Category Archives: Legislation

Ryan-Wyden Reflective of Western Approach to Medicine

By now, it’s old news that Republican Congressman Paul Ryan has worked with Democratic Senator Ron Wyden to draft a bipartisan plan to “fix” the Medicare program. What is being proposed, essentially, is a system of “premium support”–the federal government would make fixed contributions to offset the costs of seniors purchasing insurance from an exchange of private plans, while the traditional Medicare fee-for-service program would remain an option for those who wanted to remain in it.

If this sounds a lot like the Affordable Care Act with a public option included, it’s because it is. If that didn’t fly before, why would it be seen as the ideal way forward for saving Medicare? It’s simple, the Democrats envisioned such a plan as a way of moving the health care system towards a system of managed competition or even single payer, while the GOP sees this as a way of moving Medicare away from single payer to a system of managed competition or even traditional private coverage. The problem is that, while it may mask some of the problem, it won’t solve it.

In Western medicine, there seems to be much more emphasis on treating symptoms rather than preventing or curing disease, and this, in my opinion, is the same approach taken by Ryan-Wyden. In theory, injecting competition into the Medicare market should treat the symptom of high health care costs. The problem, however, is that it won’t work. The symptom is a result of the underlying design of the health care system, by which I mean “fee-for-service reimbursement by third-party payers.” There is a mountain of evidence pointing to the fact that a single-payer system, in which the payer has no intention of generating a profit, is the least expensive option for the design of a health care system. Moreover, there is ample evidence that capitation or global budgeting is far less costly than fee-for-service. Those are the elements that need to be introduced into the health care system to start cutting health care costs. Moving Medicare from single-payer towards an exchange of private payers will make it more, not less, difficult to make those changes. Without addressing the underlying “disease,” we will have no choice but to seek out new compromises in an attempt to treat the “symptoms” or else be left to suffer with them.

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Posted by on December 26, 2011 in Legislation



A Little Perspective on Page Length

Travel back with me to 2009 when the debate over health reform was really going strong. You may recall that one of the chief complaints from opponents of the bill was it’s length. At roughly 2,400 pages, it was considered far too complicated and critics routinely asserted that no one in Congress had actually read the thing. Set aside for a moment the obvious questions like: “If no one in Congress read it, how did it get written?” and “How many pages should it take to begin reforming nearly one-fifth of the U.S. economy?”

Rather, ask the more simple question: Is 2,400 pages a lot for a document? I think you’ll find that out of context the answer is clearly “It depends.” If, for example, I purchased a newspaper one Sunday after church, I’d find 2,400 pages a daunting way to spend the afternoon. On the other hand, I’d expect that certain reference books might easily number at least 1,000 pages, and my shelves are lined with them. Clearly, context matters.

So, let’s say that your goal is to design a house. You could do it on a cocktail napkin, but you might prefer hiring an architect to draft a set of blueprints. Similarly, when writing a law, there’s a lot of ground that needs to be covered. The length of the bill pales in comparison to the length of the regulations subsequently generated, but 2,400 pages is still a lot. But is it too much? Well, as I said at the outset, the health care system is a very big thing, and affecting it at all requires a similarly big effort. So, I think that the 2,400 pages is actually about right–maybe even impressively short given all it aims to do–but if you disagree, allow me to provide you with another number: 57,000. That’s the number of pages in General Electric’s 2010 tax return. Even more striking than the page length is what the document manages to achieve: Despite making $14 billion in profits that year, GE paid no taxes on the earnings.

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Posted by on December 1, 2011 in Legislation

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