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the ruling class not wanting to pay for it is holding it back.

The IRS tax stats are readily available. The 'ruling class" (say everyone making over $1 million/yr) only accounts for 13.3% of total gross income (2016, column E).

% of total income - income bracket
0.3% - less than $5,000
0.8% - $5k to $10k
1.4% - $10k to $15k
1.9% - $15k to $20k
2.2% - $20k to $25k
2.4% - $25k to $30k
5.1% - $30k to $40k
5.1% - $40k to $50k
12.1% - $50k to $75k
11.0% - $75k to $100k
25.0% - $100k to $200k
15.5% - $200k to $500k
5.9% - $500k to $1 million
2.3% - $1 million to $1.5 million
1.3% - $1.5 million to $2 million
3.2% - $2 million to $5 million
1.8% - $5 million to $10 million
4.7% - $10 million or more

The bulk of the income in the U.S. is made by the upper middle class and the lower upper class - people making $50k-$500k per year. They're the ones you have to tax if you want to fund any sizable programs. (And no, increasing corporate taxes won't help. Corporate taxes are paid from profits, so higher corporate taxes would reduce the profits distributed to stockholders. So increasing corporate taxes is equivalent to increasing the income tax of those stockholders.)

I mean, we have massive amounts of data that single payer healthcare would be infinitely superior. The latest studies (real ones done by Universities) show $5 trillion savings every 10 years.

The U.S. currently spends $3.5 trillion/yr on health care. A $5 trillion savings over 10 years would knock that down to $3 trillion/yr.

The total gross income of everyone making over $1 million/yr (column D) is only $1.36 trillion/yr. Even if you taxed "the ruling class" at 100%, you'd get less than half the money needed to pay for single payer healthcare. You'd have to confiscate 100% of the income of everyone making a bit over $200k/yr to generate $3 trillion in tax revenue ($200k/yr and up have a gross income of $3.5 trillion).

they still didn't implement basic social net such as free health care

Free? Really? What propaganda.

Paid for by taxes instead of paid for by consumers. Nothing's free. The US covers the poor and the elderly, with government medical spending accounting for about 45% of the industry.

US government spending on health care works out to ~$12,500 per taxpayer. That's not a small bill. We consume a heck of a lot of medical care in the US ($3.3 trillion in 2016, 17% or our GDP).

How much does your government spend per taxpayer on medical care?

In some markets, health Insurance companies have little reason to do what you describe. Under the PPACA they must pay out 80% of the incoming claims dollars for medical services. The other 20% covers all administrative costs (claims processing, salaries, utilities, negotiating networks, leases, computers, training, HR, claim review, approval review, etc) related to servicing existing customers and advertising (necessary to replace existing customers who pick a different plan, leave the service area, or die) and profits. If they pay out less than 80% premiums to medical claims, they have to rebate the difference back to the policy holders.

In fact, this limitation adds a perverse incentive to pay out MORE in claims, not less. If, hypothetically, an insurer doubles their premiums and doubles their medical pay outs (by not checking claims carefully, by approving questionable procedures, by not negotiating as hard as they could with medical providers) to keep within the 80% limit, the 20% they get to keep also doubles. Also, their expenses related to claims review and network negotiation probably drops as they they would just have to pay rebates back to policy holders if they deny claims and miss the 80% requirement. So, much - maybe more than all - of the increase in the 20% can go to pure profit.

Of course, if they raise their rates (and pay out more in claims), they may lose customers in a competitive market -- but in some areas there isn't a competitive market. For example, there are 1565 counties where there is only one provider on the exchange. In 2016, 30% of the participants in the Federal exchange had only ONE choice available to them. Also, since many people's premiums on the exchanges are highly subsidized by tax dollars, many people are not nearly as price sensitive as people who are paying their own way so raising rates in "one insurer" markets won't drive away business like it would in a conventional free market.

Well, you're 80% rule OBVIOUSLY doesn't apply where I live. Plus, we went from a 2-Insurer to a 1-Insurer "choice".

In some markets, health Insurance companies have little reason to do what you describe. Under the PPACA they must pay out 80% of the incoming claims dollars for medical services. The other 20% covers all administrative costs (claims processing, salaries, utilities, negotiating networks, leases, computers, training, HR, claim review, approval review, etc) related to servicing existing customers and advertising (necessary to replace existing customers who pick a different plan, leave the service area, or die) and profits. If they pay out less than 80% premiums to medical claims, they have to rebate the difference back to the policy holders.

In fact, this limitation adds a perverse incentive to pay out MORE in claims, not less. If, hypothetically, an insurer doubles their premiums and doubles their medical pay outs (by not checking claims carefully, by approving questionable procedures, by not negotiating as hard as they could with medical providers) to keep within the 80% limit, the 20% they get to keep also doubles. Also, their expenses related to claims review and network negotiation probably drops as they they would just have to pay rebates back to policy holders if they deny claims and miss the 80% requirement. So, much - maybe more than all - of the increase in the 20% can go to pure profit.

Of course, if they raise their rates (and pay out more in claims), they may lose customers in a competitive market -- but in some areas there isn't a competitive market. For example, there are 1565 counties where there is only one provider on the exchange. In 2016, 30% of the participants in the Federal exchange had only ONE choice available to them. Also, since many people's premiums on the exchanges are highly subsidized by tax dollars, many people are not nearly as price sensitive as people who are paying their own way so raising rates in "one insurer" markets won't drive away business like it would in a conventional free market.

Wow, you win "biggest lie of the thread" with that whopper. $600B on disability per year?

Citation provided, bitch. 2018 Medicaid numbers are $575 B, plus administrative costs.

No, it's because in Canada and Europe, the state buys from the drug companies. When an entire country is buying the drugs, they buy in bulk because they're buying for everyone in the country.

Canada's entire population is less then the number of people served by Medicare.
And in reality, most of these health systems are actually multiple systems, I know Canada has one for each province, and the UK system is actually 5 systems.

The Federal Government spent $730 billion on healthcare in 2011 (see table 05-3). That is more than defense. The stat you have may be correct, but Medicare is just half the equation; there is also Medicaid and other Federal healthcare spending. You cannot legitimately compare ALL Federal defense spending to only a portion of Federal healthcare spending and say we spend more on defense than health.

Yeah, no.

I'm more convinced by the McKinsey analysis that RCA begins with than the rest of that article. And the Stiglitz report it links to doesn't prove what is claimed, at all.

That's not much of an argument.

A few points:

1) Adjusted Household Disposable Income and Actual Individual Consumption are widely acknowledged by people that have studied this to be superior indicators of material living conditions. GDP is a measure of domestic production, full stop. It is not and was never intended to be a measure of resources actually available to households and it is the household perspective that matters here. GDP is often used as a proxy for these types of measures in lieu of better data, but they're not the same and they can and do deviate quite significantly for a number of reasons.

2) When it comes to predicting national health expenditures and other health system characteristics, these measures, AIC and AHDI, fully mediate GDP in multiple regression and in multiple specifications (much the same if one subtracts HCE from these household measures).

3) CMS uses a close analog to AHDI, disposable personal income, as the dominant exogenous variable in their long-term projections because their research and theory suggest it's much superior as a predictor.

4) These measures are also much stronger predictors of essentially all other measures of living conditions (e.g., life expectancy, life satisfaction, satisfaction with financial conditions, poverty rates, access to clean water, etc). Indeed, if one sets about systematically comparing indicators from organizations like Social Progress Index, Gallup/WVS, Legatum, and others, at least 90% of these indicators have markedly higher r-squared with AIC than GDP. Likewise, in OLS, AIC clearly mediates GDP or, if one disaggregates GDP, the remaining components of GDP (e.g.,net exports, CFC, etc).

5) There is also tremendous consistency in consumption patterns if one looks at disaggregated SNA data by function (COICOP and the like). The patterns the US exhibits in consumption across individual categories/functions is highly consistent with its aggregate AIC, adjusted household disposable income, and so on. The US consumes much more of almost everything in real terms (especially those goods and services that are clearly elastic at a national level). It certainly consumes more in most categories than the handful of significant countries with higher GDP, so it can hardly be surprising that the US would also consume much more healthcare (one of the most elastic categories with respect to national income).

Note: These results are also consistent with what we find if we look at other sorts of more granular measures (e.g., number of rooms per capita, household possessions, private car ownership rates, frequency eating out, etc).

CMS has promised to eliminate SSNs from Medicare by April 2019. See site for more info:

https://www.cms.gov/medicare/n...

The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires us to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number (HICN) on the new Medicare cards for Medicare transactions like billing, eligibility status, and claim status. You can find more details in our 5/30/17 press release and latest Open Door Forum slides (6/8/17).

Unlink SSN from TID (Taxpayer ID). Banks need TID, they have no business with SSN. Unlink SSN from healthcare (it wasn't legallay required until Obamacaare, although healthcare providers used it).

One good thing: Unlinking SSN from Medicare is being done. Everyone that has Medicare will get a new non-SSN Medicare account number. The new cards will be mailed in 2018. https://www.cms.gov/Medicare/N...

The new Medicare card will no longer have the primary (usually husband's) SSN as the Medicare number.

https://www.cms.gov/Medicare/New-Medicare-Card/index.html

First, regarding the topic, what companies still offer pensions? For example, Verizon employees haven't been eligible for pensions for well on a decade. So they're only talking about their current load of mostly already retired previous employees. Many other companies stopped offering pensions decades ago as the 401K push really started in the late 80s. So this is an accounting issue that mostly applies to the past, and has no real bearing going forward more than a few years.

According to the numbers from CMS studies on health care costs, medicare/medicaid expenditures on average for males/females above the age of 64 is near $20k/year. Much of that is nursing home care, which the obese require more of and sooner.

Medicare/Medicaid spending was about $1191 billion in 2015.

https://www.cms.gov/research-s...

The US population was 322 million in 2015, or about 302 million citizens.

https://www.census.gov/popcloc...

That comes to $3698 / person / year or about $3977 / citizen / year. That's comparable to the total per capita public health care spending in France, Japan, Iceland, the UK, Finland, New Zealand, Italy, Spain, Israel, etc. The following is total per capita spending (public+private) in those countries:

https://en.wikipedia.org/wiki/...

Are you for real? All women have a huge risk of sexual assault - 50%. And the vast majority are repeat victims. So my experience is typical. It comes with the territory, and the problem isn't transition, the problem is men who think with their dicks. Nice victim-blaming you've got going there, jerk.

In a large enough population, you're going to get some people who, just at random, have a much higher number of "bad things" happening to them than others, same as if you pick random 4-digit numbers, you'll eventually come up with 4444, 1234, etc. Numbers that don't look random, but are.

Where is your proof for the claim that the public health care system (medicaid/medicare) in the US isn't working? These are people who would have NO care without it. Are you saying that people with no health care do better than people with health care? Absurd, but that's what your statement leads to.

And no, medicare/medicaid don't account for about half of US health spending. Total health spending in 2015 was 3. trillion, of which Medicare combined accounted for $1.191 trillion, out of 3.2 trillion total health care spending. That's 37%, a far cry from half. A billion here, a billion, there, and soon you're talking about real money.

Also, since you cited Israel and Greece as doing better, you proved my point. They both have universal public health care plans.

We did it without telling anyone. About half of all healthcare spending comes from Governments. Another 20% is from businesses, and that is overwhelmingly regulated and required by Governments (meaning - they aren't directly spending it but forcing it to be spent). So about 30% is left for consumers. Meaning - the vast majority of healthcare spending is driven by Government. That's a socialized system.

Hate to be that guy, but:

[citation needed]

Here is a sample calculation done by the various people who make that claim:

typical study of reduction in lifespan due to smoking:
https://www.ncbi.nlm.nih.gov/p...

The average geezer on SSA gets 15K a year.
https://www.ssa.gov/policy/doc...

The average medicare per-person yearly cost for the over 65 people is $19K.
https://www.cms.gov/research-s...

cigarettes killing the old folks 7 years early save $238K from SSA and Medicare

Lung cancer is an expensive way to go. typical last-year costs are 95K.
cigarettes death include heart failure and strokes. quick deaths are cheap.

What's the share of US GDP consumed by health care again? Why it's 17.5%. It's not going down. More and more people are getting these supposedly rare billing conditions. And we need society for other things than merely paying medical bills. You know, things like food, shelter, security, etc.

I am a fan of capping medical care at some reasonable level once you reach a certain age. We should as a society be willing to pay a million or two to save a child, who has their whole life ahead of them, but once you hit the median life expectancy, you should accept the fact that you are going to die soon. Everyone dies, be thankful that you have now lived longer than half (the day after you pass the median life expectancy). In the US we have socialized medicine for those over 65 (medicare) so the US tax payer ends up paying 20% of all health care spending on 55 million retirees (.37% spent per million people), along with another 16% for medicaid to care for the 65 million poor (0.25% spent per million people). Meanwhile, just 33% is spent on/by private insurance that covers 58% (~186 million; 0.17% spent per million people). So to recap, the working insured are footing 100% of the bill and only receiving 33% of the benefits. Theoretically they will eventually use Medicare as well, if they live long enough.

The problem is that the retired block all votes, so it is the political third rail to talk about capping medical benefits past a certain age. The working insured are the cheapest block to provide health care for. It is also widely known that Medicaid is heavily used by emigrants from other countries either legally or often illegally. Anyone venture a guess as to how often Canada or Mexico puts up with that from a US citizen?

http://kff.org/other/state-ind...

https://www.cms.gov/research-s...

A hospital that falls under EMTALA cannot refuse care because of lack of payment or insurance (which covers nearly ALL hospitals with scant few exceptions). I've looked up the pre-hospital ALS protocols and drug list for paramedics in Springfield, and there aren't any treatment they are authorized to perform or drugs they can give (no Heparin on board their ambulances) for pulmonary embolism. They would be able to provide life support services were he to have experienced cardiac/respiratory arrest secondary his PE, which is why he should have called an ambulance. Typical response times onto a major highway are usually on the order of minutes for most major metropolitan ambulance services. A 20 mile drive takes roughly 20 minutes and highway speeds, which is plenty of time to suffer a permanent brain or cardiac injury (yes, including death) due to either cardiac or respiratory arrest, both possible side effects of a PE.

He should have pulled onto the side of the road with his hazards on and waited for paramedics. He risked dying at the wheel with no help available for what would have been very manageable emergencies for first responders.

If you want to get a visceral appreciation for the complexity of medical billing today, check out the Medicare Claims Processing Manual.

It almost seems like you can't merely get an administrative assistant, but you need someone with an A.A. in medical billing.

The thing that really left me aghast was the move from ICD 9 to ICD 10 (diagnosis codes and descriptions). Those #$&!!?! policy geniuses completely abandoned the ICD 9 codes and instituted all new ICD 10 codes. There was a big infrastructure around ICD 9. There is plenty of overlap in the codes, so it's a recipe for mass confusion. It's stunning that there was not even any attempt to have even a scintilla of backward compatibility.

It is almost like there are no senior database or programming architects involved in any of these decisions regarding medical IT. From what I've seen, it seems to me that it's purely non-technical policy staff driving this stuff. You have to get senior database and programming and UI architects in some of these decisions to reintroduce some sanity and control over the complexity of the solutions.

So, what does the CCIIO do if they're not in charge?

https://www.cms.gov/cciio/

All of these packages I've talked about are Windows based, so unless a hospital were to develop their own stuff (using Linux or whatever), their hands are somewhat tied. From what I've told, the cause of the big technology gap is the CDC and AMA approval process; by the time a new piece of software passes through certification, it's already out-dated.

Yes, all the EMR vendors use Windows so we're stuck there, but no, the CDC and the AMA do not approve software. CMS (Centers for Medicaid and Medicare Security (???)) gives guidelines about how to go about looking for certified EHRs. A quasi governmental body called CCHIT used to certify EHRs but they've given up on that.

And there is no real 'technology gap' in modern EHRs. They are large, complicated programs so, like other large, complicated programs they tend to be conservative in how they are constructed and they are, of course, a bit of a kludge. But they run on modern hardware, use modern databases and have pretty good performance if they are set up right.

They are giant pains-in-the-ass as far as clinical staff is concerned but that is because the Powers That Be have decided it's OK for highly paid, busy professionals to be secretaries and data entry clerks. Until we get over that paradigm, this won't change much.

Yeah, the cost of prostate biopsies should go down somewhat. As a specialty, Pathology has gotten whacked in recent years on reimbursement rates. The current rule for reimbursements on prostate biopsies was finalized in Jan for 2015. I posted a link, but you may need to agree to TOS, etc. If so, look up code G0416 which is for prostate biopsies of any amount. Medical billing is a cryptic and mysterious art and I'm (thankfully?) shielded from that, but as near as I can tell it's going to cost somewhere between $200-$500, plus whatever the surgeon charges (code 55700?), etc.

http://www.cms.gov/apps/physic...

...
    However, each insurance company has a different set of policies on how visits should be coded. ...

I'm a software developer for a large hospital and have worked with healthcare billing software. Healthcare billing is.... complex.

The insurance companies don't have policies. They have contracts. Each hospital negotiates a contract with each insurance company. The contract will state what the insurance company pays for certain diagnoses and treatments. Commercial insurance is fairly straightforward. There will be a few convoluted gotchas, but a typical contract is only 20-30 pages long and is mostly understandable.

The government stuff is different. Those, of course, aren't negotiated, you just take what you get. But the complexity is a couple of orders of magnitude higher than the commercial stuff. Medicare inpatient billing rules are complicated. Medicare outpatient is outrageously ridiculous.

Go read the CMS Medicare Claim Processing Manual, Chapter 1 (General Billing Requirements). All 312 pages of it. It will make your head spin. Medicare Claim Processing Manual

There are recurring news items about Medicare/Medicaid billing fraud. Some of this is intentional fraud. The majority is honest mistakes. The government will periodically do an audit of a sample of patient accounts at a hospital to find problems. They are, of course, only looking for issues where they overpaid, never where they underpaid. We have done internal audits and on the balance find that we under bill as often as we over bill. I challenge anybody to create a flawless healthcare billing system. I don't think it's possible given the current structure of the industry.

You can download an excel spreadsheet with ALL codes and descriptions/explanations:

http://www.cms.gov/medicare-co...

Current LCDs
and
Current and retired LCDs (57.2MB zip file)

By using the spreadsheet, the codes referenced in this story are:

87481 - INFECTIOUS AGENT DETECT BY DNA/RNA; CANDIDA, AMP PROBE

87491 - INFECTIOUS AGENT DETECT BY DNA/RNA; CHLAMYDIA T, AMP PROBE

87798 - INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA), NOT OTHERWISE SPECIFIED; AMPLIFIED PROBE TECHNIQUE, EACH ORGANISM

WTF?

ICD9 codes are diagnosis codes.

There are ICD9 diagnosis codes, there are also ICD9 Procedure codes. The procedure codes mentioned in the story are ICD9 procedure codes. You can download all of them from the Centers for Medicaid/Medicare services here.

There are also CPT, HCPCS BETOS codes that could describe procedures. Procedures are a little harder because there are multiple classification standards. In the medical system data warehouse I work on we check procedure codes in claims against the multiple reference lists and reject the claims if the codes are not found in any of the lists. The tools health care providers use to create claims should only allow the entry of a standard set of choices. I don't usually see much rejection, unless something has gone terribly wrong with the data, for example character set encoding problems. However, when something that bad happens, all of the fields get messed up.

It was very different back in the day, when claims were actual paper forms!

Your question is essentially "How would we finance medical research if drug patents stopped being effective?"

The Medicare/Medicaid drug reimbursement is more than the yearly total loaded research costs for all drugs, when using the highest available academic estimate as of mid last year (estimates vary wildly, from $100M to $1.8B in for this estimate, by researchers from Lily, a pharmaceutical company). There is one non-peer-reviewed estimate that is even higher ($2.6B), but that is only for NMEs (new molecular entities),(completely new drugs), and multiplying that by all drugs approved each year isn't reasonable, as most approved drugs aren't NMEs. There's about 22 NMEs approved per year. At $2.6 billion each, that's $57.2 billion.

The 2015 federal cost of medicare drug reimbursement is $54.12B - for outpatient subsidies only. Medicaid had a cost of $63.34B (see page 184); this is presumably also excluding inpatients, as hospital costs are listed separately. These two programs sum to $117.46B, or a bit over *twice* the cost of the NMEs. Non-NME costs are much, much lower (tens of millions), and there aren't lots of them, so they don't really add up to much either.

If you're in the US, you can no longer can be denied medical insurance based on pre-existing conditions nor can your premiums be different because of those conditions - unless, of course, the Republicans succeed in abolishing the ACA.

That is simply not true. It is a State matter, and it does differ among the 13 States that created ACA exchanges. I know of at least one state that adopted the ACA except the pre-existing condition inclusion.

You are flatly incorrect. The ACA is a Federal Law and the only thing the states can opt-opt of is the Medicaid expansion - as per the Supreme Court ruling.

Perhaps you're thinking of the Pre Existing Condition Insurance Plan which was a *temporary* measure (that states could choose to participate in) that expired in 2014:

The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market.

In 2014, all Americans – regardless of their health status – will have access to affordable coverage either through their employer or through Health Insurance Marketplaces, and insurers will be prohibited from charging more or denying coverage to anyone based on the state of their health.

Considering obamacare is the law of the land (all fifty states) and hospitals can't refuse service on the bases of insurance stop trolling.

Emergency Medical Treatment & Labor Act (EMTALA)
"In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide STABILIZING [emphasis added] treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented."

Hospitals CAN and DO provide minimal treatment for "non-emergent" cases. Hence, the "take two of these and come back if it gets worse" treatment. Yes, logical forward-thinking people might conclude that "this person came from Africa, could be Ebola". However, this isn't TV, and a plucky nurse isn't going to get her hospital to take a person for an expensive admission "just in case it isn't a bad cold".
MAYBE after the hysteria, that scenario might happen, especially in that city. Maybe not.

Your exception swallows your rule. Insurance companies do not decide what to offer in many cases -- they may only decide what to cover for high-end, elective or other (usually less-used) categories of treatments. If you look at what is required by your state's EHB benchmark, you will probably be surprised how much insurers are required to cover. For example, in Virginia, I cannot opt out of coverage for "Over the counter drugs; drugs used mainly for cosmetic purposes; Drugs for weight loss; Stop smoking aids, Nutritional and/or dietary supplements", or even limit that coverage to generics -- every QHP in the state must cover even specialty drugs in those categories, with no limit. If I think chiropractic (chiropractice? chiropraxis?) is a crock, that does not matter -- my insurance must cover up to 30 visits a year.

On the other end, once the PPACA's tax on "Cadillac plans" kicks in, you can expect more expansive plans to start dropping off the market.

I waited until the last minute because 'fuck the government' right? But when I did call, I got a really nice lady that walked me through the whole process in less than 30 minutes. They basically ask you the questions from the forms (the forms are also available to fill out yourself and mail in. Forms link, and instructions link)

I have a family of 4 and we'll end up paying $74.00 per month for Blue Cross Silver plan. It's better than what I have right now through Blue Cross, and I've been paying $400 a month for it.

I waited until the last minute because 'fuck the government' right? But when I did call, I got a really nice lady that walked me through the whole process in less than 30 minutes. They basically ask you the questions from the forms (the forms are also available to fill out yourself and mail in. Forms link, and instructions link)

I have a family of 4 and we'll end up paying $74.00 per month for Blue Cross Silver plan. It's better than what I have right now through Blue Cross, and I've been paying $400 a month for it.

Mmm... how do you square that understanding with the $500 million in rebates that US families just got due to insurers not meeting the MLR guidelines? AFAIK, not-for-profit medical insurers don't have to worry (since they already met the MLR guidelines), but about 20% of insurers _do_. Hence half a billion in rebates due to the provision.

Centers for Medicare & Medicaid Services

It's shut down rigt now, fools. That's why it isn't working right!

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsRevisionAnalysis.pdf

http://www.forbes.com/sites/theapothecary/2013/09/23/its-official-obamacare-will-increase-health-spending-by-7450-for-a-typical-family-of-four/

no, not kidding

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsRevisionAnalysis.pdf

Let us ignore the fact that if we got rid of the military tomorrow the next day we would probably be overrun by some other country the following day. Also if we ignore all the other things external to military spending (jobs that are needed to support the military, the money military members spend, etc) your numbers still won't produce a balanced budget. There also is the interest on the debt that is still accumulating that will further increase the debt but we can even ignore that and your numbers don't work. For reference see the following:
There is the obligitory XKCD Money chart
The NY Times "Obama’s 2012 Budget Proposal: How $3.7 Trillion is Spent"
The NY Times "Obama’s 2011 Budget Proposal: How It’s Spent"
The NY Times "Four Ways to Slice Obama’s 2013 Budget Proposal" best when viewed by department as it is pretty worthless otherwise
The U.S. National Debt Clock showing the 6 largest budget items.

It's not like eliminating all military spending would magically produce a $500+ billion surplus each year. Yes it would get us much closer to a balanced budget for a few years but there are also major structural issues with Social Security (you can find this in section II Overview pages 2-5) now projected to take in less in taxes that it distributes (in 2022 the trust fund will start to decrease as the interest no longer makes up difference) indefinitely. In 2033 it will be unable to meet the all current obligations. There are also similar issues with Medicare and Medicaid but those are going to be happening sooner.

Now back to real world were things have consequences and we are basically screwed. From what I have read in the past on this subject we are fully capable of digging our selves out of this hole as 13 years ago we were running a budget surplus at the federal level and actually retiring what debt could be. The problem is that everyone wants to keep their government benefit, tax break, subsidy, etc and we have politicians that know that cutting someone's benefit or raising someone's taxes is political suicide so it is just easier to put off the hard decisions until later. That way it is some other congress critter's problem when the shit really hits the fan. In the '90s with Clinton in the White House and Republicans in charge in the house and the senate it was easy with the economy booming the necessary changes were being made and people didn't feel it. Now in a bad economy these changes would be devastating and people might have to break out the pitch forks and torches which no elected official wants.

You are absolutey, incredibly, incorrect when you say "...pays for services at whatever rate the medical community claims they are worth.."

Really? Do you know how the SGR is computed? Lets see...

The statute specifies a formula to calculate the SGR based on our estimate of the change in each of four factors. The four factors for calculating the SGR are as follows:
(1) The estimated percentage change in fees for physiciansâ(TM) services.
(2) The estimated percentage change in the average number of Medicare fee-for-service beneficiaries.
(3) The estimated 10-year average annual percentage change in real gross domestic product (GDP) per capita.
(4) The estimated percentage change in expenditures due to changes in law or regulations.

https://www.cms.gov/SustainableGRatesConFact/Downloads/sgr2012p.pdf

With medicare everything is a formula, but the underlying values being plugged into the formula are correlated with a number of things, including most importantly doctors fees and "locality cost of business". Guess who sets those values? Now if you feel that medicare is underpaying you, what is the best way to get more money from medicare? Well raising your retail rates of course, because you can get ahead of the curve by raising your rates in expectation of your costs in one or two years time. In other words, you overprice your retail numbers, so that you get paid sufficiently from medicare next year. Of course, the same game applies for insurance companies too, which use formulas directly correlated to the medicare payment schedule. The end result is very few people are paying the retail numbers, but the majority of the patients are isolated through medicare/insurance which are basing their numbers on the retail costs.

If you're homeless, you probably qualify for Medicaid.

Homeless doesn't matter, other than no state agency will touch you if you can't show you're a resident. Such as a utility bill in your name. What matters for eligibility, mainly, is if you have children or whether you're employed (working poor). https://www.cms.gov/MedicaidEligibility/02_AreYouEligible_.asp

Medicaid doesn't pay for uninsured people who show up at the ER. Instead the hospital tacks it on to its general cost structure, which gets passed on to those insured. So the insurance rates paid already reflect the uninsured.

Which is slightly less than taxpayers in the US pay just to fund medicare/medicaid, which partially cover only a fraction of the population.

Calculation: (figures as of 2009 from U.S. Dept of Health and Human Services)

Total National Health Expenditure (NHE) was $8086 per person

Medicare cost 20% of this, medicaid 15%, for a total of 35% = $8086*.35 = $2830

Which is roughly $235 per month.

So to recap:

• US: $235 per month in taxes per head to partially cover a fraction of the population.
• UK: $200 per month in taxes per head to cover every person in the country from cradle to grave.

Note: I can't tell whether the US figures include the additional taxpayer burdens of insuring government workers, medical care for those in prison (see...I'm on topic!), or medical expenses borne by the states and other non-Federal Government entities.

Oh and by the way there are many other hidden costs. Have those of you in the US ever looked at what the medical coverage part of your auto and homeowner insurance costs you? How about those of you in the UK? Oh wait...you don't have to pay that in the UK do you!

I couldn't find one provable assertion in that entire post - the gov't collects about $2.6T/year and spends about $4.3T/year, a $1.7T deficit each year (excluding the exceptional TARP, Stimulus, and other one-off spending events). The Bush Tax Cuts "cost" $470BN/year ($400BN/year for the "middle-class tax cuts" everyone was so keen on maintaining, and $70BN/year for the top 1-2% that we simply couldn't afford), and last year our entire military expenditures came to about $660BN/year, for all operations, including our "overseas contingency exercises" - that leaves you about $500BN/year short of being "in the black"...

Medicare & Social Security will implode in a few years, something needs to be done - your acceptance of the lie that Republicans want to "end" medicare is exactly why the Democrats have taken their "Thelma & Lousie" approach to simply over-promise benefits and gun it for the cliff...

MSNBC will be glad to know you're reflexively parroting their talking points without question.

In 2009 private health insurance expenses were already $801.2B. It was growing anywhere from 1.3-11.6% each year in the decade leading up to it, typically in the 7-10% range. It's close enough to a $TRILLION right now that quibbling is just acknowledging that your real point was wrong.

But you fail to subtract the huge percentage of the market that is handled by non-profit insurers. They don't make a profit.

Look, it's obvious that you don't have any facts, or any real familiarity with the insurance business.

I'm not the one making the false statements and repeatedly having to issue corrections.

In 2009 private health insurance expenses were already $801.2B. It was growing anywhere from 1.3-11.6% each year in the decade leading up to it, typically in the 7-10% range. It's close enough to a $TRILLION right now that quibbling is just acknowledging that your real point was wrong.

Which it was. There's a huge and growing profit in running a health insurance corp, despite your saying the opposite. I haven't "railed against profits". I've railed against spending more into a cartel - that, as I pointed out, keeps competitors out, largely by keeping the costs of entry in the $billions. The profits + the waste amount to probably close to 10% of insurance costs to consumers. You might not want to keep 10% of your insurance expenses, but I do, and I expect most Americans do.

Look, it's obvious that you don't have any facts, or any real familiarity with the insurance business. You're not even bothering to cite or specify your arguments, while I give exact facts and citations. You're the one engaged in "partisan talking points", and nothing more. You're wrong, and refuse to even acknowledge what you're talking about because it's wrong. Facts and logic aren't changing you, and I'm learning nothing from you except to dislike you.

Goodbye.

Just a note on your #2 point: Although price lists of actual items or procedure costs can often be secret and proprietary, what Medicare pays for them is not, and should be a good comparison against what you receive on a bill.

You can find the medicare payment rates here.

Those are the same rates I use to build the fee schedules we use to pay doctors at the medical group I work for. The Medicare rates are free to the public to download in csv format or to look up on their website, and there is no registration required.

I don't want to say there is anything wrong with your statement that healthcare costs themselves can often be hidden, but finding out what the gov is willing to pay for them is useful.

From http://www.cms.gov/hipaa/hipaa2/default.asp:

Strategic National Implementation Process (SNIP) - A collaborative healthcare industry process for the development and implementation of standards. Site includes white papers on transactions, security, and privacy.

For some reason, when I hear the phrase "SNIP" from the medical industry I have a tendancy to wince. *g*