We’re fighting our Medicare wars in a hermetically sealed bubble, impervious to global benchmarks that suggest our efficiency ambitions are far too timid. Official bean-counters only reinforce our blind spots. When the Congressional Budget Office talked about Ryan’s earlier voucher plan eventually shifting to seniors per-person costs of $6,400, it assumed that the system would coast along more or less as is. When Medicare actuary Richard Foster says, “The best available evidence indicates that most health care providers cannot improve their productivity” much because of “the labor-intensive nature of these services,” you have to wonder what evidence Foster is looking at. Clearly the man needs to get out more.
All this shows why the entire Medicare (and broader health) debate needs to be recast. Rightly understood, health-care entitlement reform is not, as conservatives suggest, a matter of lessening the dependency of big chunks of the population on government largesse. It’s about weaning the members of our medical-industrial complex from their entitlement to far higher payments, despite shabby results, than their counterparts abroad get. This license for inefficiency, issued by both parties to doctors, hospitals, health plans, drugmakers and device firms, is diverting precious resources in an aging America from urgent non-health care, non-elderly needs.
This is what’s really going on. It’s also what’s slated to continue, regardless of what you’ll hear in the campaign about big “cuts” a-coming.
The politics of reform are awful, because every dollar of health care “waste” is somebody’s dollar of income. And no one has a sure fix, though I’ll look at promising ideas in a future column (or five). As with any alcoholic, however, the path to renewal begins with admitting that you have a problem. When “cuts” that leave U.S. health care wildly inefficient compared to our peers are damned by both sides as “savage,” our political process dooms us to denial.
Maybe it’s too much to expect a conventional campaign (or conventional media coverage) to address this. But if we don’t get serious about it during one of our brief intervals of governance, progressive ambitions are toast.
Matt Miller is a senior fellow at the Center for American Progress and co-host of public radio’s “Left, Right & Center.” He writes a weekly online column for The Post.