- The American Conservative - https://www.theamericanconservative.com -

A Cure for Healthcare Costs

So a left-of-center president delivered a left-of-center inaugural address–how shocking is that? Barack Obama is a winner, and he acted like one on Monday; he can be a liberal now. He is, after all, entering into a select club within a select club: assuming that all goes well for him, he will be just the 14th American president to serve two full terms in office.

But when the panegyrics have died down, Obama will confront the problem that every president re-elected since the passage of the 22nd Amendment [1] is also a lame-duck president. And in spite of years of negotiations in his first term alone, no one, least of all Obama, has solved the looming problem of healthcare—which is the root of our spending and entitlement troubles.

Medicare and Medicaid together cost more than $800 billion a year, and that total is rising fast. An aging population requires even more costly healthcare, no matter who pays for it. No simple compromise between the parties will make the problem go away.

On the basic issue of the size of government, conservatives still have an edge. A Fox News poll taken earlier this month found that 83 percent of Americans think that “government spending is out of control.” And that’s up from 78 percent who said so in 2010 and 62 percent in 2009. Today, a mere 11 percent of Americans think spending is being managed carefully [2].

Advertisement

To be sure, huge majorities of Americans also support entitlement programs. So Republicans and Democrats will continue to fight for the right issue-frame: for Republicans, attacks on “big government” à la Andrew Jackson; for Democrats, FDR-ish defenses of popular benefit programs.

In his Second Inaugural, the president put himself in an interesting position [3]. “The commitments we make to each other through Medicare and Medicaid and Social Security, these things do not sap our initiative, they strengthen us,” he said, continuing, lest anyone wonder what he really thinks of Romney, “They do not make us a nation of takers; they free us to take the risks that make this country great.”

Is the president thus ruling out changes in Medicare along the lines suggested by legislators like Paul Ryan, such as “premium support”? Maybe, but in the same speech, he also said that we are going to have to make “hard choices to reduce the cost of health care and the size of our deficit.” Every “deficit hawk”—including those within the Obama administration—has a prescription for shrinking the increase. The problem is that voters don’t much like those “curve-bending” prescriptions. And neither do most Democrats.

Plenty of waste exists within the public health system, but voters tend to be suspicious of cost-saving reforms because they long ago concluded long ago that Washington, D.C. is more interested in saving money on these health programs, especially those for the elderly and the poor, than it is in improving and saving lives through better care.

change_me

And that rampant mistrust can be toxic to even the best intentioned of entitlement reformers. As the late Jack Kemp said, “They don’t care how much you know until they know how much you care.” If entitlement reformers regard healthcare programs simply as targets for savings, then the beneficiaries will naturally seek to defend themselves. That makes entitlement reform next to impossible.

So is there another way out—a way to save money that doesn’t risk ballot-box backlash?

Inside the expenses of our healthcare system is an item that dwarfs the others in magnitude. Alzheimer’s Disease currently costs the US economy some $200 billion a year, mostly in direct outlays from Medicare and Medicaid. That number is rising toward $1 trillion a year by mid-century.

While it’s easy in 2013 to reach a deal that calls for saving money on Alzheimer’s costs in decades hence, such a deal will likely be unenforceable in the far future, when the reality of 24/7 care year-round for tens of millions of dementia patients is upon us. If that many people are so sick, the U.S. will either move toward some sort of euthanasia system or else shoulder the ruinous costs. Surely there’s a better way.

And that better way could be a cure: to do to Alzheimer’s what we did to polio—make it disappear.

There’s no guarantee that an attempt to cure Alzheimer’s will succeed. But the history of focused medical research efforts—not just the March of Dimes campaign that led to the polio vaccine, but the development of antibiotics, the worldwide eradication of smallpox, and the enormous progress made against HIV/AIDS—argues strongly that significant gains are possible in a relatively short time, provided there’s enough leadership and scientific and financial effort.

Policymakers, looking ahead and seeing that “silver tsunami” of Alzheimer’s sufferers roaring toward them, should be actively strategizing about how to thwart the illness: that is, strategizing the way the Pentagon strategizes about acquiring a new airplane or ship.

The 2012 elections settled one question: national health insurance, in one form or another, is here to stay. Uncle Sam is ultimately going to be responsible for the nation’s healthcare.

But that answer has given rise to new questions: How can we make healthcare as affordable as possible without sacrificing quality—and dignity? How can we use medical research and technology to make actual improvements in people’s wellbeing, as opposed to mere maintenance? Unless we address those questions, and soon, we will never find a politically or morally satisfactory answer to the problem of rising healthcare costs.

The need to fend off such a bleak prospect ought to bring leaders of both parties back to the bargaining table, for their sake as well as ours. A cure for Alzheimer’s and other costly diseases won’t be found in D.C., but if the Beltway is oblivious to the need to help foster medical research and development, then the lifesaving cure as well as cost-savings might never be found.

James P. Pinkerton is a contributor to the Fox News Channel and a TAC contributing editor. Follow him on Twitter [4].

20 Comments (Open | Close)

20 Comments To "A Cure for Healthcare Costs"

#1 Comment By Nathan On January 25, 2013 @ 6:29 am

According to published reports, including a story in USA Today memory disorders including dementia which both my mother and her brother had at the time of their deaths will afflict about 20 percent of the baby boomers. Another recent USA Today story said that three out of four people approaching age 65 have less 30,000 dollars in savings and that half of this group will be at or below the poverty line and attempt to live on five dollars a day for their ENTIRE food budget. We can also look at a 50 percent divorce rate and note that baby boomers are childless at around a 20 percent or higher number.

All that is a prescription for disaster. Who makes the decisions for these people in the absence of a spouse or child? With no funds and no insurance, who pays?

That said, there are private groups today that are working on memory disorders among them the Alzheimers Association. Why again does this have to be a government initiative? Why tax dollars as opposed to voluntary donations to these organizations? Yes, let’s encourage our fellow citizens to donate to worthy charities. But Mr. Pinkerton here is just doing another unconstitutional “good intentions” exercise. Madison couldn’t find the article in the constitution that allowed Congress to spend constituent funds on behalf of benevolence. Have you sir suddenly found the article that the father of the Constitution couldn’t locate and would you care to cite it?

Just because the government and this country has gone so far from the principles embodied in the Constitution and espoused by the Founders doesn’t mean we should just surrender and continue to go down that road. We should be trying to do our best to return to those principles not go farther away, not because we are stone age neanderthals but because ultimately those principles form the basis for the best way to do things. Government programs ARE wasteful and inefficient. They for the most part aren’t the best way do produce the results we want.

Good intentions, whatever they are, torture detainees to save American lives, gun control to save children, whatever is simply not acceptable when they are contrary to the Constitution. I’m sorry but no.

#2 Comment By Hank On January 25, 2013 @ 8:21 am

It’s cute that you think a Republican Party that just ran for the presidency on a budget that would significantly cut research funding would agree to anything like this.

#3 Comment By JLF On January 25, 2013 @ 9:00 am

I think Pinkerton is on to something when he observes that entitlement reform is popular only to the extent it doesn’t touch benefits. Not only do the elderly not want to see Medicare/Medicaid go away and nursing homes become more and more upper middle class, Joe Sixpack doesn’t want to look forward to moving Mom and Dad into the kids’ room right after they go off to college. Like it or not, the real beneficiaries of Medicare/Medicaid are all of us.

So how do you control costs? Premium vouchers (aka insurance company subsidies) only shift the burden of saying “no” to the insurance actuaries. Death Panels already exist at every insurance company and HMO that decide to limit/deny coverage to treatable conditions. There is an effective way to lower health care costs while at the same time maintaining the essentials of the free market that consumers care about: free choice among providers. Make government the single payer and health care a monopsony.

As long as government doesn’t attempt to nationalize health care by making every health care worker and supplier a government employee, market forces can continue to play a part in health care delivery. If you are a doctor or hospital administrator that can no longer operate at the reimbursement levels government provides, become more efficient or leave the market. The latter option, of course, puts pressure on government to raise reimbursements in order to maintain the level of services society demands. And when society is no longer willing to pay for certain services, they will no longer be available. And only a single payer can make this happen.

#4 Comment By EliteCommInc. On January 25, 2013 @ 11:27 am

Correction: Regardless of the response,

I am going to push this issue on medicaid and medicare — Just what did the healthcare initiative accomplish if we are still using these programs and what’s worse is any suggestion of expanding them . . .

Aren’t these programs now moot . . .?

#5 Comment By Tim On January 25, 2013 @ 12:34 pm

JLF,

We do have single-payer in this country. It’s called Medicare, and it costs the American taxpayers at least $60 billion a year in mistaken and fraudulent claims, a number which dwarfs the combined profits of all the largest private insurers. Single payer Medicare and its fee-for-service system are the single biggest driver of our exploding health costs, and your solution is…more single payer? No thanks.

Medicare is also hurtling towards insolvency as Richard Foster, the chief actuary of the CMS, has told Congress that the Medicare Trust Fund will be depleted within about ten years. We can’t afford the single-payer system we have now let alone expand it.

#6 Comment By JLF On January 25, 2013 @ 1:45 pm

Tim,

You mislabel Medicare as a single payer. It is most definitely NOT the source of all medical spending in the United States. Only when medical providers have a single source for income (a true monoposony) can the payer control costs. When the choice is take it or leave the profession, few will leave the profession. And if the provider market will no longer work for the amount offered, a single payer must adjust as constituent demand for services rises. And since the single payer that I posit affects the well being of all of us, not just the poor, tolerance for cheating will also shrink.

#7 Comment By Dan Phillips On January 25, 2013 @ 1:51 pm

What article and section of the Constitution authorizes expenditures for healthcare reasearch?

I thought James Pinkerton had a reputation as libertarian leaning. But here he writes about infrastructure improvements and Federal funding of medical research. What’s up with that?

#8 Comment By cdugga On January 25, 2013 @ 2:51 pm

Non-policy issue as far as marshalling public money to find a cure for Alzeimers. Since almost everybody will be susceptible and effected by it in their lifetime, a private research push to find treatments and cures would be a profitable investment. Highly profitable. Trying to dissect out the parts of healthcare that elderly voters are likely to support, from the broader need for healthcare in general, is not going to work. There is a need for healthcare for everything, especially in an aging population. Public research is taking enormous hits which seem unavoidable, but unlike AIDs research that pertained mostly to a smaller group, Alzeimers research should be more popularly supported. The healthcare issue is different because it is NOW, and pertains to everything including Alzeimers. All those affected now, including family and healthcare providers need resources and strategy now, regardless of any additional allocation of revenue to public financed research. And, if medicare is single payer type healthcare, and single payer healthcare does not work because of fraud, then that is what needs to be addressed (funded enforcement). I don’t junk my truck because something is broken. And if too much is broken to fix, I don’t buy a new truck unless an affordable one is available. Offer up an affordable truck available to everyone that everyone is going to need eventually (leave out the extravagent options if you must, like if I can’t park the thing myself then I deserve to die anyway), then complain about broken healthcare spending. Anyone can point at something that isn’t working as good as it should, and anyone can take something apart and find something they think would work better if it was engineered better. Do that, offer a better plan, and even include funding research. Until then stop trying to junk my truck and sell me an expensive gas guzzleing golden calf with a bed just big enough to put a lawn mower in if you fold the handle just right and turn it sideways and then tell me not everyone deserves such a practical vehicle. Let’s sees that practical plan for healthcare. More AR15’s to reduce future costs? Where is the conservative plan, not the republican free market death squad personal financial responsibility selective rationing one.

#9 Comment By Siarlys Jenkins On January 25, 2013 @ 8:07 pm

Mr. Phillips, the constitution is a jurisdictional document, not a laundry list. Congress has the authority “To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defense and General Welfare of the United States… To promote the Progress of Sceince and useful Arts…

I note that that last phrase precedes “…by securing for a limited time to Authors and Inventors the exclusive Right to their respective Writings and Discoveries.” But then, the Second Amendment begins “A well regulated Militia being necessary to the security of a free State…” (Not even a free people, but a free state). Everyone expands the parts they want to expand.

I might add that medical care delivery at this time is, unfortunately, almost entirely interstate commerce, and so long as that is true, congress has broad powers to regulate it. I suspect that bringing down health care costs by finding a cure for a disease that renders thousands of citizens helpless to care for themselves is both a matter of “general welfare” and a good way to reduce costs incurred in commerce.

#10 Comment By Tim On January 25, 2013 @ 8:51 pm

JLF,

Plenty of people who agree with you on this seem to think Medicare is a single-payer system.

[5]

There is lots more where that came from. And I never said it was the source of all medical spending in the U.S. I said it was the biggest driver of medical costs in the country, which is true.

The ability to impose price controls on providers leads to shortages…long lines, rationed care, etc. That’s why even in countries that have single payer the wealthy end up paying a bit more for better service. The rest are stuck waiting.

As long as you have third parties handling billions of taxpayer dollars, you will have massive fraud. It’s not their money after all. Private insurers however do have a huge interest in rooting out fraud, since they will lose business if they do not. This accounts for some of what they spend on overhead.

#11 Comment By Robert L. On January 25, 2013 @ 9:53 pm

Who wonders why European healthcare is so much more cost effective than ours: less spending with greater longevity? And those two are just for starters.

#12 Comment By spite On January 26, 2013 @ 4:58 am

JLF
Truly incredible, you want government to impose price controls on hospitals, and then claim that markets forces will still work make it work efficiently, well market forces always work, but not in the way you want, when price controls are imposed then people WILL leave the profession. As for cheating part, the main problem is not the cheating part, the problem is the very simple fact that not all doctors are the same, the best will leave the worst will stay.

#13 Comment By Chaos On January 26, 2013 @ 8:56 am

Its a shame that Palin demonized re-evaluating end of life care as “death panels”. So much of the Medicare budget is spent in the last few months of life when the prognosis is poor.

As a physician, I try to explain to my conservtive friends/patients whose heads are filled with deliberate mis-information & fear that we have always had health care rationing via the insurance companies. We just need to apply more realistic & humane standards.

BTW, I was raised in a republican family, but had to leave the gop as I just cannot muster enough hate to spread among science, gays, women, immigrants, rape victims etc., etc., etc. A few months ago I happened upon your site & I love it. The articles/blogs & comments are rational & well written. It gives me hope that someday the republican party can resurrect & be intelligent, moderate & inclusive. It would be nice to have more options at the polls. (But until you drive out the religious crazies & tame your corporate masters, I will enjoy your death spiral.)

TAC is truly one candle in the darkness. Keep up the good work.

#14 Comment By Workingclass On January 26, 2013 @ 12:33 pm

Universal, single payer health care is the obvious way to bring down the cost of health care while eliminating barriers to access. Thats right. Socialized medicine.

As for the cure – although I doubt they would turn down research money, it’s not in the interest of the medical industrial complex to actually cure anything. You lose customers that way. Keeping you alive and sick is the goal – or dead if you are neither wealthy nor insured.

For profit health care is a huge cash cow for insurers (extortionists) and drug makers (monopolists) especially under Obama Care. It guarantees poor care, high cost and lack of progress.

#15 Comment By JAC On January 26, 2013 @ 5:36 pm

“Inside the expenses of our healthcare system is an item that dwarfs the others in magnitude. Alzheimer’s Disease currently costs the US economy some $200 billion a year, mostly in direct outlays from Medicare and Medicaid.”

Question: How much is “mostly?” Does anyone know how much of this $200 billion is spent on direct outlays from Medicare and Medicaid? And how reliable is the source for the $200 billion figure? Curious.

#16 Comment By John McIntosh On January 27, 2013 @ 1:58 am

Alzheimer’s is a syndrome not a desease.

There is little evidence of a single cause and is likley the result of many different ones, none of who its important to note do we currently have even a basic understanding of.

Calling for a cure for Alzheimer’s is as non sensical as calling for a cure for cancer, or old age, or desease.
It may make a great slogan for a money raising campain or medical company moralistic boilerplate but it is a fundlemental misrepresentation of the state of the problem.

It is definately not a basis for a sound policy

#17 Comment By Michael N. Moore On January 27, 2013 @ 4:02 pm

At the beginning of the health care debate it was pointed out that Massachusetts General Hospital employed 360 non-medical people to deal with health insurance, but Toronto (Canada) General Hospital employed only 3 people to deal with health insurance. Of course, Congress failed to address this massive private health insurance boondoggle. With the medical-industrial complex, like the military-industrial complex, we have managed to combine socialist inefficiency with capitalist profiteering.

Medical progress into the 20th Century has obviously been beneficial, but sooner or later you have to ask if extending people’s life expectancy is simply generating worse ways to die. Alzheimer’s does not just destroy its victims; it destroys their relative’s lives. Would you prefer dropping dead of a heart attack at 70 or a slow death of cancer at 80? This is what statins are causing.

The entire medical project for extending life needs to be reevaluated. Not only is it bankrupting us with medical expenses, it is also bankrupting us with elder-care expenses. This is something that conservatives, who accept the limits of life and the limits of human intervention, should be promoting.

I would like to hear just one of our leaders say to the Public: “You know, we all have die, like it or not”.

#18 Comment By Georgina Davenport On January 27, 2013 @ 10:59 pm

It would be very nice to cure Alzheimer. However, if that’s the plan to lower healthcare cost, why don’t we add cancer, heart disease, etc, to the list? While we are waiting for the cure to happen, what do we do with the uninterrupted spirally healthcare cost?

#19 Comment By Lord Karth On January 28, 2013 @ 4:46 am

Euthanasia’s coming, and within the next 20 years. It’s only a matter of how it’s implemented.

Your servant,

Lord Karth

#20 Comment By Ian Fraser On February 10, 2013 @ 7:32 pm

Federal support for medical and scientific research should be phased out and left to private foundations, other private organizations and commercial research companies. This will be much more efficient and less expensive.