Here are the facts. Medicare is a critical program that helps people age 65 or older achieve health security. But it’s headed for a painful collapse. Independent experts and leaders in both parties agree that if we do nothing, Medicare will exhaust its trust fund in nine years, putting enormous pressure on the federal budget as health-care costs continue to rise. Unless we act, we’re moving toward a debt-fueled economic crisis, harsh cuts that affect today’s seniors and enormous tax increases that diminish the dreams of the next generation.
We can save Medicare, but we have to reform it so that it delivers the high quality we expect, at a price we can afford.
Medicare is one of the worst examples of forced cost-shifting at the point of a gun. It creates monstrous distortions in the delivery of health care and, when coupled with a legal environment that permits behavior illegal in other fields (anti-trust exemptions, demands to provide service to those who cannot pay, including those who can’t pay by choice and explicit legal support for price-fixing across international boundaries) we have created a “free money spigot” that has cranked up the cost of health care at multiples of the general inflation rate while failing to materially improve the quality of care.
But compound functions like this cannot go on forever. The solution is not “vouchers”, which simply shift the cost yet again, this time onto the back of seniors instead of the population generally. Nor can we realistically exempt anyone 55 and older – the bulk of the boomers are in the bracket from 55-65, and they will enter the system over the next ten years.
We must fix the structure of health care in the United States.
But neither the left or right is interested in doing this. Fixing the structure of health care means telling the medical industry to stick it. It means repealing EMTALA and forcing level pricing and billing for everyone, forbidding medical providers from forcing you to pay for Juanita’s illegal entry to the United States which she did for the explicit purpose of obtaining “free” medical care when she gave birth. It means telling the pharmaceutical and device firms that if they are going to sell drugs in other first-world nations like Canada for $2/pill they cannot price-fix here, and that if someone buys those drugs in another nation and re-imports them, that’s perfectly legal. It means having the conversation with the American public we needed to have two decades ago, explaining that Grandma cannot have two new hips and Grandpa a quadruple-bypass – we simply don’t have the money to provide one hundred million of those over a space of 20 years, and that’s what the current system is demanding we provide.
It requires that we have an honest discussion about not only personal responsibility, but also a full and robust scientific review of what we’re telling people about diet and exercise. Does everyone need that 30 minutes of moderate exercise at least three times a week? Yes. But is the “food pyramid” as currently constructed and promoted valid? That’s a better question, especially in the world of engineered “foods” such as high-fructose corn syrup and other high-glycemic-index processed foods that do nothing about satisfying hunger but do plenty to fatten both waistlines and “food” company balance sheets.
Never mind the other problem we have with the medical industry – being sick is big business. Especially if you’re “chronically” sick but the industry can give you a nice pill and make it all better. For a while, anyway. We have a diabetes epidemic in the United States but much of it is self-inflicted. It’s easier to demand a $300/month prescription for some wonder drug (even with its risks and side effects) than to buy a $100 pair of running shoes and get off your ass, even though a huge percentage of Type II diabetics are 50lbs or more overweight and if they lose the weight their blood sugar will either come back into balance or they will be able to control it with older, generic medications that cost pennies. What is our social responsibility as a nation to provide? The running shoes, the $300/month pill, or nothing, since the solution is as close as the suffers’ pie hole?
None of this is easy and it sure as hell is tougher than simply running the common demagogue positions on the left and right. The right wants to throw Granny down the stairs. The left wants socialized medicine.
The truth is that if we don’t cut the crap we’re going to wind up both ridiculously ill and broke. Our nation cannot continue on the path we’re on. We cannot “get our health care costs under control” while maintaining the system for health care as it exists now in the United States.
There’s no way to solve the cost escalation problem, with near-double-digit increases every year in actual cost, without shutting off the cost-shifting and changing the paradigm on how health care works in the United States. EMTALA may have been well-intentioned but it has become of the biggest drivers in the escalation of hospital costs, rendering nearly anyone, even those who are insured, subject to instant financial ruin should they have a medical emergency.
The common tonics dispensed by the left and right sound good but they’re both wrong and time is running out to do the right thing.
Ryan’s plan isn’t it.