Hundreds of NHS managers have amassed million-pound pension pots while presiding over the worst financial crisis in the history of the health service… As patients face crippling delays for treatment, A&E closures and overcrowded wards, bureaucrats have quietly been building up huge taxpayer-funded pensions. They will be handed tax-free six-figure lump sums on retirement, and annual payouts from the age of 60 of at least £55,000 – guaranteed for life.
Nearly 300 directors on NHS trust boards have accrued pension pots valued at £1million or more; At least 36 are sitting on pots in excess of £1.5million – with three topping a staggering £2 million; The NHS pays a staggering 14.3 per cent on top of employees’ salary towards their pension – almost five times the average of 3 per cent paid in the private sector…
Back in 2013, I got very upset when I learned that senior bureaucrats at the IRS awarded themselves big bonuses, notwithstanding the fact that the agency was deeply tarnished by scandal because of …
The fact that Medicare has been put on a sound financially footing – for the first time in its history – has never appeared in any official government announcement. Ditto for the fact that the disabled and the elderly may bear a heavy cost along the way.
These facts have not been in the headlines of any major newspaper. They have not been addressed in any news article. To my knowledge they have never been discussed in any opinion editorial. Even more surprising, they are repeatedly ignored by scholars and in scholarly reports at think tanks around the country (other than my own).
Here is a third thing l bet you don’t know. Although Republicans have criticized the “Obama cuts in Medicare spending” as threatening access to care for the elderly, the GOP alternative essentially does exactly the same thing.
What no one bothered to discuss was the much bigger budget story: an enormous reduction in future Medicare spending and its impact on the health and financial well-being of the 54 million people in Medicare.
Here is a bit more detail.
The legal barriers put in place to discourage private medicine were nothing compared to the shitty quality of care driving Canadians to hurdle those barriers. As the Supreme Court of Canada noted in the 2005 case, Chaoulli v. Quebec, “Access to a waiting list is not access to health care.
As we noted above, there is unchallenged evidence that in some serious cases, patients die as a result of waiting lists for public health care.” That decision set aside only Quebec’s ban on private health insurance, leaving other provincial barriers in place. But the same pressures that blew apart one province’s restrictions drove an explosion in private health care elsewhere. “In British Columbia, private clinics and surgical centers are capitalizing on patients who might otherwise pay for faster treatment in the U.S.,” the Los Angeles Times reported in 2009. “Private clinics continue explosive growth,” the Canadian Medical Association Journal added two years later, noting that many “private clinics were openly violating” restrictions on billing private parties while contracted with government Medicare.
This year Quebec officials moved to legalize many of the fees that private providers were already charging. That makes sense, since those providers were delivering actual care when the state system could only offer “access to a waiting list.”
The U.S. certainly isn’t North Korea or Pakistan; it isn’t even Canada. But the laws of economics apply here too. The Affordable Care Act—Obamacare—is already running afoul of the Canadian Supreme Court’s warning that “access to a waiting list is not access to health care.” Two years ago, news reports cautioned that top hospitals were declining to participate in the program. Last year, CNN reported that “In many areas, the largest hospitals are not participating and many doctors are not accepting the coverage.”
In fact, small but growing ranks of providers are refusing all coverage. Freed from burdensome bureaucratic overhead, they offer less expensive care in return for direct payment by patients.
Those doctors aren’t doing anything illegal, but the Americans who refused to pay the premiums for Obamacare-compliant coverage are breaking the law. Millions of Americans were forced this year to pony up fines to the IRS (which has been tasked with enforcement), with many millions more exempted, and an unknown number just flying under the radar. The penalties were a bargain compared to the inflated price of obedience to the complex and expensive government mandates.
Economies and cultures may differ, but the U.S. faces the same economic pressures that confront the regime in totalitarian North Korea, bureaucrats in poor Pakistan, and elected officials in prosperous Canada. The choices are the same too: They can criminalize medical care provided outside official channels. Or they can recognize and legitimize the arrangements that patients and providers make when governments can only offer Bernie Sanders’ empty vow of “a single-payer national health care program” that guarantees nothing more than a spot on a very long list.
…government attempts to mandate healthy behavior don’t work. For example, a 2015 scientific study analyzed the “Los Angeles Fast-Food Ban”, a 2008 zoning regulation restricting opening/remodeling of standalone fast-food restaurants in South Los Angeles. Data showed that consumption of fast food and obesity increased in all geographic areas from 2007 to 2012, and the increase was significantly greater in the regulated area.
Politicians need a “system” to expand central control. Central control breeds mediocrity. Government programs play to the lowest common denominator. One size fits all quickly becomes one size fits none. Call me crazy, but I want the second opinion about my treatment to come from physician, not a government bureaucrat evaluating me from his cubicle.
As Malcolm Gladwell of Tipping Point fame opined, rather than expanding insurance we should keep insurance in its proper role for “unexpected, big-ticket things.” And “the bottom end of healthcare should be a market-driven cash economy.”
Competition brings out the best in us. For example, Theranos, a company started by a Stanford freshman provides 14 accurate basic kidney/liver function tests from one drop of blood for $7.27 at Walgreens. By contrast, my insurance co-pay for lab tests is $40.
Politicians can’t fix our medical care access problems. That’s up to us. As a start, consider enlisting direct pay physicians (here, here, and here) who give personal care at reasonable prices and replace the ACA with your own healthcare system.
Loyal readers already know that health care spending was proceeding moderately until the advent of Medicare and Medicaid. Amy Finkelstein showed that in the first ten years Medicare had no impact on the health of the elderly. And fifty years after the fact, we are still arguing about whether Medicaid affects the health of the poor. Yet this massive infusion of federal spending fueled health care inflation that has been barreling along ever since. The same thing appears to have happened in education. According to economist Richard Vedder, the explosion in college costs began about the same time as the cost explosion in health care ― with the Higher Education Act of 1965.