There are many pages in these forums devoted to healthcare reform. In this particular thread, until now that you have asked for my opinion on expanding medicare, I have steered clear of the many options for reform and just steadfastly maintained that we must do something, and that if we don't we are finished as a first rate nation. Medicare-for-all has been on the table in the past, and it would be the most "natural" transition for the U.S. among all the single payer options that have been considered --or pseudo single-payer, because private insurers are still involved via medicare supplements. This in itself would not bring down costs, and that's where the problem lies. The medicare administration, as you know, is blocked by Congress from operating efficiently in a way that would greatly reduce costs. It is all about preserving profits in the private sector. Medicare isn't allowed to negotiate drug prices, and they certainly would not be permitted to buy drugs directly from the Indian, Puerto Rican and Irish plants where they are being manufactured, though that would reduce costs in some cases from dollars to pennies. Even drugs under patent can be obtained for far less outside the U.S., but it's officially illegal to do so. With the present medicare system a person can easily be left with a 20 to 40K (or more!) bill after a brief hospitalization if they have no supplemental coverage, and supplemental coverage is expensive because both hospital and doctor charges are much higher in the U.S. than elsewhere. Medicare is not responsible for outrageous U.S. medical costs, but neither would it bring down costs by much if extended to everyone as its constituted now. There is so much money to be made from the present arrangement that it is extremely difficult to get any kind of change that would actually bring down costs by much because of all the vested interests. Just look at the opposition to Obomney care. What we ended up with was what you would get from an unruly committee -- somewhere in the middle between wonderful and awful. We will get more people covered. But the cost is going to remain outrageous even if it comes down some. Ultimately it is cost that is out of control, and you can't bring that down without some vested interest making less money. I've always said that my preferred way to tackle the cost problem would be to introduce competition and deregulate, because that way the market, rather then some bureaucrat, decides who is going to make less money. But the more I think about it, the less likely it seems that's a reasonable possibility. As time goes by, I am more and more leaning toward accepting that medical care is something that does not fit, and can't be made to fit, the capitalist mold with a satisfactory result. What's interesting is, that based on the other industrialized countries we compare ourselves to, there is an extra 1.4 trillion dollars bouncing around in the U.S. health care system every year. That means that were we to drop our per capita costs back to the average of the other thirteen nations, there could be as much as 1.4 trillion dollars bouncing around in the economy that would then end up in different pockets then it is ending up in now. That's really the crux of this entire medical care issue.
oh yes, of course my friend, who wouldn't know that? That's all they talk about on tv. Just walk out on the street with a microphone and ask any common man on the street, "You do know that medicare is blocked from operating efficiently by congress don't you?" And I'm sure they will all say, "Yes."
We ALREADY are a second rate nation, you just have to take the blinders off...and FWIW, many third world countries have completely stratified economies, which is something that has been ongoing in this country for many years now.
Of course the average person on the street doesn't know that, nor do they think about it. But you are far and away more knowledgeable than average. I know that you know, Oldtime, that Congress specifically blocked them from negotiating drug prices. But that's just the tip of the iceberg. Medicare administrators can potentially bring huge pressure on hospitals and physicians and force down prices, but they don't do half of what they could do. They do set limits on pricing as it is, but those limits are far above what they could be if medicare administrators really felt free to put the screws to hospitals and physicians. I mean what are the hospitals and physicians going to do about it. Refuse 70% of their customers. I don't think so! The reason they would have this power, if Congress were to allow them to exercise it, is exactly the same reason Walmart has tremendous power over their suppliers --and Walmart does exercise it!.. Walmart, for example, is a huge component of Proctor and Gamble's market. And medicare and medicaid combined are a huge component of both hospital and physician markets. Most people have very little interaction with the medical care system until the reach age 65 or older.<sup>*</sup> If you broke down the entire medical care market by age group it would look like the breakdown of Proctor and Gambles sales by retail outlet. _________________ <sup>*</sup> I suppose this is why you read so many naive posts re access to medical care in these threads, i.e., the respondents are relatively young and have had relatively little interaction with the U.S. medical system other than their school vaccinations and such.
now piezoe, you and I both know medicare part d was just to pay off the fascist crony capitalist drug makers by George Bush. But you know, getting back to taking care of poor people It is a very stickey problem Once you break the bonds of the free market, you open up the doors to government abuse
wow, that says a lot in a few words. I have become a firm believer that the government's proper role is to protect free markets, and assure that competition is not shut out. But I've noticed that "free markets" does not mean the same thing to everyone. To some it means that you as a market participant should be free to operate any way you choose, and in particular without interference, i.e., regulation, from the government. The people who believe this tend to equate "free markets" with laissez faire capitalism. On the other hand, I use the term "free markets" to mean that all participants should be free to enter and compete in a market on equal footing. This is not the same as laissez faire capitalism because under laissez faire capitalism you are free to form monopolies and syndicates with the goal of shutting out competition. I maintain that, by my definition, this latter behavior is anti-free market . Furthermore, by my definition, it would be difficult, if not impossible, to maintain "free markets" without government regulation.