Apr 012010
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Do you believe that all Americans should have access to healthcare? Can you answer this question with a simple “yes or no?” Do you think the inquiry immediately begs other questions? Is cost an issue in your mind? These and many other questions are at the heart of the heated debate over healthcare in America. But the raging arguments never seem to address the core issues, at least not in a substantive manner. Instead, hyperbole has become the rule of the day.

Real leadership would require that the debate be taken back to its root, at the point where we, as a nation, must answer the values question, the question regarding access for all Americans. This question is essentially ethical in nature and should be addressed in that isolated context. Whether or not we can afford the corresponding solution is a practical matter that also demands attention, but it shouldn’t be allowed to impact our basic ethical decision.

Personally, I cannot fathom the rationale supporting a negative response to the primary question. My answer is, “Absolutely yes!” I have no doubt that the only legitimate response is acknowledgement; the only appropriate ethical position is that healthcare is a right, not an entitlement. So, does this make me a supporter of the healthcare “reform” that President Obama just signed into law?

Ignoring the bitter taste left in my mouth from the way in which our Congress passed the healthcare legislation, I will admit that it does address some serious issues. An unbiased analysis of the Democratic position must acknowledge that the bill does indeed promise to provide healthcare to some 32 million nonelderly Americans who would otherwise not have coverage. But that same analysis might not be so pro-Democrat when investigating the legitimacy of their claims of fiscal responsibility.

It is true that the Congressional Budget Office (CBO) estimates that the combined bill (H.R. 3590, as passed by the Senate, and the reconciliation proposal) will reduce the federal budget deficit by $143 billion over the next 10 years. This is the fact upon which the Democrats rest their claim of fiscal soundness. But how credible is this assertion?

A close look at the CBO report reveals that, while the basic analysis reflects such a savings, the likelihood of that outcome is not so substantial. The problem is that the analysis is rife with potential holes and assumptions. For example, taking only the probable discretionary costs into account (IRS enforcement, DHHS administration, and explicit authorization for grant and other programs), which the CBO projects to be as much as an additional $70 billion over that same 10 years, the actual deficit reduction would be nearly cut in half.

Discretionary costs aside, the $143 billion estimate is based only on changes in direct spending and revenue, but even within this category there are some line items that give cause for concern. One such item is the reduction in Medicare FFS (fee for service) costs. Identified as a $196 billion cost reduction in the CBO estimate, the savings is wholly dependent upon Congress staying the course with regard to physician payment rates. Should they decide instead to approve legislation that increases said payments, all bets may be off.  In fact, the CBO estimates that if H.R. 3961 were passed, which it already was by the House in the fall of 2009, the budget deficit would be increased by $59 billion. So much for the reduction and fiscal responsibility.

To be fair, maybe there is some small chance that Congress could stay their hand and resist raising Medicare payment rates, even in the face of doctors refusing to provide services at the 21 percent rate reduction scheduled for this April. So, let’s for a moment put on our rose colored glasses and assume it’s so — does that seal the deal for sound fiscal practices? I’m sorry, but “no.” We’re still left with some serious potential issues that give reason for skepticism.

One such issue is the validity of the estimate of the funding required to subsidize health insurance purchases. The CBO sets this number at $350 billion over that 10-year window.  This projection may be high, and it may be low.  The CBO states that chances are about equal, either way, and I certainly don’t have a crystal ball, but in the absence of any real reform, I think most people would agree on where the smart money would be. I mean, how many unscrupulous rate increases, like the 39 percent recently levied by Anthem Blue Cross in California, did the CBO include in their analysis?

Taken together, these issues definitely cast some doubt on the fiscal character of the healthcare legislation. Add to the mess, the intentional skewing of the numbers related to reductions projected from the CLASS (Community Living Assistance Services and Support) program and your doubt will likely turn to dismay. CLASS accounts for $70 billion of savings in the CBO estimates. It does this through the miracle of advanced premiums being collected for 5 years prior to any benefits being paid. Sound a little like sleight of hand? I think we can agree that the practice is dubious at best.

As much as I’m in favor of providing healthcare for ALL Americans, in the end, I’m afraid I have to call it straight up — the great Democrat healthcare victory is really just a sham. It is nothing more than the latest round of underfunded legislation adding to the $56 trillion black hole that is our national debt and entitlement liability.

America is in desperate need of real healthcare reform, and what was just written into law is not it. Real reform will address the issues that cause healthcare services to be so costly. It will remedy medical malpractice, include provisions to encourage healthier lifestyles, replace fee-for-service payments with a manageable system, and likely establish a central program that provides basic healthcare for one and all.

I’m not in the Republican, “Repeal and Replace” camp, but I can certainly see that we’re a very long way from real reform. With the Baby Boomers coming into retirement age, the time to act is now. That Black Hole isn’t getting any smaller.

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