Democrats to Cut Medicare
Politics
| September 15, 2009
| Tim
Dr. Arie Szatkowski, a cardiologist, via Instapundit:
If enacted as scheduled on Jan. 1, 2010, policy changes recommended by the federal Centers for Medicare and Medicaid Services (CMS) -- the government's insurer for the elderly and disabled -- will severely cut current Medicare reimbursements to cardiologists and oncologists for critical care services...
Not long after GW Bush's second election, the Denver Post ran a screaming headline: "Bush to cut Medicare." The family I was staying with, who generally leaned left and apparently didn't read the details with a critical eye, groused about how of course Bush would certainly cut out important medicare services and leave the disadvantaged to die. Just like him!
Yet the article, if one bothered to read it, eventually admitted their source was allegedly an "unnamed official" somewhere in the Bush administration, who said Bush would have "no choice" but to cut Medicare. Uh huh. That certainly deserves a front page headline, no? Some anonymous friend of one of your staffers says he works for the administration and has a feeling that Bush might cut Medicare sometime. Stop the presses!
Bush, of course, massively expanded Medicare. But never mind facts.
So I'm waiting for the Denver Post to write the same headline about Democrats. (Might even be appropriate now that such cuts are actually planned.) And for my friends to similarly freak out and proclaim the immorality of it all.
I have a feeling it's going to be a long and fruitless wait.
I'm not holding _my_ breath… *sigh*
I'll be glad if the Democrats can pull this off. Payback from the 60+ voting block is heck and it needs to be done.
I suspect part of the reason that this move is not as criticized by the left is that Obama seems to want to use the money from Medicare to fund other forms of government healthcare.
While I'm not a fan of government-provided medicine, I do think that things like improved neo-natal care for the poor will net far greater benefits than medical spending for the elderly.
Though if your point is simply that George W Bush was not the fiscal conservative that many people, right and left, expected him to be then agreed.
Well, my points are many and varied.
As far as this particular cut, I'm not sure I'm in favor of it at all: there are people who have planned their lives around promises of Medicare, and I think it's wrong to pull the rug out under them. Same for Social Security. Also, if you read the article, he makes a decent case that these particular "cuts" will actually leave people disabled and dependent on the state they could have been otherwise mobile. That's both immoral and expensive in the long run. Put yourself in their shoes if you don't think so.
Real reform would include, in my book, always having minimum copays (scaling; higher for ER services -- to make sure everybody shares in the pain, and minimizes frivolous abuses), rolling back Bush's idiotic expansion, kicking the wealthy out of Medicare (*why* are we paying for Medical treatment for those who can more than afford it?) and putting them into a giant group insurance pool, better bidding for services, doing far more fraud investigations, and probably many more that I can't remember in under a minute.
I suspect part of the reason that this move is not as criticized by the left is that Obama seems to want to use the money from Medicare to fund other forms of government healthcare.
I suspect a bigger part is simply *who* is doing it. Bill Clinton was able to cut spending in many programs because the media doesn't react at all the same way. A bit like Nixon going to China, perhaps.
Though if your point is simply that George W Bush was not the fiscal conservative that many people, right and left, expected him to be then agreed.
Yeah, I agree: W was hardly a fiscal conservative; basically social and fiscal centrist, wanting to put tariffs on steel, let people know the government was there to 'help them', but also cut taxes.
But the bigger point is that I'm simply rather disgusted with the obvious propaganda I've come to expect from news outlets. I wouldn't even care if they were actually principled in their political bias (such as hating medicare cuts no matter who did them). But the double standard and selection bias, combined with reaching for nearly complete fabrications when necessary, has me irked.
Strange word, irked.
Up there with ilk.
My ilk is irked. Hrm. :-)
Also, if you read the article, he makes a decent case that these particular "cuts" will actually leave people disabled and dependent on the state they could have been otherwise mobile.
Where does he says that these cuts will leave people disabled? His argument seems to be that the treatments he's discussing decrease mostly mortality, not morbidity. Perhaps there are other treatments he's not discussing but also affected by the changes, re the following;
Admittedly, I hadn't read the article. He seems to be referring to some new issue. Here's a reference to what I think he's discussing. I agree, this is more relevant than reducing other forms of end of life care which is what I assumed the topic was. I haven't entirely parsed the proposed changes.
Put yourself in their shoes if you don't think so.
Personally, I feel I get more health benefit spending my money on improved diet and lifestyle as opposed to cytotoxic drugs. One of my good friends overcame cancer through changes to his diet, eschewing chemotherapy. He would counsel other people who had cancer on what that kind of treatment required, and was repeatedly frustrated with their inability to keep simple dietary commitments in the face of their own mortality.
You make an interesting argument that people are depending on Medicare. But if we'd restricted medicare treatments to the ones available when people paid into Medicare, I'm not sure that cost would be the issue that it is.
Some quick background that I dredged up;
Until 1996, only fluorouracil plus leucovorin
(FU/LV) was available for the treatment of patients with colorectal
cancer. The median survival of patients with metastatic disease
was approximately 12 months.
...
For example, clinical trial populations that had access to fluoropyrimidines,
irinotecan, and oxaliplatin had an overall survival
of approximately 21 months.17
...
Table 4 provides cost estimates for commonly used regimens.
The drug cost of FU/LV is less than $100 for a 6-month course.
Commonly-used regimens that add irinotecan or oxaliplatin cost
$20,000 to $30,000 for the same 6-month course. Bevacizumab contributes
an additional $24,000, and the cost of weekly cetuximab alone
exceeds $50,000. As shown in Figure 3, the aggregate drug cost for
treatment of patients with metastatic colorectal cancer is $150,000 to
$200,000 for an additional year of survival compared with FU/LV
alone.21
source
Obviously the average is the result of a wide variance.
your proposed reforms sound good.
A bit like Nixon going to China, perhaps.
I actually debated using that exact phase in my original reply.
But the double standard and selection bias, combined with reaching for nearly complete fabrications when necessary, has me irked.
Fair enough. Though as medical care improves, I think a principled discussion of the issue will have to involve answering the question "how much should a particular institution in a given situation be obligated to pay in order to extend the life of a 5 year old, a 25 year old or a 50 year old by one month on average?" That way, we could at least evaluate a government's allocation or reallocation of resources. But that's the discussion that it's just not politically correct to have.
My ilk is irked. Hrm. :-)>/i>
I don't blame it. It's almost ilk season.
My source for chemotherapy got eaten. source
Re-reading my list of Medicare cuts, I realize I forgot one of my top ones: Phase it out over time. As I mentioned, the current elderly were promised Medicare, and thus planned (or didn't plan) around that. But if we could inform the next generation that things will be different, they'd probably be more likely to buy insurance and plan for it.
Instead, we could take a fraction of the money per capita (akin to Murray's generous proposal), put it into some giant insurance pool (or set of them) in their name, auction those pools off to buyers, and then provide some sort of portability.
The price tag for Medicare is $217 billion in 1998 and
averages about $5,600 per person covered by the program. [PDF]
I'm guessing that's per year, in, as noted 1998 dollars. Today, several million in catastrophic coverage per year costs well under $2,000 a year. So that's more than enough to provide some initial seed investment which will automatically turn into a catastrophic insurance policy when they reach retirement.
If they're reasonably wealthy, it doesn't kick in until they fall under some line, and goes back into the pot — or returns some fraction back to a named beneficiary.
Where does he says that these cuts will leave people disabled?
My bad: I think I was reading two similar articles near the same time, and conflated them in this particular reply.
"These cuts will force cardiologists and oncologists to limit care to their Medicare patients, withdraw from treating Medicare patients altogether..."
I apologize: as you say, he's only implying some will die. :-/
Personally, I feel I get more health benefit spending my money on improved diet and lifestyle as opposed to cytotoxic drugs...
I'd argue a lot more studies needed to be done before we could be sure that "improved diet and lifestyle" was some kind of meaningful treatment policy. While I'm not closed to the idea (though I haven't read the links yet) I'm also not sure the link between the two are quite as strong as such words imply, nor that mass behavior is quite that malleable (even if so).
Nixon, ping pong: I actually debated using that exact phase in my original reply.
"Debated" describes my choice to use it as well. It's a bit inapt as the media was hardly anticommunist at the time. So I doubt Johnson (say) would have received flack either, had he done the same thing, other than from a few John Birch society members. To compare that to the mainstream media's noise last year about Bush's overspending and the deficit (and near complete silence on the same topics today) strikes me as, shall we say, a similar directional vector, but of a rather different magnitude.
Though as medical care improves, I think a principled discussion of the issue will have to involve answering the question "how much should a particular institution in a given situation be obligated to pay in order to extend the life of a 5 year old, a 25 year old or a 50 year old by one month on average?"
Who says we need to decide that in some central fashion?
On the "con" side, I'd argue that we could let a combination of the market (decisions by the afflicted, relatives, loved ones, living wills, etc.) and charities sort that out. Before medicine became more "socialized", doctors generally gave a good percentage of their week to pro bono work, and would probably have made as many good/bad such decisions, in aggregate, as any proposed gov't mediwonk.
I was going to argue a "pro" side here too, but I think I just realized it (hospitals give lifesaving care regardless of ability to pay today) already falls under my "con" argument.
The decision only needs to be centralized if the control of care itself becomes centralized.
If you mean that we should have such a debate informally, then I'm all for it -- but would say it's probably ongoing already.
I don't blame it. It's almost ilk season
LOL! :-)
The role of IGFs in cancer is supported by epidemiologic studies, which have found that high levels of circulating IGF-I and low levels of IGFBP-3 are associated with increased risk of several common cancers, including those of the prostate, breast, colorectum, and lung.
source
The current evidence suggests that milk consumption may increase the circulating IGF-I level.source
RESULTS: After a month of drinking whole milk, Mongolian children had higher mean plasma levels of IGF-I ... and 75th percentile of GH levels (p = 0.005). After a week of drinking low fat milk, Boston girls had small and non-significant increases in IGF-1, IGF-1/IGFBP-3 and GH. CONCLUSION: Milk drinking may cause increases in somatotropic hormone levels of prepubertal girls and boys. The finding that milk intake may raise GH levels is novel, and suggests that nutrients or bioactive factors in milk may stimulate endogenous GH production.
source
RESULTS: Overall, there was a moderate but statistically nonsignificant inverse association between intake of low-fat milk or calcium from dairy food and colorectal cancer risk.
source
Animal models, usually for colon and mammary tumorigenesis, nearly always show that whey protein is superior to other dietary proteins for suppression of tumour development. This benefit is attributed to its high content of cystine/cysteine and gamma-glutamylcyst(e)ine dipeptides, which are efficient substrates for the synthesis of glutathione
source
In short, the Insulin Growth Factor in milk, despite what other benefit it might give in terms of increased height in growing children, increases cancer risk. My friend with cancer was evangelically against milk and milk products. I took a more moderate view, since it seems that whey protein (particularly hydrolyzed whey) has an anti-cancer effect for reasons that are still debated, but which would account for the anti-cancer effects of skim milk. High levels of cystine in whey relative to other amino acids has been proposed.
The Rotterdam study has shown that menaquinone (K2) has some amazing effects on arterial calcification.
For that matter, aerobic exercise has been shown to be better than lithium at treating bipolar disorder.
(Oddly, aerobic exercise + lithium did worse than aerobic exercise without lithium.)
nor that mass behavior is quite that malleable
I'm open to debating the benefits of diet and lifestyle changes. But if someone is unwilling to alter their own behavior I think that diminishes their moral claim to public services.
(My concern is more with the quality if nutritional information that people tend to get. )
Who says we need to decide that in some central fashion?
I'm speaking as far as allocation of government resources are concerned. Putting aside for a moment the question of whether a tax dollar should be spent at all, if the government gives seniors medicare, it's worth asking whether that same money could be put to better effect if spent in some other way.
Though having some up-front agreed upon standard (between, say, an insurance company and a client) might help resolve some of the lawsuits which plague the system. One problem with markets for insurance is that people often pay for things long before they know what they're getting. On an only slightly tangental note; when my uncle discovered his wife was having twins, his insurance repeatedly 'did not receive his payment.' He finally drove the payment in to the office. This seems like attempted fraud to me on the part of the insurance company, and worthy of government regulation or intervention.
discovered his wife was having twins,
...I meant triplets.
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I'm not holding _my_ breath… *sigh*
Posted by: Michael Zappe on September 15, 2009 01:42 PM