|based on the Medicare program.
Oh yes, the infamous Medicare program. The approach of Medicare to reduce costs? Simply pay less for reimbursments. Private insurance companies negotiate with practices to determine reimbursment rates, but not Medicare. Physician practices and, to a lesser degree hospitals, are beginning to not take patients that have Medicare as their insurance. A couple of examples of the Medicare approach:
1) A friend of ours is one of the chief Gastroenterologists at Duke. They have a procedure that is fairly frequently performed which required $48 in disposable materials each time. It costs the hospital roughly $8 to prepare and send a bill. It takes 30 minutes to an hour of a physician and a nurse, plus prep and clean up time, to perform the procedure. The Medicare reimbursement? $16!! It would be more cost effective to just not send the bill, but according to Medicare that would constitute fraud, so they not only lose money on the procedure the lose more money sending the bill.
2) When my wife does a follow up visit on a Medicare patient in the hospital the reimbursement is $3. The visit can take anywhere from 15 minutes to an hour. It costs her practice more to send the bill than the total reimbursement, but again the Medicare belief that if you don't bill it constitutes fraud.
As far as administration: Medicare reimbursements are notoriously slow in being processed. To start with it takes up to 125 people to handle a single claim, compared to the normal of 3 with private insurance companies. This creates a huge and very expensive overhead. The months it often takes for payments to be made seriously effect the cash flow of providers. How well do you think the nurses, office staff, telephone company, suppliers, mortgage company, etc. will take it if you tell them "We can't pay you for 6 months until Medicare pays for the services we've already provided." The actual cost of the Medicare programs when compared to similar private insurance is several times what is should be for the services currently provided. Every working person pays 1.45% of their gross income plus a employer matching 1.45%, or $1,450.00 annually ($120.00 per month) for family with a median income of $50,000. No, the Medicare model is an extremely poor one.
The VA Hospital system, also government run, is another example of poor administration. We have a friend that's the chief of Dentistry at the local VA. The administration's approach to cost containment is simply cut support staff, limit raises, hire less experience (or less trained) for job openings, and generally require they see more patients with less personnel. This creates a predictable high burnout rate with the expected high turnover, which in turn requires more time which has to be allotted for training of new staff. Another friend is a Cardiologist at a VA Hospital in New York. In addition to staff reductions that hospital has several times used the accounting stunt of "reducing receivables" to cut costs. This is accomplished by reducing inventory of supplies, from 60 days supply to 45, to 30, to 14, etc. While this creates an initial cash flow advantage, there is no real savings and the risk of supply shortages increases with each cut. The last we heard there were continuing problems with materials being out of stock because of this change.
|While I'm not sure why you've tossed in this information
It was just an interesting tidbit. The Olsen twins are among the richest in the entertainment industry. I found that rather amazing.
|And yes, I do believe that the people who hold the vast majority of wealth in the US should pay most of its taxes
They already do, by a substantial margin. Not only do they pay more because of higher income, they pay substantially
more because of the brackets. Why not provide only one type of car, but charge everyone a different amount based on their income? How about food, clothing, etc. As it is 5% of the population pays over 90% of the taxes, a rather ridiculous inequity from my point of view. This gets to the concept of using the government to redistribute wealth, commonly known as socialism. It's the "I want, but someone else should pay" mentality.
From an economic standpoint the increased taxes on the "wealthy" have an inevitable self defeating effect. Economic growth including jobs, industry, manufacturing, etc. are not produced by magic or by government taxation. All this is produced by people that employ other people. In Connecticut the manufacture of luxury yachts is a major industry. A few years back a rather substantial "luxury tax" was added to the purchase of each boat. Sales fell off dramatically (duh!), resulting in lowered production, layoffs, and an inevitable significant loss of tax revenues. When the tax was repealed the sales quickly recovered, resulting in greater production (jobs!) and the corresponding tax revenues from income tax, plus the associated stimulation of the rest of the economy as more people had more money. As with previous tax cuts, the most recent cuts have already produced corresponding economic stimulation. Contrary to the ongoing claims of a continued downturn, the third quarter statistics indicated an improvement in direct proportion to the tax cuts. Preliminary indications from the current quarter indicate the expected domino effect of economic improvement.
It never amazes me how people can be so generous with someone else's money. Oh, Heavens to Betsy, how about that people that want a program being willing to fund it themselves. It's remarkable how so many people can quickly decide that a program is much less important when it's their own pocket that funds it.
|Mind you I'm Canadian so it's not up to me, but if I were aloud I'd take a little drive down to the states just to vote for anyone but him during elections.
So why don't those of us in the US run up and decide who should lead Canada and tell the Canadians how to run their country? Or how about us running Mexico, or Germany or France? Seems fair to me.