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    After supercommittee failure: figure out how to cut health costs

    We have had a demonstration of the nation's failure to govern itself. But what about our failure to control our health care costs, which make it impossible to compete internationally?

    President Obama, V.P. Biden and staff react as the House passes health care reform.

    President Obama, V.P. Biden and staff react as the House passes health care reform. White House

    A simple statement from the two co-chairs of the Joint Select Committee on Deficit Reduction. “After months of hard work and intense deliberations, we have come to the conclusion today that it will not be possible to make any bipartisan agreement available to the public before the committee’s deadline.”

    And, they continued, “despite our inability to bridge the committee’s significant differences, we end this process united in our belief that the nation's fiscal crisis must be addressed and that we cannot leave it for the next generation to solve.  We remain hopeful that Congress can build on this committee’s work and can find a way to tackle this issue in a way that works for the American people and our economy.”

    But let’s be clear about this statement, the committee, and Congress itself. This represents a failure to govern. There is a structural inability to make difficult choices about what the country needs to do to finance its operations. The so-called supercommittee is no different than the country and its citizenry. We are divided, locked into a struggle with significant differences about what to do next.

    Some of us believe that we should balance two competing ideas: We should invest in jobs. Now. Again. And keep doing that until everyone who wants a jobs has access to one. Then, and only then, the government should begin a long-term strategy of rethinking promises made through entitlement programs.

    The other view says cut government now. Shrink government, period. Don’t raise a single dime in new taxes — and let the economy grow again (after it crashes).

    Now we will read over the coming weeks and months about the tragedy of automatic budget cuts as the real numbers surface. Some will complain about how much smaller our military must become. Others will note the deep unfairness in cutting domestic programs that serve people who are at the lowest end of the economic spectrum. The president has already promised to veto any bills that try to get around the automatic budget cuts.

    But the real problem, the much bigger issue, is that this exercise represents a failure to govern. Congress could not reach a decision last summer, so it passed on extraordinary powers to the so-called supercommittee. Before that the administration passed on its authority to a bipartisan committee charged with coming up with a financial plan.

    So failure becomes the norm in our political discourse, we are defined by our inability to forge consensus.

    I live in rural Idaho and listen to local talk radio. The people who call the station cannot understand, let alone appreciate, any differences about how other citizens approach these difficult fiscal issues. It’s the same in the Blue Cities, only opposite. That divide makes it nearly impossible to acknowledge areas of common ground. This is not new in our history. Divides this great were present before the election of 1812 (some call it the second revolution), before the civil war, and before Prohibition was incorporated into the Constitution.

    Take health care. If we really want to fix the deficit in a way that will last, we need to reduce the cost of health care. We cannot afford to spend $7,538 per person when the rest of the industrial world spends under $4,000. Or, looking at it another way, we cannot compete in a world economy where we spend 16 percent of our Gross Domestic Product on health care when France pays 11.2 percent or Japan 8 percent.

    We need to make health care sustainable. That’s how we fix our budget. If we do this one thing, our budget problems will shrink into a manageable form. But we cannot even agree on the baby step we took last year with the Affordable Care Act. Perhaps that should be the only issue we debate during the 2012 election because it’s the only way to really get the cost of government under control.

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    Posted Sat, Nov 26, 1:10 p.m. Inappropriate

    Mark Trahant mischaracterizes the first camp. We do not believe in "rethinking" entitlement promises. We are firmly committed to the Social Security, Medicare, and Medicaid social insurance programs (let's call them by the proper name, since we have paid for these benefits all our working lives) and want to find ways to make them serve Americans better and make their financing more secure. Social Security can be fixed relatively easily, mostly by raising the cap on income subject to the payroll tax. Fixing the Medicare and Medicaid cost problems is inextricably tied to addressing the cost problems throughout the wasteful, quality-deficient U.S. health care system. Cutting Medicare and Medicaid eligibility and benefits doesn't solve any problems, it just transfers the problem to individuals, families, businesses, health care institutions, and state and local governments. Last year's health reform law is an important start in doing this the right way. Trahant also engages in standard mainstream media false equivalence. Both sides were not equally responsible for the supercommittee's impasse. For better or worse, the Dems put plenty of big cuts in social insurance programs on the table in exchange for ending the Bush tax cuts for the rich. The Republicans responded by proposing to cut the tax rate for the rich. So come on, let's tell the truth about what happened and stop with this fair-and-balanced pretend game.

    Posted Sat, Nov 26, 3:36 p.m. Inappropriate

    A single-payer system is the best way to reduce health care spending as a percentage of GDP. This is not theoretical; we know this from over 100 years of observing other national health care systems in every other industrialized country, from Canada and Japan to Germany and Finland, from politically conservative countries like Poland and Switzerland to politically liberal countries like Sweden and the Netherlands. Until Americans can understand this and are prepared to accept a single-payer system (or even a hybrid system as in the Netherlands or Germany), our health care costs will continue to bankrupt us.

    I agree that false equivalence is a serious problem in reporting on this and other budget-related issues. If a Democrat commits murder and a Republican gets a speeding ticket, or vice versa, a speeding ticket is still not the same as a murder just because the person in the other party committed murder.


    Posted Sat, Nov 26, 4:16 p.m. Inappropriate

    Todays “corporate journalism" confuses issues with words like gridlock and stalemate in articles about entitlements and healthcare. It gives the impression that both sides of the aisle are working on positive outcomes when clearly one side wants to sustain programs while the other wants to terminate them. Sadly, it's actually worse than no news coverage at all.


    Posted Sat, Nov 26, 6 p.m. Inappropriate

    Your sights are way low. I look for "single payer" food supply. We all need food and the wealthy and upper middle class eat far more healthy, nutritious, not to mention tasty, meals--they live longer too. The idea that we all, rich and poor, compete to buy food simply drives up the price. If the government supplied the food, made healthy choices available (if not mandatory) and controlled production of food we'd all save money, eat better and have more choices. Farmers would love it. Why this rational approach to nutrition is regarded as radical in western countries is a reflection of our insularity.


    Posted Sun, Nov 27, 11:37 a.m. Inappropriate

    On the subject of entitlements the two core ones are not entitlements despite the word being used. If you pay for SS for 50 plus years like have and if you pay for an annuity from Mutual of New York for 30 years like I have which one is an entitlement? Which one could I lose or have taken away ethically? Sure they both can be taken away but is it ethical. Does our congress remember that word? On Medicare I have paid in to it since I guess some where around 1965 or whenever it was started. I still pay into it as a retired person and that plus my supplemental insurance comes to about $3800 a year which is not cheap on retirement income but better than the ten grand I paid a year before the age of 65. Maybe it should have been made a little more securely financed like SS is. Remember SS has been borrowed to death for other government programs.

    Posted Sun, Nov 27, 11:54 a.m. Inappropriate

    The only way to control health care costs is to control pharmaceutical costs. Drug costs are the main driver in the rise in premiums; drugs, not procedures, keep people alive and semi-healthy (and semi-happy, in the case of anti-depressants). The US is where Pharma makes its profits; other developed countries control drug costs through regulation. Unless we remove ourselves from being the cash cow for Merck, et al., we'll never bring down costs.


    Posted Mon, Nov 28, 9:14 a.m. Inappropriate

    The problem isn't health costs, it is health insurance costs.

    Compare the profit levels in the insurance industry with the healthcare industry. Hospitals are laying off staff left and right. Is Regence?


    Posted Mon, Nov 28, 1:50 p.m. Inappropriate

    It's both health & malpractice insurance and pharmaceutical costs.

    If a doctor doesn't want to be sued, they have to order every possible test that's in the text book. A malpractice insurance pool would help doctors. Pharmaceuticals could be less if we let transborder or pooled purchases by medicare.

    Medicare for everyone would at least provide minimal care for everyone and instead of ending up in the emergency room, people could get preventative care. That alone would cut our costs hugely.

    Thirdly, having a giant pool of everybody insured would give an incentive to the government to promote healthy lifestyles. That's funding for bicycling and pedestrians because there's a payback in lower health costs. And possible banning GMO foods which increase obesity etc. Better regulation in the food supply might also have healthier people with lower costs.


    Posted Mon, Nov 28, 9:23 p.m. Inappropriate

    It's insane to me that each fall, those of us who are employed at a place with health care need to pore through possibly a variety of plans, health coverages, etc. This is a waste of time and effort, much like our bloated tax code.
    I worked in health care for five years in a department that cost $1.2 million, the major purpose was analyzing healthcare data. One cannot compare one plan to another easily: different procedures are covered or not, different co-pays, co-insurance, deductibles - individual and family, etc. Another department just existed to get the coding straight.
    The simplest solution of all is a single payer. Absent that, a handful of coverages that all employers can choose from (assuming we keep the employer-based system). Individuals can add on pre-defined packages if they desire. In other words, end the free-for-all for coverages. What also makes senses: having "best practices" rule throughout the land (sharing). Having some control over what machines are available where so that the facility doesn't have to justify the cost of a machine by referring people towards using it. There are many, many ideas out there, these are just some. And, of course, a controlled approach to obesity, rather than having choices, as this epidemic costs us all.


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