April 21, 2014
April 18, 2014
Rabbi Yonason Goldson: Clarifying one of the greatest philosophical conundrums in theology
The Kosher Gourmet by Julie Rothman Almondy, flourless torta del re (Italian king's cake), has royal roots, is simple to make, . . . but devour it because it's simply delicious
: Trying hard to be 'positive' but never succeeding? Blame Your Brain
April 14, 2014
Rabbi Dr Naftali Brawer: Passover frees us from the tyranny of time
: First degree: How America really recovered from a murder epidemic
: When love is not enough: Teaching your kids about the realities of adult relationships
: How you can tell if your financial adviser is setting you up for potential ruin
: Up to 500,000 people die each year from hepatitis C-related liver disease. New Treatment Has Over 90% Success Rate
: Eating Watermelon Can Help Control High Blood Pressure
April 11, 2014
Rabbi Hillel Goldberg: Silence is much more than golden
: How to value a child for who he is, not just what he does
: A Simple Blood Test Might Soon Diagnose Cancer
: Have A Slow Metabolism? Let Science Speed It Up For You
April 9, 2014
Jonathan Tobin: Why Did Kerry Lie About Israeli Blame?
Samuel G. Freedman
: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau
: A resolution 70 years later for a father's unsettling legacy of ashes from Dachau
: How Beans, Peas, And Chickpeas Cleanse Bad Cholesterol and Lowers Risk of Heart Disease
April 8, 2014
Coffee Drinkers Rejoice! Your Cup Of Joe Can Prevent Death From Liver Disease
Electric 'Thinking Cap' Puts Your Brain Power Into High Gear
April 4, 2014
A life of love: How to build lasting relationships with your children
Older Women: Save Your Heart, Prevent Stroke Don't Drink Diet
Why 50 million Americans will still have spring allergies after taking meds
Teacher keeps promise to mail thousands of former students letters written by their past selves
April 2, 2014
Should South Carolina Jews be forced to maintain this chimney built by Germans serving the Nazis?
Get happy: 20 scientifically proven happiness activities
It's Genetic! Obesity and the 'Carb Breakdown' Gene
Jewish World Review
Sept. 14, 2009
/ 25 Elul 5769
Give It to Us Straight
Robert J. Samuelson
We cannot, it seems, have a candid national conversation on health care. President Obama's speech the other night was a brilliant performance, and it may improve prospects for congressional passage of his "reform." But no possible plan will fix the "health care problem" for all time. When Obama says that "I am not the first president to take up this cause, but I am determined to be the last," he is indulging his ambition for a special place in history and illustrating why Americans don't discuss health care honestly.
The political problem was simple: Support for "reform" was collapsing. In April, 43 percent felt they'd be better off with his "reform" and only 14 percent didn't, according to a Kaiser Family Foundation poll. By August, it was 36 percent to 31 percent. To restore momentum, Obama needed to convince more people that his program would help them.
Americans generally want three things from their health-care system. First, they think that everyone has a moral right to needed care; that suggests universal insurance. Second, they want choice; they want to select their doctors and want doctors to determine treatment. Finally, people want costs controlled; health care shouldn't consume all private compensation or taxes.
Appealing to these expectations, Obama told Americans what they want to hear. People with insurance won't be required to change plans or doctors; they'll enjoy more security because insurance companies won't be permitted to deny coverage based on "pre-existing conditions" or cancel policies when people get sick. All Americans will be required to have insurance, but those who can't afford it will get subsidies.
As for costs, not to worry. "Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan," Obama said. He pledged to "not sign a plan that adds one dime to our [budget] deficits either now or in the future." If you believe Obama, what's not to like? Universal insurance. Continued choice. Lower costs.
The problem is that you can't entirely believe Obama. If he were candid if we were candid we'd all acknowledge that the goals of our ideal health-care system collide. Perhaps we can have any two, but not all three.
If we want universal insurance and unlimited patient and doctor choice, costs will continually spiral upward, because there will be no reason or no one to stop them. We have a variant of that today a cost-plus system, with widespread insurance and open-ended reimbursement. Higher costs push up premiums and taxes. That's one reason health spending has gone from 5 percent of gross domestic product in 1960 to 16 percent in 2007. (Other reasons: new technologies, rising incomes.) But controlling spending requires limits on patients and doctors.
Studies of various health proposals conclude that their long-term costs exceed their long-term financing. In its second decade (2020-29), H.R. 3200 the main House bill would increase federal budget deficits by $1 trillion, estimates the consulting firm Lewin Group. Total health spending would reach 28 percent of GDP by 2029. How can Obama claim to control costs and never add to the deficit? Well, he'd adopt a provision requiring "more spending cuts if the savings we promised don't materialize." Sound convincing?
It isn't. Congress often enacts automatic triggers to control spending. The triggers usually don't work. When they might bite, Congress delays or modifies them. Consider one trigger: the "sustainable growth rate" (SGR) that Congress created in 1997 to control doctors' spending under Medicare. Since 2002, the SGR formula has consistently called for annual cuts in doctors' reimbursements. Congress has routinely overridden the formula. Now, there's pressure to scrap the whole SGR.
Obama's selling of "reform" qualifies as high-class hucksterism, but in fairness, many conservative opponents match or exceed his exaggerations and distortions with low-class fear-mongering.
These critics charge that Obama would curtail Medicare benefits or create "death panels" to deprive ill seniors of desirable care. Not only are these charges mainly false (as Obama says), but they wrongly suggest that we put some important subjects off-limits. Medicare represents one-fifth of personal health spending. Why shouldn't we debate what should be covered and who should pay? Similarly, doctors, patients and families should discuss end-of-life care. It's not just that 25 to 30 percent of Medicare spending occurs in patients' last year. Expensive, heroic care often compounds suffering.
The candor gap reflects a common condescension. One side believes it must fool Americans into thinking "reform" will do more than it will; the other thinks it must frighten Americans into believing that it will harm them in ways that it won't. Given Americans' contradictory expectations, any health-care proposal can be criticized for offending some popular goal. We refuse to face unavoidable and unpleasant choices.
Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.
Comment on Robert J. Samuelson's column by clicking here.
09/07/09: Bad Future for Jobs?
08/24/09: A Rail Boondoggle, Moving at High
08/10/09: Championing the Status Quo
08/03/09: We'll remain in denial, prisoners of wishful thinking, until the fateful reckoning arrives in the unimagined future
07/27/09: Obama's misleading medicine
07/13/09: Americans' self-indulgence hurts us
07/06/09: Economists out to lunch
06/29/09: Panics R Us!
06/08/09: Flirting with deflation or inflation? Now the economy might be at risk of both
05/25/09: A crisis America needs
05/18/09: Will somebody finally say that Obama is irresponsibly mortgaging our future?
05/04/09: The Bias Against Oil And Gas
04/27/09: Environmentalists maximize the dangers of global warming while pretending we can conquer it at virtually no cost
04/20/09: Our Depression Obsession
03/23/09: Geithner treads a line between financial paralysis and populist resentment
03/23/09: American Capitalism Besieged
01/06/09: The limits of pump priming
12/29/08: Humbled By Our Ignorance
07/31/08: The homeownership obsession
07/24/08: A Depression? Hardly
07/17/08: Why isn't globalization making the interconnected world more stable?
© 2009, WPWG