For some reason, this all strikes me as perverse.

I focus on the demand side because that is where the problem largely lays. It is the subsidizing of demand via Medicare, Medicaid, etc. that is driving things here.

For example, I'm not at all convinced on the administrative cost argument. The government is probably the worst offender when it comes to bureaucratic excess and red tape...after all they are the primary producers of said red tape and bureaucratic excess. The thing is that private industry and the public sector measure administrative costs differently. So the comparisons are at best dubious. Basically, the argument is that government will produce less administrative waste even though they don't have a profit motive, and private industry does.

From your post on emergency rooms,

I think it’s pretty difficult to draw too many conclusions by comparing health care systems between different countries....

But you seem okay with drawing conclusions about two different methods of allocting resources that use quite different objective functions (profits vs. I don't know what for government run bureaucracies).

Part of the problem with things like emergency rooms could be the result of subsidizing health care and at the same time laws that make it mandantory to treat patients irrespective of ability to pay. That is ultimately a demand side problem and focusing on the supply side is treating the sypmptom and ignoring the cause. The supply side solution might work for a period of time, but the underlying problem is still there.

That covers a lot of territory including means testing, limitations on what's covered, and major reform in the entire health care system.

I don't happen to think that the results of Steve's oft-repeated plea for a demand-side only reforms will have the results that Steve thinks they will. I think that both the demand and the supply sides of the equation need to be addressed.

Healthcare generally is one of the thorniest issues we have to address and the numbers indicate pretty clearly that if we do nothing (which seems all too likely) there will be very serious consequences and IMO that means we'll be saddled with an even lousier system as an emergency measure.

I think we're in for a bumpy ride. This morning there was an article in Salon arguing for a fully-socialized system.

Talk about staying the course right over a cliff.

Daydreams for academics. Medicare is a wildly popular program. What pol wants AARP death squads at his door? The Sunnis got nothin’ on them, trust me.

Then unless a miracle happens like lots of baby boomers suddenly drop dead, amazing advances in science, or something else un-foreseen the budget picture is going to get very grim and it will start to have serious impacts on the economy as well.

Daydreams for academics. Medicare is a wildly popular program. What pol wants AARP death squads at his door? The Sunnis got nothin' on them, trust me.

Negotiations work pretty well with defense contracts. The government gets increasingly sophisticated innovative hardware and the defense contractors make a pretty decent profit. Only an idiot would think that negotiations cannot work equally as well for prescription drug contracts.

Yes, that $500 hammer was a heck of a negotiated price!

As for this,

Employers did that long ago. There is no need to duplicate coverage which only drives up the overall cost of medical care without providing a dimes worth more value.

Cost will indeed go up as more people reach the age of eligibility. So what? Your alternative is what? Encourage early death instead?

So you acknowledge that this will drive up the costs. Costs that the GAO says we cannot pay as they are currently scheduled. So you alternative is to expand the program. What a sure fire way to get that early death you seem so worried about. Brilliant ken, simply brilliant.

Anderson,

Yep, TANSTAAFL.

If we accept that we have to have this plan, then allowing for some integration to include surgery, drug therapy, and other approaches to dealing with problems might also help contain costs. If the Democrats suggested something like that, it would be better, not great, but at least better, and a far cry better than the Republican's best efforts to date.

Honestly, now — medical care without meds is a fake. Unless we’re just going to abolish Medicare (which we’re NOT, Steve … I see that look on your face!), then we’ve got to come up with something for prescription meds.

Heh. Well, why not, there is Larry Kotlikoff's plan. Despite ken's assertions, I'm not some ogre that wants the old to simply crawl into a corner and die. If we are going to take this issue seriously, I think we should consider junking the current program and look for alternatives that will still keep the elderly from suffering. Right?

For one thing, the prescription drug plan will likely induce employers to cut back and even eliminate drug coverage benefits to retirees. This will have the effect of raising costs for Medicare. Also, these programs just seem to have a way of becoming much, much more expensive than they are initially deemed to cost.

Employers did that long ago. There is no need to duplicate coverage which only drives up the overall cost of medical care without providing a dimes worth more value.

Cost will indeed go up as more people reach the age of eligibility. So what? Your alternative is what? Encourage early death instead?

Further, the government doesn’t “negotiate” it dictates things by fiat.

Negotiations work pretty well with defense contracts. The government gets increasingly sophisticated innovative hardware and the defense contractors make a pretty decent profit. Only an idiot would think that negotiations cannot work equally as well for prescription drug contracts.

Honestly, now -- medical care without meds is a fake. Unless we're just going to abolish Medicare (which we're NOT, Steve ... I see that look on your face!), then we've got to come up with something for prescription meds.

Let's hope the parties work together to come up with something that makes a tiny bit of sense.