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Showing posts from April, 2011

The New York Times: A Real Choice on Medicare

The New York Times editorializes on competing plans for the future of Medicare:
We know it is not how most people want to spend their time, but Americans need to give a close reading to the Democrats’ and Republicans’ plans for Medicare reform. There are stark differences that will profoundly affect all of our lives — and clear political choices to come.Click here for the complete editorial, which lays out the differences and similarities between the Democratic and Republican plans for the nation's 46-year commitment to old age health care:
President Obama wants to retain Medicare as an entitlement in which the federal government pays for a defined set of medical services. The Ryan proposal would give those turning age 65 in 2022 “premium support” payments to help them buy private policies. There is little doubt that the Republican proposal would sharply reduce federal spending on Medicare by capping what the government would pay at very low levels. But it could cause great hardship…

grilled plum little cakes

Grilled plums are glorious. Enough said. No, I think I'll say a little more. Grilled plums coated in vanilla sugar then popped into a pan to caramelize is one amazing thing if not only for the juices it makes, but putting them into little cakes like this and topping it with key lime vanilla syrup is over the bar. The syrup alone is something if not spectacular. I saw the little bags of key limes at the grocery and knew I just had to do something with them, so I set my self up with the grueling task of juicing the little limes. Not fun. But believe me it well worth it. This I'm sure would be pretty sweet drizzled on pancakes too.
So enough about limes and plums. Is everyone enjoying the long weekend? It's going by far too fast for me, which is the usual case isn't it? At least later today I'll be heading to my Grams for Easter dinner and probably eating far too much. What is everyone else up to?

key lime syrup 1 cup key lime juice 1/2 cup superfine sugar 1 tsp…

Paul Krugman: Patients Are Not Consumers

Paul Krugman writes:

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.What has gone wrong with us?
More here.

Consumer Driven Health Care advocates legitimately point out that health care's supply-driven economics insulate patients from costs and thereby increase them. However, CDHC counts on a degree of health literacy that isn't possible under the best of circumstances, and the United States doesn't have the best of circumstances. For example, patients rarely have access to care outside of their insurance plan, meaning that quality and competition is subject to financial penalty. Moreover, there are no standa…

Canadian Critique: A Response

One hardly knows where to begin. Although he claims to be Canadian, Mr Bugos apparently remains ignorant of the fact that Canadian health care is not socialized. Of course, he also believes that anyone disagreeing with him is either a socialist or -- worse -- a Soviet. 

I appreciate that Mr Bugos is Canadian and that I am not; however, this renders his at times factual mischaracterization of Canadian health care all the more baffling. Essentially, his argument is one long assertion without supporting data; also, he states things like “economics teaches us” as if he were advancing a truism rather than a debatable point. A couple of observations:
Unlike the Veteran's Administration in the United States, Canadian health care is not socialized: The government does not own and operate the means of production or service. Instead, the thirteen provincial and territorial governments administer tax-financed insurance a la Medicare (the name of the Canada’s health care system) to reimburse pr…

Canadian Critique

An associate recently forwarded the following critique of Canada's health care system, written by a Canadian Ed Bugos:

A subscriber and friend, Laurence Hunt (who has his own blog here, who lives in Canada, as do I, made some comments to the effect that the Canadian socialized medical system is better than a free market medical system.This is a very prevalent attitude in Canada.  Here was the main thrust of his argument:"The Canadian system delivers world class healthcare at half the cost due to disintermediation. The system is run like infrastructure, like the highways, and is more economical.   I'm still an advocate of government running infrastructure, as there has to be a method of collective participation. I do think that without government, the bullies would be in charge (they are hard to restrain under any system). Nothing is perfect, including freedom."The following is my response:Laurence I respectfully disagree with your comment. First, we would hope that he…

lazy days

This is one of those meals that even in your laziest moments turns out amazing. No dough rolling or unthawing, just a simple whole wheat pita topped with some healthy goodness. I have to tell you, as of late, I have become obsessed with tomato pesto. It tastes good on everything... well almost. So forget sauce on pizza it's all about the pesto it really is. Finish it off with wasabi arugula (which I never knew existed before but tastes pretty darn good), roasted red peppers, olives, fresh tomatoes and goat cheese and it's sure to be a pleaser. I think I ate this just about three times last week. Yep that good. It being so super easy, just top all your faves on to a pita and stick it on a pizza stone or pan and set into a oven at 350 d for about 10-15 min or until your cheese has melted and you're good to go.

Rationing of Health Care

The cost of eliminating all medical needs, no matter how small, means forgoing the benefits of spending those resources to meet other needs, such as food, clothing, housing, and education. Forgoing these other needs is the real cost of fulfilling all of our medical needs. As no country can afford to spend unlimited resources on medical services, each society must choose some mechanism to ration or limit access to medical services.Paul J. Feldstein, Health Policy Issues: An Economic PerspectiveThe question, then, becomes one of fair and effective access. If health care must be rationed, how to ration it in order to ensure the best possible outcomes across a population?

What are the costs to the United States in terms of foregone food, clothing, housing, lost wages, and education? Currently, America spends about 18%, or 2.61 trillion, of its $14.5 trillion Gross Domestic Product on health care, by far the most in the world. This amounts to a per capita expense of about about $8,400. Swit…

The Rise in Medical Expenditures (6)

What events occurred during the 1980s in both the public and private sectors to make the delivery of medical services price competitive? The HMO Act of 1974 legitimized HMOs; the lifting of restrictive federal qualifications in the 1980s allowed HMOs to flourish.Meanwhile, federal subsidies to medical schools increased the supply of physicians and exerted downward pressure on prices. The introduction of DRG payments incented hospitals to reduce length of stay and to monitor physician practices that increased costs.
Meanwhile, as the United States emerged from a recession, businesses eager to continue their recovery pressured insurers to better control the cost and use of services. Other practices, such as increased deductibles and copayments, prior authorization and length-of-stay reviews, and application of antitrust laws also contributed to a reduction of prices.

The Rise in Medical Expenditures (4-5)

Why were HMOs and managed care not more prevalent in the 1960s and 1970s? Organized medicine’s success in including the concept of free choice of provider along with state restrictions retarded the development of HMOs. HMOs preclude their enrollees from choosing any physician in a community, which is a violation of the free choice concept. The government thus could not make capitation payments to HMOs, further entrenching fee-for-service as the primary form of reimbursement.
What have been the federal government’s choices to reduce the greater-than-projected Medicare expenses? Increased Medicare expenses left the government with three choices: (1) Raise the Medicare payroll tax and income taxes on non-elders; (2) require elders to pay higher premiums along with increased deductibles and co-payments; (3) reduce payments to hospitals and physicians. Although each risks antagonizing an important constituency, government efforts have focused on reducing payments. Some policies (ending free c…

salted goods and other goodies

So I went on a little salt kick and made some salted pb and chocolate chip cookies from here and salted caramel popcorn. Oh my, both were pretty darn delicious, it's all about the salty sweet mix isn't it? It really is. It's probably one of my absolute fav's and I've made those cookies twice since. I just had to, they were getting eatin' up!
I guess I decided to get a little crafty too and label my cutlery jars which I just had to show you all. They are pretty self explanatory in their own right but who doesn't love a cute simple label? Totally easy too. Just some sticker letters stuck to the jar. I'm in love with it. Oh and the prints below of the vintage knives and wooden spoons? Just a little something I've been working on. Like or dislike? I'm thinking about adding them to my shop.

salted caramel popcorn recipe adapted from Jamie Magazine issue 13
70 ml peanut oil 60 g icing sugar 50 g popping corn a big pinch of salt
heat the peanut oil and …

The Rise in Medical Expenditures (2-3)

Why has employer-paid health insurance been an important stimulant of demand for health insurance? The high inflation rate of the 70s began pushing employees into upper tax brackets. Employers responded by supplanting salary increases with additional health insurance, which is not taxable. This had the effect of stimulating demand and increasing prices.
How did hospital payment methods in the 1960s and 1970s affect hospitals’ incentives for efficiency and investment policy? Medicare’s cost-plus-2% reimbursement for services gave hospitals little incentive for efficiency and great reason to expand services even if that meant duplicating services available in nearby hospitals. Meanwhile, physicians pressured hospitals to invest in new technology so that they would not have to refer patients elsewhere, and possibly lose them. Typically, patients covered by hospital insurance were hospitalized for diagnostic workups. Less expensive outpatient services were usually not covered.
Next: Why were …

The Rise in Medical Expenditures (1)

Paul J. Feldstein is Professor and Robert Gumbiner Chair in Health Care Management at the Paul Merage School of Business, University of California-Irvine. Feldstein has written six books and over sixty articles about health care, including Health Policy Issues: An Economic Perspective, a standard text in Public Health and Health Care Administration programs. Over the next few months, HealthMatters will publish responses to the discussion questions in Professor Feldstein's book, starting with:

What are some of the reasons for the increase in demand for medical services since 1965?
A) Medicare lowered out-of-pocket prices for elders, leading to an increase to an increase in demand for hospital and physician services. B) In the late 1960s and 1970s, growth in income, the high marginal tax rate, and inflation (which pushed people into higher tax brackets) stimulated growth in private insurance. Employers took advantage of a tax subsidy to provide more before-tax insurance, which in turn …