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Friday, May 2, 2008
Health care’s shot-in-arm: People’s choice
The Atlanta Journal-Constitution
The debate that keeps raging — the one that divides legislators, policy-makers and others who weigh the role of government in our lives — comes down to this:
Can individuals be trusted to make responsible choices in their lives?
The conservative belief — and generally where most Republicans come down — is yes. That certainty is at the core of virtually all major domestic-policy disagreements that tend to divide along party lines. Education. Health care financing. Retirement planning. All divide on the basis of one’s belief in the ability of informed individuals to act in their own best interest and that of their families and children.
The U.S. Secretary of Health and Human Services, Mike Leavitt, a three-term governor of Utah, is squarely in the corner of those who believe that an informed citizenry, aided by government leaders with a shared vision and purpose, can bring about revolutionary change. Two related issues offer specific examples.
“Medicare,” he says, “is drifting toward disaster.” No surprise here. “The core problem is that costs are rising significantly faster than costs in the economy as a whole. … When I was born, [health care] was 4 percent of the economy. When my son was born it had doubled to 8 percent. When my first grandson was born two years ago, it had doubled again to 16 percent.”
Now 12 percent of the population is 65 or older, he notes. By 2030, it’ll be 20 percent. Fewer workers support more old folks. Medicare’s insolvent in 11 years.
For young families now starting out, “the typical household is going to see its health care spending basically double in the next 20 years,” he says, “from 23 percent to 41 percent of total compensation” while the federal share of spending for Medicare will nearly double from 13 percent to more than 23 percent. Bleak. At some point, and soon, the generations clash.
“What I have discovered after nearly four years is the symbiotic relationship between Medicare and the larger health care reform,” Leavitt said in a conversation last week. “Medicare is not just the single largest payer, but it is the foundation upon which all other billing systems and practice-management systems are based.” On Medicare, he says, “we will have to do three things: separate the commitment from the pain, pick the right moment, and modernize the budget-scoring conventions.” Those are political processes and they warrant separate discussions.
On health care, it means both changing behaviors and systems to deliver better quality at lower cost. First up is developing national measures quality. Second is to gather and report costs for procedures, by physician and hospital. “Our system of billing is insane,” says Leavitt. He compares it to an automobile, except everybody bills separately without regard to total charges.
“The way we price health care cannot be understood by a human being of average intelligence and limited patience.” Last year Medicare paid for 255,000 knee operations. “Believe me, when you pay for 255,000 of anything, you know what medical supplies, services, procedures, and facilities somebody getting a knee operation is going to use.” Developing a single-price system for common procedures “would promote coordination and accountability that does not exist now,” he says.
His department is developing demonstration projects on “bundled payments for hospital-based episodes of care.” Hospitals would bid for procedures. Savings would be shared with patients who chose cost-competitive hospitals.
Providing incentives for higher quality and lower cost, and making information available, should motivate consumers to search out better care at lower cost.
Part of that was announced last week. An HHS Web site, www.medicare.gov, offers comparisons of hospitals, nursing homes, dialysis centers and home health agencies. When consumers have sufficient information both on hospitals and physicians and when they have incentive to care what things cost, they’ll change the way they make health care decisions.
Are we smart enough? Yes. The momentum and the necessity exist, along with the tools, to save Medicare and to change the health care delivery and financing system. In the process, we can avoid sucking young families dry by forcing workers to divert more and more of their quality of life to the baby boomer generation.
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Gasoline prices; Clayton school board
The Atlanta Journal-Constitution
Thinking Right’s weekend free-for-all. Pick a topic:
Barack Obama blames high gasoline prices on a political establishment that hasn’t faced down the oil companies. “The candidates with the Washington experience —- my opponents —- are good people. They mean well, but they’ve been in Washington for a long time, and even with all that experience they talk about, nothing has happened.” Change. For the record, according to the Department of Energy: Crude’s about half the pump price of a gallon a gas, refining accounts for 28 percent; taxes, 14 percent; and distribution and marking, 8 percent. Wonder where Obama is on drilling in ANWAR? Nevermind. It’s the oil companies’ fault.
A Florida lottery winner —- $13 million in 1990 —- dies nearly broke at age 60. Gambling, gifts and luxuries. Hand out a million dollars on the to passers-by on the street corner and at least some of the recipients would be panhandling a month later.
When a story starts like this, “The U.S. has less than 5 percent of the world’s population but almost 25 percent of the world’s prisoners,” as the one from the New York Times did, you know disapproval follows. “Criminologists and legal scholars in other industrialized nations” are said to be “mystified and appalled.” Much that dismays liberals here —- whether in our legal system, environmental practices or national security policies —- mystify and appall select portions of “industrialized nations.”
Democratic strategists say they have identified 30 to 35 Georgia House districts that “are either competitive or may become competitive.” Yes. The latter. But probably not in their lifetimes. Barring a last-minute surge in top-quality candidates qualifying in the right districts, Democrats will gain no more than five seats in the House (giving Republicans a 102-78 majority) while the Senate remains static (34 Republicans, 22 Democrats).
People who run for public office for the pay are not the ones you want there. A salary of $17,000, plus $173 per day for food and lodging, and two-year terms is about right for the General Assembly. Higher salaries don’t necessarily attract higher-quality people. After all, dumbos and dullards are drawn to higher salaries, too.
Clayton County is a reminder. “Local control” means parents empowered to do what they think is best for their child, not the administration or the school board, which is in this case dysfunctional. Imagine agreeing to give a new superintendent in an imploding system 107 days off. Gimme my child back.
Have a chicken for lunch Sunday. It’s International Respect for Chickens Day, a day that “celebrates the dignity, beauty and life of chickens and protests the bleakness of their lives in farming operations.”
Congressional Democrats accuse the Bush administration of changing Environmental Protection Agency reviews of chemicals in a way that opens the process to “politicization.” Specifically, they object to a proposal to allow other agencies to submit comments and requests for further research. We’ve been trained to believe that bureaucrats are pure and political appointees are corrupting. The reality is, however, that it ain’t that simple. Advocacy groups know the best way to get the decision you want is find like-minded zealots in the bureaucracy.
Case in point: Hans von Spakovsky, as a top official in the U.S. Justice Department’s civil rights division, was accused of overruling career bureaucrats in clearing voter ID legislation passed by the Georgia General Assembly in 2005. If so, he was right. They were wrong, and as I discovered during the brouhaha over redistricting (when Cynthia Mckinney carved herself a congressional district, with the aid of civil rights division lawyers), Justice Department bureaucrats can have agendas, too. (The Senate should now affirm von Spakovsky’s wrongly blocked nomination to the Federal Elections Commission.)
*Gasoline prices; Clayton school board Two bowls are added to college football’s post-season, bringing the number to 34: The Congressional Bowl and the St. Petersburg Bowl. Pretty soon it’ll be like the NBA. Everybody goes bowling. Give us playoffs.
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