More Hamburger Today!

The editors of the New York Times excoriate those who think that operating costs should be paid with operating revenues:

Republican critics have a fiercely argued list of reasons to oppose health care reform. One that is resonating is that the nation cannot afford in tough economic times to add a new trillion-dollar health care entitlement.

We understand why Americans may be skittish, but the argument is at best disingenuous and at worst a flat misrepresentation.

They go on to provide four arguments for why we should start spending a lot more on healthcare immediately:

  • The status quo is unsustainable.

    I agree. That’s why I’ve argued here for some time that we need major reforms in healthcare. However, if you were to think that the editors of the NYT wanted to solve the problem of an unsustainable healthcare system by proposing something that was, in fact, sustainable, you’d be wrong.

  • $1 trillion sounds like a lot of money but the Republican plans past and present are worse.

    How the irresponsibility of past administrations or alternative current proposals justifies their preferred irresponsibility eludes me. There are alternatives, e.g. Wyden-Bennett that are fiscally responsible. These alternatives are “politically impossible” which is another way of saying that the Congressional leadership doesn’t like them.

  • We can’t solve our fiscal problems via healthcare reform.

    Sure we can. We just can’t solve our fiscal problems via the irresponsible healthcare reform that the NYT editors prefer. They then go on to point out that several historical Congresses, mostly controlled by Republicans, have actually cut Medicare reimbursement rates. That sounds more like an argument for electing Republicans than it does for the Senate’s brand of healthcare reform. I challenge the NYT editors to demonstrate that this Congress is likely to cut Medicare reimbursement rates. If they wanted to do so, they don’t need this sort of healthcare reform to do it.

  • The current bills include a number of pilot proposals that might cut costs some time in the future.

    I’m skeptical of trading certain current spending for hypothetical future savings and I think everybody else should be, too. I’m further skeptical of things like electronic medical record keeping as a vehicle for huge cost savings. Some, yes, but huge?

  • There are more cost saving ideas coming down the pike.

    That’s wonderful! Why don’t we implement all of these wonderful cost savings measures and then use the money to pay for expanding coverage?

To my eyes the entirety of the NYT’s position is that of Wimpy: “I’ll gladly pay you Tuesday for a hamburger today.” Tuesday is already here.

9 comments… add one
  • steve Link

    Question 1). What political party has run on and won an election with controlling health care costs as part of its platform?

    Question 2). With our present politics, is it possible to do anything other than incremental changes? We need a big change like Wyden-Bennett or going to a French/Swiss/Singapore/Taiwan model, but is that possible? I kind of lean towards the only politically viable alternatives being the status quo, or something like is on the table. Maybe, big maybe, if the Republicans had gotten behind Wyden-Bennett it could have worked. I dont think Obama really has cared that much about how coverage is expanded, just as long as more people got covered and it did not add to the deficit, it was ok with him.

    At some point in time, map out how you think we achieve the political will/system/ability to do that for which you advocate.

    Steve

    Steve

  • How will change become politically possible? I think it will become much more politically possible after we default. IMO that’s unnecessarily cruel and unjust but it’s a mathematical certainty without more fiscal prudence.

    What I’m proposing is not particularly radical by any reasonable definition of the word but I guess it is by current Washington standards. I’m just asking that we stick to a budget with normal current year expenditures matched to normal current year revenues. That isn’t even requiring a balanced budget. It’s just tailoring regular expenses to fiscal reality.

  • steve Link

    What you are pushing for then, in real political possibilities, is the status quo. No change is better than this bill. As long as you are ok with that extra 45,000 a year dying, I can see how you would be alright with that. Let the system crash, and have more and more uninsured on the way as businesses stop insuring people. Say 25% insured with health care costs at 40% of GDP?

    Steve

  • Andy Link

    Steve,

    45k people a year dying because they lack of health insurance? Source please.

  • I think it’s more likely that they’re dying because they’re receiving no or inadequate medical treatment. Refusing to treat or giving inadequate treatment to those without insurance is both illegal and unethical.

  • The Urban Institute estimates that 22,000 people are dying each year as a consequence of the lack of insurance.

    I suppose it would be excessive of me at this point to there was an article in JAMA not too long ago which produced figures suggesting that iatrogenic (physician-caused) and hospital-caused death is the third-leading cause in the United States. If the objective is saving lives, 39,000 could be saved per year by reducing the deaths caused by just failure to rescue, bed sores, post-operative sepsis, and post-operative pulmonary embolism by 20%. That’s more than the 22,000 and it would probably be cheaper.

  • Cutting reimbersements, even if it can be done, can create more problems. A doc that orders a $100 test for a $10 profit may order two $100 tests if they only get $5 profit a piece. The result is that health care costs just went up.

    I found it interesting that The Mayo Clinic is strongly opposed to the Medicare Buy-In. The Mayo Clinic is precisely the sort of provider that we want to see more of. Their doctors are salaried, so there’s not a race to stack billable procedures and tests. They’re non-profit. They were the counter-example to McAllen used in that New Yorker piece you like to cite.

  • steve Link

    Alex-

    http://www.ncpa.org/pdfs/2009_harvard_health_study.pdf

    Dave- We could treat no one and reduce that to zero. I am not sure what that would accomplish, but it would be even cheaper. If you looked at that Annals of Internal Medicine article I cited, the excess mortality, at least in the 55-64 group comes from not adequately treating diabetes and cardiovascular disease which makes a lot of sense if you think about it.

    Steve

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