Please Drop Dead

(Editorial cartoon by Mike Luckovich and published 8/24/12 by the Atlanta Journal-Constitution. Click on image to enlarge and then kindly return.)

When I read the news about the "fiscal cliff" and rumors of a "grand bargain" to avoid it, I get nervous. It does indeed appear that the White House and the Democrats are only too happy to deal away Social Security and Medicare/Medicaid. The latest has to do with raising the eligibility age for Medicare to 67.  The excuses are always the same: people live longer now, thereby using up the money more quickly; as the Baby Boomer generation hits 65, many more people than anticipated will be getting the benefit, thereby using up the money more quickly; healthcare costs are rising and Medicare will soon be eating up more and more of the budget. All of that is bovine excrement being spread to hide the fact that our owners want the programs ended and all of us dependent on private insurers who will charge accordingly.

The Los Angeles Times published an editorial which, I assume, attempted to be "balanced" by listing all of these arguments as if they had merit. However, to be fair, the editorial did get around to addressing the real issues behind the rising costs of Medicare and Medicaid and suggesting more rational approaches to solving the problems.

Many of the steps lawmakers are considering treat Medicare's growing costs as an isolated phenomenon. In fact, they're symptoms of larger problems in the healthcare system. The United States spends far more per capita on healthcare than any other country, including Western European nations with much older populations. The extra spending yields better results in some areas, worse in others.

One factor in the elevated costs is advancing medical technology, or rather the fact that new and more expensive technologies are continually introduced with no consideration of whether they're more effective than what's already available. Another factor is the way healthcare is organized, delivered and paid for. Historically, there has been little coordination among the various doctors, specialists and hospitals who see a given patient. The payment system is even more Balkanized, creating a confusing matrix of prices and reimbursement rates that seem to have no relation to the value of the service performed.

More fundamentally, the system rewards providers for treating the ill and injured, not for keeping the public hale and hearty. Its financial incentives encourage providers to deliver as much treatment as possible. And there's little or no connection between what providers are paid and how effective their care is. As a result, the industry has an incentive to deliver an increasing number of treatments of greater complexity — to build more capacity, then find a way to fill it.

Bingo!

For those who would scream that this approach is just another form of health care rationing, I would point out that private insurers have been rationing health care, or at least the portion they are willing to pay for, for a long time.  And that rationing has often been capricious and malicious, requiring multiple appeals and threats from state insurance commissioners for those claimants with the time and money to protest. The kind of rationing to which the editorial refers are open and transparent and make sense. They also will save billions over the years.

Digby suggests that the rumor to raise the eligibility age for Medicare may be just a trial balloon being floated by the White House to see if it will fly. If Digby is right, and she usually is, then we really need to continue to phone, email, fax, write our representatives and the White House to let them know that the balloon is made of lead and not worthy of consideration.

I urge you to do some kingbirding and continue to bug Washington until it gets the message.