Members of a heretofore independent panel on Gulf War Illness are accusing Veterans Affairs Secretary Eric Shinseki of “shooting the messenger” by gutting their committee and slashing half its members in a recent charter rewrite.
A member of the Research Advisory Committee (RAC) on Gulf War Illness told The American Conservative over the weekend that Shinseki was retaliating against them for their unvarnished, public criticism of the agency—in the press and on Capitol Hill. Most recently, members Anthony Hardie, a Gulf War veteran and advocate for the estimated 250,000 vets suffering with Gulf War Illness (GWI), and Dr. Lea Steele, a longtime GWI researcher, testified with former VA scientist Steven Coughlin on the Hill. Both RAC members complained that bureaucrats and researchers in the agency were driven by an agenda that preferred viewing GWI as a psychological rather than physical condition.
TAC interviewed Coughlin and Hardie after the hearing. Coughlin said his bosses manipulated and ignored data that did not coincide with their agenda. Hardie concurred, saying that the RAC had been forced to deal with this VA bias for some time and that complaints about it had been ignored. In 2008 for example, the committee released a report saying that GWI was a physical condition caused by toxins, including pesticides and the pills that the soldiers were given to counteract the effects of nerve gas. Since then, committee members have accused the VA of trying to undermine their findings. (The VA’s critics say it is trying to avoid the massive expense of liability, a charge the VA has adamantly denied. Officials have also denied that the VA is trying to push the psychological explanation over the physiological one.)
The damage done to the 15-year-old RAC last month by Shinseki’s hand might forever take the teeth out of the scrappy committee, which is supposed to convene for a regular meeting this week in Washington. The changes to the RAC charter would ax six of its 12 members and replace them “in accordance with VA policy,” according to a letter to RAC chairman James Binns signed by Shinseki’s interim chief of staff, Jose Riojas. The letter was provided to reporter Kelly Kennedy, who wrote about it at USA Today on Friday. The measure also removes Binns—whom the committee called their “principled, fair, just, non-partisan, longstanding champion” of veterans—after a one-year “transition period.” The letter does not identify which other members will have to go. Read More…
Human cloning is real.
Yesterday, the prominent scientific journal Cell published a paper by scientists at Oregon Health & Science University announcing that they had successfully derived stem cell lines from cloned human embryos. Some context is necessary, however, to start to grasp the implications of what has taken place.
First of all, a brief primer to the science. Cloning is more commonly referred to in scientific circles as “somatic cell nuclear transfer (SCNT),” where scientists take the DNA from an adult (somatic) cell and transfer it into an unfertilized egg, which has had its own DNA removed. Normally to begin developing into an embryo, a fetus, and ultimately an adult human being, the egg has to be fertilized by a sperm to which kick off the series of coordinated steps that constitute human development.
Instead of having the genetic material from two parents combine into a unique new life, however, cloning takes the full genetic information from an adult and places it into the emptied egg. These researchers immersed the egg in a caffeine solution and delivered regular electrical shocks, among other techniques, forcing it to enter development, dividing and growing until it reached “blastocyst” stage, where a protective outer layer called the trophoblast surrounds the mass of inner cells (ICM) that will constitute the myriad parts of a human body, and being.
At this point, as is the necessary procedure to obtain embryonic stem cells, they dissolved that protective outer layer to obtain the inner cells rich in total potential, and grew them into an “immortal” line of stem cells. To prove their success, some of those cells were programmed into muscle cells and grown into tumors under the skin of immune-suppressed mice. The muscle cells were made to contract, and filmed doing so.
The controversies and debates about cloning specifically are legion, and will be given new intensity with this announcement, but some points can be made at the outset. For those who believe that human life is worthy of protection from its inception, the creation of a human life for the express purpose of destroying it, and manipulating what could have been a child into reproducible tissue for manipulation and research is abhorrent.
Cloning compounds these considerations by transforming the nature of human life itself. As sexual beings, every child is the product of a union, possessing a unique inheritance unto themselves (identical twins notwithstanding) that will generate and govern their own story going forward. Cloning, however, gives that child the inheritance of a life already once lived. Many of our reproductive technologies already run perilously close to making the creation of life into manufacture, and cloning would drastically advance that by beginning to recycle the very material of life, to some degree inevitably making a newborn into a do-over. The demand is already there, to recover a lost child, to regenerate a dead genius, to live on forever genetically intact. We should not provide the supply.
These scientists protest that they have no interest in reproductive cloning, though, and indeed claim that a forthcoming paper will prove that their technique cannot be used to bring a child to term even if they wanted to do so. Even here, their justifications are weak. Embryonic stem cells, far from the promises of universal supply kits of personalized medicine promised at the DNC a decade back, have an inherent limit: human embryos are hard to come by. They require women to undergo highly invasive and sometimes risky techniques not to give birth, but to give scientists material to work with. The women used in this study were paid thousands of dollars, raising concerns over the exploitation of the poor, the commodification of the human body, and the commercialization of women’s reproductive powers. Furthermore, the research shows that while these scientists were very efficient, techniques obtaining more than 16 eggs at once produced eggs drastically less capable of being used for cloning.
Moreover, human embryonic stem cell research has fallen off dramatically since the discovery in 2006 of a technique for turning adult cells back into the “pluripotent” state embryos are so desirable for, at much less cost and without the ethical concerns of destroying embryos. Those cells, induced pluripotent stem cells (iPS), won Shinya Yamanaka a Nobel Prize for his efforts this year, and have revolutionized the stem cell research world. That breakthrough, it must be recognized, took place under a Japanese regulatory regime that made experimenting on human embryos almost impossible.
Taken together, a strong case is made for banning human cloning of any sort, and for keeping scientific research within the bounds of what is morally acceptable. Science wields awesome powers for achieving the ends we set before it, and we should not do it so little credit as to assume that medical progress must be ethically transgressive.
Tevi Troy has an article in the new issue of National Affairs on presidential transitions, after working as the director of domestic policy for the Romney Readiness Project (or R2P, as it was called). The Romney campaign was the first to benefit from the 2010 Pre-Election Presidential Transition Act, which bumped up the timetable for federal transition support to after the party nominating conventions instead of after elections. The most interesting tidbit in Troy’s article pertains to how Team Romney intended to roll back Obamacare without a full repeal:
One key campaign promise that affected the Department of Health and Human Services was the pledge to repeal Obamacare. This promise elicited widespread skepticism, because even in the optimistic scenarios that had Romney winning the presidency, the prospects for a GOP majority in the Senate were plummeting fast (and the odds of a GOP supermajority of 60 votes were zero). Without full control of both houses, a straight-up, all-out repeal was unlikely.
In response to this challenge, the R2P team, which included some of the GOP’s top health-care thinkers, came up with an aggressive approach that would have both stopped and rolled back the implementation of Obamacare in such an overwhelming way that Senate Democrats would have had to come to the table to discuss some kind of repeal package. The law gives HHS enormous leeway to make a large number of key implementation decisions, and in the hands of an administration eager for repeal, our experts concluded that this leeway would make it possible to effectively nullify the new system through a carefully choreographed series of executive actions. The regulatory rollback would have been so complete that we were confident Obamacare never could have gotten off the ground and that a path toward real, market-based health-care reform would have been opened.
Basically, eat away at enough of the the thing that collapse is inevitable and repeal seems like the better option to Senate Democrats.
Count me with Rod, Conor Friedersdorf, and many, many others in thinking the lack of media coverage of Kermit Gosnell’s charnel house is pretty damning. Mollie Zeigler Hemingway has begun her own inquisition of sorts, calling up journalists and making them explain their lack of coverage, for which an Atlantic senior editor accused her of fomenting anti-Semitism.
But as some people are finally starting to point out today, Dave Weigel among others, many of the details from this case have been known since at least January 2011, when the indictment came down and the grand jury report was released. There is a documentary too which I’ve embedded above, which was posted to YouTube in January. It’s pretty rough to watch; you’ve been warned.
Back in 2011, Will Saletan wrote, in an essay critiquing the pro-choice absolutist view that abortions should be legal without regard to the age of the fetus:
There’s no moral difference between eight, 18, and 28 weeks. No one has the right to judge another person’s abortion decision, regardless of her stage of pregnancy. Each woman is entitled to decide not only whether to have an abortion, but how long she can wait to make that choice.
It’s one thing to preach these ideas in the lefty blogosphere. It’s quite another to see them in practice. That’s where Kermit Gosnell, the doctor at the center of the Philadelphia scandal, comes in. According to the newly released grand jury report, Gosnell accepted abortion patients without regard to gestational age. “Gosnell catered to the women who couldn’t get abortions elsewhere—because they were too pregnant,” the report explains. … You can argue that what Gosnell did wasn’t conventional abortion—he routinely delivered the babies before slitting their necks—but the 33 proposed charges involving the Abortion Control Act have nothing to do with that. Those charges pertain strictly to a time limit: performing abortions beyond 24 weeks. Should Gosnell be prosecuted for violating that limit? Is it OK to outlaw abortions at 28, 30, or 32 weeks? Or is drawing such a line an unacceptable breach of women’s autonomy?
He was criticized over at Feministing for his “anti-choice bullshit”:
Perhaps most importantly, let’s not forget why the likely majority these women went to a potentially criminal practice like Kermit Gosnell’s: because of the anti-choice measures that limit women’s access to safe and affordable (and, in this case, legal) abortion care.
The same day Saletan’s article came out, The Daily Beast’s Michelle Goldberg had one of her own arguing basically the same thing, and that Gosnell operated a “rogue clinic”:
Gosnell’s crimes only underline the need for all women to have access to affordable and genuinely safe providers. His patients subjected themselves to terrible abuses because that’s what women will do when they’re desperate and they don’t see other options. … Gosnell was able to do what he did because the women who came to him had fallen through the cracks of our damaged medical system.
There were others back then too. Today, there are lots of people saying more or less the same thing. Not a single one of them have even attempted to reconcile that the failure to keep tabs on Gosnell’s clinic was apparently due to a political decision in 1993 not to inspect it. From the grand jury report:
After 1993, even that pro forma effort [to inspect Gosnell's clinic and report its failings] came to an end. Not because of administrative ennui, although there had been plenty. Instead, the Pennsylvania Department of Health abruptly decided, for political reasons, to stop inspecting abortion clinics at all. The politics in question were not anti-abortion, but pro. With the change of administration from Governor Casey to Governor Ridge, officials concluded that inspections would be “putting a barrier up to women” seeking abortions.
In other words, it strongly suggests the absolutist pro-choice view that any regulation of abortion constitutes an infringement on reproductive rights led to the clinic not being overseen properly. All of these people had access to the grand jury report, even back in 2011. To ignore that and then make the case for why abortions should be more widespread and less regulated is incredibly dishonest.
James Pinkerton has been making a series of arguments here advocating research into cures as the best way of controlling healthcare costs, especially since cures have far and away the greatest non-financial benefits to society, compared to rations or restrictions on care. In a fortuitous bit of timing, just as the conclusion of his latest two-part-series posted yesterday, the New England Journal of Medicine published a report exposing just how great the cost of our current state of affairs is becoming.
In one of the most through investigations of dementia on record, researchers led by Dr. Michael Hurd of the RAND Corporation used “the Health and Retirement Study (HRS), a nationally representative longitudinal study of older adults” to greatly improve on the previous attempts to quantify dementia’s monetary costs. By controlling for the additional illnesses dementia patients are subject to due to accidents of age and demographics, the researchers were able to determine that dementia alone incurs additional marketplace costs of approximately $28,501. Adjusted, almost half, $14,000, of this was for nursing home care.
Dementia’s costs are not purely born out in the marketplace, however, as it is much more likely to involve informal home care by family members or unrelated volunteers. When the researchers added a valuation for home care informally provided, the cost of dementia soared to approximately either $41,689 or $56,290, depending on whether you valued that care by foregone wages or the value of equivalent marketplace care.
These are the total financial costs for a theoretical average individual dementia patient, controlling for many variances. Aggregated, the costs are vast, and are only set to explode. The researchers found that the total marketplace cost of dementia in 2010 was $109 billion, and either $159 or $215 billion for total cost including informal care. That’s the good news. Predicting that the cost of care would remain constant, a conservative assumption, they predicted that by 2040, less than thirty years away, dementia costs would rise to $259 billion in marketplace care, and either $379 or $511 billion in total care. Even adjusting for the ability of population growth to moderate some of the effect of this explosion, per-capita costs of dementia would increase nearly 80 percent.
As I wrote in the aftermath of Pope Benedict’s age-driven resignation,
Older wisdoms need to be brought to bear to teach us once again about mortality, and living life well to the end. New strategies need to be created to help us care for ourselves and each other.
The tremendous diversity we find in all things human is all the more present here. We will each age distinctively, in keeping with the discrete combinations of genetic inheritance and lived experience that make us who we are. Some will find their body betray them as their wits are still sharp, some will have their body persist past their best days. Many will stay strong to the very end. My own grandfather may have lost some of the pep off his driver on the golf course, but he still undershoots his age and beats his son-in-law and grandson every time out. But the lives we set up for ourselves in the post-war era of independence now, independence forever, may not survive unchanged under the strain of the challenges we face. We may need to reach back and revive older traditions of multi-generational households. We may have the wealth to continue building a service sector to support us in our later days. However the years to come turn out, we can be sure that our society will soon look very different than it does today.
Perhaps the brain-mapping plans outlined in the President’s recently revealed $100 million BRAIN Initiative will lead to cures somewhere down the line, but it is wise to be cautious about the ability of scientists to truly understand and minister to our inner selves. Even if large medical advances come out in the decades ahead, as one presumes will happen, the lesson of the past fifty years should teach us that better health is not always cheaper, and new technologies are expensive to bring to market.
What seems certain, though, is that dementia and the costs of aging will be an ever-increasing part of our public and personal concerns.
Writing in the New Republic, in 2005, less than a year after the reelection of George W. Bush had left many liberals feeling that they’d lost the “war of ideas,” Jonathan Chait, as ever contrary, insisted that there was no need for “new” ideas. The old ones, so to speak, were just fine. What the center-left lacked was the power to enact them:
It’s one thing for Democrats to sketch out the sort of alternatives they would prefer if they ran Washington. But, as long as Republicans do run Washington—and certainly as long as Bush sits in the Oval Office—doing nothing is often going to be the best available scenario for liberals. Emphasizing the downside of bad change rather than the upside of positive change reflects political necessity, not intellectual failure.
I thought of Chait’s piece as I read through House Budget Committee Chairman Paul Ryan’s latest annual budget resolution, otherwise known as “The Path to Prosperity.” If you pulled Ryan aside and threw the Lasso of Truth around him, I imagine he’d say something very like what Chait expressed in 2005: “I like my ideas. I could have done a lot more to realize them if I were vice president. But for now, I have to wait.”
The Ryan budget has two overarching policy objectives: 1) Entitlement reform: specifically, putting a limit on Medicare’s annual budget and giving states a lot more flexibility over their Medicaid rolls; and 2) radically simplifying the tax code.
Ryan is no fool; he knows there is no chance the Obama administration will accept Medicare premium support or Medicaid block-granting. But it’s what he believes should be done, and so he’s proposing it as a matter of course. There is, however, a sliver of hope that Republicans will reach an agreement with Obama on tax reform. As Ezra Klein has noticed, Ryan’s budget is vaguer in this area than it had been. A top tax rate of 25 percent is not a hard plank, but rather a “goal” he’d like Congress to “achieve.”
Add that wiggle room to Ryan’s remark yesterday that he has no desire to relitigate the fiscal cliff battle over revenue, and you have a white smoke signal that says, “On taxes, we might be able to do some business.”
Some of my favorite Ryan-watchers, like Ross Douthat and James Pethokoukis, had clearly been hoping that Ryan would produce something fresher and less straitened than he did. I appreciate where they’re coming from, and yet, perhaps too charitably, I’m reading in the Ryan Budget 3.0 a Chait-like sigh of resignation—of resignation to, as he has put it more than once since losing in November, the “reality of divided government.”
Aside from its base-stroking unrealism about a balanced budget in 10 years, there is a subtle sort of realism about this new Ryan budget. In its very lack of creative “new ideas,” there is an admission that “The Path to Prosperity” no longer has the magic-rabbit power it had after the 2010 midterm election. It’s a budget document scarcely worth more than the PDF pixels in which it’s displayed.
I think Ryan knows this, and expended very little effort to hide the fact.
In this New Yorker chronicle of House Majority Leader Eric Cantor’s role in the various budget crises in Washington over the last two years, Rep. Tom Cole, a Republican from Oklahoma, makes an interesting observation:
This is a very different Republican Party than the one I got elected into. It’s much more domestically focused, much more fiscally responsible, much less concerned about America’s position in the world or about defending the country. It almost takes for granted the security that we have now. It’s not a group shaped by 9/11. Their 9/11 is the fiscal crisis, the long-term deficit [emphasis mine].
There are two senses in which Cole’s observation is apt (neither of them in the way he intended, exactly).
The first is that of hysterical overreaction.
After the September 11 attacks, carried out by 19 men with box-cutters, and supported by an occult international financial network, Americans were warned of an existential threat to our way of life and our very physical persons. To meet this threat, America commenced two land invasions, followed by a war of record-breaking length in Afghanistan and a calamitous occupation of Iraq; established a ghastly new domestic cabinet agency; and defenestrated longstanding prohibitions on torture. These wars cost the lives of 7,000 American servicemen and -women, plus many tens of thousands more Iraqi, Afghan, and Pakistani civilians.
The overreaction to the “fiscal crisis,” as Rep. Cole calls it, stems from this notion of singularity—one big Fiscal Crisis, rather than a cluster of fiscal problems. The $1 trillion-plus annual deficits that the federal government ran during Obama’s first term were the direct consequence of the financial crisis of 2008 and of the recession that began in December 2007. If Sen. John McCain had been elected in ’08, he would have dealt with the same $1.3 trillion budget deficit that Obama did. These slowly shrinking deficits are linked, in the crisismonger’s mind, to the entitlement-driven debt projected in “extended fiscal alternative scenarios” gamed out by budget wonks. Taken together, short-term deficits and long-term debt, and the multifarious causes of each, add up to one simple fable of moral incontinence.
Cole’s analogy works for the cynic as well as the moralist.
The September 11 attacks furnished neoconservatives with what they saw as justification for a final reckoning with Saddam Hussein, which they’d been itching for throughout the Clinton years. The Fiscal Crisis, in the same way, does the heavy lifting for policies that dramatically alter the nature of federally financed social insurance—in the case of Medicare premium support, by partially privatizing it; in the case of Medicaid, by elevating the role of state governments. These are reform ideas that, like those long-gestating plans for dealing with Iraq, antedate the Fiscal Crisis.
Don’t get me wrong. I think these are arguments worth having. I’m more committed to the preservation of the welfare state more than the average conservative might be, but I’m not wed to any particular composition of that welfare state.
What I’d like to see is any proponent of the Ryan budget—let’s not pick on the Tea Party alone—pretend that it’s, say, the late 1990s, when the idea of a Medicare voucher, or “premium support, was first proposed—when there were annual surpluses “as far as the eye could see.” If the idea had merit then, conservatives needn’t resort to an all-encompassing Fiscal Crisis to sell it today.
What we’re getting, instead, is the folly of the Balanced Budget Amendment and predictions of Greek-like fiscal collapse.
We’re getting the fiscal policy equivalent of the “existential threat” of terrorism and the invasion of Iraq.
The Pope has resigned. He has not died, or been taken up like Elijah, but resigned because “both strength of mind and body are necessary” for his work and he is running out of one, the other, or both.
The history books will likely see this as an emblematic moment of an old dilemma with profoundly new reach and seriousness: we are starting to outlive our competency, outlive our health. What makes the Pope such a particularly compelling example is how his office aspires to permanence and timelessness, for he gives us a very public display of our nature as finite, limited creatures endowed with that transcendent, troublesome ability to participate in the infinite. For millions beyond the Catholic Church itself, he is the man most associated with the quest to stretch ourselves beyond our sins and earthy limitations, towards a higher calling. Ross Douthat wrote in the immediate aftermath of the announcement that:
“There is great symbolic significance in the fact that popes die rather than resign: It’s a reminder that the pontiff is supposed to be a spiritual father more than a chief executive (presidents leave office, but your parents are your parents till they die), a sign of absolute papal surrender to the divine will (after all, if God wants a new pope, He’ll get one), and a illustration of the theological point that the church is still supposed to be the church even when its human leadership isn’t at fighting trim, whether physically or intellectually or (for that matter) morally.”
And yet Pope Benedict XVI resigned. Instead of waiting to be called heavenward he exercised his own judgment (profoundly informed by long and searching prayer, doubtlessly) that he was no longer fit for the office to which he had been called. What does it mean to outlive a post meant for a lifetime? Read More…
As I imagined it earlier this month, the sequester offered Republicans a chance to reset budget negotiations with the White House. The debt ceiling battle, with its specter of global financial crisis, had been set aside. There were renewed qualms about the pace of economic recovery. Moreover, the president seemed eager to move beyond the impasse of fiscal politics and begin piecing together a second-term legacy.
“If they’re smart, [Republicans] will husband this leverage wisely and press for modest measures to rein in spending over the long haul,” I wrote.
Needless to say, it hasn’t worked out that way at all. It turns out the leverage that the sequester represents is worthless if, as Justin Green of the Daily Beast notes, spending cuts-and-spending-cuts-only is the default bargaining position. (The idea that the terms of the original debt-ceiling truce oblige both parties to an all-cuts replacement for the sequester, as Bob Woodward charges, doesn’t quite pass the smell test. Recall that House GOP leaders floated Erskine Bowles’s testimony before the debt-reduction supercommittee as a framework for a fiscal cliff compromise. That sequester replacement, such as it was, called for $800 billion in new revenue. The GOP has every right not to compromise with Obama on taxes this time—but the “goal posts” in this case dictate only the “how much,” not the “how” of deficit reduction.)
As things stand now, the sequester is almost certain to kick in (although its effects may not be fully felt until later in March, when funding authorized under last year’s continuing budget resolution runs out). Unless the administration beats a dramatic retreat, Republicans will not secure anything in the way of Medicare or Social Security reform without also agreeing to roughly $600 billion in new revenue captured from tax loopholes and deductions.
But, damn the torpedos, they will have their sequester cuts.
It’s worth asking what is the upside of these cuts.
Will they meaningfully reduce the deficit?
By proponents’ own reckoning, they will not.
You can’t simultaneously allay fears about the sequester—“Calm down; these are pissant reductions in the rate of growth”—and then congratulate yourself for reining in spending. Read More…
While they were negotiating over the fiscal cliff, President Obama reportedly told House Speaker John Boehner, “We don’t have a spending problem”; we have a “health-care problem.” Right-leaning commentators have zeroed in on the first half of the statement without acknowledging the, well, acknowledgement contained in the second.
But here’s my question: if the president agrees that financing the healthcare costs of an aging population is the No. 1 fiscal problem for the United States, why isn’t he acting more urgently to address it? As Megan McArdle observes, “It’s like saying that I’m rich—except for the money I have to spend on food and mortgage.”
Health care costs are path dependent; you can’t just hit the reset button and decide we’d rather do it West Germany’s way. America does all sorts of things more expensively, from medical education to staffing levels to private hospital rooms instead of wards. Some of those things can’t be undone at all (the hospitals that have been built with private rooms cannot easily be retrofitted for cheaper open wards). Others cannot be undone without brutal political fights: doctors and nurses have planned their whole lives around the higher-than-OECD-average-wages that their services command in the United States, and they will not give in without an ugly fight.
Rather than confronting the problem head-on, David Brooks suggests that Obama’s nomination of former Sen. Chuck Hagel to head the Defense Department is an indication that the president is triaging the process of budget reform, finding in Hagel a useful ally in shrinking the Pentagon:
As the federal government becomes a health care state, there will have to be a generation of defense cuts that overwhelm anything in recent history. Keep in mind how brutal the budget pressure is going to be. According to the Government Accountability Office, if we act on entitlements today, we will still have to cut federal spending by 32 percent and raise taxes by 46 percent over the next 75 years to meet current obligations. If we postpone action for another decade, then we have to cut all non-interest federal spending by 37 percent and raise all taxes by 54 percent.
As this sort of crunch gradually tightens, Medicare will be the last to go. Spending on things like Head Start, scientific research and defense will go quicker.
When pressed, the president typically cites Obamacare as proof that he’s willing to tackle healthcare spending—the $716 billion in cuts to Medicare providers that he was pilloried for in his reelection campaign, for example. But the truth is, Obamacare’s most forthright boosters admit that we can’t honestly know yet how successful the law will be in reining in healthcare spending.
Among the most common criticisms of the law is that it did very little to address the cost of health care. That’s nonsense. It’s arguably the most ambitious effort to reduce the cost of medical care in history. It captured some of the obvious sources of savings, such as overpayments to insurers that offer a private coverage alternative to Medicare beneficiaries, and it launched dozens of pilot programs, testing out schemes to make health care more efficient—everything from reducing payments to hospitals with high rates of inpatient infection to “bundling” payments so that Medicare isn’t simply providing financial incentives to perform more tests and treatments.
Here’s the situation: President Obama believes healthcare spending is The Problem. He doesn’t yet know the best approach to fixing it, but we can be assured that we’ll know it when we see it.
Just have patience.