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July 7, 2011

Budget Battles vs. Reality

Patricia A. Kelly

The battle rages. Republicans refuse to raise the debt ceiling without spending cuts. Democrats accuse Republicans of reactionary politics, and lack of concern for the people. Both sides declare that their special offerings to their constituents must be honored.


“NMSP or not my special program” seems to be the watchword, as usual. A lot of emotional talk and accusations are being bantered about, without serious effort to find reasonable answers.


One would think that the government of the United States of America should have access to the most brilliant minds in the world in the area of finance. Suze Orman could do a better job of planning our country’s financial life than the Congress, access to brilliant minds notwithstanding.


It doesn’t take much intelligence to get that, if you keep spending more money than you have, you’ll end up in financial distress. Unlike countries such as Greece, which have no resources to fall back on, we do have some. Just reversing Bush tax cuts, or a onetime tax surcharge could help us out of trouble.


That would not, however, solve the underlying problem. What the people seem to want is the more appropriate solution, limitation of spending, and a balanced budget.


Health care and entitlements inspire huge arguments. The word entitlement implies something that is owed rather than something which is earned. In the present case, nothing could be further from the truth. People did pay for social security, and they have a right to collect at least what they paid. No matter that the U. S. government stole money from the Social Security Trust. (That is what you call it when money is borrowed and not repaid.)


As for Medicare, people paid into that, too, also without choice, and have not made other plans for late in life healthcare. President Lyndon Johnson started this program when it became very difficult for older people to get private insurance.


The solutions called for, reduced provider payment and reduced benefits to consumers, are extremely simplistic and would cause more problems than they would solve. As it is, physicians are reluctant to take new Medicare patients.


What would happen if their payments were reduced further? A review today of one patient’s medical bills for the first half of 2011 showed reimbursement by private insurance of only 60% of charges. There’s something wrong with this picture. Would physicians be paid even less if they charged more reasonable fees?


The health provider reimbursement system that we have is quite similar to the tax code in that it is a rabbit warren of confusing rules. Just as the tax code has spawned the game of “push the envelope” among taxpayers, the reimbursement system has spawned a new industry among healthcare providers that could be named “skip through the rules and get the money.” Hospitals have full time staff working on getting maximum reimbursement per patient visit. Physician practices have “people” who work full time at staying ahead of rule changes so that physician income can be maximized.


Just as people have to pay professionals to minimize their tax payments on complex, present day returns because the rules are so difficult to follow, most people have no clue as to actual costs for medical care. That means keeping costs down is a very difficult trick. People who are insured concern themselves with co pays, not prices. People who are uninsured go from emergency to emergency, often simply not paying the bills because they can’t afford them.


As it is, insurance and malpractice issues run health care, as physicians feel that they must run questionably necessary tests if insurance covers them. The reason for this is that a bad outcome for the patient would be blamed on the physician if he did not run a test that was paid for, and thus established as part of the standard of care. The new healthcare reform bill will lead to more of the same. If you knew how many highly radioactive abdominal C.A.T. scans were run on young women who show up in emergency departments with belly aches, you would wonder why there are any children born without two heads or three eyes.


Careful examination of hidden costs would go a long way toward saving money for health care programs. Responsibility for care decisions should rest with informed consumers and physicians. If your belly ache doesn’t go away a few days after you don’t get that C.A.T. scan, it should be your responsibility to return for a re-check, not the doctor’s.


One good element of the health care reform bill is payment for the care conference held by the physician and family to discuss likely results of care and treatment, especially in people who are probably nearing the end of their lives. This already happens sometimes, but not often enough. In a free country, people should be allowed to choose even long-shot treatment, but many languish in nursing homes receiving futile care that doesn’t help the quality of their lives at all. If many of these people or their families had been informed of the likely outcome of treatment, they would have chosen comfort measures instead.


Our system is so full of long standing, tightly woven relationships, from donors, to voters, to lobbyists, to corporate interests, that a long row of sacred cows stands between the problems we face and reasonable solutions. No one even looks at things that could really help because they don’t want old “friends” to be upset. This must stop, and a careful look must be given to the entire picture, not just to simplistic, vote generating solutions that actually damage the working, tax-paying people of this country.


It’s time to play hardball, and look for real solutions before we both bankrupt ourselves and violate the traditional values of our society.


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