Health Care in the Democratic Matrix…

Just keep telling yourself and your friends…

“There are no “savings”


A Savings Mirage on Health Care

Let’s start with the numbers. Unfortunately, the word “savings” is used misleadingly. It doesn’t mean (as is usual) actual reductions; it signifies smaller future increases. There’s a big difference.

In 2009, national health spending will total an estimated $2.5 trillion, or 17.7 percent of gross domestic product. By 2019, it’s projected to rise to $4.67 trillion under present policies, or 22.1 percent of GDP. With CAP’s “savings,” it rises a little less sharply to $4.49 trillion, or 21.3 percent of GDP, according to Harvard economist David Cutler, the study’s co-author who provided these figures. Similarly, family health insurance premiums rise from 19 percent of median family income in 2009 to 25 percent in 2019 under present policies and 23 percent with CAP’s “savings.”

The point is simple: Even with highly optimistic assumptions, health spending remains out of control. It absorbs more of government, business and family budgets. Higher health spending would put pressure on future budget deficits, already projected to total about $9 trillion over the next decade. If new taxes and Medicare “savings” are real, they could be used exclusively to pay down deficits, not finance new spending.

But many may not be real. Writing in The Wall Street Journal, Dr. Jeffrey Flier, dean of the Harvard Medical School, gave the various health bills a “failing grade” and said they wouldn’t “control the growth of costs or raise the quality of care.” Quoted in Newsweek, Dr. Delos Cosgrove, head of the Cleveland Clinic, said much the same. Richard Foster, the chief actuary of the federal Centers for Medicare & Medicaid Services, doubts the cost-saving provisions touted by CAP would save much money. He’s also skeptical that Congress, facing complaints from hospitals and a squeeze on services, would allow all the Medicare reimbursement cuts to take effect. True, Congress has permitted some reimbursement reductions to occur but has repeatedly blocked the Sustainable Growth Rate adjustment for doctors, which most resembles the new proposals.



The ‘Cost Control’ Bill of Goods

Mr. Orszag proposed another option, citing academic research observing that as much as 30% of health spending is “waste” that doesn’t affect outcomes. He argued the country could save $700 billion a year without harming quality—more than enough to pay for universal coverage.

Thus cost control migrated from Orszag theory to free political lunch. Mr. Gawande wrote an influential New Yorker essay on the topic in June, and the theme shaped both the case for a new entitlement and especially the appeal to potential opponents in business.

But then Congressional Budget Office director Douglas Elmendorf testified in July that “the curve is being raised,” given that ObamaCare lacks “the sort of fundamental changes” necessary to tamp down costs. Meanwhile, it became clear that Mr. Orszag’s favored research was always more nuanced and qualified than his pose of papal infallibility. One of his main gurus, Jonathan Skinner, mused recently that “the key lesson” from a new study challenging some of his findings “is how little we know about the science of health-care delivery.

And yet they want to saddle us with this truly awful bill.