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according to Chris Cox and Bill Archer's report in the Wall Street Journal. While the national
debt is some $16 trillion, the total money that will have to be spent on CMS, federal pensions,
and Social Security is $86 trillion, with Medicare accounting for $43 trillion and Social
Security $20 trillion. There is not even enough tax receipts to pay the annual amount of $8
trillion needed (total personal gross income amounts to $5.1 trillion annually, business $1.6
trillion, for a total of $6.7 trillion). Furthermore, issuing bonds by the Treasury to cover the
costs will become increasingly difficult as China for two years has essentially stopped
investing in Treasury Bonds]. The situation for state and city obligations (not shown on
balance sheets) are also staggering with the total debt obligations to retiree defined benefit and
retiree healthcare obligations, based on a study jointly from Harvard and U Penn, totaling $7.3
trillion, an amount that also seems insurmountable and certainly crippling. The aim of
government healthcare is access for everybody (note this does not mean actual appropriate
treatment for everybody, particularly if payments do not cover the cost), high quality, at a low
cost. But hospitals, and also physicians will increasingly have to struggle with less
reimbursement, particularly as specialist and in hospital revenues are cut, and the difference
between government reimbursement and outlays will grow. In the case of Shongwe, the
balance in shortfall was made up by overseas donations to compliment the quality and access
for all - until the government stepped in and then the high quality doctors passionate about
their work left and quality then deteriorated, just as had happened in Sweden, where the money
had come from. According to some surveys say between 25% and 50% of the hospitals in the
USA are now are losing money. While the explosion in new hospitals in the 1970s onwards
was largely funded by increasing heart surgery particularly coronary artery bypass surgery,
with the decline in risk of coronary artery disease, cheaper treatments, and less profitable
margins, hospitals are coming under increasing financial pressure. Of the some 5,000 hospitals
in the USA, 1150 odd do cardiac surgery, but this will almost certainly consolidate. Hospitals
thus will struggle to find revenue under the current health care system, and this will become
even more difficult under the ACA. It is worth noting that hospitals employ some 5.5 million
people and indirectly support some 15 million jobs and contributes about 2 trillion dollars to
the national economy. While the system clearly has inefficiencies, cutting it will also affect the
employment rate, particularly in smaller towns and rural areas where hospitals are the biggest
employer and indeed healthcare is one of the biggest employers in the country. When in 2001
the Massachusetts General and Partners announced a $22 million profit in the Boston Globe,
many questioned this and later a clarification was issued that the loss on operations was $44
million but the balance of $66 million was made up from research grants. While research
grants, other business ventures by hospitals and innovation royalties, and philanthropy may
bridge the gap for now, this is not sustainable in the long term.
Whatever happens, hospitals will concentrate more on quality of care, value (HCAPS score,
a list of 10 questions about doctors, nurses, hospital and treatment that Medicare patients fill
out after discharge, like hotel surveys), efficiency, and bundled payments, rather than volumes
of patients for reimbursement and they will have to become more efficient with less money
available for care and restrict patients access to doctors. At the same time, with more than
three quarters of patients on federal, state or local government “insurance” plans,
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