Friday, December 04, 2009
I actually agree with something Paul Krugman wrote this morning:
The Republican campaign against health care reform has rested in part on the traditional arguments, arguments that go back to the days when Ronald Reagan was trying to scare Americans into opposing Medicare — denunciations of “socialized medicine,” claims that universal health coverage is the road to tyranny, etc.
But in the closing rounds of the health care fight, the G.O.P. has focused more and more on an effort to demonize cost-control efforts. The Senate bill would impose “draconian cuts” on Medicare, says Senator John McCain, who proposed much deeper cuts just last year as part of his presidential campaign. “If you’re a senior and you’re on Medicare, you better be afraid of this bill,” says Senator Tom Coburn.
If these tactics work, and health reform fails, think of the message this would convey: It would signal that any effort to deal with the biggest budget problem we face will be successfully played by political opponents as an attack on older Americans. It would be a long time before anyone was willing to take on the challenge again; remember that after the failure of the Clinton effort, it was 16 years before the next try at health reform.
That’s why anyone who is truly concerned about fiscal policy should be anxious to see health reform succeed. If it fails, the demagogues will have won, and we probably won’t deal with our biggest fiscal problem until we’re forced into action by a nasty debt crisis.
Krugman is, of course, correct: We need to do something about the exploding cost of Medicare, and that will necessitate treating the old folks more cost-effectively. That will, in some fashion, mean that seniors who are entirely dependant on government subsidies for their health care will need to eat a cut in benefits if we are not to put our country into an awful fiscal position in the future. It would be much better for Republicans to modify or defeat this legislation without making Medicare as sacrosanct as the Democrats have argued Social Security should be. Two wrongs do not make a right, and political expediency does not justify every foolish argument.
Let's not confuse tactics for arguments. This is a tactic designed to make the Democrats admit that for the last twenty years at least, since the time it became obvious that neither social security or medicare could fiscally survive, the Democrats have used this tool effectively to silence GOP attempts to reform the entitlements. One must use the tools at hand.
If the Democrats fail in passing this new entitlement, it'll be because they cannot but admit that past entitlements have failed. Hence, this one will too, because it is just a bigger, more expensive version of Medicare. That's the argument, and Krugman is (of course) wrong.
"...seniors who are entirely dependant on government subsidies for their health care will need to eat a cut in benefits..."
What's wrong with a higher cost share? Anyone on Medicare is entirely dependent on that program. There are no opt outs -- at least not that I'm aware of.
And Republicans over the past several decades have made efforts to rein in the costs of Medicare and Democrats, with Krugman silent if not encouragement, hammered them over their "cruel cuts".
Yes Krugman has a point. He's not the one who has much standing to make it.
But the point is still good: the Republicans have been shameless with the scare tactics on this matter.
C'mon! Leave your too obvious pro-Princeton bias out of this fight!
You seem to have fallen for Krugman the Idot's argument based solely on his standing as part of your club!
This whole charade has little to do with health care reform and everything to do with ultimate control over people's lives by a government ruled by "the wise ones", e.g. those with Ivy League degrees.
The Repub's tactics to defeat the monstrosity is well'justified.
Call me when you find a bill that actually addresses the problems with healthcare costs that Repubs are unreasonably fighting and I'll readily join your eltitist efforts at criticizing them!
Obama has no interest in "reforming" "healthcare;" his only objective is destroying the American middle class!
The aggregate cost of "healthcare" in America may be one problem, it's rate of change another. How much a citizen should have to pay for his own medical services and how much should be paid by insurance or society is another. So too, are tort reform, waste and theft, coverage for illegal aliens, long term wharehousing, extreme measures, etc.
Attack the problems one at a time with reasoned debate. Don't address these with democrat crap based on babble left over from Fat Teddy.
The scare tactics that Mr. Krugman is referring to are not that unreasonable; actually they are mathematical. You can not claim to take out $300 - $500 Billion of Medicare costs out of the system over 7 years and say that the quality of care will stay the same; even if the current Medicare population stayed constant. Unfortunately, the U.S. population is aging and more Americans will qualify for Medicare over the next 20 years than ever before, coupled with longer life expectancy. In order to even keep costs constant, nevermind remove them, there would have to be some sort of degredation of service; especially since none of the 2,000+ page bill deals with real cost reducing measures.
Just a few days ago I was talking to one of my colleagues about how in the hell AARP is not fighting this legislation similar to the way they fought Social Security reform. The math is irrefutable.
The broader issue with this current crappy bill is that it does not do nearly enough to reduce the systematic cost of healthcare. I am in the Healthcare industry and the amount of waste is collossal. However, the amount of new regulation that is being introduced will only make that waste greater. The topper to all of this debate is that the single largest influence on both cost and quality of care that is the lynch pin to reducing so much down stream cost is medical malpractice reform. If the Democrats were truly serious about Healthcare reform (versus creating yet another entitlement that will keep them in power for another 50+ years) medical malpractice reform would be on the table, but as such it is not.
In short, Mr. Krugman is either unaware of where costs in healthcare are driven today or he is completely full of shit on the motives behind the Republican's stance.
There is a substantial difference in cuts and efficiencies. Cutting coverage is bad, making Medicare more cost effective is good. Estimates are between 30 and 40 percent of all Medicare expenditures are fraud or waste. If we can cut these expenditures, we can reduce the cost of Medicare without cutting coverage. If we can't cut these expenditures, then government is inherently wasteful which is the biggest reason government should not be in the healthcare business.
The continued assumption in this argument is that America spending 20+% of GDP on health care is excessive. Have we questioned this assumption? Isn't the idea of capitalism that we spend our money on that which we value most? We necessarily value health care a great deal, thus we spend a great deal of our productivity on it. Naturally, we should do so in an efficient manner, controlling waste as effectively as possible, but that is a detail of execution, not of strategy.
I doubt the "lynch pin [sic] to reducing so much down stream [sic] cost is medical malpractice reform." No doubt such reform would increase overall system efficiency by reducing the need for defensive medicine, but it would not solve the underlying driver of medical costs: demand for the best at any cost. Malpractice reform is just one more (albeit important) link in the efficiency chain.
Krugman's arguments are all wet. While I agree there are better arguments against nationalized health care than denouncing the associated Medicare cuts, this is a political game that has to be played. If the GOP can get seniors on their side by pointing out these cuts, they can help win the day in defeating this measure.
The author is mistaken in the belief that the coming Medicare population expansion will necessitate cuts. This is just a form of the thinking that 20% of GDP is "too much". Because of the pay-as-you-go nature of Medicare funding, there may indeed be an eventual political day of reckoning for the program. When the younger generation has the political power after the Baby Boomers have largely died off, they may be able to end the program, but that day is at least 35 years in the future. Furthermore, that has nothing to do with the actual health care economics involved.
The GOP argument is therefore one not of principle, but rather one of political expediency. It's probably a mistake to stand on principle with the Hun at the door, as he is right now. Better to use whatever tactics you have at your disposal to fend him off, and save the principled fight for another day. Perhaps that is intellectually repulsive, but even the greatest thinkers cannot change everything overnight. Politics is a funny game, and sometimes one must turn his foes' weapons against them despite his disdain for those weapons!
The way you solve big problems is to break them down into smaller ones. The big problem with this bill is that it attempts to solve the whole problem all at once. It will be a huge mess regardless whether it is passed without Republican support or whether it is passed with the co-opted Republican support Krugman is looking for.
The design of this bill is, I think, unworkable. It should be set aside and a new one found. That is not simply done so I agree with the first Anonymous comment that Republicans should adopt the tactics necessary to get the job done. Once it has been established that Democrats and Republicans grovel the same, perhaps we can return our focus to the common good in less dramatic but more functional ways.
I wish more people would read Jane Jacobs', The Nature of Economies. Our attempts to engineer the perfect society should be tempered with insight into the lessons nature has taught us about systems which survive.
The best way to bring down the cost of health care in the US, and of Medicare in particular, is for the government to get out of the way of the free market and let competition do its job. The Republicans have proposed many market-based solutions, and none of them got out of Democrat-controlled committee (and the Republicans have done a crappy job of getting that message out).
Those evil Insurance companies aren't allowed to compete, and they aren't allowed to charge risk-based premiums (that being what true insurance is--a transfer of risk from one person/entity to another for a fee--as opposed to what the Democrats want "insurance" to be: another welfare program of guaranteed payouts.) They can't sell across state lines, and the state jurisdictions dictate what the insurers must cover and what they'll be allowed to charge for that coverage. And we have the Democrats' latest diktat: insurers must take pre-existing conditions at no additional cost to the (newly) insured. Really? And how will those extra costs, from that higher risk, be covered?
Friedman (if I recall correctly) ran a study about the cost of hospital beds shortly after Medicare, with its mandated participation, became the law of the land. In the year prior to the law taking effect, the cost of hospital beds was rising faster than the rate of inflation. In the year after the law took effect, the cost of hospital beds, with the now artificially inflated demand, was rising even faster. The principles of supply and demand described in Economics 101 held then, and they hold now. You don't lower costs by mandating participation and inflating demand. You lower costs by letting competition adjust supply and demand freely. And there is a level--the actual cost of producing and providing the good--below which its market price cannot descend.
"Just a few days ago I was talking to one of my colleagues about how in the hell AARP is not fighting this legislation similar to the way they fought Social Security reform. The math is irrefutable."
The AARP is in the business of making money. Tha AARP has agreements with Medical Insurance companies to sell offset insurance to seniors. AARP will make money if MEDICARE benefits are cut.
I do not understand why this is more widely known.
Mr. Ed as always your comments are well informed and spot on. To that end, I would like to clarify my comments about malpractice reform.
The broader challenge with healthcare today is that it is by nature a highly regulated industry for obvious reasons. When that is further challenged by run-away malpractice insurance/exposure the two combine for an extremely inefficient system. Here is how malpractice plays into the daily life of healthcare providers:
1) Malpractice Insurance - for some practices such as OB/GYN are so high Doctors have stopped practicing Obstetrics; therefore supply has been altered and demand has increased hence higher costs.
2) Excessive tests are ordered whether they are needed or not, because it is safer to have them ordered so when a doctor gets put before a jury he can say he did everything possible.
3) When something goes wrong, Doctors are taught to keep quiet and go into hiding. The valuable lessons that could be taught that may save lives as well as drastically reduce costs, are never shared amongst doctors for fear of being sued.
4) Insurance companies will dictate care and protocols on the liklihood of being sued by plaintiff attorneys.
5) Hospitals are the most overly litigious institutions one could ever imagine. Hospitals expect that everything a care provider does will be scrutinized in a suit and as such, layers upon layers of added staff are created to ensure suits are kept to a minimum.
6) Many doctors are fearful of using electronic medical records or other practice management software for fear that when they get sued a plaintiff's attorney could dive into a Doctor's records looking for "X", but can readily find "Y" or better known as "Tort fishing."
There are a thousand of other small examples of how much impact malpractice law has on our healthcare system. All of these add up to substantially large wastes of money.
Krugman is also wrong in that if there are to be efficiencies to be found in Medicare we don't need this health bill to implement them.
Republicans have said this repeatedly, but nobody hears them.
"If a Republican makes a statement and the MSM doesn't report it, does that mean that the statement was never uttered?" Falling trees, forests, nobody hears, no sound.
Krugman's first paragraph berates Reagan, whose opinion of government sponsored health care was deadly accurate.
So, as I understand it, the logical argument for funding this latest imbroglio is the discovery and remedy of massive fraud and abuse in a system that has had unfettered fraud and abuse since it's inception.
What happens if Uncle Sam maintains his current level of competence in reclaiming "fraud money"? We will have an even BIGGER program, with even MORE fraud and abuse.
I suspect we would reclaim more money sifting the fraud and abuse out of the day to day interactions of congressmen and lobbyists, but I digress.
What they really mean by cost containment is rationing, downgrading the acceptable quality of the average medical graduate, reducing physician and hospital payments, disallowing (or taxing)certain procedures, controlling options for end-of-life care and disallowing aggressive care for cases with low statistical probablility of cure.
Well...at least it will keep all those pesky foreigners from coming to America to get health care.