CBO's Long-Term Spending Outlook

Improvements in medical technology + deficiencies in the medical-care financing system + the aging of America with increasing life expectancy + a belief that health care ought to be distributed according to need rather than wallet thickness:

Comments

[Matt]

We built all those houses for nurses?

[JoshK]

I'm curious how a left wing person thinks about this. Given that wallet thickness shouldn't count, what about personal care and maintenance?

eg. Should the public fund a heart bypass operation for a low-income ardent cheeseburger eater?

or: Should the public fund phsyical therapy for a low-income adult injured while doing a dangerous activity (skateboarding?)

If no, then what is the threshold that should be applied for when deciding not to fund?

[Brett Dunbar]

Respectively:

Probably, based on the likely clinical outcome in the specific case, they may have to see a dietician in order to increase the chance of success.

Yes, absolutely, the treatment isn't that expensive and has a large clinical benefit.

This is based on that being what the NHS does, the NHS costs less per capita than medicare and medicaid do, so is affordable at the price you already pay for a far less extensive system.

NICE (National Institution for Clinical Excellence) will normally approve a treatment which typically costs less than £30,000 per quality adjusted life year. That is then available to any patient.

This has quite a lot to do with why the NHS is massively popular.

[Neal]

Try this on for size, Josh:

Medicare/Medicaid in 2001 took up about 3.5% of GDP. Total medical spending in 2001 took up 13.1% of GDP (or about 3 times Medicare/Medicaid spending).

So according to that, by 2082, total medical spending would be 60% of GDP. Do you think the US economy can support that, regardless of who is covered or by what means?

So it's a total healthcare problem, not just for the people who can't afford 12K per year (currently) for insurance.

The US system-the most costly, with lower outcomes, more dissatifaction, more lawsuits. Good for insurers, not so good for everyone else.

[divF]

I'm sorry, this graph is suspicious to me. The projected cost of medicare / medicaid (which is mostly medicare) is not being driven by changes in the elderly population, otherwise social security would track along with it (as is does in the past.) In particular, you don't see any effect of the baby boom dying off starting 25-30 or so years from now. So is a projection by the CBO regarding the cost of medical innovation ? If so, based on what evaluation of scientific progress ? Or is this just a WAG ?

[PrahaPartizan]

If we collectively decide to slash health care spending, what new employment prospects are supposed to exist for the US population long term? Health care positions are the only type which have shown any consistent growth over the last ten to fifteen years. Cut them out of the equation and we'd have no growth in jobs at all. Cut out the low level positions in hospitals and home nursing care and you'll have lots of very unhappy people with loads of time on their hands to realize they're getting screwed. Do the poobahs who create the CBO stud really want that to happen? They might be sorry to get what they wish for.

[Matt]

My sister-in-law is a nurse, she owns three houses. If she buys four more, she could put a patient in each house.

Perfect economy. Gen X pays her to drive to the store, buy groceries, visit each patient, feed and turn, go home.

[Denis Drew]

Which chart really means [for panicky Malthusians out there] that by 2082 -- when our great-grands should be enjoying quadruple the average income (per capita GDP, average income, etc., doubling every 40 years) -- the great-grands will be dropping 120% of today's GDP into their federal taxes: leaving "only" 280% of today's GDP to spend on everything else (flying cars for the same $25,000? -- much technological progress not even registering in growth and inflation figures).

Sounds like a tough life. Wonder what kind of medical care will eat up that much absolute income with another two generations of tech progress? Sounds like it could even be eternal life.