the important and the not-so-important, horribly conflated.


In healthcare on June 15, 2009 at 9:40 am

any real reform to our nation’s health care system must take a close look at medicare, the current health “safety net” for millions of americans. tyler cowen’s piece in the sunday business times argues for the creation of an independent medicare expense review board, an idea supported by the white house. before any new public plan is implemented, cowen asserts, we need to get the costs of medicare down:

“67 percent of Americans believe that they do not receive enough treatment and [only] 16 percent believe that they have received unnecessary care. If the Obama administration covers more people with government-supplied or government-subsidized insurance, the political support will broaden for generous benefits, their continuation and, indeed, expansion of current expenditures.”

The line of thinking goes like this: if we are already over-treating patients (and we are), and unnecessary care is responsible for skyrocketing costs, we will see expenditures spiral out of control if we treat the 67 percent of the nation who don’t think they get enough care like the 1/3 who do. as a solution, Cowen proposes–coupled with the medicare review board–a one-time tax on health benefits. OK. That creates incentives for both the public and private sector to demand more efficient, lower cost care… but it will also undoubtedly lead to medicare cuts (something Obama proposed on friday as a possible source of funding for a new public option), which creates an even higher, perhaps unscalable, barrier to care for groups like the homeless, drug users, and illegal immigrants who depend on hospitals with medicare support.

i reject the premise that fiscal responsibility and moral obligation are mutually exclusive in the ongoing health care reform debate. we can have equal and efficient care–politicians need to realize that they are the ones who must make sacrifices, not their constituents.


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