Very important NYT article today on Republicans’ failure to identify any specific spending cuts despite using the deficit as a political tool. Indeed, as I wrote after the first 15th district debate, none of the candidates have put forward a serious plan to deal with the deficit, since none of them even mention Medicare/Medicaid.
Credit where it’s due, Jake Towne’s plan to cut defense spending by disciplining missions is highly laudable and would definitely do the most of all three plans, but it is still inadequate for closing the long-term gap.
So before the next debate, I hope reporters and moderators will familiarize themselves with this David Leonhardt column and ask the candidates what they propose to do about Medicare cost-control instead of asking what to do about the deficit:
The huge budget deficits that the country faces in coming decades are, above all, because of Medicare. The program will have to cover growing numbers of baby boomers while health costs are likely to keep going up.It won’t be possible to pay the bill by cutting other programs. They’re not big enough. Making big cuts to everything but Medicare and Social Security — shrinking the military and other programs to their smallest share of the economy since World War II — might save $200 billion a year by 2035. But by then, annual Medicare spending is projected to grow by more than $1 trillion.
So any deficit strategy needs to focus on Medicare.
In the new issue of the journal Health Affairs, two doctors, both former Medicare officials, have laid out a plan to do so. It would give expensive new treatments three years to prove that they worked better than cheaper treatments, or their reimbursement rates would be cut to that of the cheaper treatments.
I understand that the idea will strike some people as — gasp — rationing. More modest ideas were shouted down during the debate over health reform. But I’d urge anyone who does not like the doctors’ plan to think a bit about how Medicare should be changed. The status quo isn’t really an option.
We are now in a political campaign in which everyone seems to talk about cutting spending without offering many ideas for how to cut spending. When the campaign ends, all that talk won’t balance the budget. Neither will cutting waste, fraud, abuse and foreign aid. Nor will ending the war in Afghanistan and the Bush tax cuts for the rich.
Policies like those can help shrink the deficit, yes. Raising taxes and tweaking Social Security can help even more. But you probably can’t call yourself a fiscal conservative unless you are willing to support changes — that is, cuts — to Medicare.
By contrast, the most serious Republican proposal that’s been put forward is Paul Ryan’s plan, which would turn Medicare into a voucher program, and then allow the value of the vouchers to fall behind health care inflation. Of course it’s true that simply ceasing to pay for Medicare would solve the budget problem, but have fun building support for that approach with old people – especially as seniors make up an increasingly large part of the Republican political coalition.
The next few years are going to see a lot of very important decisions made in this area, so it would be great if moderators used the debates to get the candidates on the record with this stuff, rather than wasting everyone’s time with inane trivia.
"The Deficit is a health care problem"
Hey, I have an idea; why don't we turn ALL health care over to the government, then that will solve the deficit problem.
At least that's the logic I glean from the libs
Read the article. I think the payment reform idea is good. Basically we need somebody with real market power to pay less to providers and bring the rest of the market with them. I'm for turning all health care finance over to the government, but not the provision of services. The private insurers do a much worse job of holding down costs than Medicare does.
The idea that we are turning ALL health care over to the government is completely false and needs to be called out. Health care reform is about government (as payors) holding health care systems and insurance companies to standards that will cut waste and improve quality. For example, a hospital gets paid for an inpatient stay. If they cut the person too soon, or they don't provide the necessary aftercare and the patient gets readmitted, the hospital gets paid again. There are no financial incentives for hospitals to keep people healthy and we are spending billions on unnecessary readmissions. Cut out 50% of the unnecessary readmissions and you save enough money to insure a majority of the uninsured (most of who are hard working middle class people making $40-60,000 per year, but have no benefits and can't afford to buy their own). By providing these folks with access to good quality primary care and wellness services, we save millions more from good health management (done by health care, not gov't)and chronic disease management. There are billions of dollars to be saved and as Jon points out, this is as much of an economic issue as it is a health care issue. Our energy needs to be focused on making health care reform work, not trying to repeal it.
you're right – government intervention has always worked in the past – what could go wrong?
Anon 1:09- I don't understand your point. I'm sure you can find examples of govt interventions not working and even more examples of govt interventions that have worked. I thought the point of this discussion was about the deficits being caused by health care-which is exacerbated by the fact that we're still incredibly unhealthy. The Affordable Health Care Act helps get handles on a lot of the out-of-control spending in health care AND improves health. Are there people out there who oppose saving money and improving health?
For the example given by Anonymous…
We have to assume that the heath care professionals were so uncaring as to release patients too soon because they could always come back later to get milked for more money. First we demonize that which we want to "reform".
Then throw out a percentage, say 50%, that more regulations will supposedly correct.
Remember HMO's? That was the government regulation to provide primary care and wellness services and reign in costs.
And:
"…and you save enough money to insure a majority of the uninsured (most of who are hard working middle class people making $40-60,000 per year, but have no benefits and can't afford to buy their own)."
Priorities, priorities, priorities… guess we don't need them when the government is there to step in.
Wayne:
I appreciate you keeping the discussion going.
Of course health care professionals are not intentionally releasing people early so they get sick again and get re-admitted. That's just silly!
1) They do sometimes release people when insurance companies tell them the patient is healthy enough to beneifit from a lesser restrictive level of care.
2) The lack of communication and coordination between the in-patient system and the different out-patient offices (primary care and the various specialists many sick people need to see) is staggering and has many falling between the cracks, overmedicated, etc.
When the health care system is given the proper reimbursements and change their system based on these proper reimbursements, we will see significant changes in the quality and cost of health care.
Glad you mentioned HMOs. Good concept poorly executed and, although not a collosal failure, did not result in the success anticipated. But we cam list a dozen other attempts to "reform" health care (medical school standards, patient safety standards, DRGs, the FDA, Medicare, etc.) that have led to some very positive changes.
Bottom line- health care will absolutely kill our economy if we don't do SOMETHING soon. That's a priority! The Affordable Care Act is far from perfect and will need a lot of adjusting over the next few years (not unlike the Social Security Act that passed in the 1930s and wasn't effective until the 1940s). This bill has some incredible opportunities to save money and improve care.
There are a lot of components of the Act that are aligned with Republican thinking and make sure that decision making is still in the hands of the patient (like Health Insurance Exchanges). This is NOT Government running health care, this is government making changes to how they will reimburse for health care services by allowing the health care system to get paid for keeping people healthy instead of getting paid for (less than effectively, according to all international studies) taking care of sick people.
If "This is NOT Government running health care" then why are there 111 new government agencies created as a result of this disaster
There are not 111 new government agencies. According to GOP.gov and Fox News (hmmm), there are 111 new "boards, bureaucracies, commissions, and programs" created because of this new bill. Take a look at the list (http://www.gop.gov/policy-news/09/11/02/new-federal-bureaucracies-created-in)
We can pick apart this list all day and night, but there are a couple of important points to make here (and I'm certainly not trying to defend 111 new anythings in DC).
1) Many of these oversight structures have to do with Health Insurance Exchange. This is an important part of Health Care Reform and one of the components that Republicans wanted as part of the plan. (actually fought for by the Heritage Foundation- one of the most conservative advocacy groups in the USA). Read up on this…it's anything but govt run health care. Personally, I'm glad it's in there. An excellent example of how bi-partisanship can improve health care reform.
2)Many of these structures provide oversight and accountability. Another recommendation from across the aisle (and another I strongly agree with) assures that govt just can't spend willy nilly.
Please don't get me wrong here. This act needs a lot of work in order for it to be successful. If repealed, we won't see health care reform again in my lifetime. Which administration would be foolish enough to take this on? Without govt intervention, the health care/insurance system can't/won't do it on its own.
Left unchecked, health care debt will rise and we will be faced with an economic crisis never faced by this country.
Let's continue to fight this out over the next few years and figure out how to make it work.
Wayne and Anon 9:20, I appreciate all of your comments and thoughts. An informed public will go a long way in getting this right.
When I mentioned priorities I was trying to point out how people who can afford insurance simply don't make that a priority and then end up looking as if the can't obtain it.
My daughter has graduated from college and was going need insurance since my insurance only covers students over 18. I was going to do the responsible thing (even though I'm at the lower end of the middle-class range you listed) and find an individual program for her but now the regs have changed and my insurance must cover her to 26.
According to Jon and his ilk I should be jumping up and down and be thanking DC for this opportunity to suckle at the teat!
But I realize that everybody's rates are going up, due in part to financing my family's obligations. And how many others who could have afforded their own?
And those policies that would have covered my daughter will now wither away since those potential customers will not need them.
So the effect in this one area is to subsidize those who could afford to pay for their own and to reduce the choices available.
We can expect to see these sort of unintended results to other areas in the future…