Political Animal


September 03, 2011 9:55 AM Driving the point home on health care costs

By Steve Benen

Over the last couple of years, there’s been plenty of talk — far too much, really — about the nation’s long-term fiscal challenges, and it’s true that it’s a problem that we should deal with responsibly in time. But the talk is often overly broad — what we have is a fiscal challenge related to long-term health care costs specifically, not just long-term debt in general.

As Jared Bernstein put it the other day, “As long as health care costs (and, as the population ages, demand for services) continue to spiral up, it’s going to create huge problems.”

To drive the point home, take a look at this image the Bipartisan Policy Center published yesterday.

It may be a little tough to see but there are four lines, showing long-term spending, as a percentage of GDP, on health care, Social Security, discretionary spending, and other mandatory spending. That blue line that shows the sharp increase? That’s health care.

As Sarah Kliff noted in response, “Even as someone who spends a lot of time writing about health policy, this new chart … is still one that gives me a bit of pause.”

This should matter in the context of the debate in Washington, because if policymakers want to address long-term debt issues, they should at least realize, to borrow Willie Sutton’s line, where the money is.

But they should also realize that there are different approaches to controlling health care costs, and Republicans have the policy completely wrong. After all, what does the GOP propose? Three things: (1) repeal the Affordable Care Act; (2) raise the age of Medicare eligibility; and/or (3) end Medicare and replace it with a privatized voucher system.

And what’s wrong with this? Well, first, the ACA is already working to lower costs, and eliminating the law would increase the deficit and reverse the progress on curtailing costs. Second, raising the Medicare eligibility age would actually be a rather dramatic step backwards. And third, the Republican plan to end Medicare wouldn’t save any money at all — it would just shift the burdens onto seniors and their families.

My concern is that some folks, especially on the right, will see the chart like this one and think this somehow bolsters the Republican argument. In reality, it does the opposite.

Steve Benen is a contributing writer to the Washington Monthly, joining the publication in August, 2008 as chief blogger for the Washington Monthly blog, Political Animal.


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  • walt on September 03, 2011 10:21 AM:

    The right sees everything, from the sunrise in the morning to the evening star as proof that their arguments are correct. That's why they're belief-based. It saves a lot of energy having to make logical arguments based on facts when the only thing that matters is that your tribe is the good one.

    If Obama loses next year, which is looking like a fairly good possibility, Republicans will repeal ACA. Then the magic of the free market will be unleashed and we'll contemplate Christian Science as an alternative to sky-high health-care insurance premiums.

    We have a good example of Republican economic theory in the presently-constructed health-care system: protected cartels immunizing themselves from competition and health-insurance companies walling themselves off from governmental regulation. This creates the perfect storm of runaway health-care inflation and a fundamental maldistribution of a necessary product.

    If you're wondering why ACA is so unpopular given this reality, consider that President Obama can't be bothered to give it a ringing defense. It wouldn't be bipartisan and adult-like.

  • meander on September 03, 2011 11:06 AM:

    "Prevention" seems to be unmentioned in the cost-control debates that I read about -- or, perhaps, buried in the 20th paragraph of the stories. It seems to me that a significant fraction of U.S. health care expenses are for conditions like heart disease, lung disease, diabetes, hospital infections and general bad health. Many of these cases could be prevented for the next generation with better diets, more exercise, improved hospital practices. So why aren't policymakers talking about a crash program to do these preventative measures, thereby having a healthier population and reducing expenses on dialysis, heart operations, high blood pressure drugs, and so forth?

    For example, Professor Marion Nestle relays some new research at her blog Food Politics: "The journal, Obesity, has an analysis of the cost of obesity to states. Obesity costs states an additional 7 to 11% in medical expenses. Between 22% (Virginia) and 55% (Rhode Island) of state costs of obesity are paid by taxpayers through Medicare and Medicaid."

    I can guess some of the answers why prevention is not discussed: improving our diet = totalitarianism; exercise programs or gym in school = tyranny and time not spent on the 3 R's; blood pressure medication is big business, i.e., sick people are a lot more profitable than healthy people; drug companies, hospitals and dialysis clinics have a lot of influence in Washington.

  • chopin on September 03, 2011 11:45 AM:

    I don't think you are having the same argument. The GOP "plan" is designed to lower health costs TO THE GOVERNMENT. They claim they want the government out of the cost mix altogether with respect to the cost of health care and want the responsibility transferred to individuals. They just don't want to make their point so bluntly that the electorate get it. And the corporatist-minded leaders are focused on that goal like a laser. Your chart shows the cost of health care to the citizens and responsible leaders are concerned about bending that curve in the other direction as a responsible service to their constituents. The problem isn't whether or not an informed electorate wouldn't elect responsible representatives. It is how to achieve an informed electorate via a corporatist owned media monopoly. A take-no-prisioners president with a bully pulpit would be a great asset. But we ain't got one of them. A focused party with cojoles would be another great asset. Turns out we got us one of them all right. But it is bought and paid for by corporatists. Too bad we don't have an equally focused opposition party.

  • Anonymous on September 03, 2011 2:49 PM:

    I don't really see the gloom and doom about next year that others do, but I could be wrong.

    We would then see a country in which the GOP would be able to undo not just the good things Obama did but the rights of everyone else but the rich in this country.

    Then it would be time to leave the country.

    The GOP only wants to control the government to ensure that nothing of your tax money returns to you in services and pensions, etc.

    In other words, they want your tax money to be what it was to King John and the Sheriff of Nottingham: tribute you pay to them just so they won't kill you.

    And people would vote for that? Because they THINK the GOP is pinching their pennies on their behalf?

    How dumb can people be?

  • Patti Batchelder on September 03, 2011 7:53 PM:

    OK everybody � I just read the article and all your comments. As a voracious reader, a person with a degree in economics, and 14 years as Office Manager for a solo Family Practitioner, I want to knit it all together for you.

    1. Don�t forget the military budget (ours is 6 X China�s and = to rest of world�s put together). That has to stop. But healthcare has to be fixed, or the system will collapse. It�s starting to now.

    2. walt, meander, chopin, and Anonymous all had sharp insights into the causes of the problem, the roadblocks to solving it (the media is controlled by corporate ads, NPR by corporate donations, cuts to education funding), and some bits of the solution (preventive medicine)


    3. The BIG sources of waste are OVERPRICED DRUGS, and ADMINISTRATIVE COSTS OF PRIVATE INSURERS (150,000 different plans if you include Medicare D, each with their own rules, websites, passwords, PBMs, subcontractors to prior-authorize CTs, MRIs, upper endoscopies, sleep tests�and on and on)

    The private insurers� admin. costs are 8 X as high as Medicare�s! Medicare works � I�m on it. And it would work GREAT if we used some of the savings from �see above. And my doctor boss says he�d be happy with Medicare�s pay rates because he�d have lower staff costs.

    4. SOLUTION: SINGLE PAYER. Offer Medicare to anyone who wants it. Within 5 years hardly anyone will pay Blue Cross�s rates. (That�s why Republicans will fight it to the death!) And Medicare can negotiate down drug prices.

    Get the message out!! Tell your friends! Write letters to the editors, especially local papers. Help save American medicine. And my office. ( He�s a great doc.)
    P. S. Ask me why Romney's a jerk and his plan, like Obama's compromise, is no good. But you probably know.

  • Patti Batchelder on September 03, 2011 7:55 PM:

    Help! How do you punctuate on this site?

  • exlibra on September 03, 2011 9:05 PM:

    meander, @11:06 AM (if you ever come back to read),

    The short answer is that removing a foot and replacing it with a prosthesis provides a lot more income to a lot of people than does a class teaching diabetics to take better care of themselves and preventing that drastic, last resort, measure.

    "Cui bono?" is a question the answer to which operates in more than just the legal circles.

    "itypois 58.60" announces Craptcha. No wonder our healthcare is so expensive, if each typo gets clocked at that price.

  • inicell on September 04, 2011 10:01 PM:

    Exlibra has it exactly right. I work for a healthcare company and all that anyone cares about is marketing and getting more revenue. Oh, and it would probably be good if we didn't kill anyone in the process and get sued. Making people healthier is fine, but we don't want anyone doing that on their own. We have to have a whole army of administrators and a inhouse specially developed computer system to support the very expensive degreed healthcare professionals who are going to tell you to put down that donut.