The Role Of Government

I spoke this week with a friend.  He pointed out numerous problems with Medicare, Medicaid, and healthcare in general, which if corrected would produce a lower cost and just as effective delivery of health care services.  I suggested an alternative approach might be to adopt a system drawn from the experience of over two dozen other modern countries around the world which offer all residents health care at one half the cost the US spends, and produce outcomes equal to or superior to those of the US.  He dismissed this notion with “I just wouldn’t trust the government with doing anything”.

My friend is intelligent, informed, and a genuine decent person.  I could not help ask, “what was he thinking?”

As we talked further I got a clue.  My friend spoke of corrupt or self centered elected officials.  Hmmm.  He said these members of Congress are only interested in their own best interests and would make healthcare decision that directly or indirectly enriched themselves.  Why would he think that?

The next few weeks should remind us of why.  Congress has two deadlines.  One concerns how to fund daily government operations.  In the perfect world Congress would be debating a budget (like any normal corporation).  Instead Congress members cannot agree on a spending plan compatible with an effort to balance the budget so they will resort to the infamous “continuing resolution”.  The CR allows Congress to avoid any real cuts and keeps things as they are.  No risk for the Congress members.

There is a second deadline coming right behind.  The national debt is about to exceed the limit set by Congress.  Even though the debt is about money already spent (authorized by Congress itself), Republicans want to “negotiate” an extension.  The GOP says it wants offsets for any agreement to increase the deficit.  At first this sounds plausible until it dawns on you that the budget discussion is the place to incorporate reduced spending.  Hmmm.

A good number of Congress members are quite vocal about holding spending hostage if they were to agree to increase the debt.  But now even more (all Republicans) are saying they would accept a delay in implementing the Affordable Care Act (that is delaying the availability of health care insurance to millions) in exchange for increasing the debt limit.  Hmmm.

The implied message here is that if the President does not negotiate, the GOP will allow the Country to default and in the process shut it down.  Is that governing?

Motives are always hard to know.  Why would some members of Congress tie healthcare to the debt?  Why wouldn’t Congress have discussed and debated budget alternatives sufficient to reduce the deficit over time earlier in 2013?  Why wouldn’t the GOP have published position paper after position paper on how it would propose to balance the budget?  Why wouldn’t men/women of good intentions not have openly discussed how the deficit and debt could be dealt with?

Ironically, most experts have said that any compromise to balance the budget or bring the debt under control runs right through healthcare.  Medicare, Medicaid, and Defense are the three largest Government expenditures.  A national healthcare fix such as found in Germany, France, Japan and some 20 other countries would eliminate the need for Medicare and Medicaid and could drive costs down for individuals as well as the Government.

My friend’s fear of government involvement, if based upon the performance of 113th Congress, is sadly understandable.  I guess we will be left with mediocre but expensive healthcare and third world like Congressional governance until the Country bankrupts.

The Affordable Care Act represents a noble advance from what preceded it, but falls far short of universal healthcare and will cost a lot more.

I continue to think Congress “could” do better, and my friend continues to hold that Congress “would not” do better.  Hmmm.

 

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