Friday, May 15, 2009

blind and naked

Both David Brooks and Andrew Sullivan are missing the boat on the Administration's plans (and hopes). You can find Sullivan's piece here and it will further link you to the Brooks op-ed in the Times. Both are suffering from the great red herring of the here-and-now. What triggers this realization for me are these two paragraphs from the op-ed:

"Obama aides talk about "game-changers." These include improving health information technology, expanding wellness programs, expanding preventive medicine, changing reimbursement policies so hospitals are penalized for poor outcomes and instituting comparative effectiveness measures.

Nearly everybody believes these are good ideas. The first problem is that most experts, with a notable exception of David Cutler of Harvard, donĂ­t believe they will produce much in the way of cost savings over the next 10 years. They are expensive to set up and even if they work, it would take a long time for cumulative efficiencies to have much effect. That means that from today until the time President Obama is, say, 60, the U.S. will get no fiscal relief."

I'll call this the "next Monday I stop smoking" plan. Both Sullivan and Brooks believe that having one marshmallow now is better than two marshmallows later. (I know, read this if you must know.) This mentality always put forth the idea that if some program won't happen in the next two years, the next month, or the next week, then it's not worth our effort: and that's the most dangerous of all ideas and it runs rampant through myriad politically-charged issues. If your grand plan doesn't involve where we will be in ten or fifteen years - especially based on our current morass - then you're the problem. The Obama plan is certainly premised on reducing healthcare costs across the board in order to not only fund some of the spending required to support the American economy, but to prevent the spiraling costs from, well, spiraling. The Sullivan commentary even reposts a poorly chosen chunk from Bruce Barlett in order to support something:

"To summarize, we see that taxpayers are on the hook for Social Security and Medicare by these amounts: Social Security, 1.3% of GDP; Medicare part A, 2.8% of GDP; Medicare part B, 2.8% of GDP; and Medicare part D, 1.2% of GDP. This adds up to 8.1% of GDP. Thus federal income taxes for every taxpayer would have to rise by roughly 81% to pay all of the benefits promised by these programs under current law over and above the payroll tax."

I love Sullivan but he's simply circled back on himself by using this example as support for why reducing health costs isn't the solution. If you remove the 1.3% tagged to Social Security, you're left with the larger 6.8% chunk. If those numbers are reduced, and significantly, not only can we avoid increased future outlays but we can start saving now - and by now I mean over the next few years. As usual, the yelling and screaming must have impeded the use of a calculator, something I'll get to in a minute. Where exactly does Sullivan and Brooks think the demand for Medicare dollars come from? I'll wait a second while they think about it. What? Those costs (and percentages) come Huh? From healthcare needs for those that can't afford it and/or don't have any coverage, or preventive medicine, or good health, or helping those who eat Twinkies everyday. If we don't even consider the future savings - or the resulting spirals that can be avoided we can suddenly go to our calculator powered by silence and get some real numbers. The average GDP (the mysterious GDP from above) from 2006-2008, in 2008 dollars, is about $14 trillion. My handy-dandy calculator tells me that 1% of that number is $140 billion. If we can cut just 2% from the 6.8% of the GDP that accounts for those parts of Medicare then we've can save $280 billion over the course of one year. If we assume that the GDP will grow, maybe slowly for a few years but quickly in the later years, and I can project the current number over six years then I'm sitting at about $1.68 billion in savings by lowering the amount of money spent to unfuck people's health, and the system. That's a big chunk of the TARP, stimulus, and etc. that we've already spent to prop up our addled economy. When you consider future numbers beyond that: possible further percentage cuts, maintaining a lower cost level, and providing better healthcare to everyone, then I'm cool with looking beyond Obama's time. As I've said before, this cat looks and plans way beyond what we imagine: every time. How many times do you need to be fooled?

As for Brooks, who finds savings of $100 million across agencies, or $17 billion in budget cuts to be comical, fuck off. I can look out beyond next Friday and say that if we have sorted out the massive issues we face today by the time Obama is 60, well done. You know, you have to start sometime, right? It's Monday, get onboard.

Why don't you guys just have your one marshmallow and go home.



No comments: