Nobel Winning Economist Wants Death Panels, VAT To Save Medicare

[I AM NOT THAT GUY 5,715]

From today's ABC News Sunday:

MARCUS: ... and the grown-up in the room. I agree with what Senator Conrad said. The non-report, the recommendations from the co-chairs were a useful dose of shock therapy just to educate people about the incredible gulf that we have between the government that any reasonable person wants.

You could have a discussion about what size it should be and the revenue that we have to fund it going forward, and you need to understand the scope of the problem before you can agree on solutions.

Right now, 75 percent of people believe you could balance the budget without touching Medicare or Social Security; 75 percent of people believe that you can balance the budget without raising taxes. Well, you could, but it would be extraordinarily painful.

People need to get a little bit of reality therapy. There's going to be another dose coming on Wednesday when another group is going to submit their recommendations, very concrete recommendations about how to do it. That's the conversation we need to have before we start picking apart solutions.

KRUGMAN: If they were going to do reality therapy, they should have said, OK, look, Medicare is going to have to decide what it's going to pay for. And at least for starters, it's going to have to decide which medical procedures are not effective at all and should not be paid for at all. In other words, it should have endorsed the panel that was part of the health care reform.

If it's not even -- if the commission isn't even brave enough to take on the death panels people, then it's doing no good at all. It's not educating the public. It's not telling people about the kinds of choices that need to be made.

MARCUS: But they did talk about -- just -- just as a fact, they did talk about strengthening that commission, the famous IPAB...

KRUGMAN: Yes.

MARCUS: ... and giving it more power to go after more aspects of the health care system, which -- because it's now rather constrained.

KRUGMAN: They made no headlines with that. And some friends of mine are calling this the commission -- the commission to put caps on lots of stuff. It's a lot of numerical caps without any explanation of how they're going to happen.

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WILL: Secretary Gates doesn't want to buy any more C-17s. He wants to put a lid on F-22. There are lots of ways of...

(CROSSTALK)

KRUGMAN: Can I just get into magnitudes here, though? The cost of permanently extending just the upper-end Bush tax cuts, as opposed to only extending the middle-class tax cuts, the 75-year cost of that is just about identical to the 75-year accounting shortfall in Social Security. So we've got people who are saying, oh, Social Security, got to do something about it, but let's extend those tax cuts for rich people. This is showing how the priorities are all skewed (ph).

AMANPOUR: But what is going to happen? I mean, are you clear on where a compromise is going to be? It's got to be discussed before the end of the year, no?

KRUGMAN: No. Some years down the pike, we're going to get the real solution, which is going to be a combination of death panels and sales taxes. It's going to be that we're actually going to take Medicare under control, and we're going to have to get some additional revenue, probably from a VAT. But it's not going to happen now.

http://abcnews.go.com/ThisWeek/week-transcript-madeleine-albright-sen-lindsey-graham-sen/story?id=12143913&page=4

[Pooky 3,366]

KRUGMAN: No. Some years down the pike, we're going to get the real solution, which is going to be a combination of death panels and sales taxes. It's going to be that we're actually going to take Medicare under control, and we're going to have to get some additional revenue, probably from a VAT. But it's not going to happen now.

Way to go at making sure you become an irrelevant footnote for the rest of your career.

One thing it clearly illustrates is that at least a portion of those on the left of the spectrum didn't buy the "it's not going to be a death panel" explanation, either.

[Mr. Big Dog 10,747]

Krugman is right. You cannot demand bringing down the cost of medicare (and any other medical insurance scheme, for that matter) while not endorsing the idea that the coverage will go towards effective and necessary treatments only. All industrialized countries do that and their populations live longer, healthier lives than we do. Their health care system is more effective than ours and cost less than half of we shell out.

You can get all excited about these propaganda terms but that doesn't really help the debate. As long as we demand that there will be no diversion from the fatal course we're on in terms of effectiveness research and funding guided based on that, we're going to drown in our debt. And leave tens of thousands of people dying year after year as a result of this insanity.

[Gary and Alla 3,694]

Best reasons to end Medicare I have heard in a long time. What we need is a death panel for Medicare.

[Mr. Big Dog 10,747]

Best reasons to end Medicare I have heard in a long time. What we need is a death panel for Medicare.

The elderly would be blessed to be at the mercy of private, for-profit insurance companies that would go so out of their way for that business.

[Pooky 3,366]

Krugman is right. You cannot demand bringing down the cost of medicare (and any other medical insurance scheme, for that matter) while not endorsing the idea that the coverage will go towards effective and necessary treatments only. All industrialized countries do that and their populations live longer, healthier lives than we do. Their health care system is more effective than ours and cost less than half of we shell out.

You can get all excited about these propaganda terms but that doesn't really help the debate. As long as we demand that there will be no diversion from the fatal course we're on in terms of effectiveness research and funding guided based on that, we're going to drown in our debt. And leave tens of thousands of people dying year after year as a result of this insanity.

So you agree that there will be death panels.

Good to know the outrage was all fake, then.

[Mr. Big Dog 10,747]

So you agree that there will be death panels.

Good to know the outrage was all fake, then.

Good to know that you get off on stupid labels. The IPAB is NOT a death panel. If you can't get that into your skull, then you can't debate health care reform on any level outside Palin's inner circles.

Can we control costs without Congress?

It is a sad commentary on Congress that the most promising cost control in the Affordable Care Act is the one that takes much of the responsibility for controlling costs away from Congress and hands it off to an independent board of experts. That board -- officially known as the Independent Payment Advisory Board -- has made it through to the final bill, and in substantially stronger form than I, for one, expected. The House had always been more skeptical of the idea, but then the Senate bill became everybody's bill and the energy on changing it shifted to the big-ticket items such as affordability and surviving reconciliation. The result was that a strong version of IPAB slipped through almost unnoticed.

The IPAB is a 15-person, full-time board composed of health-care experts and stakeholders. Members need to be confirmed by the Senate and will serve six-year terms, with one possible reappointment. But the important thing isn't who serves. It's how they vote. Or, as the case may be, don't vote.

If Congress approves the board's recommendations and the president signs them, they go into effect. If Congress does not vote on the board's recommendations, they still go into effect. If Congress votes against the board's recommendations but the president vetoes and Congress can't find the two-thirds necessary to overturn the veto, the recommendations go into effect. It's only if Congress votes them down and the president agrees that the recommendations die. “I believe this commission is the largest yielding of sovereignty from the Congress since the creation of the Federal Reserve,” says Peter Orszag, who's been one of the idea's most enthusiastic supporters.

The board will propose packages of reforms that bring Medicare in line with certain spending targets. Those reforms won't increase cost sharing or taxes and they won't change eligibility or benefits. Instead, they're reforms of what Medicare pays for and how it pays for it. By 2018, the target growth rate is the average five-year increase in GDP plus one percentage point. So if GDP has been growing at 3 percent, the target is 4 percent. If Medicare's growth is faster than that, then the board is charged with saving the lesser of 1) the difference between the target growth rate and the real growth rate, or 2) 1.5 percentage points off the projected growth rate.

There are some weaknesses in the board. If Congress can find 60 votes, it can amend the board's recommendations without finding offsetting savings elsewhere. The board can't seriously change payment rates until 2018. And if Medicare is growing more slowly than the rest of the health-insurance market, then Congress can protect it from the board every other year (so it would have to save more money in, say, 2020, but not in 2021).

Nevertheless, this is the most powerful cost-cutting agency we've seen. For all those folks saying Congress can't stick to cuts, this is the closest thing to a solution that anyone's come up with. It gives Congress a way to let someone else take on the hard decisions that it doesn't have the expertise or political will to make. If Congress so chooses, it could let the IPAB do its work without ever bringing the recommendations up for a vote: They'd still go into effect, and no one would be on the record in either direction.

As a commentary on Congress, is all this a bit sad, and even weird? Yes. But it may also be necessary. And it will be interesting to see how it interacts with the private market: You could see the reforms that get seeded into Medicare being adopted by everyone else (which is common even now). And if Medicare does bring its costs far down while private insurance finds itself unable to make meaningful changes, pressure could increase for some sort of Medicare buy-in program along the lines of what Alan Grayson is proposing.

The bottom line is that IPAB creates a continuous system for controlling costs in Medicare and trying out new reforms and experiments. For all those disappointed by Congress's fecklessness when it came to cost controls in the Affordable Care Act, know that Congress actually agrees with you, and is trying to do something about it. Or at least let someone else do something about it.

[mawilson 2,133]

The elderly would be blessed to be at the mercy of private, for-profit insurance companies that would go so out of their way for that business.

LOL - of course, who wouldn't want to insure the highest risk group out there?

[Pooky 3,366]

Good to know that you get off on stupid labels. The IPAB is NOT a death panel. If you can't get that into your skull, then you can't debate health care reform on any level outside Palin's inner circles.

The irony is that you completely forget that I am all in favor of single payer healthcare and I was not the one putting stupid labels to things. Mind you, while those in favor of the farce of a Bill were debating it, they ridiculed others for calling it just that. Good to see that the Bill's supporters can call it that now and not get reamed for it by their friends.

So get off your high horse and quit being offensive. Krugman is an idiot for calling it what he did and his description will do more to stiffen opposition resolve to get the current Bill killed (good) than it will to bring sanity to the discussion (not good).

[Heracles 417]

Krugman is right. You cannot demand bringing down the cost of medicare (and any other medical insurance scheme, for that matter) while not endorsing the idea that the coverage will go towards effective and necessary treatments only. All industrialized countries do that and their populations live longer, healthier lives than we do. Their health care system is more effective than ours and cost less than half of we shell out.

You can get all excited about these propaganda terms but that doesn't really help the debate. As long as we demand that there will be no diversion from the fatal course we're on in terms of effectiveness research and funding guided based on that, we're going to drown in our debt. And leave tens of thousands of people dying year after year as a result of this insanity.

There is a debate? The right sticks to the best health care in the world rhetoric and cares little to debate. Study after study illustrates the US system neither being the best nor the most efficient, yet they still beat the same drum.

As long as the system is run for-profit and there is no invoice-price NHS (va equivalent) to compete with the private sector, the cost will never come down in the US.

Edited November 15, 2010 by Heracles

[Obama 2012 1,714]

Good to know that you get off on stupid labels. The IPAB is NOT a death panel. If you can't get that into your skull, then you can't debate health care reform on any level outside Palin's inner circles.

Of course it is.

Any system that allows any type of beauracracy to dictate if it's 'cost effective' enough for you to maybe live another 6 months or so, is promoting 'death panels.'

While that's a bit pusing the terms, sometimes it can be a death sentence.

What about all those times when it says, 'oh this will keep you alive another 6 months' and that 6 months ends up turning into 4 or 5 years...

When you allow the government to do this, you're almost asking or genocide of the elderly. If you're 25 and need that surgery, ok fine.... but if you're 65, hey well you lived your life so screw you.....

[I AM NOT THAT GUY 5,715]

LOL - of course, who wouldn't want to insure the highest risk group out there?

Or, the richest, I am just saying.

[I AM NOT THAT GUY 5,715]

Of course it is.

Any system that allows any type of beauracracy to dictate if it's 'cost effective' enough for you to maybe live another 6 months or so, is promoting 'death panels.'

While that's a bit pusing the terms, sometimes it can be a death sentence.

What about all those times when it says, 'oh this will keep you alive another 6 months' and that 6 months ends up turning into 4 or 5 years...

When you allow the government to do this, you're almost asking or genocide of the elderly. If you're 25 and need that surgery, ok fine.... but if you're 65, hey well you lived your life so screw you.....

If the taxpayer is on the hook to pay for the treatment, then this is exactly the discussion that needs to be had. Talk about an unfunded mandate...

If the patient wants to be kept alive by extraordinary means, then let the patient pay for the treatment. Otherwise, time to take a dirt nap.

Edited November 15, 2010 by ##########

[Mr. Big Dog 10,747]

I was not the one putting stupid labels to things.

Really?

So you agree that there will be death panels.

[Mr. Big Dog 10,747]

Of course it is.

Any system that allows any type of beauracracy to dictate if it's 'cost effective' enough for you to maybe live another 6 months or so, is promoting 'death panels.'

While that's a bit pusing the terms, sometimes it can be a death sentence.

What about all those times when it says, 'oh this will keep you alive another 6 months' and that 6 months ends up turning into 4 or 5 years...

When you allow the government to do this, you're almost asking or genocide of the elderly. If you're 25 and need that surgery, ok fine.... but if you're 65, hey well you lived your life so screw you.....

No, Paul Palin, is isn't. Effectiveness research and coverage and funding of procedures based on that takes place in all other industrialized nations today and the health care systems there provide for longer, healthier lives of the populations at a significantly lower cost. It's hard to argue that these are "death panels" seeing that nations that them actually end up living longer and healthier than those that don't have them. But hey, you're Paul Palin so you are forgiven for not knowing any better.