I have identified four primary sources of the rise in costs - the impact of medical research (2/26/10), restrictive entry into medical schools causing anti competitive pricing (3/2/10), an over insured population (3/5/10), and tort law suits (3/9/10). These four issues must be addressed in order to contain health costs. Here are the components of the Stabler Health Cost Reduction Plan:
1. Medical schools must reorganize their teaching methods, particularly in the clinical programs, and use their impressive resources more efficiently in order to double or triple the number of doctors produced each year. If medical educators really put their mind to the project, I suspect that the additional tuition income would come close to covering the marginal costs of educating additional students. The economic savings coming from increased enrollments would significantly reduce costs, increase the availability of medical services and thus produce a far superior health care system.
2. I propose to limit tax deductible plans to those that pay no more than 80% of the ordinary medical costs with a 20% deductible paid by the insured. I believe that in most cases the cumulative savings from lower premiums would exceed the cost of paying the larger deductible. With low cost plans being the norm, universal coverage would be much easier to accomplish.. Moreover, the patient who has a 20% stake in the cost of medical services will pay much closer attention to how the money is spent. The Stabler Plan would allow greater, but not 100%, coverage for catastrophic expenses and would provide some sort of welfare payments for the indigent.
3. It is doubtful that the pace of medical research will ever happen, nor should it. The only way I can see that its effect on medical costs can be reduced would be to invest more public moneys into research to replace the work of pharmaceutical and medical equipment companies. Public investments do not need to be recovered out of the proceeds of sales. Nevertheless, the savings, if any, from that source would require much more investigation and study that I am capable of producing.
4. I see little prospect of material cost reduction coming out of tort reform as long as health care is dispensed in a noncompetitive environment. Therefore, the Stabler Plan requires that the supply of doctors and other health professions be dramatically increased before tort reform is included in the program. (See my discussion in the posting issued on 3/5/10). It would be unconscionable to give the doctors full immunity from the consequences of their tortious actions. Two features of tort reform have merit, however. Punitive damages deserve to be curbed, or even abolished. I believe that it is the province of the criminal laws to mete out punishment. The proper role of civil law suits is to compensate victims for their loss. Second, tort laws could be amended to give the medical professionals a good faith defense. Most medical procedures have a risk attached to them. The defendant who can prove that he or she acted in good faith and with diligence should be given a break.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Thursday, March 18, 2010
Tuesday, March 9, 2010
Is Tort Reform Really the Answer to Rising Health Costs?
Is Tort Reform Really the Answer to Rising Health Costs?
Tort Reform is one of the cornerstones of every Republican health care proposal. Normally the tort reform package proposal takes the form of some sort of cap on recoveries. Tort reform is not simply a cost savings device. There are considerations other than cost that weigh heavily in the tort reform debate. My limited concern at this point is whether tort reform can induce meaningful cost savings.
The proponents frequently make the argument that there are too many frivolous malpractice claims. It is true that there are many frivolous claims because, at least in Alabama, the defendant prevails in a very high percentage of the claims filed. Nevertheless, I submit that it is not the frivolous claims that raise the costs most significantly. It is the meritorious claims that cost the big bucks.
Costs of tort reform can be easily identified because virtually every practitioner carries insurance and the premiums define the dominant cost. The complexity comes from the fact that the premiums vary widely based on the specialty. The highest premiums are paid be obstetricians which have been reported to be in the range of $150,000. The reason for this are because babies suffer the most serious damage and have the longest life expectancy extending the time that they may suffer the consequences of an adverse event. Both factors run up the cost of claims dramatically. These premiums are not typical. I suspect that the premiums for pathologists would be toward the bottom of the scale and would be negligible, but other specialties are spread all over the landscape. The point is that there is more need for reform for some aspects of the practice than others.
I cannot figure out whether tort reform would have any effect on the cost of medical services. As I have discussed in another posting, the doctors enjoy monopoly power which means that they can raise their prices above the competitive level. Insurance would be classified as a fixed cost. As I recall from distant studies of price theory the true monopolist will raise prices until the price matches the marginal cost. Marginal cost represent the additional costs for serving one more patient. The cost of insurance does not materially increase when a patient is added.
Put another way. Competitive prices have a close relationship to costs. In a competitive environment additional costs translate into higher prices. On the other hand the monopolist charges what the traffic will bear regardless of total costs. Therefore, it would seem to me that the cost of insurance does not govern the prices set by the medical profession for their services.
I suspect you can detect, that I really do not fully know what the economic impact of tort reform on the cost of health care would be. I would like to find studies done by respectable academicians (who are not employed to find a predetermined answer). Under any circumstances I do not believe that tort reform is likely to produce substantial cost savings..
This is the last posting for the week. I will publish the next one on Tuesday, March 16, 2010 . At that time I will discuss my ideas as to the most effective means of containing health costs.
Tort Reform is one of the cornerstones of every Republican health care proposal. Normally the tort reform package proposal takes the form of some sort of cap on recoveries. Tort reform is not simply a cost savings device. There are considerations other than cost that weigh heavily in the tort reform debate. My limited concern at this point is whether tort reform can induce meaningful cost savings.
The proponents frequently make the argument that there are too many frivolous malpractice claims. It is true that there are many frivolous claims because, at least in Alabama, the defendant prevails in a very high percentage of the claims filed. Nevertheless, I submit that it is not the frivolous claims that raise the costs most significantly. It is the meritorious claims that cost the big bucks.
Costs of tort reform can be easily identified because virtually every practitioner carries insurance and the premiums define the dominant cost. The complexity comes from the fact that the premiums vary widely based on the specialty. The highest premiums are paid be obstetricians which have been reported to be in the range of $150,000. The reason for this are because babies suffer the most serious damage and have the longest life expectancy extending the time that they may suffer the consequences of an adverse event. Both factors run up the cost of claims dramatically. These premiums are not typical. I suspect that the premiums for pathologists would be toward the bottom of the scale and would be negligible, but other specialties are spread all over the landscape. The point is that there is more need for reform for some aspects of the practice than others.
I cannot figure out whether tort reform would have any effect on the cost of medical services. As I have discussed in another posting, the doctors enjoy monopoly power which means that they can raise their prices above the competitive level. Insurance would be classified as a fixed cost. As I recall from distant studies of price theory the true monopolist will raise prices until the price matches the marginal cost. Marginal cost represent the additional costs for serving one more patient. The cost of insurance does not materially increase when a patient is added.
Put another way. Competitive prices have a close relationship to costs. In a competitive environment additional costs translate into higher prices. On the other hand the monopolist charges what the traffic will bear regardless of total costs. Therefore, it would seem to me that the cost of insurance does not govern the prices set by the medical profession for their services.
I suspect you can detect, that I really do not fully know what the economic impact of tort reform on the cost of health care would be. I would like to find studies done by respectable academicians (who are not employed to find a predetermined answer). Under any circumstances I do not believe that tort reform is likely to produce substantial cost savings..
This is the last posting for the week. I will publish the next one on Tuesday, March 16, 2010 . At that time I will discuss my ideas as to the most effective means of containing health costs.
Friday, March 5, 2010
Medical Costs- Are We Overinsured?
Monty and I went to the health department the other day looking for shots immunizing against various diseases we might contract on an upcoming trip. The lady at the desk advised me that my insurance and Medicare probably will not cover the costs. There was a prominently displayed sign on the wall of the nurse practitioner showing the exact cost of each and every shot that was available. We were asked whether we wanted to take a typhoid booster shot. She said that there was some typhoid threat in the jungles of the country we plan to visit, but that if we stay in the city the chance of contracting typhoid are very small. I saw that the shot would cost about $100.00. I considered whether immunizing against an extremely low risk of contracting typhoid fever was worth $100.. And decided not to take it. Would I have taken the shot had it been covered by insurance? Probably. After all there was some risk, and it would cost me nothing.
This story underlines the fact that our own over consumption of medical service is skewed because most of us are over insured. Doctors quickly cite the malpractice threat as a cause of over treatment, which has some merit. Who is complaining that our decisions to acquire medical service are unrestrained by any economic considerations. We are on a treadmill. We utilize more tests, more discretionary treatment because the insurance company will pay for it. The insurance company turns around and increases the premium to cover the costs, and we complain. Put on your glasses. You will see the enemy and the enemy is us.
Nowhere is the overuse of medical services more prevalent than when end of life decisions are faced.. Whenever our loved one dies of a long illnesses we tend to want to be sure that we have done everything we can to save her. That approach is certainly proper and laudable. However, when the decision is made on house money, too many of us keep searching for a miracle and prolong life that would have terminated earlier had not medical science devised means to sustain people who are terminal. The Democratic solution to the end of life dilemma is to have a bureaucrat make the decision taking the family and the doctor out of the equation.
Obama promises that the health plan will not increase the deficit. He is relying in part on a belief that the younger population will pay more in premiums that they will receive in benefits. That is to say, the insurance companies will overcharge the younger population to underwrite the older people who are sicker on the average. I do not know he has made his calculations.
I do know to a point of moral certainty that the additional thirty million persons receive coverage will increase their use of medical services. We already have a severe shortage of medical personnel. Has anyone addressed how we will cope with ever greater demands on a severely stretched health system?
My next blog which will most likely be posted next Tuesday to discuss tort reform. Then, in a following posting, I will discuss the elements of what I would consider to be an effective reform of the system.
This story underlines the fact that our own over consumption of medical service is skewed because most of us are over insured. Doctors quickly cite the malpractice threat as a cause of over treatment, which has some merit. Who is complaining that our decisions to acquire medical service are unrestrained by any economic considerations. We are on a treadmill. We utilize more tests, more discretionary treatment because the insurance company will pay for it. The insurance company turns around and increases the premium to cover the costs, and we complain. Put on your glasses. You will see the enemy and the enemy is us.
Nowhere is the overuse of medical services more prevalent than when end of life decisions are faced.. Whenever our loved one dies of a long illnesses we tend to want to be sure that we have done everything we can to save her. That approach is certainly proper and laudable. However, when the decision is made on house money, too many of us keep searching for a miracle and prolong life that would have terminated earlier had not medical science devised means to sustain people who are terminal. The Democratic solution to the end of life dilemma is to have a bureaucrat make the decision taking the family and the doctor out of the equation.
Obama promises that the health plan will not increase the deficit. He is relying in part on a belief that the younger population will pay more in premiums that they will receive in benefits. That is to say, the insurance companies will overcharge the younger population to underwrite the older people who are sicker on the average. I do not know he has made his calculations.
I do know to a point of moral certainty that the additional thirty million persons receive coverage will increase their use of medical services. We already have a severe shortage of medical personnel. Has anyone addressed how we will cope with ever greater demands on a severely stretched health system?
My next blog which will most likely be posted next Tuesday to discuss tort reform. Then, in a following posting, I will discuss the elements of what I would consider to be an effective reform of the system.
Friday, February 26, 2010
Why do health costs go up? -- Research
I have previously pointed out that economic regulation will ineffective in holding down health costs. Before addressing how to contain costs, discourse should begin by exploring why costs are so high. I do not pretend to have all the answers. Nevertheless there are several obvious sources of high health costs that I will explore in this and other blogs. We will start with the impact of medical research.
Much is made of the shortfalls in our investment in science and technology. That cannot be said about medical research. I doubt the world has ever seen an explosion of medical advances like those which have occurred in my lifetime. I hear it said that the quality of care in this country is not superior to other countries. That may be true, but I find it hard to believe. Every day I see myself and others who have escaped the grim reaper because of leading edge medicine.
When I was young, my father suffered from a thyroid condition that the doctors could not diagnose for two years. He almost died because of the delay. Today standard blood tests routinely identify thyroid abnormalities. My mother died of breast cancer that would be picked up in a regularly scheduled mammogram today. My brother in law died of heart attack that would have been corrected by open heart surgery today. Two aunts were institutionalized for conditions that would now be controlled by drugs. On the other hand, my prostate operation came in time to spare me of the ravages of cancer because of the PSA test which is regularly administered on a yearly basis to middle aged males. My gall bladder operation that required a three and a half hour stay in the hospital and about a twelve hour recuperation was once a dreaded massive operation that could send the patient to bed for months with a scar that stretched across the torso..
These stories are not unique. Our life expectancies are expanded because of massive investments, public and private, into medical research over the previous decades. Nevertheless, inventions carry their costs. When a new medicine is developed, its inventor receives a legal monopoly for a specified period of time. The FDA must allow the pharmaceutical company to recover its research costs of developing that drug. These companies must also recoup the costs attributable to exploratory research that did not result in producing a marketable drug. Otherwise the enterprise cannot sustain itself.
Moreover when a drug, device or procedure is invented, the costs must often be recovered out sales in a relatively small market. An MRI machine for instance can only be sold to a handful of hospitals and other diagnostic centers. You cannot sell MRI machines like automobiles that fill up two car garages.
Some demagogues argue that those costs can be avoided by letting the government control all medical research thereby eliminating “excess profits.” Don’t believe it. The costs described above exist regardless of who may bear them. If the government does not receive enough return for its investment to cover the successful and unsuccessful research as well as the cost of raising the necessary capital, then it must absorb the costs and charge us to make up the loss costs either by taxing us or borrowing the money from somebody, probably the Chinese. We are getting a full dose nowadays of the dangers of that tactic.
The costs of research are vividly revealed when our favorite medicine becomes generic and the research costs are no longer a factor. Our insurance companies have educated us to the fact that generic drugs are the same medicine at drastically reduced prices, simply because the influence of research costs on the price of medicine has ended.
Under any circumstances, I doubt that our appetite for medical innovation is waning. I do not believe that we, the consumers, will tolerate a reduction in medical research, particularly with respect to the ailment that affects us or our families. Moreover, I would not be surprised if the recoverable costs actually increase as the drugs and devices brought onto the market become more specialized treating fewer patients a thereby creating ever smaller markets for the products.
In my next blog, I will discuss American medical education and how it contributes to higher costs.
Much is made of the shortfalls in our investment in science and technology. That cannot be said about medical research. I doubt the world has ever seen an explosion of medical advances like those which have occurred in my lifetime. I hear it said that the quality of care in this country is not superior to other countries. That may be true, but I find it hard to believe. Every day I see myself and others who have escaped the grim reaper because of leading edge medicine.
When I was young, my father suffered from a thyroid condition that the doctors could not diagnose for two years. He almost died because of the delay. Today standard blood tests routinely identify thyroid abnormalities. My mother died of breast cancer that would be picked up in a regularly scheduled mammogram today. My brother in law died of heart attack that would have been corrected by open heart surgery today. Two aunts were institutionalized for conditions that would now be controlled by drugs. On the other hand, my prostate operation came in time to spare me of the ravages of cancer because of the PSA test which is regularly administered on a yearly basis to middle aged males. My gall bladder operation that required a three and a half hour stay in the hospital and about a twelve hour recuperation was once a dreaded massive operation that could send the patient to bed for months with a scar that stretched across the torso..
These stories are not unique. Our life expectancies are expanded because of massive investments, public and private, into medical research over the previous decades. Nevertheless, inventions carry their costs. When a new medicine is developed, its inventor receives a legal monopoly for a specified period of time. The FDA must allow the pharmaceutical company to recover its research costs of developing that drug. These companies must also recoup the costs attributable to exploratory research that did not result in producing a marketable drug. Otherwise the enterprise cannot sustain itself.
Moreover when a drug, device or procedure is invented, the costs must often be recovered out sales in a relatively small market. An MRI machine for instance can only be sold to a handful of hospitals and other diagnostic centers. You cannot sell MRI machines like automobiles that fill up two car garages.
Some demagogues argue that those costs can be avoided by letting the government control all medical research thereby eliminating “excess profits.” Don’t believe it. The costs described above exist regardless of who may bear them. If the government does not receive enough return for its investment to cover the successful and unsuccessful research as well as the cost of raising the necessary capital, then it must absorb the costs and charge us to make up the loss costs either by taxing us or borrowing the money from somebody, probably the Chinese. We are getting a full dose nowadays of the dangers of that tactic.
The costs of research are vividly revealed when our favorite medicine becomes generic and the research costs are no longer a factor. Our insurance companies have educated us to the fact that generic drugs are the same medicine at drastically reduced prices, simply because the influence of research costs on the price of medicine has ended.
Under any circumstances, I doubt that our appetite for medical innovation is waning. I do not believe that we, the consumers, will tolerate a reduction in medical research, particularly with respect to the ailment that affects us or our families. Moreover, I would not be surprised if the recoverable costs actually increase as the drugs and devices brought onto the market become more specialized treating fewer patients a thereby creating ever smaller markets for the products.
In my next blog, I will discuss American medical education and how it contributes to higher costs.
Tuesday, February 23, 2010
Obama's Price Controls- Is he disingenuous or brain dead?
Obama is in a hole. He needs to get out of it as soon as possible. He needs a bill with the title “Health Care Reform” on top of it. He needs to put this mess to bed as fast as possible and go on to other matters. I was encouraged last week that he had seen the light. This week I am not so sure.
He is now pulling out his new panacea. He is pushing for a general federal jurisdiction over price controls on health care insurance, effectively controlling all prices for hospital and medical services as well as pharmaceuticals. If he seriously pushes for this jurisdiction, he will drag the country back through the dismal swamp of partisanship. I cannot believe that a reprise of this sort will enure to the benefit of his party. It is bad politics, but it is worse economics.
It has been pretty well established since the New Deal experience that government regulation could can be quite effective in matters other than prices. such safety and environmental regulations. Business interests predicted the sky would fall in when OSCHA and automobile mileage standards were enacted, but by and large these laws have worked.
On the other hand studies have shown that efforts to control pricing have not effectively reduced costs. Price control has been tried in industries classified as so called natural monopolies such as transportation, communication, natural gas and electrification It is pretty well established that these control have resulted in no significant savings to the consumer.
Instead regulated industries have often become inefficient and unncompetitive as a result of regulation. For instance, when the airline industry was deregulated, prices were reduced drastically because of competitive forces in the industry. Regulation was actually holding prices up rather than down.
Nixon’s attempt to resurrect price controls during the spiraling stagflation was ineffective. Market forces are simply too strong to be controlled by a bureaucracy.
So, when Obama suggests that health costs can be controlled by the government for any length of time, he is either disingenuous or brain dead.
Sen. Judd Gregg of New Hampshire claimed on the PBS Newshour last night that this attempt to regulate health care insurance is a predicate for going to a single payer system, which is a euphemism for extending Medicare to all persons. Democratic Senator Sherrod Brown did not deny the allegation.
If Gregg’s assertions are correct, we are really facing a debacle. It is generally agreed that the federal budget problems are caused primarily by the rigid entitlements found in Social Security, Medicare, and Medicaid.. Our president voices concern about that deficit and at the same time seems to be working toward quadrupling Medicare, which is our biggest fiscal problem. He reminds me of a lawyer person I once knew whose nkickname was Gator. That is, he smiled at you and ate you up.
He is now pulling out his new panacea. He is pushing for a general federal jurisdiction over price controls on health care insurance, effectively controlling all prices for hospital and medical services as well as pharmaceuticals. If he seriously pushes for this jurisdiction, he will drag the country back through the dismal swamp of partisanship. I cannot believe that a reprise of this sort will enure to the benefit of his party. It is bad politics, but it is worse economics.
It has been pretty well established since the New Deal experience that government regulation could can be quite effective in matters other than prices. such safety and environmental regulations. Business interests predicted the sky would fall in when OSCHA and automobile mileage standards were enacted, but by and large these laws have worked.
On the other hand studies have shown that efforts to control pricing have not effectively reduced costs. Price control has been tried in industries classified as so called natural monopolies such as transportation, communication, natural gas and electrification It is pretty well established that these control have resulted in no significant savings to the consumer.
Instead regulated industries have often become inefficient and unncompetitive as a result of regulation. For instance, when the airline industry was deregulated, prices were reduced drastically because of competitive forces in the industry. Regulation was actually holding prices up rather than down.
Nixon’s attempt to resurrect price controls during the spiraling stagflation was ineffective. Market forces are simply too strong to be controlled by a bureaucracy.
So, when Obama suggests that health costs can be controlled by the government for any length of time, he is either disingenuous or brain dead.
Sen. Judd Gregg of New Hampshire claimed on the PBS Newshour last night that this attempt to regulate health care insurance is a predicate for going to a single payer system, which is a euphemism for extending Medicare to all persons. Democratic Senator Sherrod Brown did not deny the allegation.
If Gregg’s assertions are correct, we are really facing a debacle. It is generally agreed that the federal budget problems are caused primarily by the rigid entitlements found in Social Security, Medicare, and Medicaid.. Our president voices concern about that deficit and at the same time seems to be working toward quadrupling Medicare, which is our biggest fiscal problem. He reminds me of a lawyer person I once knew whose nkickname was Gator. That is, he smiled at you and ate you up.
Thursday, February 4, 2010
The Failing Health Care Reform Bill IV - The Belligerent Left
The far left seemed to insist on strict conformity with their own agenda and regularly threatened to bolt if anything less was adopted. They ignored the fundamental fact that they can only pass what the sixtieth senator will support.
For instance Senator Baucus warned them early in the fall that the public option was dead. Yet the far left threatened to revolt, if it did not stay in. Keeping that issue alive prevented the Senate leadership from reaching the magic number of 60 before the Massachusetts election..
Obama also reneged on his promise that he would seek a bipartisan solution largely because the far left forced him into a more strident posture.. Both sides accuse the other of abandoning bipartisanship. I come down squarely on the side of the Republicans on this issue. Not because they were enthusiastic participants in a bipartisan strategy, but because the Democrats gave them no other viable alternative.
The Democrats have been in charge and must take the initiative. It appears to me that the Democratic idea of bipartisanship is to adopt their own plan and ask the Republican to rubber stamp it..
I do not believe that the Democrats ever really wanted to reach an accommodation with the Republican leadership. Instead they were simply trying to pick off a handful of backbenchers so that they would have a comfortable margin to pass the Democratic plan. That is not a bipartisan strategy in my book. Those tactics made the job of the Minority Whip to keep the Republicans in line very easy.
If the bill does not pass it will be the left who killed it.
For instance Senator Baucus warned them early in the fall that the public option was dead. Yet the far left threatened to revolt, if it did not stay in. Keeping that issue alive prevented the Senate leadership from reaching the magic number of 60 before the Massachusetts election..
Obama also reneged on his promise that he would seek a bipartisan solution largely because the far left forced him into a more strident posture.. Both sides accuse the other of abandoning bipartisanship. I come down squarely on the side of the Republicans on this issue. Not because they were enthusiastic participants in a bipartisan strategy, but because the Democrats gave them no other viable alternative.
The Democrats have been in charge and must take the initiative. It appears to me that the Democratic idea of bipartisanship is to adopt their own plan and ask the Republican to rubber stamp it..
I do not believe that the Democrats ever really wanted to reach an accommodation with the Republican leadership. Instead they were simply trying to pick off a handful of backbenchers so that they would have a comfortable margin to pass the Democratic plan. That is not a bipartisan strategy in my book. Those tactics made the job of the Minority Whip to keep the Republicans in line very easy.
If the bill does not pass it will be the left who killed it.
Wednesday, February 3, 2010
The Failing Health Care Reform Bill III - Transparency
Obama vowed to bring transparency to government. Ironically, he is now identified with a massive, secretive and sometimes confusing campaign to pass health care reform.
We hear about backroom deals with blue dog senators that do not pass the smell test. In most instances the bill was drafted behind closed doors without significant dialogue in public hearings explaining how it works. It was initially presented to Congress and the Senate without any explanation as to how the costs would be covered. The public was simply supposed to trust them.
When details on financing came out, the vast bulk of the costs were to be underwritten by savings which the plan was supposed to generate. The proponents skipped over the details about how these costs would be wrenched out of the system. Obviously they were placing a lot of the burden on new regulations that they were also proposing.
I for one am cynical about cost reduction. History has proved that regulations coming out of the New Deal era were totally ineffective in reducing costs in the long run. Moreover, our government has proved that it has a rapacious appetite for spending saved moneys rather than paying off debt. I have watched the Department of Defense save costs decade after decade, but somehow the actual totals go up. We have already seen the Obama Administration’s propensity to spend. Last year the administration was downplaying the long term cost of TARP loans, because the banks would pay it back. Now that some of the banks are repaying the loans, Obama seems to be looking for ways to put the money into other give away programs.
Moreover, there are a myriad of taxes, including medicare premium increases, being proposed. Virtually every one of these taxes have been met by a maelstrom of criticism.
The sheer size of the bill also prevented thoughtful and thorough discussion of the ramifications of the plan. Most of the public, including me, does not understand all that the it entails.
Democrats charge the tea party types with distortion when they claim that the Federal government is planning to kill grandmother in order to save costs. The claim is easy to make, however, when no one can give an adequate explanation as to why that will not be the case. The cost savings are largely dependent on removing “unnecessary” expenses incurred in the final months of life. Admittedly a large portion of the costs are related to the final illness. Moreover, the present tends to enable incurring excessive expense for heroic but futile efforts to extend life. Who is going to make the decision as to which costs are unnecessary? Some bureaucrat?
The sprouting Tea Party movement has probably benefitted most from the non-transparency. They smell a conspiracy and have found that many others do, too. It is only human nature to believe that anyone who is hiding something does not want us to know the truth. I do not believe that the Democrats ever took them seriously enough until after they showed their muscle in Massachusetts. And then it was too late.
We hear about backroom deals with blue dog senators that do not pass the smell test. In most instances the bill was drafted behind closed doors without significant dialogue in public hearings explaining how it works. It was initially presented to Congress and the Senate without any explanation as to how the costs would be covered. The public was simply supposed to trust them.
When details on financing came out, the vast bulk of the costs were to be underwritten by savings which the plan was supposed to generate. The proponents skipped over the details about how these costs would be wrenched out of the system. Obviously they were placing a lot of the burden on new regulations that they were also proposing.
I for one am cynical about cost reduction. History has proved that regulations coming out of the New Deal era were totally ineffective in reducing costs in the long run. Moreover, our government has proved that it has a rapacious appetite for spending saved moneys rather than paying off debt. I have watched the Department of Defense save costs decade after decade, but somehow the actual totals go up. We have already seen the Obama Administration’s propensity to spend. Last year the administration was downplaying the long term cost of TARP loans, because the banks would pay it back. Now that some of the banks are repaying the loans, Obama seems to be looking for ways to put the money into other give away programs.
Moreover, there are a myriad of taxes, including medicare premium increases, being proposed. Virtually every one of these taxes have been met by a maelstrom of criticism.
The sheer size of the bill also prevented thoughtful and thorough discussion of the ramifications of the plan. Most of the public, including me, does not understand all that the it entails.
Democrats charge the tea party types with distortion when they claim that the Federal government is planning to kill grandmother in order to save costs. The claim is easy to make, however, when no one can give an adequate explanation as to why that will not be the case. The cost savings are largely dependent on removing “unnecessary” expenses incurred in the final months of life. Admittedly a large portion of the costs are related to the final illness. Moreover, the present tends to enable incurring excessive expense for heroic but futile efforts to extend life. Who is going to make the decision as to which costs are unnecessary? Some bureaucrat?
The sprouting Tea Party movement has probably benefitted most from the non-transparency. They smell a conspiracy and have found that many others do, too. It is only human nature to believe that anyone who is hiding something does not want us to know the truth. I do not believe that the Democrats ever took them seriously enough until after they showed their muscle in Massachusetts. And then it was too late.
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