Let’s discuss some sobering projections on the cost of Medicare and Medicaid.
Long Run Projections
The American Enterprise Institute (AEI) discusses a Unified Long-Run Macroeconomic Projection of Health Care Spending and the Federal Budget.
MPW stands for AEI authors Mantus, Pang, and Warshawsky.
CMS stands for Centers for Medicare & Medicaid Services, which has every incentive to understate costs.
The AEI projections start on page 24.
Base Model Projections
As shown in Figure 11, the projected ratio of national health expenditures to GDP increases from around 18 percent in 2021 to 20.8 percent in 2032, 26.2 percent in 2052, and 41.5 percent at the end of the horizon.
The total government share of health care spending (not shown) is projected to increase from 61 percent to 65 percent, largely as a function of the larger role of public spending in the health care provision for the aged, holding current policy constant. CMS has a lower share of health spending in GDP in the out-years, even without government price controls (illustrative alternative).
Federal Debt as a Ratio to GDP
Figure 12 shows projected federal debt as a ratio to GDP. It increases from about 100 percent currently to 135 percent in 2032, 268 percent in 2052, and 785 percent at the end of the projection period; the Financial Report (FR) reports a projected level of debt of around 570 percent of GDP in 2095. These levels are unprecedented for the US and even for other large countries with currently high ratios, such as Italy, at around 150 percent, and Japan, at around 250 percent. It is also worth noting that Japan has an exceptionally high domestic savings rate. Whether the bond market and foreign and domestic investors would support such high federal debt for the US, rising steadily over time, even with no financial crises, is unlikely in our opinion, but it is unknowable in advance when break points will occur. According to our model, these debt levels increase interest rates and thus depress investment and capital stock formation and, as we will see below, consumer welfare. Although there is assumed to be an increase in private savings, that is not enough to offset the effect of deficits.
Ratio of Government Health Spending to GDP
Official projections include the impact of an assumed relative price increase, but it is smaller than produced by our model and trends downward, whereas we find the relative price increases, on average, at 1.2 percent per year with this annual rate of growth increasing from about 1 percent to 1.5 percent, as shown in Figure 18. The underlying low productivity growth in the health care sector plays a role in this trend. The main driving factor, however, is the increasing scarcity of labor. Future demographic conditions lead to both a slowdown in the growth of the labor force and an increase in the demand for health care. With the lack of substitution of capital for labor, on top of low productivity growth, the health care sector takes a larger and larger share of the economy’s labor, drawing from the “all other” sector where labor could have been substituted for capital, whose stock is being starved by the growing deficit. The labor share for health care services rises from just under 10 percent in our base year to 27 percent by the end of the period. This absorption of labor increases the rate of growth in the relative price of health care. This is a prime example of Baumol’s cost disease but with a vicious dynamic twist given future demographic conditions.
Comparison of Official Projections
CBO is the Congressional Budget Office. OECD stands for the Organization for Economic Cooperation and Development.
CBO does short-term (10 year) and medium-term (30 year) projections of the budget (revenues and outlays and debt) of the federal government. In its annual projections of May (short-term) and July (medium-term) 2022, CBO notes that the projected deficit in 2022, at 3.9 percent of GDP, was smaller than the record amounts in 2020 and 2021, and projected it would decline again to 3.7 percent in 2023. (Note, however, that these projections assumed continued low interest rates and high asset prices – assumptions clearly belied by experience in the past year.)
Subsequently, deficits increase, so that deficits average 5.1 percent of GDP over the 2023-2032 decade. They further increase to 7.4 percent of GDP in the 2033-2043 decade and to 10 percent in the 2043-2052 decade; in 2052, the deficit is projected to be 11 percent. The projected growth in total deficits is driven in part by increases in interest costs, as net interest outlays more than quadruple, rising from 1.6 percent of GDP in 2022 to 7.2 percent in 2052. Social Security and Medicare are part of the cause too – Social Security’s spending increases from 4.9 percent in 2022 to 5.9 percent in 2032 to 6.4 percent in 2052 and its contribution to the deficit increases from – 1.0 to -1.5 to -1.8 percent of GDP over the three decades of the CBO horizon. Medicare’s contribution to deficits is even larger, increasing from -2.3 to -3.4 to -4.1 percent of GDP over the projection periods. Note that CBO has a more pessimistic view of the finances of Social Security and Medicare and the overall economy than the Trustees.
Baumol’s Disease
Please consider Revisiting Baumol’s Disease: Structural Change, Productivity Slowdown and Income Inequality
The growing importance of services has led to significant structural change in advanced economies, with the service sector now accounting for the largest share of employment in developed countries. In his seminal model of the so-called cost disease of services, William Baumol noted that the prices of services, especially in health, education, arts and culture, tend to rise faster than the prices of material goods. Central to his model is the disparity in labour productivity growth rates between stagnant and progressive sectors. Baumol’s model sheds light on the reasons behind the rising cost of services and provides a deeper understanding of its economic consequences. This article argues that Baumol’s model of the cost disease of services retains its explanatory power and relevance today. It refutes criticisms that productivity growth in services is mismeasured and underestimated and that the increasing importance of services as inputs in manufacturing renders Baumol’s model irrelevant. Instead, the article argues that Baumol’s model can highlight the overlooked consequences of rising income inequality, particularly the severe impact of the cost disease, which disproportionately affects the poorer segments of the population.
Simpler Explanation
Forget Baumol’s Disease. I have a much simpler explanation. Government and labor unions both add costs and inefficacies to anything they touch.
Look no further than the costs of education vs the cost of a chicken or round steak. When I started college in 1971, the cost of tuition at the university of Illinois was $250 per semester.
I worked at a grocery store at the time. Round steak on sale was a loss leader at $1.00 per pound. I bought it on sale a few weeks ago for $2.99 per pound.
Tuition is now $9,090 per semester.
The government has no idea how to run Medicare or Medicaid. The programs are rife with fraud.
The Corruption and Incompetence of Chicago’s Mayor Has No Bounds
Regarding the cost of public education, please see The Corruption and Incompetence of Chicago’s Mayor Has No Bounds
Chicago mayor Brandon Johnson stepped to new lows when his hand-picked board fired Chicago Public Schools (CPS) CEO Pedro Martinez without cause.
Public unions, mayoral graft, and gubernatorial graft have bankrupt the city, the state, and all the pension in the city and state.
Also note that In Chicago There’s Under a 50 Percent Chance Police Show Up If You are Shot
Good luck in Chicago getting the police to show up if you are shot, stabbed, a victim of domestic violence, or any number of other serious crimes.
Team DOGE
There is one heck of a lot of waste, fraud, and corruption. I sure wish DOGE success.
But unless they address Social Security, Medicare, and Medicaid, the most success they can have is picking around the edges of a massive deficit hole.
Importantly, DOGE has no power to do anything. And they haven’t really come up with anything that hasn’t already been proposed.
The problem is not lack of ideas. The problem will be getting those ideas to pass Congress with the slimmest of slim majorities.
Rude Awakening for Trump, No Business as Usual Applies to Him Too
Meanwhile, please note Rude Awakening for Trump, No Business as Usual Applies to Him Too
No business as usual applies to Trump as well. 36 reps refused to go along with Trump’s demand to eliminate the debt ceiling.
That’s a good thing. But I keep coming back to this: On December 18, I asked Do You Have Any Faith that Sheriff DOGE Will Reduce the Fiscal Deficit?
Trump’s own proposals would add trillions of dollars to the deficit. Democrats may go along with some of them. But they won’t go along with social budget cuts.
It is going to be very difficult to reduce the deficit, when Trump’s own proposals would add to it and Democrats are screaming “Medicare for All”.
I see no way that US debt will hit 700% of GDP. We will have a fiscal crisis before then, with all the consequences already seen when other nations have gone bust. In a worst case the USA could go bankrupt like the USSR had in 1991, and parts might break away or be broken away from the USA.
As for healthcare and the broader economy, there is a good chance that we will “top out” (or have topped out) and be headed into a standard of living decline. Much as is already occurring for Great Britain and Japan.
If they can’t may be they won’t in whole or in part. It may be this way with a lot of things if the economy will not provide the tax revenues to make ends meet or better.
Don’t fall in love with government spending.
One thing that is happening and will progress is that Medicare reimbursements will be cut like Medicaid and drive more primary doctors to offer concierge service. So while more and more healthcare consumers will end up on Medicare, fewer docs will accept Medicare in the years to come.
The title of this article is very misleading. It should read, How is the US going to fund Chronic Disease Care? Mish, are you familiar with Karl Denninger’s ideas on how to address this issue?
https://market-ticker.org/akcs-www?post=231949
Incentivization is completely mis-aligned at every level in the current system. Denninger’s ideas might work in a world where big pharma/insurance are not manipulating everything. I think job # 1 is outlawing employer-provided health insurance. That would be a shot across the bow telling the world that we-the-people are going to have to start being good consumers, not blindly accepting every drug and treatment protocol without counting the cost.
SO, axe the one thing that works for a lot of people, with the people and their employers paying the cost.
1) phase out o-bo-mo care
2) phase out medicare
3) phase out medicaid
unfortunately they all have to be phased out because the government has intentionally made so many people dependent on government health care.
4) get out of the way of the free market and allow the free market to work.
5) make every politician and bureaucrat dependent on the free market and stop supporting them with tax payer dollars.
cut every boomer from the free healthcare next problem
It isn’t free.
How about a 100% inheritance tax instead?
The problem is the uneducated have been programmed to expect simple solutions, usually one or two word phrases, jingoistic, to give them feel good solutions, like “Green Energy” “Diversity,Equity, And Inclusion”, etc.
Healthcare is not simple, it comes from the premise all people get ill and need care. While this is true, we can limit how many people get ill and how severely, by changing entire aspects of our culture.
This a a basic and necessary, premise that doesn’t even enter the thought patterns of the programmed. Our American lifestyle is engineered to provide maximal girth and weight, neither of which is healthy. But a fat,stupid, populace cannot fight back against any enemy, except a doughnut.
RFK, knows, the 1st fix for health care is making the population healthier, not with a useless food pyramid that creates obesity and diabetes, and heart disease. Not with expensive prescription medicines that enrich corporations and destroy long term health for short term benefits, which add to the longer strategy of continuing health care for those delibatated by the Pharma Express they ride every day to the city of metabolic disease.
We fix health care by fixing our broken systems, bringing back physical mobility, limiting internet, especially social media which is pyschic and physical poision for youth and middle aged as well.
we return to not for profit healthcare systems, and we can start by taxing pharma et al, and directing the money to free loans for qualified medical students especially Doctors and Nurses, but also Nutrionists and Alternative Health workers.
We fix our lifestyles and our media and medicine which encourages stupid, destructive choices, that lead to expensive healthcare that taxes our financial system and our government.
1% or less interest on medical debt would be a good start.
“we return to not for profit healthcare systems”
lol, yeah have to re-write those laws too since too many “non-profit healthcare” systems are buying up so much property with grotesque profiteering too
health care is very simple, when you get the government out. no hospital will charge more if they lose customers. no doctor will charge more than the customer can pay, if they want to stay in business. it will take a while and it will be painful. it’s always painful when an addict is forced to get clean. but in the long run it is better for them not to be addicted. btw, just in case you missed it, the government is the pusher and the American people are the addicts.
The “addict” is the health care industry with all the grotesque profiteering
Hospitals are businesses. They won’t “charge less” – they’ll just close. And the local community will be the loser.
Doctors also move to wherever patients can pay.
The problem is not unique to America.
It’s much worse in Europe.
The public cannot be weaned off free healthcare, they will vote for it, vote against measures to repeat it, and use it until it breaks. Rolling back the big state is too painful, even though the debt it creates slowly crushes the voters’ incomes.
What is accelerating the implosion of public funded services is illegal immigration on top of the demographic pressure.
Evidence shows that immigration of any kind tends to result in the immigrant population having the same outcomes as the host population. There is no magic demographic wand or intervention that will create growth and new funding for the bloated public sector, it has simply become too big, and diverged from its original model and purpose too much.
I can’t see it changing other than by collapsing as it is in the UK.
The most practical solution is to step out of any economy that has such a system and use a private one in a cheaper economy.
This is obviously not an option for most people, especially in large countries, where health outcomes look bleak.
Not just healthcare but retirement options too. This is the downward slope of the postwar boom, that seems to have peaked and broken with the GFC.
First, it is not just ‘uneducated people who have been programmed to expect simple solutions. Anyone who does NOT think critically accepts green energy and DEI.
Critical thinking begins with all people get ill and need care.’ At what point does one counter with:
`All people need food and housing, education, transportation, entertainment…. AT what point is your healthcare (etc) my problem?
You have the basic ideas, and then up in the same place–‘not-for-profit.’ The solution is MORE COMPETITION. Small, efficient companies offering packages they define might emerge at a far lower cost…
The numbers are going to be a lot higher because they don’t take into consideration the recent increase in health care due to vax injuries.
We also need to eliminate free healthcare. You must pay cash up front for healthcare if you don’t have insurance. Eliminate Medicaid.
And higher still. Has NY actually paid for all these illegals? That money was not in any budget. Me thinks they will be asking DT for 20 Billion.
NO FREE healthcare. The illegals need to pay cash before they can get healthcare.
Any immigrant, legal or otherwise, needs proof of sustainability, or a sponsor who will cover such expenses.
Debt-to-GDP ratios are obviously contrived metrics. Unprecedented large deficits “absorb” a disproportionately large share of N-gdp (as gov’t spending is a component / factor of gDp).
To appraise the effect of the federal budget deficit on interest rates, it is necessary to compare the deficit, not to the debt to a GDP-ratio (a contrived figure), but to the volume of current net private savings made available to the credit markets (including the monetization of gov’t debt by the commercial and the Reserve banks)
the solution has already been put in place in the UK and Canada and it’s called euthanasia.
https://www.bbc.com/news/articles/c0j1z14p57po
I predict by 2030, it will be likely legalized in the U.S. with doctors receiving ‘incentives’ to encourage their elderly patients to consider end-of-life options. It’s either that or off to the soylent green factory.
Since no politician has the courage to address medicare, the obvious path will be to give people a choice to exit. I honestly think it’s far better than wasting away at a nursing home. Heck the first thing the doc should say to them is, “have you been to a nursing home lately?”
And that’s nursing homes now where there is only acute labor shortages not critical ones. The elderly are going to have a hell of a ride over the next decade.
Here is an article on the UK one.
https://www.nytimes.com/article/uk-assisted-suicide-parliament.html
Exactly what the insurance companies would LOVE to implement legally, ‘cuz, $$$$$$$$$
Think of it as abortion on the other end.
Very good post. But Medicare and Medicaid are not rife with fraud. These programs are rife with legalized corruption. And if we shift health care provision more to the private sector, we will get even more legalized corruption. Other countries have figured out perfectly sensible health care policies. We Americans seem to be simply too dumb to learn from those other countries’ experiences.
It’s not just the government. Corporations use health insurance as a job perk to attract the people they want and as an anchor making it harder to change jobs.
My former employer claimed to spend $14,000 a year per employee on health care. The ACA penalty for not providing health insurance to the employees is only $2000 per year. They would have been money ahead to pay the penalty even if they gave everyone a $5000 per year pay raise.
Yes its a perverse system when Healthcare is used as a cage to keep you in the system, on the Eddie Employee treadmill to death and a shitty retirement.
Every body sees the problems and think they are independent little nuggets to be solved, but they are entertwined in a maze of madness meant to destroy your quality of life and any chance at happiness.
Yes, the ACA penalty is an option for cash-strapped corps. My former employer considered that option, in lieu of providing health insurance. It was cheaper.
In the end, they decided they needed to offer health insurance, to attract quality employees.
As a comparison, Christian Healthcare Ministries covers a family of 4 for $861/month. Deductible is $1000 per year and wellness visits and vaccines are out of pocket. Interestingly, a family could have 6 kids and will pay the same rate of $861/month.
Too dumb or too manipulated, I guess its just 2 sides to the same coin, The average American spends years of their lives listening to Pharma commercials and making healthcare decisions based on an infomercial, Just like a Bespangler or a Flowbee, or a George Foreman Burger Machine.
Sorry I can’t offer a more recent informercial, I turned off the propaganda machine 20 plus years ago, I have no idea what shit they are hawking and fools are buying.
Medicine used to work in the USA, how about somebody in government crack a history book and figure it out???
Really just Medicare and Medicaid departments for good, but the DOD the department that kills, no that’s OK. Get your head out of your a.
Medicare for All could save money – but at the expense of the stock market.
Increasing the efficiency of healthcare and reducing payments for drugs would tank the value of several stocks.
Sure, I’d like single payer, non-profit healthcare system also..
But what do you propose to do with the many millions who make their living through the current organization of the US healthcare system? Many will become unemployed and IMO, a majority would likely not be able to find replacement work at the same pay levels that they currently make.
Not only the doctors and nurses who would have to take significant payout’s but all the people who process and police billing codes, approvals/rejections of service, and numerous others who shuffle paper (physical or digital) from desktops in the US and around the world? And so many more.
I can’t even begin to list the millions of people that would be affected by such a change. Look at all the healthcare jobs listed by the BLS.
I am convinced that it is these stakeholders who are/were/will be the voices that will protest any attempts to reform this industry.
But don’t let me spoil the party with a does of reality. Carry on…
Yes, millions would be put out of their current job. But, if the current system is not reformed, many more millions of people (by a multiple of 100), will lose access to critical health care procedures and wait times will increase to the point where those procedures may be rendered pointless.
Because the bloated and wasteful healthcare system implodes under its own morbid financial obesity..
And if you are concerned about these cost-multiplying layers of paper-pushing employees who add nothing to the quality of care, where was the concern when millions of decent paying factory jobs (with benefits) were moved to China after the GATT Treaty when China was given (without merit) “Most Favored Nation” trade status?
And where was the concern when ten+ million American construction workers and meat-packing employees were displaced by the WAVES of millions of illegal invaders came over our Southern border from 1986 until today?
It’s time that America faced reality. We cannot print and spend to maintain a parasitic healthcare system.
Oh yeah, and PBMs. Look up what those leeches add to your costs…
Suggest you write a note to your Congresspeople advocating for this. Let us know how they respond! [lol]
Downscaling one’s lifestyle is inevitable, most doctors etc are not small business owners of a “practice” but wage slaves to large mega medical corporations.
Inflation, and insanity are two of the biggest problems of modern life. When I entered the workforce, I made 4,000$ a year and I could afford to buy a new car, rent an apartment (with 2 drinking buddies) buy groceries, go to live concerts, buy clothes, go to bars and restaurants, you know have an actual life.
in fifty years, they f*cked up the entire economic system.
thats the real problem, healthcare, taxes, social security, etc are just symptoms of the economic systems problems writ large.
Sure thing. I wonder how the MD’s SO might think about that?
Umm, put them to work elsewhere like the steel industry, coal, industry, TV manufacturers, textiles, etc had to do.
They are not special, just paper pushers
If anything it would offer a nice, large, competent workforce to stop this BS about “needing” immigration to stay alive.
Uh huh. Or train them to be web developers or Influencers, like we are going to do with all the truck drivers and longshoremen when robots take their jobs.
Still fretting over those buggy whip makers? Wooden spoke wheel makers?
Single payer won’t create unemployment in the medical industries it will increasethe number of employed. More people will be able to avail themselves of those services needing more employees. What would suffer are the paper pushers filing and refiling claims to various “insurance” companies.
Ask doctors if they could have a US Medical Service much like our military where college, office personnel, malpractice insurance, all their supplies were provided free by the US Medical Service which system they would take? A VA employed GP today starts at about $150,000 annual salary, I think a lot of them would take it.
Mish,
Good comments as always.
You may also want to address the continuous resolution of the US government budget office, which basically means an 8% increase year over year, adopted one Obama was in office. This is one of the causes for the government debt drawing year over year. I strongly believe we need to return to a balanced budget, or each item is reviewed, debated, and funds are allocated according to what that item truly requires. This is not the economy that will live in today. A recent “government shutdown” is a perfect example of that.
“If something cannot go on forever, it will stop.”
— Herb Stein, Senior Fellow at the American Enterprise Institute
First, cancel Obama Care. Second, open up the competition. Let companies cross State Lines. When the Government gets involved they fuck it up every time.
I think Musk is on the right track – put everyone on Ozempic. That would solve a ton of our health problems (people tend to stop drinking and doing drugs along with overeating).
Still gotta start letting old people die rather than spending a fortune to keep them alive an extra month or two, though.
Solve the fat/alcoholic problems and solve the old people hanging on in a coma problem and you’re set.
I’d take it, but it interferes with my ketamine regimen.
Im pretty doubtful that the ozempic or zepbound or whatever other name stuff is, is good for a person. Sounds like they’re just scamming people looking for a cheap fix to an unhealthy lifestyle. Probably has some bad long term side effects from whatever nasty drugs and chemicals are in it. It’s very simple and cheap to get a healthy weight. A 40oz of container of oats at wally world is around $4.00. That will make a lot of bowls of oatmeal that along with some physical activity and other cheap healthy fruits and veggies, getting sunshine, drinking water, etc. will melt the pounds right off.
America wants its wings and chips with queso on NFL Sunday. Why not do a 70 mile bike ride or a five mile run Sunday instead? We all know what big fat American wants.
they have been programmed. it works so well, they will cause self harm to follow the program.
Replace the fluorine in the water with Ozempic?
and lots of estrogen to stop those mean mens..
even the bears will get gay if they drink out of the resevoir….
I could have a pet bear then?
Well I’m hoping that Musk and company, can resolve a lot of the health issues. This will occur through what’s currently being allowed in our food supply to be more closely monitored. Some of what we eat daily, wouldn’t even be allowed to be sold in other places throughout World.
The area of Alcohol is taboo, because it’s addictive, and by far, the most widely used. We literally Do Not have enough places to cure this problem in America today! The money made is another issue, as it would bankrupt half or more of the Restaurants in the Country. It’s where most of the profits are made from. That’s just for starters. How about the “Unemployment that would follow due to loss of jobs and with no replacements for even close to all of them, and probably not for most of them.
Not happening!
they don’t need drugs, they need to stop eating, its that simple. fasting 2 days a week and all the fat and diabetes etc goes away.
its not sexy and it doesn’t make a ton of money for big pharma and all its ancillary industries like big media, big advertising, big medicines, but it works
if the house is on fire stop throwing lumber on the blaze.
if you are fat, stop eating.
fast 2 days a week.
its free
it works
its simple
it doesn’t make money for anyone.
its imposible to sell ……………….
OT- banks are suing the Fed. Expect it to be like the wild wild west once January 20th comes. We will get a crash of historic proportions when banks are allowed to go hog wild. Don’t say you weren’t warned or didn’t vote for this if you voted for Trump or Repiblicans.
The crash will make me much wealthier, and that’s what matters.
Even if we had funding there are not enough medical personnel to care for everyone. I don’t know why people ignore this problem. It’s like saying everyone gets a Toyota Corolla knowing damn well there are not enough of them to go around. The solution Canada and Western Europe came up with is a WAIT LIST.
its not difficult, the problem isn’t healthcare. its too many sick people, the answer isn’t euthanasia.
People have an innate ability to heal themselves, its sort of how the world worked before big medicine.
the problem is the lifestyle that has been programmed by their governments and NGO’s.
Fasting, sunshine, physical activity. no social media, no neuroses, good food in sensible portions.certain vitamins, and herbs.
its not sexy, and its not simple, but our entire lifestyles have to be undone and the programming has to be destroyed or re oriented to actually create a healthy world.
we live in a sewer of media and internet and cant understand why everybody is sick? We eat garbage and we eat a lot of it and as frequently as we possibly can, and we get fat and sick and nobody knows why or what to do.
Are we stupid, are we uneducated or are we programmed to ignore the reality we are immersed in?
Lets binge watch netfix for 48hrs and get ubereats to deliver the MegaChicken and RIbs special with the wheelbarrow of Cheesecake…
and a diet coke Zero (72 ounces, please)
For a medical doctor friend of mine, who is at least 100 pounds overweight, an all-you-can eat Chinese buffet is a slice of heaven. Exercise is a walk from the kitchen to the garage. He is a big user of Medicare services.
“DOGE has no power to do anything”
Lol. And yet DOGE will prove to be the most formidable force that entrenched government has ever faced.
Mish stuck in the past. Hoping for failures
Mish does seem rather Trump-centric these days. Maybe his newsfeed is misbehaving? Somebody hacked his Alexa or whatever zombie gadget has enchanted the world with its “shiny object” status.
6 out of 10 articles on his home page (page 1)
have the word “Trump” in the tile, I think Trump seems to be his most often topic. That is trump-centric, whether you like it or not. its statistics.
I’d like to see a modest legislative success or serious set of executive orders before claiming any success.
Are you blind?
blindness is a side effect of Olzempic per recent studies. Semiglutide or whatever, the gift that keeps on taking..(your weight,your eyesight, your organs,your lifespan)
It will do what it’s intended to: misdirect the rubes from my pardon for SEC crimes.
US consumer confidence drops unexpectedly to near-recession levels ahead of Trump’s 2nd termhttps://archive.ph/wE1XU#selection-1473.0-1473.92
The long national nightmare is ending
Mish might finally be right on his recession call!
Offer painless euthanasia to anyone that wants out. Half of those tired of working just to pay the bills would tap out.
3/4 of health care is spent in the last year keeping zombies alive in assisted living facilities. Is this fraud? They suffer. We suffer. Let them die with dignity. And save a whole lot of money.
https://m.youtube.com/watch?v=W4rR-OsTNCg
A lot of time, someone in the immediate family doesn’t want to let them go. This is often rooted in psychological issues or religious beliefs.
Agreed. The federal government should have centers in each city that would allow people to check out on their own terms when they feel ready or needful.
Offer 2-3 days of psychological counseling to ensure that decisions made are not just spur of the moment due to sudden bouts of depression or mental illness.
Offer assistance with listing/contacting relatives/next of kin, disposing of assets or making a simple will, processing the body. Allow the [to be] decedent to sell their body parts to pay debts or bequeath something to family or to charitable institutions.
Sounds like a decent business model to me!
what do you do, when a good idea become mandatory? Have you seen Logan’s Run?
some would say life is over after 30. will you run or will you ride the euthanasia carousel?
I’m all for appropriate euthanasia. This would clear up the homeless problem quickly.
It’s simple: healthcare will eventually bankrupt us, unless somehow we’re able to eliminate 90% of the waste, fraud & abuse as a start.
Baby boomers are 60 to 78 years-old. Over the next 10-15 years, the cost associated with this cohort and the older Gen X’ers will stress the system to the point of no return.
Obviously, the cost of Medicare will explode. As such, we have about 10 years before we’re forced into making healthcare a not-for-profit industry. While I don’t think a single-payer system is the answer, I’m not sure what the alternative looks like once we’re forced to eliminate the profit motive.
To start, eliminate fraud, deport illegals and don’t forget the supply side.
Socialism is never the answer.
The problem isn’t healthcare, its health. fix health, fix healthcare. stop digging the hole.
One thing the feds should NEVER do is provide glyophosate (those weight loss drugs) to combat obesity and diabetes. The war on saturated fat has been a tragic scandal that began after Eisenhower’s heart attack in 1955 and gathered steam until in the mid-1970s, the government leaned on the food processors to reduce fat in their foods.
Food is either protein, fat, or carbohydrates, and there are definite limits on protein, too much of which causes severe digestive problems. The result has been replacement of fats with carbohydrates. Since the late ’50s and early ’60s, diabetes has risen eight fold; obesity three-fold, and “morbid obesity” 10-fold.
Dietary fat produces satiety, the feeling of fullness. Carbohydrates don’t do that, and in fact they strongly tend to make people want to eat more of them. They metabolize to glucose, which causes insulin over-production and diabetes, and obesity. These things have skyrocketed since the mid-1970s in particular.
Hand it to the union of Big Medical, Big Government, and Big Pharmaceutical: First they cause the crisis, then they introduce a hyper-expensive “cure” with all kinds of bad side effects. The research is definitive, yet the feds still push low-fat, and now government wants to pay for drugs that mimic the effect of dietary fat by producing satiety.
This is a monstrous crime in more ways than one.
Guess what else makes you feel fuller longer? Fiber. Fiber supplements are a lot cheaper than Ozempic type drugs (GLP-1 agonists).
Another comment goes to spam when I edited it. You know what? This site isn’t worth the trouble. Bye, Mish. And good luck with your attempt to become yet another political pundit, as if we are lacking in those.
yeah its annoying. I just post with errors, typos, whatever… it aint shakespeare, it aint even Mark Twain..
Fiber is the platform or structure gut bacteria live upon. A healthy gut biome will lead to a longer healthier life. Non-digestible fiber is better than a digestible carbohydrate fiber, Inulin ..
Inulin is a type of carbohydrate that’s not digested by your body, but feeds your gut’s good bacteria. It can help with bowel movements, prevent overeating, lower cholesterol and improve mental health,
don’t overdo it, you only need 3 capsules a day.
It’s not only about overuse of one nutrient. Physical laziness is a driving factor as is too many calories. It’s not a simple matter of limiting one nutrient or another. Maybe all those tattooed fat girls could attract a man if we made them run five miles a day? Just a thought.
Seed oils have to go. Canola (rapeseed) oil is in everything.
Soybean oil is in everything, canola is much less common.
canola oil is closer to the composition of olive oil than either soybean or corn oil.
chart here, scroll down.
https://en.wikipedia.org/wiki/Vegetable_oil
Canola is rape seed oil, CANada OiL and add an A. People often get confused about the difference between canola oil and rapeseed oil, though. These two plant-based cooking oils, however, are different. Canola is genetically modified version of the rapeseed plant.
I used to use it, switched to butter and bacon fat. Taste better and its easier to digest and better for you.
Glyophosphate is roundup, a product of Agent Orange research. Its toxic to gut bacteria, but labeled as “safe for humans” – never mind your gut bacteria, its likely the cause of leaky gut and hence immuno diseases like Celiacs, etc.
Peanut allergy is likely caused by peanut oil being used in vaccines since 1976, its not labeled as peanut oil, so most folks dont have a clue.
but yeah glyophosphate doesn’t belong in the food chain or in food products for human or animal consumption.
we can fix healthcare, but it requires fixing alot of non-adjacacent issues, like intentional poisioning of our food and water supplies for profit.
I gave up Oats because of Glyophosphate and most other grains. Until I can grow my own or have a known good source of flour. limit your poisons ..
Ban insurance companies or go to single payer.
I can’t believe the comments supporting this grotesquely profitable industry.
Even with UHC, they have more people denying care in claims than they do doctors, yet raking in immense profits by denying health care to those paying into it.
I’ve paid UHC/Aetna for 35 years, with damn near no claims at all for me or my family. I need a hip replacement from an injury, and they are fighting all the way.
Screw them and the entire leech industry.
Nancy Pelosi got a hip replacement within 24 hours. Bill Clinton got a hospital bed after going to the ER with a fever. I waited over 12 hours in the ER to get a hospital bed when I had a life threatening infection. Good for Clinton and Pelosi though as they don’t have to worry about delays or denials.
I’m literally on a FOUR MONTH WAIT!
So much for,” don’t be like Canada and the EU, you’ll wait months” and I can barely get around the house with the pain, while my knee progressively gets worse to compensate for the loss of the hip. By that time, I’ll need a knee replacement next.
Except I wait longer and I still pay out the nose for it.
We also made sure that filthy Luigi guy got found chop chop, and got a full battle rattle perp walk, just to let the proles know we’re not to be messed with. There is the wealthy, and there are the nobodies. Keep to your place.
You may want to read the story about the rich man and Lazarus. On the day of reckoning, all will be summoned, and all the wealth in the world will not avail those who have wronged their own souls with greed and corruption during their lives on earth. A warner comes to everyone, and all their thoughts and deeds are recorded in a profound record. They will be repaid without the least injustice.
I *AM* God!
They are considered VIP’s. YOU are not.
its true, the demons go to the front of the line in Demon World. We can know more by the actions of a system, than by the words produced by said system.
watch and learn…
Once again, the mouth breathers think with their mouths. If government is so good at running things, let’s see how they do with the rest of the economy. You attack the symptoms of the problem and can’t see the wood for the trees. Corruption doesn’t start at the bottom – look at who regulates the industry and how it got so big and stays so powerful. Certainly the industry delivers awful results to the payers but it’s the legislation the drives it. There’s nothing so bad that government can’t make worse. Obamacare anyone?
Who do you think pays for the legislation?
take “in God we trust” off the money, and replace it with “Best Government Money Can Buy”.
Truth in currency act 2028…
What is the current insurance regime but a single payer for immense private profit while American die for lack of care? I’d take a central governance above what’s happening now.
Social security could be fixed by a couple of tweaks, Medicare however is a disaster. 1 out of 5 dollars goes to Medicare. If we don’t fix that nothing else matters… good luck
Social Security is socialism. Socialism fails with every attempt. Prosperous societies teach personal responsibility in schools. Happy people prepare themselves to provide value to society. Work, save, and invest. Calamity happens to everyone. Keep on keeping on.
Socialism works on small scales, families are socialism. sometimes small towns are socialistic.
it only works when people share emotional and financial bonds. when you try to scale it fails and turns into graft, grift, and outright theft.
What?!?!? What do you think insurance is now? It’s literally socialism, and in healthcare, yes, you’re right, it’s failing everyone but the wealthy through their death panels…
Health care is a personal responsibility. Government made a mistake by giving tax credit to corporations for providing health care. The result separated corporate employees from costs. Medical prices exploded. The cure is to remove the tax credit. When people are responsible for what they purchase they pinch pennies. The price of medical care will plunge.
There definitely has to be a move towards transparency in both directions, whereby your premium is at least in-part based on your health. Like you’re suggesting, individuals have to be incentivized to live a healthier lifestyle.
First we need to fix Medicare. It’s totally broken . An example: my aunt had a procedure done twice that shouldn’t have been needed if the doctors were on their game. Once at a fantastic surgeon’s office for $600 and once done at Marina Cedar’s ER after being pushed there by Cedar’s Urgent care $19k and change. Without the customer in charge of shopping and keeping costs down this will never get better. Between the military and our medical system one could easily balance the Federal budget by eliminating fraud and waste.
Unfortunately there are boat loads of people making untold amounts of money off of fraud and waste. They will fight tooth and nail to keep the grift going.
1) Get rid of Medicare Advantage – “For Profit Healthcare” is a disaster. Read Kenneth Arrow’s Nobel Prize winning paper.
2) Dump on Bernie Sanders all you want but seniors on Medicare are happy. So why wouldn’t everyone else be happy with it?
3) Why worry about the cost when the government can create new money out of thin air?
The problem isn’t “for profit” healthcare. There’s nothing wrong with profits. The issue is that plenty of other industries operate under a profit incentive without such problems as we have with healthcare. So, it isn’t profit, but the incentives and means by which profits are generated. And those means and cause of incentives come from government intervention.
I hope that the patient’s well-being comes before the doctor’s profit incentive. What about the private equity firms buying up physician practices?
MAWA, make America Walk Again.
Saves trillions.
Repeal a few laws and enforce antitrust law in the medical industry.
From Wilder, Wealthym and Wise:
In the 1980s, healthcare went from a still-manageable 6.9% (1970) to 12.1% (1990) – nearly doubling in size. This was largely driven by a 1986 law (EMTALA) that made emergency treatment a right at any hospital that receives Medicare, whether or not the patient had any ability to pay. It’s like saying that if I’m really thirsty, that McDonald’s™ has to give me an iced tea.
Today, there are roughly 7.5 million kids with learning disabilities so profound that required by federal law to have an Individual Education Plan, so, per one article that’s 15% of kids in schools (school being between the ages of 5 and 18 for most kids). Most of these IEPs are not for gifted kids, rather they’re for people who can demonstrate disabilities.
Parents, especially low-income urban parents, love having their children on IEPs. Why? Having an IEP does quite a few things:
Yeah, you can see just this one program from just one federal law (the 1975 Individuals with Disabilities Education Act, with the horrible acronym IDEA) has spawned trillions of dollars in direct spending, but has also destroyed the educational experiences for those left in the normie-tier classrooms.
This one misguided GloboLeftist program, IDEA, has probably cost the United States between $1.5 trillion (low end) to $3.3 trillion (median) over the last 20 years. The result?
All true
Wondered what these IEP’s were about..damn!
This has nothing to do with why insurance and healthcare companies have literally taken over cities with the grotesque profits they make
There are lots of problems with mainstreaming some kids but that’s usually state or local policy. IDEA just says you have to make sure kids with disabilities get an education.
Most IEPs are just for things like dyslexia so the kid gets pulled a couple times a week for intervention. Works ok.
Not relevant to healthcare, though, really.
When I look at your chart, I see a 100% chance that the current US government will not exist by the year 2092. Let that sink in. 100%.
The End of the US is now due. // Read the Fate of Empires (Sir John Glubb, 1976) online PDF. It’s but 24 (26 total) easy read pages. On page 15 into 16 read XXIV The Arab decline, especially regarding “the [negative] influence of women” (pars. 4-7). On page 24 read the Summary to cut to the quick, and especially note “An influx of foreigners.” The End of the US will be Very Ugly. Prepare as inclined. ☮️✝️
Read it a decade ago. Good short read.
The solution to out-of-control medical costs is more competition, not less. Competition will provide incentives to innovate treatments, delivery systems, etc. Currently, insurers are setting standard charges with allied hospitals–which do nothing to reduce cost, and actually incentivize ways to increase charges in other ways–passing the excess on to the patient is, of course, increasing.
Always MORE COMPETITION. Not less. Not government managed, with overpaid slugs/roaches working from home, with 42 days of paid vacation…. etc
What will competition do with the costs that illegals entail who pay nothing for care as citizens get billed to bankruptcy?
Illegals are a big problem, since they are leeches. It would require modification of the Good Samaritan law that enabled it in the first place. Setting a $ limit on Good Samaritan cases would be a good start.
At some point, the US has to realize it cannot provide free healthcare to the world.
One solution would be to require every person entering the US to have real health insurance, paid in advance by themselves, or a sponsor.
Meanwhile, the biggest problem is health insurance is NOT risk-based insurance, but a debauched welfare benefit with NO control mechanisms–thank you, OBAMA!
Well said
Much of medicine (if not most) is not conducive to shopping around. There are the exceptions like knee replacement – which could be shopped for, but emergency care, ambulance rides, whether or not an emergency MRI is needed, which nephrology treatments are best… Most people don’t have the ability or time to make those judgments. Remember that the average IQ in the USA is 98. “Think about how stupid the average person is, and realize half of them are stupider than that.” – Carlin
More competition would be a good thing and even possible in the cities. But how many hospitals do you think a city of 20,000 can support?
The same applies to grocery stores or gas stations or any other good or service.
that would depend on 2 factors, the health or lack thereof in the citzenry, and their economic wealth or ability to incur debilitating debt.
Healthy people need little if any healthcare. poor people can afford little if any healthcare.
like ethics, healthcare can be divided into 2 classes or society.
The rich and poor often have little to no ethics, due to their economic station. The rich can afford it, they have lawyers and bribes, The poor cannot afford the niceties of ethics, they must survive,
So too, the rich have unlimited medical resources, and the extremely poor will have as much as the emergency care system can dole out.
Those poor bastards in the middle are the meat in the sandwhich, squeezed by those with bread and those without bread, into a slender slice of baloney ethically beleiving in a system that exists merely to slice them into bits and consume them.
Countries with public health services like Great Britain or Spain have the same problems. A product with zero cost has infinite demand, that’s elementary economics.
Services are overpriced because there is no competition. Let chinese universities give academic degrees online and the tuition fees will go down. The same if EEUU would allow italian lawyers, spanish architects or polish accountants to work without barriers online.
But we are going in the opposite direction, tariffs everywhere.
Go Fund me?
Eliminate Medicare, Medicaid and Social Security. That eliminates the yearly deficit and the 200 trillion in unfunded liabilities, and pays off the debt in short order.
Here Here
Merry Christmas to you, too, Scrooge.
It’s time for sacrifice
Ah! A volunteer to be first under the bus! Thank you for your service.
Merry Christmas to you as well.
Under current law there are no unfunded liabilities, meaning once the trust funds get to zero, benefits get cut to match the cash inflow. The unfunded liabilities spoken of assume benefits are maintained and the money is just borrowed. But that would require a change to current law.
No worries. Just forget what I said about eliminating the 200 trillion in unfunded liabilities, since by ”law”, they don’t really exist.
Just eliminate Social Security, Medicare and Medicaid.
Then run a fiscal surplus and pay down the debt. Then use the surplus to create a sovereign wealth fund.
And we won’t even have to talk about those non-existent unfunded liabilities.
Which you should know will not be allowed to happen. Taxes will be increased as necessary, age to qualify for benefits will be increased, despite the kicking and screaming.
Meet FRED, a 33-year-old data tool from St. Louis, Mo., and the economics world’s most unlikely celebrity.Everybody Loves FRED: How America Fell for a Data Tool – The New York Times (archive.ph)
you mean how America fell for a propaganda campaign. who beleives anything in the New York Times, etc?
The only solution is to cut the corporate tax rate to zero. End taxes on social security and tips. And we definitely need a concept of a plan to replace Obamacare. Problem solved.
This is what you get with a corrupt for-profit healthcare system which screws patients with the most expensive costs in the world, while industry bribed representatives in congress never vote to negotiate serious discounts for Medicare.
Instead, the proposed solution will involve taking coverage away from the People who have been taxed all their lives.
Maybe the real question is why health costs are increasing, before you blame the ‘for-profit’ healthcare system? After all, most of the food-supply system is for-profit. Ditto for clothing. Transportation… etc
We have almost no transparency about actual cost in healthcare. An uninsured person gets billed $100k for a hospital stay after a car accident. The same services to an insured person get billed for $20k – of which most patients will pay $6-8k (their deductible) and the insurance company pays the rest. The price should be the price, no matter how it gets paid. Then maybe we could move on to figuring out how to cut the cost.
This practice should be recognized for what it is. Extortion and racketeering. The insurance is just protection money paid to a mob.
at least the mob usually has good restaurants in the neighborhood….
This is exactly what I was thinking , No where in the article does it discuss or postulate why. We are about double the industrialized world in per capita health care costs and the absolute worst in health care outcomes. BTW these other countries have single payer systems for the most part. With all the horrible criticism about single payer why do we rank dead last in everything? There should be a national debate on this and voted on.
Some suggestions to reduce costs.
4. Finance the single payer with a national sales tax and payroll for those working. The total individual costs per capita for health insurance I bet would be far less then the individual outlays now.
A well planned and researched single payer system should work much better than the FUBB corrupt system we have now.
Since our country is one of the few where health care is provided as for-profit for the most part, the question answers itself. Every other country that matters on the planet has single-payer (government) health care. Yes, it has problems — the rich may have to wait awhile for a skinned knee. But taking the profit out of the delivery, and removing the mountains of paperwork, and dumping clerks telling doctors what is authorized, would cut costs substantially.
As long as you are ok with death panels
Death panels went out with Hillary. Anything THIS century you’d like to use? 🙂
Nothing is unlimited.
actually, nothing IS the only thing that is unlimited in the entire universe, and they are making more every day, according to the generally accepted theory of the big bang and the expanding universe.
What don’t you understand? Should people be entitled to unlimited healthcare? Granny is 95 and needs a new heart. The cost is $400K. Yes or no? That baby with the birth defect heart will have a lifetime healthcare cost of $15 million, assuming they live to 21.
By that logic, no can of food should be set less than $10 because peas at 79 cents a can means people would buy up every can of peas and eat them all tonight. Maybe you like hanging around the hospital and in the waiting rooms but I dont. People self-regulate.
like peas, they have a shelf life.
Umm, where have YOU been?!?!
Insurance companies ARE LITERALLY DEATH PANELS
naw, insurance companies are money pumps, from the insured to the shareholders with a tidy sum extracted by C-suite, along the way.
The death panel thing is an unfortunate side effect of the lack of assets by the insured. The insurance company would be happy to keep pumping money out of the insured, but alas their money has expired and hence their life as well.
we have death panels, they are called your wallet, when its empty you are dead. like a video game, but you can’t reboot…
All that ‘paperwork’ is largely a result of Obamacare. Ask your doctor.
Obama also has been gone since 2016. A lifetime ago. Things that need changing get changed pretty fast these days.
Obama was a POS the healthcare system is fucked way worse because of him. I hate him my private health insurance was good and paid for everything basically and then more than doubled with no coverage when that worseless piece of shits law went into effect.
Of course. Life was ALWAYS better 10, 20, 50, 100 years ago. Truth is those memories are selective and commonly called nostalgia.
Nostalgia’s not what it used to be.
Correct.
There’s a LOT of profit being made by providers and admins in “free” health care systems, and a LOT of costs by borne by healthy, productive people to pay for an inefficient system abused by the unhealthy grifter types.
Just add the costs to the increased deficit similar to all other expenses.
Cut it all.
… and give it to meeeee!
Defaults on leveraged loans soar to highest in 4 yearsBorrowers turn to distressed exchanges in the face of punitive interest rates https://archive.is/WjBbA#selection-1749.0-1753.77