Friday, May 20, 2011

Solving the Budget Deficit—Step Four: Repairing Social Security and Medicare (Part II)

There is no way to sugar-coat the solution to Medicare, so here’s the brutal truth that no one wants to say or hear: We cannot afford all of the benefits that medical, technological and pharmacological advances can provide. We have learned to delay death, but with a huge economic burden attached.

Yes, the system is inefficient and changes, especially to claims processing, will free up billions of dollars. Yes, doctors perform too many tests because we are a litigious society. Yes, doctors have a tendency to prescribe the latest (and therefore most expensive) drug therapy because some salesman touted a study (paid by drug company dollars) that showed a miniscule improvement over a generic.

Yes, Congress has put fetters on the Medicare system by not allowing it to negotiate drug costs, which any private insurance company can do. We can remove those restraints and save money.

We should make all of those changes, but even if we do, spiraling health care costs that we cannot afford will still confront us.

The conversation that we must have in the United States is this: what level of care shall we provide to all comers regardless of age or income level?
Study after study shows that preventative care for children pays for itself in reduced medical costs as the children become adults. Study after study documents the huge costs we incur extending the life of those who are terminally ill.

Economically, funding life-extending “therapies” but not funding preventative care makes absolutely no sense—there must be some other reason we make these decisions.
In part we make them because no one is paying for them—except future generations through our current borrowing. We make them because we each want the best for our loved ones and when ours are the ones dying, any cost seems justified. We make them because no one has asked us to answer the hard questions with sober minds.

We can either cut benefits or raise taxes to pay for the benefits we currently have. The way to address benefit cuts is not through the false promise of Paul Ryan’s privatization wherein the poor and sick are slowly squeezed out of the marketplace.

We need to be honest and make decisions—tough decisions—about what benefits we will provide our poor and elderly and what benefits we will not provide. If they are rich enough, they can still obtain these benefits privately; taxpayer money is no longer involved.

All the measures we have tried in the past to control medical costs have been like squeezing a balloon at its current bulge. The bulge disappeared from the one spot, but appeared somewhere else. We need to untie the balloon’s knot and let out some air. Late in 2010, Arizona decided AHCCCS (its Medicaid-equivalent program) would no longer fund all lung and some heart and bone-marrow transplants. By April this year the pressure was too much and the new budget restored those cuts.

I don’t know what the right answers are, but as a nation we need to make some really difficult decisions. Should we cover liver and heart and kidney transplants? Should we cover drugs that cost tens of thousands of dollars a year? Should we cover premature babies who cost over a million dollars just to bring to term and who will have increased medical expenses throughout their lives? Should we replace knees and hips and corneas?

Your answers may differ from mine, but if we want to solve the Medicare problem we need to collectively answer those questions, weighing what our hearts and wallets say.

I have great faith in Americans. IF we are asked to make hard decisions we will make them. Now we just need politicians willing to do the same.

~ Jim

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