Saturday, 28 May 2011

The Problem With Medicare

This is my moment of reality and introducing you to the woes of Medicare.

In the 1960s when Medicare was designed and conceived....the age of expected death was just around 70 years old, and your local doctor, clinic or hospital had fairly limited arsenal of things to keep you alive.  They could give you a simple x-ray....they could devise one or two treatments for cancer which had a usual 50-50 chance of survival....and they could give you some simple painkillers for various ailments.

Today, the expected point of death is around 77 years old.  Your local doctor?  Well....he's got problems because the operation is no longer view & treat.....he's a legit business now.  He likely has a junior partner and has to set aside a fair amount of salary.  He has a front-desk gal and a records gal.....who both require a minimum of $25k each, with benefits such as healthcare and leave.  He's renting a fine building, keeping it up and invested a fair sum of money into the furniture.  He has at least $1 million in medical hardware in the building.  He has malpractice insurance.  He has four bright nurses who he has to pay between $30k and $45k for each.  He has property taxes to pay if he owned the building.  He has state and federal taxes to pay for himself.

For you?  Well....there over fifty different varieties of painkiller now.  If your local doctor sends you onto a cancer specialist.....he's got various ways of attacking your cancer....and you can expect at least $15k to be burned up in ninety days's likely to even be more than $25k.

The pills that he might prescribe to a 65-year old guy who smoked and drank a fair amount in life, and has various ailments?  The guy might be getting at least twelve different drugs every quarter.  The cost involved?  It might be $250 if he utilized Wal-Mart's cheap generic drug deal.....or $1500 if he went for full value.

So these medical bills get generated for the doctors, and Congress began to figure this out about a decade ago.....and just started limit what a doctor could charge for Medicare folks.  They figured that would stop the issues.

So after a couple of years of this limit....doctors began to prioritize.  They were willing to give up play with the system.  Then they got to a point where they said....there will be this max of maybe 250 Medicare patients....maybe 300 Medicare patients.....maybe even 400 Medicare patients....but then no new ones.

Folks are calling to find their old doctor retired, and when they try to find a new doctor to accept's taking two or three calls before they find a guy.  By 2020, I'm guessing that you might have to call through five to seven doctors before you find a guy who will accept Medicare appointments.

Your political friends.....Republican or Democrat?  They mostly stand there and grin.  They accuse each other of "killing Medicare".  They shout during political election period and get elderly folks upset.  They spend money on TV's advertisements during scare you older folks.

The blunt truth?  We can edge the Medicare costs onto the worker, and bump it up a notch.  We can keep this going for another decade or two.  But at some point, some dimwit is going to ask how you continue with this scheme.  And the answer will eventually hit a wall.

We don't exactly have a plan B.  Nor could you devise a plan B that would work in this case.  When you have a patient who sees their doctor eight times a year, gets various care situations, and checks into the hospital for days or weeks at a time.....then they will consume $8k of healthcare in a year easily.  And we haven't even discussed drugs.

Our continual end result will be to slightly push up the percentage we take from workers to make Medicare work.  There's really nothing much else that the political guys can change things.  They can talk about limits on the doctors....but when folks start to find impossible to schedule Medicare appointments....then the whole game falls apart.

So we are stuck.  In fact, the only help in this case would be to have cigarettes and booze with no taxes attached for anyone over help them depart a little quicker in life.   Course, that would upset the kinder folks and suggest that we are desperate.  I'd see it a bit different....we all will waste more money in our youth to keep the old guys going....that we used to use toward paying on our mortgage.  A percent here, a percent there....but it all adds up.

So there, that's the simple truth on healthcare and Medicare.

The Woes of Bama

This week....some Bama folks woke up and came to realize that they have a big-time employee on the Bama state payroll....working for the the assistant finance director in charge of technology for the state....and he's a Texas resident.

By Texas resident, I mean that he flies into Bama on Wednesday morning....and leaves Friday night....back to Texas.  The gentleman in question....Rex McDowell....takes home $173k a year for this job.

Naturally, you'd be asking some questions here.  First, he has various projects which he does off his laptop back in Texas on Monday and Tuesday....thus keeping him fairly busy.  Second, he pays for his flights out of his own pocket....which you can figure it adds up to $1k a month.  Third, there really isn't a rule that says Bama state employees must be living in Bama.  Fourth, yes.....he is registered to vote in Texas, if you were curious.

Some Bama folks are a bit upset by this.  They usually assume all state employment positions are held by state residents.  I'm going to take an educated guess that you might find another dozen at the state level who might live in Florida, Georgia or Tennessee (sorry Mississippi).  I don't see the residence being such a big deal.  You've got various folks who own condos in Orlando or Nashville.....and leave for a week at a time anyway.

We could take this to the silly level of worrying about county employees who actually live outside of the county they are employed by.

Course, the other curious objection to this that he owns a software company, and he admitted in public that thirty percent of his life is still involved with that organization.  Now, that might be a curious thing to admit....considering that you are a major player in state purchases of technology.

The positive of all of this?  Well....thank God, he's not Canadian and flying back to Ottawa every Friday.