The problem with the US is, every time we talk about health care and education, people immediately change the subject, and begin to talk about defense, tax breaks of the big companies, social injustice, people out of work, poor single mothers, etc. etc. I think that is because our education is so bad. Most people have lost the ability to reason. Is it a wonder why we've been discussing health care and education for as long as I know (30 years), and they are only getting worse everyday?
Here is something to think about. Even we abolish all the defense, the saving will not be enough to finance our medicare, because the expense of the latter would just grow even bigger, like a well-fed monster. Before we talk about allocation of the tax dollars, we need to talk about cost containment. Mr. Walker is correct. Our current medicare basically issues blank checks. And no amount of money will be enough to cover the blank checks.
I agree with EVERYTHING Mr. Walker said. (By the way, he is a good speaker. A lot of fun to listen to.) Medicare premium must be based on risk factor - these are insurance programs. Not social welfare. People have the incentive to avoid auto accidents because they will raise their permium. Illness should raise premium too so people will have incenvtive to avoid illness. I know. No one wants to be sick. But how many people think about diebetis, heart disease when they eat pizza, steaks, chips and sit as cough potato?
I believe in government managed health care facilities like the VA for those who do not have the money to pay for private health care, or for those who just need basic care (like me. I have a decent income. But I maintain good health. So I don't need expensive health care. Actually, at 60, I never got sick.) We do not have unlimited resources to pay for expensive procedures, like by-ass surgueries for everyone. If a person is already 65, and is in poor health. Why does he need a bypass sugery anyway? If he can pay for it with his own money, he should by all means get it. But I, as a tax payer, much prefer using that amount to cover basic health care for many younger people. In other words, I believe in rationing, which is what they do in Canada and Europe.
Americans are so spoiled. When it comes to health care, we believe sky is the limit. We want the best things money can buy. Is it not a wonder why the US healthcare providers has given us the most expensive service in the world? The policians now are talking about high quality, lost cost health care. Give me a break. If Cadillac was cheap, people would not want Cadillac any more!
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A Fiscal ‘Tsunami’
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What are the perverse incentives right now?
Well, right now, no matter how much you smoke, no matter how much you drink, no matter how much you eat, you get the same taxpayer subsidy.
Right. So what would be the alternative?
There could be a risk-based premium. See, one of the things we have to debate … there is a difference between whether or not you ought to be eligible for a program and how much the taxpayers ought to subsidize you. Those are fundamentally different things.
How would you know, for instance, how much somebody drinks?
Well, there are lab tests you could take.
But does the government want to get into the business of conducting blood tests on people to see what kind of lifestyle they are leading?
You know, we are kind of drilling down into the weeds here. My view is there are certain types of services that I think we are going to need to make sure that everybody has. Let me give you possible examples: inoculations against infectious diseases; certain wellness and preventative-care services that are clearly cost-beneficial; protection against financial ruin due to unexpected catastrophic illness or accident (while avoiding heroic measures), and guaranteed ability to purchase additional insurance at group rates should you desire to do so. That is the basic and essential package. Then you have to say, "Well, how are you going to price it?" That gets to a whole range of other issues. Does it make sense for everybody to be subsidized to the same extent, irrespective of his or her means?
As I understand it, you regard the prescription-drug benefit as grossly irresponsible.
The most fiscally irresponsible act in decades.
Are there other measures under consideration now that you would regard as equally irresponsible?
There are always some out there, but there are very few that come with $8 trillion price tags, which the Medicare prescription-drug bill did.
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