors if they would prefer to keep Medicare for another decade or so and then have the government implode – if we are lucky that the crooks in charge can keep us going for another decade – or if they would prefer a system that would cost more, but be around to protect them long term. My guess is that with the exception of the ones that figure they will die long before the shit hits the fan and the crooks like you that want to rob others out of jealousy and greed, most will pick the later option.

What you refuse to acknowledge is that we have reached the point where we HAVE to change or we will, sooner than later, not have anything left. If you really have ever had to run a household, as you have claimed in the past, and now, as I see your insane and asinine defense of the indefensible play out, I suspect you are lying about, you would know that if there isn’t enough income to let you keep living like a millionaire on $100K a year, you will eventually end up not just broke but in trouble with the creditors and the law. That’s the problem: the left has run out of other people’s money to steal to buy votes with the collectivized state handouts.

So you guys are asking to pay $7,000 a year more for care provided by the care denying health insurance companies?

Because the current death panels in Obamacare aren’t going to be denying care, especially to them seniors that cost so much at the end of their lives, huh? Yeah, whatever moron.

And you are also hoping that they will cut your social security checks by about a $1000 or more a month. Careful boys you just may get what you ask for.

As I have repeatedly told you when you have asked, I expect SS to be bankrupt or to pay such a meaningless amount of money that I do not count on it being there. If I could stop paying it, I would, because the thing is joke of a Ponzi scheme that’s illegal for anyone else to do. I am doing my best to save on my own for my retirement, and the left is doing its best to punish me for trying to do so. Even worse, it believes I am evil for doing this and not giving my money to them to keep the indefensible scam they have straddled us with going.

BTW Moogoo, as can be expected from a scumbag lying lib like you, you forgot to mention that those currently 55 and over remain totally unaffected by any of these proposed changes. Anyway, I am curious for your explanation of how all those people that depend on SS as their sole source of income will be doing if the system isn’t changed and then implodes. I am certain that given the choice between nothing and less money they pick less money. Unless they are insane liars like you that is.

Posted by on 04/24/11 at 07:41 PM from United States

“The CBO projects that out-of-pocket costs for the typical 65-year old would be more than twice as large under the (Ryan) proposal than under traditional Medicare ($5,630) in 2022, because the cost of providing benefits is greater under private plans than under traditional Medicare.”

Factoring the buying power of 2022 dollars, the difference between the two would amount to about one tank of gas and a couple of Slim Jim’s at my local Stop&Rob;, besides, being able to see my own doctor, whenever I wanted, and have him looking out for MY well being instead of the governments, a small price to pay.

I am doing my best to save on my own for my retirement,

Muirgeo will one day learn (once the acne clears up) that being dependent on anything or anyone makes you, well, dependent, like a child who cannot do for himself. The American dream, making your own way and your own prosperity, requires you to remove the bonds of helplessness and strive for excellence. I know, totally contrary to the progressive culture of subservience to big government’s hollow promise of providing all your needs, but some do grow up and decide that being the captain of your ship, taking responsibility for your own welfare is rather exhilarating.

Posted by on 04/25/11 at 01:06 AM from United States

if there isn’t enough money to keep the current massive debt and social spending obligation of the US government going,

You saying that doesn’t make it true. We can easily afford to pay for all our countrymen’s medical needs. But the best way to do that is via a universal health care system. Putting everything into the hands of for profit health insurance companies will NOT decrease the amount we spend on health care.

Because the current death panels in Obamacare

You said death panels in relation to Obamacare. That makes you a total undeniable idiot along the lines of some creationist type thinkers...or like a Sarah Palin type of dope. DF !

I expect SS to be bankrupt or to pay such a meaningless amount of money that I do not count on it being there.

That’s because as I said you are very stupid and can’t do basic math… and because Sean Hannity controls your thought… Sean Hannity… he’s funny… I like watching him when he froths at the mouth. It makes me laugh. But yeah you’re one of his sock-puppet. Social Security has not added one penny to the debt.

Posted by InsipiD on 04/25/11 at 04:21 AM from United States

You saying that doesn’t make it true. We can easily afford to pay for all our countrymen’s medical needs.

No.  We’re already spending twice what we’re taking in, which amounts to almost 25% of the entire country’s economic output without socialized healthcare.  You’re ridiculous if you want to double-down on spending like that and your name-calling is just weak.  Go away.

Posted by on 04/25/11 at 07:18 AM from United States

Social Security has not added one penny to the debt.

You saying that doesn’t make it true.

Posted by AlexinCT on 04/25/11 at 09:14 AM from United States

if there isn’t enough money to keep the current massive debt and social spending obligation of the US government going,

You saying that doesn’t make it true.

In short, this is the left’s solution to the problem: pretend there is no problem.

Here’s some hard facts for ya Moogoo: I am not saying this the decline of the dollar is saying so, China dumping our debt and refusing to buy more is saying so, the IMF is saying so, and even Obama, while trying to also justify tax increases, a sure economy killer, which I am certain will then promptly end any effort to enact real spending cuts is saying so. But you? You are refusing to see it because you want to steal other people’s wealth to keep your ass protected from your bad decisions and lack of planning.

Posted by AlexinCT on 04/25/11 at 09:27 AM from United States

You said death panels in relation to Obamacare.

Yes I did, and that’s because they are just that: death panels, tasked with denying care to save money. You have no problem using the vilest possible language when you are painting private insurance companies with the broadest of negative brushes, so why can’t we tell the truth about Obamacare?

That makes you a total undeniable idiot along the lines of some creationist type thinkers...or like a Sarah Palin type of dope. DF !

Ah yes, pointing out that Obamacare will result in massive rationing makes me a creationist and an idiot, despite the fact that I am not a creationist and wish we took Darwinism more seriously and let it run it’s course to rid the world of idiots like you, and thus you think you won the argument!

Keep it up Moogoo, you are fucking priceless, man.

Posted by on 04/25/11 at 01:30 PM from United States

Putting everything into the hands of for profit health insurance companies will NOT decrease the amount we spend on health care.

If left to the usual mechanisms of the free market, it will most certainly reduce costs, along with providing a better product. Heaven forbid that for profit insurance companies will be ALLOWED to compete for my business, where I can choose which provider gives me not only the cheapest plan, but one tailored for my needs. Heaven forbid that I be ALLOWED to purchase what I need, and not have a once size fits all overly blotted government plan which is propped up, subsidized and over meddled by the nanny state. To allow the marketplace to compete on an even playing field, where providers (like car insurance) offering many different plans of coverage, yes, this will not only drive down costs but it will provide me with better coverage, and giving me just what I need (and am paying for) and nothing more.

It is not helpful to parrot something that you saw on another blog, you have to understand and be able to defend what you are writing, try it sometime.

Posted by AlexinCT on 04/25/11 at 01:47 PM from United States

To allow the marketplace to compete on an even playing field, where providers (like car insurance) offering many different plans of coverage, yes, this will not only drive down costs but it will provide me with better coverage, and giving me just what I need (and am paying for) and nothing more.

Are you nuts? What about the people that don’t want to pay but want everything? They have rights too! And what about the power the politicians give up when they get out of the insurance rigging game? NO WAY! This shouldn’t be allowed. Consumer shumer. Pay up and shut up! You are a racist, homphobic, denier creationist anti-science insurance industry toady that’s blocking utopia!!!11!!

Now you don’t have to bother replying Moogoo.

Posted by on 04/25/11 at 02:03 PM from United States

I still have hope for the little tyke. Maybe when he:

1)gets a job
2)has to pay taxes
3)has to find and pay for a health insurance plan

it will dawn on him that government is not, nor has it ever done him any favors, and that he needs to think and do for himself. Time to start being a productive citizen and contribute to society, not be a determent to it.

Posted by on 04/25/11 at 07:25 PM from United States

Posted by Retluocc1 on 04/25/11 at 06:18 AM from
Social Security has not added one penny to the debt.

You saying that doesn’t make it true.

Your saying that validates your ignorance… yes you are ignorant on the issue.

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