The Invisible Government Health Care System



Posted: Friday, August 28, 2009

by
Charleston Perlo

Health Care Reform is confusing and scary. Will the proposed changes make costs go up or come down? How will the quality of service be effected? Will treatment improve or get worse? And who will make the decisions that determine how cases and patients are handled? An unknown bureaucrat in Washington or one of the ten federal regions, or an unknown bureaucrat at the end of an 800 number who works for a private insurer and turns down a request for treatment as being outside of standard protocol? And who will pay for the changes? Can the nation afford to cover the 44 million uninsured? What loopholes are unforeseen?

Perlo doesn't have a crystal ball, juju beads, or oracle bones, but it clicked through google and bing and discovered an already massive, invisible system of government health care that no one is talking about and that your tax dollars pay for.

The federal government is already deeply, deeply involved in health care in a myriad of ways, from the labels on packages to manufacturing standards to expanding markets to building roads and buying ambulances to operating clinics and subsiding nutrition to funding training to reimbursing service providers for minor treatment and major operations.

A good way to assess future performance is to look at past results. There is a huge amount of data and performance reports available that can guide the national conversation about health care priorities, costs-and potential savings, and can help identify needs and a sensible path to new policies.

As Booker T. Washington, the Virginia-born founder of Alabama's Tuskegee Institute, said in his 1896 Atlanta Exposition speech, "cast down your buckets where you are." To gain a fuller picture of the dollars the federal government is currently spending, examine the annual budgets of only a few programs and departments from the government's invisible empire of health services.

There are 1,961 mentions of "health" in 181 federal budget documents for 2009.

Examine the invisible government health care expenses by several themes: treatment, costs for specific illness, drug prices, public payer, public health care providers, breath and scope of federal health services in all departments.

At first reaction, the numbers from every corner are staggering. Health care, clearly, has created a "giant sucking sound," that tax dollars are flying into, inside and outside of treatment care. Reform is necessary, if only to stop the rapidly increasing flow of dollars.

The Director of the Congressional Budget Office wrote these powerful words on his blog, about his recent testimony before Congress:

" Under current law, the federal budget is on an unsustainable path, because federal debt will continue to grow much faster than the economy over the long run. . . Unless revenues increase just as rapidly, the rise in spending will produce growing budget deficits. Large budget deficits would reduce national saving, leading to more borrowing from abroad and less domestic investment, which in turn would depress economic growth in the United States.

Measured relative to GDP, almost all of the projected growth in federal spending other than interest payments on the debt stems from the three largest entitlement programs-Medicare, Medicaid, and Social Security. For decades, spending on Medicare and Medicaid has been growing faster than the economy. CBO projects that if current laws do not change, federal spending on Medicare and Medicaid combined will grow from roughly 5 percent of GDP today to almost 10 percent by 2035. By 2080, the government would be spending almost as much, as a share of the economy, on just its two major health care programs as it has spent on all of its programs and services in recent years.

In CBO's estimates, the increase in spending for Medicare and Medicaid will account for 80 percent of spending increases for the three entitlement programs between now and 2035 and 90 percent of spending growth between now and 2080."

Clearly, the first goal of reform must be to cut costs, reduce expenses, save money. Do any of the current plans meet this goal?

Secondly, waste, duplications, inefficiencies, and hidden costs abound throughout the systems and much of the real costs are off the books and are deeply embedded in each federal department. Critical and close oversight of these widely disbursed costs must be achieved. Through coordination, cooperation, and consolidation, it appears that real, significant savings in administration, services, and support can be achieved. The expenses connected to diabetes hidden in the system are a screaming poster child for theneed for teamwork. Grouping all health care expenses on a spread sheet that cuts across cabinet lines must be a high priority.

Thirdly, costs must be matched to measurable targets. How do only one percent of all users of the system account for 27 percent of the costs? Strategies for chronic users must be developed, better profiles created, alternatives explored. Name the top three creative ideas in the current reform plans. Without new ideas, how can there be reform?

Fourthly, drug costs must be severely curtailed.

Fifth, the cost of routine procedures must be reduced. Child birth is an example of a procedures whose costs have skyrocketed. Why?

Sixth, the government does efficiently provide medicaid, medicare, veteran health care, public immunization, disease mapping, research, and large grants to communities and individuals.

Seventh, so does the private sector. But in both cases, costs are raising to rapidly.

Lastly, future fears are being used to shield the maladies, malaprops, and out of control spending of the present. The US territories, Guam, American Samoa, Puerto Rico, for example absorb a large percent of health care funding. How exactly will reform affect the territories? And why are the current bankruptcies, unfathomable bills, and budget-breaking proscription costs not a part of the public debate?

Oh, watch carefully the special interests that suggest the government will enact forms of euthanasia for the elderly, or develop a plan with cracks so wide that legions will fall through, or increase private costs more rapidly. Having chased answers for treatment and services from the smallest detail to major conditions (a few years ago, my father suffered pulmonary edema over a weekend while in the hospital and it took five days for the family to get an assessment from the primary physician-while the consulting cardiac physician refused to speak at all to a family member despite repeated requests), I believe the answer to improved care lies in better values. The culture of American medicine must be reformed, along with its cost and payment structures, and the culture of its stake holders, the unions, medical/hospital/pharma/insurance associations who tremble and fear change, and resist it even worse than the American public.

All photos, fair use.

Thanks for reading. Walter Rhett writes Southern Perlo from Kudu Coffee, in downtown Charleston, SC. In town? Share a cup w/ Walt.

Follow Walt at twitter.com/walterrhett, as he takes special note of the news, folly, and business of living at all levels around the globe.

In peace and respect, Southern Perlo marks the passing of Senator Edward Kennedy of Massachusetts, an American citizen-legislator.

Walter Rhett Walter Rhett attended Ohio State and writes from Charleston, SC. He writes about national and global affairs with an eye on Southern history and culture and enjoys listening to his readers.

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