a. demographics, i.e. people turning 65 plus those who are on disability for 2 years;

and

b. per capita spending growth, i.e. we now spend almost $12000 per Medicare recipient.

Even if item B is defeated, a rather heroic achievement, sheer demographics will push Medicare spending to $800 billion a year by 2022.

I have been saying for several years now that we cannot finance transplants on 80 year olds with just payroll taxes on dishwashers.

Medicare is going to need a lot more money no matter what the IPAB does or does not do.

Which leads me to another area I have been researching.

Medicare does spend a few billion on back surgeries or carotidectomies of questionable effectiveness. That is what IPAB is going to focus on.

But from a budget point of view, Medicare spends almost $300 billion a year on dialysis, transplants, and open heart surgery. These are things which do work– so IPAB will not challenge them.

But can we afford them?

Bob Hertz, The Health Care Crusade

Kathleen Sibelius is no Harry Hopkins.

The Democrats under FDR had a majority in Congress of about 80% after the Depression
decimated the Republican party. Even despite this, some of FDR’s programs were failures such as the NRA.

This is not to excuse Obamacare’s fumblings.
The CLASS program and the puny high risk pool had deep flaws.

Good medicine is only available to the Castros, members of the Communist party, paying foreigners and friends of the regime. Common people have to attend hospitals that look like a scenography for a horror-gore movie.

Healthy young persons will indeed pay a fine of less than $300 that will not be imposed until the next April, if then.

This could create an actuarial death spiral in the exchanges. (as has happened in every state that has offered guaranteed issue.)

Let me try one more time.

The Hinchingbrooke hospital is still funded by tax dollars, I believe. It does not charge user fees or take patients to court or send out ruinous bills as in the Brill article.

The difference seems to be that the new management is defying the NHS unions. And that is a good thing.

Sort of like an American public school being managed by a private firm. The financing of the school does not change, it is still free to the users.

Privatization means that a hospital depends on user fees. Those who can pay fees must subsidize those who cannot. it is a crappy system in many ways.

Good post, I am just quibbling about your terminology

American medicine has found many ways to shorten or even eliminate hospital stays in the last 20 years. This is due to wonder drugs and ambulatory surgery above all.

Hospital staffs and budgets should have shrunk.

Instead they have doubled or more in many locales. Find a hospital that has not had a new bed tower built in recent years, or has not added several levels of professional staff.

Hospitals have survived this by relentless upcoding, i.e. manipulating the fee schedule.
Medicare and most insurance companies are very dumb payers.

Hospitals have defied normal economics for some time.

It is very tough to solve this. Our surplus of over-equipped hospitals means that Americans with good insurance have about the shortest waits for surgery anywhere in the world.

But in any event, it is possible for a hospital to be overcharging and losing money.

http://articles.latimes.com/2009/mar/02/business/fi-hospitals2

Things have actually gotten worse since then. And when Medicare and other government payers are involved, the loss rates are even higher.

http://www.forbes.com/sites/aroy/2011/09/21/medpac-64-of-hospitals-lose-money-on-medicare-patients/

If you prefer a more conservative figure, the AHA puts the in-the-red hospitals at about a third (but that includes non-patient revenue). All of this is old news. It wouldn’t surprise you if you weren’t too lazy to do your homework.