Here is a position paper on Entitlements in general and medical entitlements in specific.

This year I turned 65 and in accordance with my former company’s policy, my health care transferred to Medicare from what was a top flight private program.  Am I happy about this?  Well, yes in a way and no in another way.

Yes:  the cost of the Medicare program to me dropped dramatically. I assume this is because of the taxes I paid during my working career and just as likely, because the taxes that other people have paid and are still paying.  My old private care – which was low co-pay and see any private specialist that I wished – cost $1000 per month.  The new coverage cost $153 per month and $ 250 per month for prescription and gap coverage. I still can see any doctor that I wish without a referral.  So the cost out of pocket has declined.  I have yet to establish the level of c o-pay but I would assume it will be about the same.  In other words, the level of care seems to be about the same but the cost has dropped.  (I do note that physicals are no longer covered, but my friends say the doctors simply see you and do blood work and don’t call it a physical.)

No: the concern here is that the government is not running the program at the break even level.  We are setting aside debts that some future tax payer will have to shoulder and this is wrong.  It does not matter whether you are a democrat and believe everyone should have the same level of health care or you are a republican and believe that health care should depend on the decisions made over a life time, such as how much money to make, how much to save, and what level of insurance one purchases.  The problem is that the current program is no fair in a generational sense. 

So I am looking at a proposal provided by Bach and Pearson:

http://content.healthaffairs.org/cgi/content/abstract/29/10/1796

Here is a short summary of the idea.

It is from far the most radical out there. The full costs of treatments would be covered for three years, which would still give companies an incentive to innovate.

After three years, absent evidence that a treatment was better, Medicare would pay no more than it paid for equally effective treatments. Only $10,000 of the bill for proton therapy, for instance, would be covered. The blank checks would not go on forever. New treatments would bring a windfall only if they improved health.

So I look at the levels of care for prostate cancer, Radiation at $10,000, $42,000, or $50,000 and I notice that surgery is not noted but in general costs about the same when hospital and all associated costs are combined.  What should the government program pay?  And, how should it be implemented?  In the case of prostate cancer treatment, the cheapest treatment option would be covered by Medicare.

Pay: 

One approach to keep the government from bankrupting the U.S. treasury would be to establish specific limits for various treatments.  This appeals to me because I firmly believe we should be responsible for our own care.  If a set payment were provided and established by some system that ended up not bankrupting the Treasury, then I would support it.  However, there is a caveat.  The person electing treatment should be allowed to pay for the remainder of the cost if a higher cost treatment is selected.  This is contrary to most health care proposals in existence today.  In fact, there seems to be a rule that does not permit health care professionals from even mentioning treatments outside the limits of the individual’s health care formulation.  If this provision is not included I would not be in favor of the proposal.

Implementation:

If this was implemented, the first thing wealthy persons would do is form an insurance company to cover the higher cost treatments over and above the Medicare set limits.  Then people with means would in effect be buying a supplemental plan that covered the things not covered by Medicare.  This sounds a lot like private insurance for the elderly.  It appeals to me, because the person without means is covered at a level that will not break the bank (presumably) and a person with additional means could buy a supplemental policy to cover higher costs – presumably because of specialist care in specialist locations.  In other words, the wealthy would have a better level of care.  It certainly is a break from the original Medicare concept but it is time that an approach such as this be implemented.

First we recognize that the problems we are really concerned with are economic and political.  (I know that there are terrorist issues here but I am dismissing that as something we will have regardless of how we solve the immigration situation.)

a)               There are millions of immigrants in the country today working and using social services.  They need to be set on a path towards assimilation but we cannot allow them to become “instant” citizens because they will presumably vote for democrats in disproportionate numbers. Solution:  give them a serious eighth grade graduation test (about what passes for a High School GED) and if/when they pass give them a green card that leads to citizenship after a waiting period. At the end of the waiting period they still must pass a citizenship test, but this should be greatly facilitated by the work taken to pass the green card test. During the waiting period they do not get the vote. If they break this law, they get deported and have no chance to use the test system again. I would suggest that the waiting period be about 6 years to reach past all current politicians’ terms. If you fail the test three times you must go back to the mother country and study to take the test at the entry point. This solves the economic issue because these people have a reason to work and study and assimilate and if there are jobs for them, then they will earn money and pay taxes.  This solves the political issue because they must wait and learn how our parties work and support them before they can vote.  My guess is that they will learn that democrats do not provide womb to tomb solutions for their lives, in fact, in the struggle to find work and stay employed they will learn that much of what they get is due to their own effort.  It also solves the moral issue because staying or leaving becomes a matter of passing a test that the vast majority of the people in this country take and pass to graduate from High School.  Did I mention that the test is only available in English?

b)               There are millions of would be immigrants waiting to enter the country legally and the waiting periods are impossible.  Thus, they find it easier to apply for a vacation visa or find a coyote and get into the country any way that they can.  Once here they frequently have a child to ensure their US anchor.  This is not a system that reasonable people should accept.  However, letting more people in is opposed by the unions and persons concerned that our welfare services (and schools and hospitals) would be overrun.  Solution:  First consider that the welfare services and schools and hospitals are bankrupt now and falling farther into debt and the public recognizes that this risks the future for all of us, so letting more people in will not end up hurting these institutions — they will fail anyway.  We must find other ways to survive this debt crisis or we must end the public entitlement systems and let people become responsible for their own welfare (unemployment), school (public), and medical care (Medicare).  People need to realize that these entitlement schemes will fail us anyway, immigration solutions such as this will hasten the day when these systems collapse, making it more imperative to find fixes for them that will really work.  (Of course every new entitlement we pass also hastens the day when the system comes crashing down.  Interestingly, more people coming into this country may actually help with the social security crisis.  So for these people waiting at the border to enter legally, I say test them too – same test.  Pass it and you get a green card with the same restrictions on voting and no need to associate with criminals to enter the country, and no problem leaving the country if you cannot find work.  This is good, because eventually finding work that matches the eighth grade skill set will become a problem.  When the demand for labor and the supply match, the unlucky ones will have to go back to their home country and keep applying for a job.  But the open door policy will stay open and once a prospective immigrant passes the test and has his/her green card, they are free to enter the country to work and return to their home country as they see fit.  When they are here working they will pay taxes and use services as any green card person is entitled to. 

c)               What will happen if we do this?  (1) People will immediately take their education more seriously both here and across the border.  Our citizens will see that they have more competition and will respond properly by keeping their education  current.  (2) Border control will become simple; the only people who will run the border will be drug smugglers and terrorists.  The border patrol will not be so overwhelmed and will be able to use stronger methods of force because these people will not be the poor downtrodden field hand–that person will be back in the home country studying like he/she never did before. We will tell anyone who is caught trying to enter the country without passing the test that they will be deported and lose their privilege to take the test.    There is no limit to the number of times a person can take the test except that they must wait two months between testing to give others a chance. (3) Countries like Mexico will immediately move to create more opportunities in their country because they will see that the US is going to freely take every individual who can show a High School Diploma level of education.  I fully expect Calderon to oppose this plan as he will see that his country will be left with people who can’t pass the test to get here. (4) All the high tech individuals who have been denied green cards will have them and they will enter this country and find work until supply meets demand.  Our high tech companies can expand when the timing is right because there will be workers ready to move in immediately and  (5) All of this will put the immigration issue squarely in the hands of a merit based solution which should please conservatives and libertarians. 

d)               What do you think?

Today I speak from a city in a “spare the air” environmental fraud alert.  Never mind what city, it could be anywhere.  We are experiencing a beautiful week-end day with temperatures soaring into the mid 70’s.  The normal off shore fog has been dissipated by a high pressure area and temperatures will rise for the next two days.  It is an ideal day to fire up the outdoor cooker kick back, and relax and if the urge for a little cooked meat strikes, grill a little for the wife and me..  Maybe even sip an adult beverage or two. 

I notice the radio calling for extreme measures, stay indoors if you have respiratory illness, don’t burn or cook outdoors, don’t mow the lawn, don’t turn on a washer or dryer or use air conditioning and don’t use vehicles unnecessarily; all in the name of what?  The air has been absorbing carbon molecules for as long as there has been oxidation.  Someone today knows something that we did not know twenty years ago?  They ought to tell the wild fire in Santa Barbara and the car fire out on the freeway about the “spare the air” day.  I do not believe man has the power to ruin the air by his cooking fires.  Even his vehicle use is unlikely to have an effect although I do not see why rail transport is not electrical.   If you want to attack some source of carbon entry into the atmosphere why not go after the really big one — power generation.  What  if the spare the air day said in effect that the air is likely to be hot today so we are turning off all our natural gas and coal fired power plants and relying entirely on the newly build nuclear plants for our power today.  We will turn the nuclear plants up on high for the next few days and turn them back down when the air alert is over.

If the announcement read like the above, even I would have to accept that the “believers” were at least being consistent.  Even the current idea of running power generation from reservoirs when we should be conserving water is crazy.  How can this logic not be seen by anyone who can read?  Folks, the man-made global warming scam will eventually be seen for what it is.  (A giant tax and spend scheme favoring the current players – green companies, green researchers, General Electric, and democrat voters.)  We are nowhere near able to model the ocean and sky and our measurements show only the normal fluctuations of warming and cooling that could be attributed to the solar energy fluctuations.  I agree with scientists keeping watch, but they should not be profiting from their support for what is clearly an anti-growth, anti-freedom, and anti-logic message.