Archive for the ‘Health Care’ Category

Retiree Stumbling Blocks

May 30, 2011

Five Retiree Stumbling Blocks

by John Wasik  May 27, 2011  posted on

Comment regarding this post by John Wasik

“Republicans in the U.S. House have proposed privatizing Medicare for those under 55.”

Not true. First, “privatized Medicare” is an oxymoron. It’s either privatized or Medicare.  The Ryan plan provides a subsidized insurance voucher so that individuals can purchase the health insurance they need. I’m almost 65 and would prefer this approach to a one size fits all Medicare system that can’t tell the difference between
Prostate Cancer (for which I had surgery 6 months ago) and “The Scooter Store” mechanized chairs.

My private, individual insurance (BCBS) for myself and my wife is less than $12,000 a year (high deductible, HSA) and it provides excellent coverage. An assist on the premium/deductible (the Ryan plan) is all I would ask for in exchange for the Medicare taxes paid in over a lifetime. [Or, don’t tax me and I’ll pay for it all.]

Raising the retirement age is shorthand for letting more people die before they (a) collect any social security or (b) before they collect enough to recover what they paid in taxes. It ends up screwing the families of those
who end up in (a) or (b). Social Security is a massive, generational Ponzi scheme that depends on an ever growing mass of workers that either die young or young enough to ensure that benefits can be paid to those who win the longevity lottery. It is an insult to those who work with their hands and backs crafted by those who sit on their butts.

“My humble prediction is that taxes will be raised on retirees, out-of-pocket medical expenses will increase, or overall retirement benefits will be cut in some way.”

We have to do something to prevent national bankruptcy. As even Bill Clinton acknowledged, we can’t let health care devour the economy. Canada is facing that fact at this time and is struggling to figure out how – besides
letting people die – to pay for all the benefits promised. Doctors are leaving the Massachusetts single payer plan. It is a hopeless bureaucratic paper shuffle to promise a benefit that can’t be provided. It is high time we geezers take the lead in moderating our entitlements.

Didn’t save enough for retirement? Why is that a problem for my children, my grandchildren, my great grandchildren not to mention my neighbors? If you would not ask your children/grandchildren/great grandchildren for $500, $1000, $1500 or more each month why would you have government take it from them
and their neighbors?

The use of TIPs as an inflation hedge pales beside high quality, dividend stocks as suggested by the S&P Dividend Aristocrats. Combine those with an investment grade bond fund or individual bonds and manage the allocation between 25/75 (bond/equity) to 75/25 (bond equity) depending on your economic outlook.

Mr. Wasik’s suggestion to be flexible is about the only useful point to this article. If you can’t determine a retirement budget (replacement rate / cost of living) how did you ever figure out a pre-retirement budget?

As for political changes? They are always coming. The best defense is to be a responsible individual and vote for the rare politician who supports responsible policies. You don’t have to agree with the Ryan plan (I don’t agree
with all of it) but it is a well developed, responsible plan that deserves honest debate. Not MediScare tactics to scare my 92 year old mother. That’s total BS. It is time to face up to the fact that our government spends too
much, we have too much debt and we must cut back in order to enable our children and grandchildren to have a chance to grow the economy. That would be the best thing we can do in our retirement.

When Experts Disagree –

March 21, 2011

For some time now I have been pondering the conumdrum of what to do When Experts Disagree. Naturally the next line would have to be, ” And, When Don’t They?”

My interests (as with many people) lie in the political, economic, financial and investment worlds but like most folks I dip into other worlds such as medicine, environment, education and social policy as I meander down life’s paths. And as I peek into those side worlds and stare at my intrinsic worlds I am confident that this issue of When Experts Disagree flows into nearly (if not every) facet of our modern life. The great question is what, exactly, do we – the decided non-experts do when those experts upon whom we supposedly depend disagree?

As an example,Professor Don Boudreaux wrote a letter to the Wall Street Journal, noting one such disagreement among economics experts:

Justin Lahart accurately reports that, as recently as last year, the late Paul Samuelson dismissed F.A. Hayek’s book The Road to Serfdom as alarmist and wrong: “Sweden and its Scandinavian neighbors are among the most socialistic countries in the world, as Mr. Hayek defined them, Mr. Samuelson pointed out.  ‘Where are their horror camps?’ he [Samuelson] wrote” (“The Glenn Beck Effect: Hayek Has a Hit,” June 17).

Indeed, do physicists even agree on the speed of light? The short answer is, at best, maybe, maybe not. From another area, Curious About Astronomy, comes another type of disagreement among experts.

However, other astronomers disagree that the experiment is able to measure the speed of gravity, arguing that the effect is much smaller than the scientists claim and that (in effect) they got their arithmatic wrong when they decided that the speed of gravity did come into the equations. They are not claiming that the speed of gravity is different to that of light, just that it could not be measured in the experiment.

Clearly this disagreement is at an intellectual level far beyond my capability. But, then, I’m not an expert in anything so almost every disagreement by experts is beyond my intellectual capability. The question though remains: what do I (we), as  non-experts do when experts disagree – as they almost always do?

Take another set of disagreements at the stratospheric intellectual level. This is the abstract for a translation of a disagreement between Albert Einstein and Walter Ritz.

During 1908 and 1909 Ritz and Einstein battled over what we now call the time arrows of electrodynamics and entropy. Ritz argued that electrodynamic irreversibility was one of the roots of the second law of thermodynamics, while Einstein defended Maxwell-Lorentz electromagnetic time symmetry. Microscopic reversibility remains a cornerstone of our current paradigm, yet we are finding more and more evidence that experimentally discerned time arrows are asymmetrical and that they all point from past to future. This paper furnishes some comments about events leading up to the Ritz-Einstein confrontation, some subsequent developments, and an English translation of their agreement to disagree. A side by side comparison of two recent summaries of their battle communiques is included to provide an overview of what they had to say about this current issue.

In matters of scientific fact we may – and most assuredly I emphasize MAY – allow scientists to conduct their experiments to discover the facts of a situation. But what happens when the science community cannot experiment but can only create models they think mirror reality? This is precisely the circumstance in the arguments regarding global warming. Or, more specifically, anthropogenic global warming (AGW), warming caused exclusively by the acts of man. The facts cannot be determined by experiment. The various scientific camps create computer models and argue about the models and the input data and it all has taken on the slimy sheen of a political argument, not a scientific one.

What would we do if our lives were dependent on deciding which of these experts, these intellectual giants was correct? Or even which was more correct? How would we decide? What would be the basis of our decision? Ultimately, might one even be so arrogant as to ask why even consult the experts? For if they ultimately disagree and we are not expert yet we must make a decision then why consult them at all? How would we, on what basis would we, differentiate between the various expert camps?

What do we do when our experts disagree?

Health Care was NOT ‘Responsible Legislation’

February 6, 2010
Is It Possible to Pass Responsible Legislation?
February 6, 2010 · by Austin Frakt · Posted in Health Policy 

This post originally appeared on 1 February 2009 on The New Republic’s The Treatment blog.

The purposes of comprehensive health reform are noble: expansion of coverage and control of costs. Yet, the latest attempt to begin to address those goals is near death. For nearly a year Democrats shepherded bills through the complex legislative process, revising and merging them to accommodate the congressional process and political realities. Ultimately two bills, similar in broad structure and differing only in detail, passed the chambers of Congress.Yet, at the brink of completion support for them has waned. What can be learned from this experience?

First, it is worthwhile appreciating how unlikely it is that policy-makers have brought health reform legislation this close to passage. It doesn’t clearly benefit all influential interest groups, a condition that normally dooms major reform. To have even pursued it was, therefore, a political risk. That Democrats, and Obama, took responsibility for attempting to solve the large and important problems of the uninsured and health care costs is laudable. In doing so they managed to mollify the concerns of major stakeholders.

One might think that support for reform would increase as more and more interest groups embraced it. That it has not has more to do with the glacial, agonizing, and ugly process of production of legislation than it has to do with its content. The spotlight hasn’t been kind to health reform. Opponents have been able to focus it on the less savory elements of legislative sausage making and on the least popular aspects of the bills, whether they exist (the individual mandate) or not (death panels).

Still, the overall structure of both the House and Senate bills is sound. The individual mandate, the low-income subsidies and other provisions are required to make the insurance reforms like the ban of pre-existing condition exclusions possible. Without the mandate people would buy coverage only when ill, increasing premiums for all. And one cannot expect low-income individuals to purchase insurance they cannot afford.

In a panicked response to the Massachusetts election, policy-makers considered chopping up the logical structure of the bills into separate legislative proposals. That’s a recipe for unworkable policy. The bills are large and complex not because policy-makers want them to be, but because they must be. It would be irresponsible to attempt to solve one component of the problem without addressing the whole. That begs the question: can comprehensive reform of the health care system or of anything else ever occur? If government controlled by one party (including a super-majority in the Senate) cannot bring about responsible reform, what can?

I wish I had an answer. We need one. I understand why reform is hard: too frequent elections, too great minority power (the filibuster), too much special interest money, among other reasons. But knowing these doesn’t lead directly to an easy fix because the process of implementing a solution is subject to the same forces that are the source of the problem. It’s a deep and difficult hole from which to legislate egress.

If health reform succeeds despite all the hurdles it will be a major accomplishment that has eluded presidents and policy-makers for decades. But if it fails (again), it will be in large part due to the challenges of governance and the imperative to win the next election. Even the best ideas face substantial risk of failure. Even for good ideas offered by responsible leaders, Congress is a graveyard.

Some say reflexively that government is not the solution to our problems. Usually proponents of markets or libertarian ideals view government as an impediment to good outcomes. The experience of health reform has revealed another sense in which government may not be the solution–because it can’t get out of its own way. That is, our government is improperly structured to solve the problems we face. It isn’t necessarily that government can’t be a solution or that government can’t propose a solution, it is that government can’t pass a solution, at least not very often. Even if health reform ultimately passes, it is clear that an historically rare level of single-party control was required to pull it off.

Unfortunately, when it comes to health care the market is not a solution either. And so we’re stuck (or may be), with a set of problems that can’t be addressed with either broad system at our disposal. It could be that the health system we have, the one resulting from a far from perfect market and a far from ideal set of government regulations, is the only one we can get. The sad consequence is that it leaves so many under-served and wastes so much of our treasure. I’m confident we can prod government into doing a little better, but without comprehensive reform, not much and not soon.

The gap between our ideals and reality is large, and even with the will and the votes the obstacles to closing it are nearly insurmountable. That’s the most troubling lesson of all.


One Response to “Is It Possible to Pass Responsible Legislation?”

  1. RedSt8r on February 6th, 2010 5:05 pm | permalink

    @AF: First, I challenge the premise. Neither proposed health care “reform” bill constituted “Responsible Legislation”. What they did constitute was a single party attempt to force selective changes to a large portion of the economy. This can hardly be called responsible.

    “One might think that support for reform would increase as more and more interest groups embraced it. That it has not has more to do with the glacial, agonizing, and ugly process of production of legislation than it has to do with its content.”
    It had everything to do with the content as only those interest groups that (a) were on the left wing of the Democrat party or (b) were bought off by either political patronage – Louisiana, Nebraska, Florida, unions or (c) bought off by false promises of enhanced profits – insurers, AMA, big pharma. When the content was so one sided the process exacerbated the issues to the point of failure.

    Why could Richard Nixon open up China? Because as a Republican he was trusted on national defense. Hence he could open up China to the US without being seen as weakening US national defense. Why could George Bush (43) pass the Medicare D (drug insurance) with bi-partisan support? Because again, as a Republican he was trusted not to squander taxpayer dollars (so much for that trust). Why could Bill Clinton reform welfare? Because he was trusted to protect the poor at least to some degree.

    Had Obama and the Democrat majority taken on their interest groups – trial lawyers, unions, politicians – and truly reformed the process they would have earned the abiltiy to pass other legislation that might have had an actual positive impact on both health care cost and availability. As it was they were clearly seen and it was clearly understood this was a left wing bill designed to serve only left wing (or bought off) interests and worse, to do so while penalizing the people. The elderly saw Medicare cuts, the young saw expensive insurance mandates, those of us in between saw a loss of personal freedom for no gain. It was a lose lose for us.

    Responsible legislation requires challenging ones interest groups not the opponents. Republicans can and should be trusted to raise taxes in the most responsible manner. Democrats can and should be trusted to reform social welfare programs in the most responsible manner. When each attempts to work in the others camp failure results.

SSA Bureaucrats and Obama’s Health Care Plan

October 1, 2009

The WSJ had a very interesting article the other day (“Social Security Owes ‘Fugitives’ Millions”, September 26, 2009 by Ellen E. Schultz) describing how the Social Security Administration (SSA) withholds benefits payments from “fugitive felons”. The article describes a well intentioned process to withhold SSA benefits payments from “fugitive felons”. This was done to save taxpayers money, of course. And, it was done with the best of intentions no doubt. 

The “Personal Responsibility and Work Opportunity Reconciliation Act of 1996” began to withhold benefits such as food stamps, housing, temporary assistance to needy families and the like. In 20001 it was extended to veterans benefits to include veteran’s dependents. By 2003 HUD (Housing and Urban Development) was also included. Continuing the trend of these good works the 1996 act was finally extended to SSA in 2005.

There are several levels of concern. First, keep in mind that the bureaucrats in charge of Obama’s health care plan will also have detailed operations manuals instructing them in every detail of the nation’s health care. Details such as who qualifies for a particular medical procedure and which medications are going to be available to what patient. Now, let’s go back to Ms. Schultz’s article. She writes that the SSA bureaucrats “… relied on an operations manual stating that anyone with a warrant outstanding is a fugitive felon …”. This meant that if you forgot (or failed) to pay some parking tickets and a bench warrant was issued you might be classified as a “fugitive felon”. Even though you are neither a fugitive nor a felon SSA would classify you as such and would then withhold your benefits. Okay, so the bureaucrats are a little energetic. No real harm right?

Second, the SSA bureaucrats would not even use a common sense understanding of the operations manual. As a result of their wanton disregard for even a shred of common sense, a 79 year old retired woman who only had the same first name, maiden name and birth date as an actual wanted felon was denied benefits. But the felon was a different race and gender, had a different social security number, different middle name and his last name was different from the woman’s actual, married last name (remember, only her maiden name was the same). Those benevolent bureaucrats didn’t check SSA numbers, gender, race, age, middle or actual names but nevertheless concluded this woman should have her benefits denied.

Not bad enough? Third, the SSA bureaucrats had to be forced to correct their obvious error. The woman contacted the New York City police where a detective gave her a letter stating she was not the fugitive in question. The SSA bureaucrats would not accept the letter. Apparently they knew better than some NYC police detective who was actually looking for the felon. The poor woman had to get help from a legal aid attorney to get her benefits reinstated. But what about the other “… at least 200,000 elderly and disabled people who lost their benefits …” you might ask? Who helped them?

Now consider a public, national health care system similar to Canada or Britain. It’s bad enough to have your SSA benefits unfairly denied. But what if some bureaucrat deep inside the Obama’s health care system decides their operations manual does not permit someone in your circumstance to obtain a surgical procedure or medication? Perhaps they mistook you for someone older and sicker. Or their operations manual was so confusing they had no idea what to do and so did nothing. Now what do you do? Call Congress? What ought to scare the bejeebers out of everyone is the prospect of a massive contingent of bureaucrats inside of Obama’s health care plan implementing  their operations manual in a manner similar to that of the SSA bureaucrats and fugitive felons.

Fourth, let’s look at the “fugitive felon” situation from another view. Take the other side so to speak. The act initiating the “fugitive felon” process was passed in 1996. It took NINE YEARS for it to get all the way over to SSA. Suppose it was a beneficial medical procedure. How happy would you be to see Californians getting the procedure while North Carolinians were still being denied?

Of course, if you die all these concerns become moot for you. Gosh, that’s too bad for you. If your health merely worsens while you attempt to straighten out the disagreement will a bureaucratic “my bad” make you feel better? Maybe, but it’s not likely. Will you have to hire a lawyer to get the issue resolved? Won’t that be fun?

Does any of this happen today with private insurance companies? Sure. But it is unlikely to happen nationwide as it did with SSA and most certainly will with Obama’s health care plan. Bureaucrats are the same mindset the world over. Still with all the flaws of private insurance you at least have the ability to appeal to the courts for assistance. And when you do, you know that the government does not have a vested interest in the outcome. Not so with Obama’s health care plan.

Obama’s health care plan promises no harm and great benefit for the many. Given every other government program it is far more likely to do the opposite. Harm the many and benefit the few. If you want health insurance for the few people who can’t afford it and who are here legally then all that has to be done is extend Medicaid and raise all our taxes. If you also want insurance reform then debate the issues and give the public an opportunity to decide. The Medicaid extension can be done quickly. There is time to debate insurance reform.