Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts

Tuesday, April 21, 2009

Poignant Orszag-ian insight

The Relationship between Quality, and Medicare Spending by State, 2004

If a picture is worth a thousand words, then in this case I would say a good chart is worth a million. The chart compares Medicare spending per beneficiary, and quality index for each state in 2004.

The results ?

Priceless.

This chart is a wonderful demonstration of the most fundamentally important inference one can make in any scientific study.

I gained a new appreciation for Peter Orszag, Obama Administration's Treasury Secretary, when I saw this slide in a presentation he gave on education and healthcare to the Association of American Universities this morning (21 APR). The presentation does not come with audio, unfortunately, although he touched on the main points of his presentation in Orszag's blog entry on healthcare reform, posted shortly after the delivery of his speech. His points were right on target on the issue of aggregate educational achievement in the US, an issue that has long been neglected in the talk about US productivity slowdown since the 90's.

Many of you have heard me go on about how important it is to reform health care in order to bend the curve on long-term costs and get our nation on firmer fiscal footing [...] When we say that health care is consuming too much of our GDP, we are not just citing an abstract statistic [...]
One might think that health care costs were unrelated to educational trends, but that would be wrong. For years now, there has been a long-running trend toward declining State investments in public universities, as growing health care costs come to crowd out States’ investment in higher education. For example, from the late 1970s to the early part of this decade, State appropriations for higher education have declined from about $8.50 out of every $1,000 in personal income to only a little more than $7 out of every $1,000 in personal income – a decline of roughly 15 percent [...] At the same time, these pressures yield tuition hikes, program cuts, and a general strain on our public universities [...]
The fewer college grads we produce, the slower overall economic growth and the higher the salaries for those fortunate enough to go to college. And since we know that those from lower-income families are less likely to go to college and graduate [...], the overall result is that we perpetuate inequality.
Bingo

Some may see this as another excuse for the Administration to push their partisain spending agendas on education and healthcare, which may be a very valid interpretation of the situation.

Keep in mind, however, that the problem of educational achievement in the US is a problem recognized across party lines, and made especially clear in the report issued by the America’s National Academy of Engineering : Rising above the Gathering Storm. Since the report was issued in 2006, it has had a tremendous bipartisain impact on attitudes about innovation and competitive advantages in the global economy.

Although Peter may have done this out of his own initiative to push the Administration's agenda, it's also possible that he was simply responding to a letter from the AAU, asking him to address the issue.



The X-axis in this case is 2004 Medicare spending per beneficiary (span: 0 - 10,000 USD), and the Y-axis is composite measure of quality care for that same year (span : 0 - 100).
Each data point represents a different US state.

Wednesday, February 25, 2009

Social Security Reform - Now officially on the Obama Agenda

(Halelujah corus playing ... )

I'm speechless. . .

Reform of the entitlement programs, Social Security, Medicare, and Medicaid

-the "elephants in the room" that are the biggest threat to the 'AAA' rating of US Treasuries, and the future of the US economy-

is now officially on the agenda.

To preserve our long-term fiscal health, we must also address the growing costs
in Medicare and Social Security. Comprehensive health care reform is the best
way to strengthen Medicare for years to come. And we must also begin a
conversation on how to do the same for Social Security, while creating tax-free universal savings accounts for all Americans.

- Barack Obama, February 24 2009 State of the Union Address

For years no politician would dare touch the issues because the backlash from the interest groups would be political suicide.

But this Administration is different.

They are focused on fearless leadership and instilling a vision of hope for healthy change in the areas the America is the weakest. They are not afraid of facing some tough political opposition, or having to ask Americans to sacrifice for the good of future generations. This bold leadership quality is unlike any seen since the last Great Depression, and although it may hurt, it is the only way the US can emerge from this crisis stronger and better prepared for the 21st century challenges.

This is encouraging news, and should resonate throughout the media and public to ensure that the Administration follows through on pushing their agenda. This is the time for those that will most be affected by Social Security reform to speak up, and voice their concerns and hopes about entitlement reform. This issue cannot slide to a second or third priority agenda. If it is not resolved now, there may not be another chance.

Wednesday, January 21, 2009

Trying to sound the alarm - The "other" financial crisis

One of the biggest challenges faced by the US in modern times is the budget crisis created by overcommitment of funds towards entitlement programs -

Medicare, Medicade and Social Security

The challenge is a challege of conflict between generations - a case in which the current working generation is paying the costs for the previous generation. The size of the problem is mind boggling, a debt problem unilke any the US has faced in its entire history. No politician or government authority has been brave enough to propose any real solution because the public has not been willing to make any sacrifices for another age group.

Until now

One brave Economist - Isabel Sawhill - speaks up on behalf of the senior generation to say that seniors will be willing to do their part in solving the crisis.


Photo courtesy of SOS Children's Villiage
http://www.soschildrensvillages.org.uk/contact.htm

Photo courtesy of ABC News
http://a.abcnews.com/Health/ActiveAging/Story?id=3487260&page=1


From Money Magazine - November 2008 article by George Mannes "Why We Have to Cut Benefits for Seniors"

Whether or not Congress or the Federal Reseve manages to solve the financial crisis, there will be an equally scary situation that has not yet made newspaper headlines:

The big three of entitlement programs - Medicare, Social Security, and Medicade - will wreak havoc on the country's finances (and yours) unless we scale them back, says Isabel Sawhill, an economist at the Brookings Institute and member of a bipartisain think tank trying to sound the alarm.

Q: You talk about fixing the unwritten agreement between younger and older generations - the "intergenerational contract." What's broken ?

A: The existing contract assumes that the working age population is going to be able to support the older population - the retired population - out into the future and should do so. And that's not a sustainable assumption.

Q: And why not ?

A: 42 % of federal spending now goes to three programs, with the majority share to the elderly.

Two or three decades from now, those three programs will be as large as the federal government is today. Lets say someone is now paying 25% of their income in taxes. To maintain the commitments we've made to the elderly, they would have to pay 50%.

Q: What's the solution ?

A: We need those who can afford it to contribute more to their own retirement costs.

Take Social Security:
Right now the benefit formula provides a pretty good retirement income to those who make more than $100,000 a year. I don't think that the working age population should contribute to fund benefits for seniors who are so well off.

Q: And you want to spend this money instead on the younger generation ?

A: Yes

We would reap enormous enconomic benefits from spending more on early childhood education. It's like any investment that has a rate of return. If you do it when people are young, its going to help make them more productive and able to earn a reasonable living.

Q: Wouldn't the AARP crowd scream bloody murder about benefits reductions?

A: I don't think all older Americans are opposed to investing in their children and grandchildren.

Q: So how do you sell this idea of spending less on the elderly and more on the young?

A: We have to change the debate, which has been focused on the idea that there's going to be a generational warfare. I'm trying to get away from that concept by talking about the fact that

Every individual, every generation, should expect more from their government when they're young and less from the government when they're old.

That's not warfare.

That's common sense. 

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