The short piece and transcript below is linked to my comments at another blog. I’ve done this because the transcript was too lengthy to reasonably be included in another blogger’s comment thread.
So basically I’m using this post, as a ‘receptacle’ for my additional comments.
The information covered here would likely be of interest to anyone who is following the current fiscal crisis, especially as it pertains to Medicare Reform.
Below is an excerpt from the ‘Roundtable’ discussion on the [February 24, 2013] Sunday political talk show This Week with George Stephanopoulos.
The topic of discussion is Mr. Brill’s excellent piece entitled “Bitter Pill: Why Medical Bills Are Killing Us.” Here’s a link to his article at Time magazine.
And here’s a link to the PNHP website [Physicians For A National Health Program] website, and their analysis of Mr. Brill’s piece. As well as a link to the full transcript of the Roundtable discussion.
This article makes an excellent case for Medicare-For-All.
Please read on.
STEVEN BRILL, TIME CONTRIBUTOR: Let me ask you something as an outsider. What I don’t understand about this, is everybody says it’s a terrible idea, an awful idea, and yet everybody voted for it. And the White House keeps repeating that they want a balanced approach and the president has all of these cuts in mind including cuts to entitlements. But I haven’t seen anything specific that he’s proposed.
RATTNER: The president has put at least two specific entitlement cuts on the table. He’s proposed on the consumer price index on Social Security, he’s proposed limiting that. He’s proposed to raise the age for Medicare eligibility.
BRAZILE: The president has come up with three different plans at various times post the sequester to try to force the Republicans to come back to the table to bring revenues into the equation.
BRILL: When has he put out a statement saying let’s raise the Medicare raise to X. I haven’t heard that.
RATTNER: Well, look, a couple of things. First of all, the president has talked about raising the Medicare age.
BRILL: To what?
RATTNER: To 67.But wait a minute, in fairness I think he has also backed off that a little bit for reasons that we can talk about, but the fact is, the president has a plan. This is his plan. $1.4 trillion cuts over the next 10 years, balanced between revenues and spending. He’s ready to have a dialogue. The Republicans, you guys are saying you actually like the sequester. You think it’s fine that the government can cut this amount of money. So, OK, that’s your position. Now let’s let it happen and we’ll see who is right.
WILL: I want to go back to what you said, Mr. Rattner, about this is knock the economy sideways. $44 billion, or $85 billion out of a $1.6 trillion economy?At the end of the Second War World, with predictions that this was going to cause chaos and pain all over the — we cut federal spending 40 percent in one year. And what resulted was what we call the post war boom.
RATTNER: I did not say it was going to knock the economy sideways. I said it was going to have an effect — OK, well I said it was going to have an effect on the economy. In the macro sense I think economists were talking about a few tenths of a percent off GDP. It might not sound like a lot. In a fragile economy it is a certain amount.But there are specific programs that are going to be affected. What every unemployed person gets is going to be reduced by 11 percent once the sequester goes into effect.There are going to be fewer agriculture inspectors to stand in food processing plants, which means those plants can’t process food. This is all going to happen.
STEPHANOPOULOS: I think the Democrats are counting on is that some time in April or May when this all starts to kick in, the Republicans are going to break again.
STRASSEL: They’re not going to because they have put this central to their strategy. They chose to do this. They want to have this debate.Again, it’s not a fallback.Because I mean, look, I think there a are a couple of dangers here for the White House. They are warning of doom and gloom. How bad is it actually going to be when it happens? That’s a big question that has not yet been answered.
STEPHANOPOULOS: We just don’t know, do we?
STRASSEL: We don’t. And we don’t also know — a lot of people are not paying attention. How many American — this is not a government shutdown, OK. People are still going to get their passports, they’re still going to visit national parks. They’re still going to do all the things they’re used to doing.How many Americans are paying attention? And how many are going to decide that this is the Armageddon that the president building it up to.
BRAZILE: It’s the government slowdown. A shutdown might occur in March 27 when the CR, the continuing resolution runs out.But this is going to have a real impact on the regional economies all across the country whether it’s the threat of furloughs to federal employees. George, we have to brace for it in the Washington region, of course. Don’t be so giddy George.But the truth is, is that it’s going to have an impact on children in Head Starts, teachers, firefighters, first responders, people who live in subsidized housing will see their checks drop. So this is going to hurt the economy at a time when people are finally getting their sea legs back.
STEPHANOPOULOS: And George, the economy doing fairly well right now, was on track for about 3 percent growth. But if the add the effect of the sequester if it holds, along with what the tax increase that came at the begin of the year, economists now saying that could take over 1 percent off of the economic growth this year.
WILL: Some economists.Other economists deny that you can have a discernible effect on, again, a $16.4 trillion with $44 billion.
STRASSEL: Also, couldn’t you maybe have a positive effect?Look, what markets are worried about is the size of the deficit, the size of the debt. They actually want some proof that Washington is making the start of fixing this problem. You do this, you let this go into effect, hopefully you do it in a more targeted and intelligent and flexible way, but you do this, you send a signal to the markets that Washington is making a start. That could help the economy
RATTNER: But what every poll also shows is that what the American people want is a balanced approach. They want it balanced between spending and taxes. As we said earlier, we’ve cut $1.7 trillion out of this relatively small part of the budget. We’re eating our seed corn. Our spending on R&D and infrastructure as a percent of our economy has gone down by half over the last 20 or 30 years. We’re not investing in the future. And these kind of cuts are the worst possible kinds of cuts.
STEPHANOPOULOS: But the American public wants health care they can afford, and health care that works for them. And that gets to the subject of Steve Brill’s cover story in Time magazine this week, as I said, sending shockwaves to hospitals across the country.Let’s put up the cover right there, “Bitter Pill: Why Medical Bills Are Killing Us.” And you had some shocking details here, Steve, You talk about sky-high medical bills for going to the emergency room for a fall in the face, people paying 1.50 for an aspirin, $300 for an x-ray that costs Medicare $20.But that’s just the beginning.
BRILL: Right. And it actually that bares on the conversation we’re having, because a chunk of that money is paid by Medicare. Medicare is I point out in the article is very efficient at most things. It buys health care really efficiently, which is a great irony, because it’s supposed to be the big government of bureaucracy.Where Medicare is not efficient is where congress, because of lobbyists have handcuffed Medicare. Medicare can’t negotiate what it pays for any kind of drugs. It can’t negotiate what it pays for wheelchairs, diabetes testing equipment. And if congress took those handcuffs off of Medicare, you could get about half of the spending cuts that we’re sitting around here talking about.
STEPHANOPOULOS: Is that true?
RATTNER: You could get a fair amount. Look, if Medicare were simply able to get the same prices for prescription drugs that Medicaid gets, it would save $120 billion over 10 years. So that’s roughly…
BRILL: It’s actually a little more.
RATTNER: But there’s a fundamental point here, Stephen, I think your piece was great. And I think you’re points are right, but I also don’t want people to be confused. I don’t believe that we can cut our way, change the pricing, do all the things you’re talking about and still save Medicare. The average person who’s at Medicare retirement age has paid in some like $122,000 in the system. They’ll get back $387,000 back in benefits. That’s three times. You’re not going to reduce that $387,000 by hospital cuts and this and that. We have to still have fundamental Medicare reforms to make those numbers work.
BRILL: Well, if you put Medicare in the context of the larger health care system, and this is something that everybody at this table is going to think that I should go to a mental hospital when I get finished saying this, the government and all of us would actually save money if you lowered — I said lowered the age for Medicare. If the Medicare age were 60 instead of 65, the economy and the taxpayers would actually save money. And George, please don’t look at me like that.
RATTNER: You’re potentially right. And part of the argument — you’re taking people out of the Medicare age to 67 is you’re taking people out of the Medicare system.
BRILL: Right. And what you would be doing, is you would be putting the most efficient player, which is Medicare — Medicare spends 80 or 90 cents to process a claim and the health insurance companies spend $18 or $20 or $25 to process a claim. Health insurance companies pay two, three, four times what Medicare pays for various services. So if you lowered the age, you would put more people into the bucket of much more efficient health care.And the worst part about it is, the reforms that we have now, with the president’s plan, are actually going to raise the costs because all of the people who are 60, or 62, or 63, who can’t afford the premiums that they’re going to have now, are going to be subsidized by the taxpayer.
STEPHANOPOULOS: George, well that becomes an argument for a single payer system.
WILL: That is one argument.Here’s an argument against that, for a different kind of reform, all the big numbers, billions and trillions, 12 cents is the most important number. 12 cents is the portion of every health care dollar paid by the person receiving the health care. Someone else is paying the rest. It was 47 cents 50 years ago when Jack Kennedy was president.Now, let me ask the five of you a question, you go to the doctor and he or she says they say I want to give you the following test? How many of you five say, how much does that going to cost?
BRILL: Give me two.
WILL: Don’t bother, because the doctor can’t tell you anyway.
BRILL: George, you’re completely wrong. We have tried that experiment with 30 million to 50 million Americans who don’t have health insurance and have to pay 100 percent right now. And they have no choice, they are powerless consumers. If you go to an emergency room and a doctor says you need a CA Scan, and the doctor may not even say it, they may just do it, you’re not sitting there as a consumer saying, gee, I wonder if this is the most efficient emergency room. I wonder if I really need that CAT scan.
STRASSEL: No, we haven’t, because we only have a small group of Americans who are doing that. We have a much larger group of Americans, like George says, who are getting their health care through their companies and it’s largely paid for them and they have no skin in the game.The important part about your piece was that you mentioned that this is a seller’s market. There’s no transparency in the market. There’s no competition. There’s no ability for consumers to look around. We spend hours deciding which toaster we’re going to buy. We put no such thought or work into where we’re going to get our health care. And you have had companies like Safeway who worked with their employees to introduce some transparency. And you’ve seen a big reduction in health care costs.
BRILL: There’s a difference between buying a toaster and buying a CAT scan.
RATTNER: This is a huge moral question for the country, because I agree with George, that right now, most Americans do not see price in deciding whether to use health care. You see price in toasters, you see price in cars and homes, everything else. In health care, you don’t see price. And therefore, I have to believe, and I think your piece eluded to this, that when people go on Medicare, they really don’t see price, they tend to consume more than they otherwise would.26 percent of all Medicare spending is last year of life. We don’t know how much of that is really efficacious spending. These are really tough moral questions for the country. But we’re going to have to deal with them if we’re really going to get health care under control.
STRASSEL: What you’re getting to, though, is the fundamental question, are you going to let consumers make those choices about end of life decisions or are you going to have Medicare about what procedures you can have and how much they’ll pay and government make those choices?
BRILL: That’s a great though if the consumers you have in mind have the money, because you’re saying they’re not going to have insurance, have the money to make those decisions the way my friend Mr. Rattner can. And that is not the world we live in. They’re making decisions now, those consumers who don’t have insurance, because they don’t have the money, they can’t write the checks. They’re being sued for their bills. This world you describe…
RATTNER: But once you go on Medicare, they’re in a different position once they go on it.
BRILL: Once they’re 65. But there are 64…
RATTNER: The point all of us are trying to make is that people who have either private insurance or Medicare, probably almost certainly consume more medical service than they need because they don’t see price.
WILL: The uninsured is not the germane cohort here, the germane cohort are people with high deductible insurance, that is no one expects your automobile insurance to cover your windshield wipers, or your oil changes. Insurance is for large, unpredictable events.People who buy high-deductible insurance, we now have enough of them that we have real data. Two things, they use the health care system less and there’s no discernible health cost to it.
At this point, Stephanopoulos brings the topic to a close.