I’ve mentioned before that, when I encounter a fallacy or other blooper in something I’m reading, I frequently find it hard to get past. That’s why I found reading this LA Times editorial so distressing. I materially agree with most of the points made in the editorial including
- we need to reduce the costs of healthcare
- many of the the problems with our healthcare system are, indeed, systemic
- Republicans who have rejected healthcare reform per se have erred
- Medicare is worth preserving, at least in some form
- the fee-for-service compensation system is part of the problem with our healthcare system
Unfortunately, here’s the opening of the editorial:
If costs keep growing at their current rate, healthcare will consume 20% of all spending in the U.S. by 2018. Nevertheless, critics of “Obama-care” argue that the country can’t afford the reform bills moving through Congress.
Not only is there nothing in conflict between those two sentences but everybody, including the Obama Administration, believes that the bills making their way through the Congress will increase healthcare spending. Being “revenue neutral”, the requirement that President Obama has said he will require from any bill that he would sign, is not the same as “reduces spending”.
Cost cutting should be interesting. Government only controls Medicare, Medicaid and the VA, for the most part. Cutting Medicare of VA spending is political suicide. Medicaid too if you realize it pays for long term care.
On the pre-Medicare side, we are not even talking about models which have been shown to reduce costs. I wonder if Republicans would even support a plan that would reduce costs? There is no political gain in supporting any plan for them.
BTW, in case you did not see it, below is link to best meta-analysis of US vs International medicine quality. Extensive footnoting. I am keeping this one bookmarked.
http://www.rwjf.org/files/research/qualityquickstrikeaug2009.pdf
Steve
If they are off the cutting block, so to speak, then health care reform is doomed to failure. The bulk of our health care expenditures are due to those 65 and older. I believe Dave had a post with such a graphic.
Found it.
Link
I guess there are two fundamentally different views of what reducing costs means. For some it seems to mean doing less. For others it means paying less for what you’re getting.
Those two aren’t necessarily in conflict. I think we need both kinds of cost reduction.
Dave,
I agree, however, steve mentioned cutting spending. That means you can do neither kinds of cutting.
And here’s a nice nightmare scenario:
The Democrats pull their thumbs out and put their heads together. They have some awfully smart people, and they come up with a fantastic way to save…mmm…lets say $100 billion over the next 5 to 7 years in terms of Medicare and it has the added benefit that it wont adverselly impact health care outcomes. Sounds good. So they push it.
Now enter, stage right (of course), the Republicans. Their message will be what? That the Dems are gong to cut $100 billion from grandma’s health care and she’ll die!!! Death panels!!! Dr. Kevorkian riding through the streets on a black horse breathing fire from its nostrils!!! Soylent Green is people!!!
And you could switch the whole thing around so that the actors are reversed (with the Dems coming in from stage left of course). Adversarial politics where each side sees winning as being more important than actually solving the problem might very well be part of our problem.
Democracy, the worst form of government save for all others that have been tried.
My long running belief is that we will not really work on cutting costs until it is more of a crisis, optimist that I am. To your list Dave, I would add stopping the subsidization of treatments that do not work or work no better than cheaper treatments. Lots of back surgery, invasive cardiac care, total joint replacements fall into this category IMHO. With malpractice reform, we could also eliminate a chunk of MRI’s and CAT scans.
Steve
Yup, Steve V nailed it. Pretty much what happened with Social Security, though I think this is a little worse because it is a little more personal.
Steve
Steve V.,
So I guess the majority means nothing and the Democrats are powerless? Sorry, I don’t buy that, particularly since it’s moderate Democrats who are the one’s against the current legislation.
I think Steve Verdon gets it right, a view I’ve tried to express here for months, perhaps in a more clumsy manner.
IMHO attempts to reduce this to faux-academic analysis are doomed to failure. Politicaly driven prescriptions are doomed to failure. Rather, I resort to economic “first principles,” which actually redirect human behavior, in all venues, not just health care. The literature on this is clear.
My “first principles” have been castigated (my words) as a solution by any number of people here or at OTB. I respectfully disagree.
They work “always and everywhere” when applied. But they haven’t been applied here, despite assertions to the contrary. Health care economics have been and are bastardized to the nth degree.
But health care simply is not exempt from the laws of economics, any more than you or I are exempt from the law of gravity. I don’t believe in perpetual motion machines. But when it comes to health care economics, some of you do.
I know so many of you wish/believe this isn’t so, and therefore have your pet theories on exotic fixes. But I ask: how’s it going? Medicare anyone?
Reintroduce price. Reintroduce real insurance. First principles.
I know, boring. But if tried…..effective. But I’m not sure how many people are interested in effective.
(As an aside, I want to make clear I accept the notion of increasing GP doctor supply….I just don’t think its a robust part of the solution. But that said, who could argue with more internists, if they are qualified?)
Andy,
Let me disabuse of two notions.
1. Politicians are, when you get right down to it, bad people. Those who seek power over others, even when starting with noble intentions, become corrupted.
2. There is no pony in Washington D.C. Never has been.
Sure the majority counts, but see number 1, politicians aren’t going to slit their own throats to do the right thing as a general rule. Because of this we get number 2.
Sure, but you don’t think that Sarah Palin and her nonsense isn’t having an effect and providing the moderates some cover?
Must reading:
http://www.theatlantic.com/doc/200909/health-care/6