Woman waits over 12 Months for Colonoscopy in Australia

Posted by PITHOCRATES - September 2nd, 2012

Week in Review

Health care in Australia is a hybrid of public and private service providers.  It is mostly a public universal health care system with a private system layered on top for those who wish to pay for it.  The federal government subsidizes private insurance to encourage some to use it and leave the federal system.  For Australia, like most developed nations, has an aging population.  Thus a growing rate of people leaving the workforce and becoming high consumers of health care services while there are fewer people entering the workforce to pay for this large rise in health care consumption results in a doctor and nurse shortage.  Which leads to, of course, longer waiting times (see Still on hospital waiting list by Richard Bruinsma posted 9/3/2012 on the Sunshine Coast Daily).

A MAROOCHYDORE woman who requires a simple exploratory colonoscopy every five years has “celebrated” 12 months on the Nambour General Hospital waiting list.

The woman, who did not want to be named, has a family history of bowel cancer and requires the regular check-ups as a precaution…

“Five years ago, I got in within three months, so I couldn’t believe a whole year has passed since I’ve been referred by my doctor…”

“If I’m waiting for 12 months for a simple colonoscopy, then what’s the rest of the health system like?”

A Nambour hospital spokesman was restricted from speaking specifically about the woman’s case but said the opening of new procedural suites at the hospital in April meant patient through-put had increased…

“All referrals to the service are reviewed and categorised according to clinical urgency and need by a medical officer. Those deemed more urgent are given priority.

“The Sunshine Coast Hospital and Health Service is working hard to assess and treat all patients on the waiting list.”

Most Australians are satisfied with their health care.  It’s one of the better universal health care systems.  Thanks to the hybrid structure of it.  And a relatively small population.  Though as baby boomers are retiring and leaving the workforce it is making an impact on their health care services.  As time goes on the Australians may love their health care system.  But they may complain about it more.  Such as in the UK.  And Canada.  Even in the United States.  Which before Obamacare they didn’t complain about the same kind of things.  The rationing of services.  And longer waiting times.  But that will come.  Because it’s happened in the UK, Canada and Australia.  And they’ve been practicing universal care for a long time.

Australia’s population is less than 10% of the United States’ population.  And it’s about a third of the UK’s.  So they don’t need a very large health care system by comparison.  But as Obamacare takes off the bureaucracy running it will be enormous.  As will the costs.  The bill itself had over 2,000 pages of new rules, regulations, fees and fines.  A lot of which were fill-in-the-blanks.  Things left noted ‘as to be determined’ by some government bureaucrat.  Meaning they will be making a lot of it up as they go.

So while the UK, Canada and Australia have universal systems with some problems with rationing and waiting times the Americans will see under Obamacare an explosion in rationing and waiting times simply because they will have so many more patients in their system than the British, the Canadians or the Australians.  Resulting in their own doctor and nurse shortage.  And if they are having problems after doing universal health care for such a long time you know some newcomer to the game will have even more problems.  Especially considering the US will have about five times the number of patients the British have.  And about thirteen and a half times the number of patients the Australians have.

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Medicare Cost Savings are Cost Transfers to Private Sector Businesses

Posted by PITHOCRATES - June 12th, 2011

Private Health Insurance Costs rising Faster than Medicare Costs

Looking at graphs makes problems easy to see.  They can make you jump to the wrong conclusions, but you can see the problems more clearly.  And the good news is that Medicare doesn’t have any problems.  At least cost-wise.  It’s the free market that does.  Because it operates without the keen and wise oversight of government.  As a result they can charge whatever they want for their insurance.  Well, the government doesn’t allow this in Medicare.  Therefore, the government way is the better way.  Just look at the graphs (see It’s the Health Care Costs, Stupid by Paul Krugman posted 6/12/2011 on The New York Times).

The larger point is that we don’t have a Medicare problem, we have a health care cost problem. And Medicare actually does a better job of controlling costs than private insurers — not remotely good enough, but better…

If Medicare costs had risen as fast as private insurance premiums, it would cost around 40 percent more than it does. If private insurers had done as well as Medicare at controlling costs, insurance would be a lot cheaper.

But graphs can be misleading.  Looking at them does support everything he says.  However, the graphs don’t explain why.  And if you want to know the ‘why’ talk to a doctor.  Ask about his or her Medicare billings.  You won’t hear a happy story.  The government keeps cutting the amount they will pay.  Because they can.  And every year further ‘automatic’ cuts have to be postponed by Congressional action.  Which usually happens.  Because these future cuts are so steep that, if enacted, will make a lot of doctors stop seeing Medicare patients.

But if the government isn’t paying doctors fairly, how can they stay in business?  Isn’t the fact that they are staying in business prove that the government-determined prices are fair?  No.  Costs are costs.  Those unpaid by the government still have to be paid.  And guess by who?  That’s right.  Private insurance.  That’s one reason why private insurance costs are so high.  They’re picking up the unpaid Medicare costs.  And unpaid Medicaid costs.  And a large part of costs incurred by people using the emergency room in lieu of buying health insurance.  Through inflated billings to private insurance companies.  Because costs are costs.  And someone has to pay them.

Of course, it’s the people who pay for private insurance who end up paying.  And because health insurance is an employee benefit, the employers ultimately pay.  Businesses.  And the more unpaid Medicare costs are passed on to businesses, the higher their health insurance premiums get.  Forcing them to make cuts elsewhere.  Make the employee share in part of the costs.  Or they simply quit providing health insurance.  So these remarkable cost savings the government achieves are nothing more than an additional Medicare tax.  That private sector businesses pay.

And when businesses have to pay more for unpaid Medicare benefits, they have less to pay their employees.  Or simply can’t afford to hire more people.  Which means a net reduction in consumer spending.  Either through lower wages.  Or less job creation.  So the more the government ‘saves’ on Medicare, the less economic activity there will be.  And possibly the less Medicare there will be (if further cuts make doctors drop out of the system).

So, yes, the graphs are accurate.  But they don’t tell the whole story.  They show a smaller rise in Medicare costs than private insurance costs.  But it’s just smoke and mirrors.  Misdirection.  A magician’s trick to make us look one way.  So we don’t see what’s really happening elsewhere.

Health Care Costs are Rising in the Military, Too

About 60% of government spending covers Social Security, Medicare/Medicaid and defense.  Each at approximately 20%.  We continue to spend more and more on Social Security and Medicare/Medicaid.  And yet these programs are projected to go bankrupt.  Defense spending has gone up, too.  But it is the only one of the three programs that ever sees any real cuts.

The U.S. population is a little over 300,000,000.  And about 40% of the federal budget covers the elderly (approximately) of that 300 billion.  About 13% of the U.S. population.  Or about 39 million people.  It’s this 39 million that is bankrupting America with their Social Security and Medicare benefits.  Those who passed Obamacare want universal single-payer health care for all 300,000,000 people.  You don’t need a higher degree in math to see that adding some 260 million more to the 39 million is going to make a bad financial situation worse.

Meanwhile the U.S. military has approximately a million and a half people on active duty and another million and a half in the reserves.  In addition to this 3 million there are about another 2 million in retirement (850,000 who are collecting a pension).  So that’s about 5 million (approximately) in our military health care and retirement programs.  These numbers are very approximate.  But the order of magnitude is accurate.  And telling.  Because even though 5 million people are a whole lot fewer than 39 million people, the health care and retirement costs in the military are unsustainable (see Panetta: Military healthcare costs are on my radar by John T. Bennett posted 6/12/2011 on The Hill).

The Obama administration is proposing increasing TRICARE fees for retirees of working age, which have remained the same for a decade. Specifically, the proposal would raise premiums for family plans by $5 per month, and by $2.50 for individuals…

“Even with the estimated savings from the healthcare efficiencies proposed in the … 2012 budget, the cost of the Military Health System continues to increase as a percentage of the DOD budget and will exceed 10 percent of the budget in just a few years,” Panetta told the committee…

“Part of this is understanding where the money is,” Mullen said. “Two of the big places the money is is [sic] in healthcare, and it’s in pay and benefits.”

First you increase the beneficiaries’ cost.  And when that no longer works you start the rationing.  The ultimate result of any single-payer system.  Just like in the UK.  Where one of the goals of their ongoing NHS reform debates is cutting wait times.  Because with the high costs of their single-payer system, people have to wait a long time for some medical tests or procedures.  Because their costs prevent them having a lot of these tests or procedures available to the UK citizenry.

Destroying the Private Health Insurance Market

Social Security and Medicare Light (military health care and retirement) isn’t working with only some 5 million people in the system.  Regular Social Security and Medicare isn’t working with only some 39 million people in the system.  And expanding Medicare-like health care to another 260 million people probably isn’t going to help.  Unless your goal is to destroy the private health insurance market.  Which will happen.  Because private insurance (i.e., businesses) simply cannot afford to pick up the unpaid medical costs of another 260 million people.

And once you’ve destroyed the private health insurance market, all those unpaid Medicare costs (and the new unpaid Obamacare costs) will have to be transferred somewhere else.  To the taxpayer.  Both businesses.  And consumers.  Which will further reduce consumer spending.  Which will reduce economic activity.  Despite all the promises of a single-payer system.  Because costs are costs.  And someone has to pay them.

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Obamacare and the United States Postal Service to have a lot in Common

Posted by PITHOCRATES - May 29th, 2011

Obama Slams the United States Postal Service (USPS)

Back during the Obamacare debates, way back in 2009, the public option was still on the table.  President Obama tried to soothe people’s worry about the public option putting private insurance out of business.  He said it was ridiculous to worry about such a thing.  Because federal monopolies can’t do anything well.  And that private business will always provide a more superior service than a government provided service.  Strange way to advance his case for more government involvement in health care.  But he said it.  And gave an example of a poorly run government monopoly providing no threat whatsoever to its private counterparts.  The United States Postal Service (see The President and the Postal Service by Ed O’Keefe posted 8/11/2009 on The Washington Post).

“I mean, if you think about it, UPS and FedEx are doing just fine, right? No, they are. It’s the post office that’s always having problems.”

President Obama is right.  FedEx and UPS are doing just fine.  And, just as he said, it is the USPS that is having the problems.  As always.  To quote Obama.

FedEx is Profitable

FedEx’s shipping volume in their fiscal third quarter set a record.  And their revenue and margins are looking pretty good, too (see FedEx offers strong outlook for this quarter and beyond by Lynn Adler, Reuters, posted 3/17/2011 on msnbc).

FedEx Express volumes were at an all-time fiscal third-quarter high, and “Ground is knocking the cover off of the ball with both volume and yield gains,” [John Koczara, portfolio manager at AMBS Investment Counsel] said.

“We expect continued positive yield trends to improve revenues and margins in the fourth quarter and in fiscal 2012,” said Alan Graf, [FedEx] chief financial officer.

One thing for sure, it doesn’t look like the public option, the USPS, is giving FedEx any problems.  Confirming what Obama said.  FedEx is doing just fine.  Score one for the private company.

UPS is Profitable

Now, FedEx is good, but there is someone even better.  And it isn’t the USPS (see UPS Profit Tops Estimates, Sees Record in 2011 by Reuters posted 2/1/2011 on CNBC).

United Parcel Service, the world’s largest package delivery company, reported a quarterly profit that beat estimates and forecast record-high profits in 2011, sending its shares up 4 percent.

Doesn’t look like the public option, the USPS, is causing any heartburn for UPS.  Unless they consume too much champagne and caviar courtesy of their record profits.  Score another one for the private company.

The USPS is Sucking Air

With FedEx and UPS booming you’d think that the USPS would be booming, too.  So are they?  Are they posting record profits in the latest quarter?  Not quite (see Sun is setting on rural post offices by Kevin Murphy posted 5/28/2011 on Reuters).

The postal service is losing $23 million a day and is $15 billion in debt, its allowed limit, said Rich Watkins, spokesman for its Mid-America District. The service has cut about 100,000 positions through attrition in the past three years and consolidated sorting and other operations, he said.

The postal service is in such bad financial condition that it may not be able to make a $5.5 billion prepayment for future retiree health benefits due September 30, Postmaster General Patrick Donahoe told a Senate subcommittee last week.

Unlike the private companies, FedEx and UPS, who are doing very well, the USPS is sucking air.  That’s private company: 3; government monopoly: 0.  Which is pretty amazing considering that they have a legal monopoly enforced by the federal government.  Only they can deliver letters.  Unfortunately, they do that so inefficiently that postal customers have found alternatives.

The U.S. agency has lost business to electronic mail and to private sector competitors like FedEx and the United Parcel Service.

That’s the problem with a monopoly.  Always trying to do something the way they did it a generation ago.  Meanwhile, people have turned to email and text messaging.  And paying their bills on line.  Because it’s cheaper.  And easier.  No postage required.  No envelopes.  No trips to the post office.  No muss.  No fuss.  And you can send pictures and video in today’s digital world.  You can’t do that with first class mail.  At least, not with a lot of additional cost.

Of course, they can compete with FedEx and UPS.  Because you can’t send packages electronically.  But the one thing the USPS can do well they still can’t do as well as FedEx and UPS.  We need to fix the USPS.  It needs to be reformed.  To meet the needs of today’s generation.  And tomorrow’s.  But that’s one thing that a government monopoly just can’t do well.  Change.  Or be efficient.  Or provide a service that people demand.

The Public Option will be a lot like the USPS

President Obama was right in 2009.  The government can’t do anything well.  And when they compete against private industry they fail miserably.  In fact, these government run enterprises are so bad that only government intervention can maintain their monopoly.  For awhile.  Because when something is that bad, even government intervention can’t prevent the inevitable.

Which begs the question why did Obama use the USPS-FedEx/UPS analogy to promote the expansion of government into the private health insurance industry?  What’s his argument?  Don’t worry about the public option.  It’ll be as horrible as the USPS that it won’t harm the private insurance market.  But we will pattern the public option after the USPS.  Because only the public option will provide affordable, quality health care.

Yes, the public option will be that remarkable.  It’ll be both horrible and the best thing since sliced bread.  Depending on who the government is talking to at the time.

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