Well, somehow we did it. Despite a hard play from tea-party folks who were apparently willing to actually cut the baby in half, a last minute deal to raise the debt ceiling got done. Unfortunately, the markets haven’t taken the deal as a reason to be positive, and today alone the DOW lost over 500 points. World markets also took it on the chin, falling anywhere from 3.3 to 5.7%.
What is driving this continued fear? The reasons are complex, of course, but a major factor is the unsustainable level of social commitments (and therefore debt) for which many Western countries are responsible. And much of this is driven by health care costs. Despite generally embracing health care programs that are self-consciously rationing care, many European countries are struggling to meet the need of their huge social welfare system in this regard. Greece’s government, for instance, has a backlog of medical bills from 2010 and has failed to make payments in 2011. Spain has discovered “piles” of hidden health care debt that was previously unknown. Italy has instituted a large co-payment for its citizens to push back against its health care debt. And the UK has now started rationing “non-urgent” operations (like hip replacements and cataracts) for similar reasons.
Europe has started to make difficult decisions. Will the United States ever get to this point? Well, the writing is on the wall:
Unless we take steps to get our health care costs under control, Medicare and Medicaid costs will simply eat us alive. Sure, we can cut waste/fraud and make the system more efficient, but it is difficult to see what will stop the trend of people living longer and using more and more expensive technology to do so. I have argued in my book ‘Too Expensive to Treat?’ that Christians in particular should understand that the finitude of our natures and of our resources means that rationing health care is an inescapable feature of human existence. We must therefore do it explicitly if we wish (1) the rationing to happen justly and (2) to push back against the unsustainable trend in the above graphic. Appeals to ‘death panels’ and to ‘balancing the budget on the poor and seniors’ are the easy soundbites of demagogues who refuse to deal honestly with this ever-growing and ultra-serious problem.
Charlie, I agree that health care costs must be addressed in order to solve our long term budget problem. Somehow, Democrats have to be convinced that refusing to talk about restructuring Medicare does not put them on the side of the poor and middle class. Republicans need to acknowledge that for Medicare to be saved, we have to take a hard look at how we do end of life care. I want my representatives to raise the tough questions, and I think most Americans do, too. Polls reported today in the New York Times show that approval ratings fro members of Congress are at an all-time low. All the political posturing was ineffective. It’s time for a grown-up conversation, and the Catholic tradition on health care can serve as a great conversation-starter.
Exactly, Julie…and that grown-up conversation will need to take us beyond the left/right clusterfrack we saw in the lead-up to the debt-ceiling deal.
Charlie – I notice that your book seems primarily to deal with neo-natal medicine. Are there other broad areas that you’d similarly advocate cuts in? For example, I have seen complaints, from both doctors and patients, about the costs associated with OB-GYN care and wonder how we might think about that.
Hi Jana…yeah, I suppose one track of my book tries to just how the necessity of rationing in virtually any health care context, and the other track is applying that argument in the context on the NICU. But what I found from my research is that each area of medicine is complicated beyond any sort of ‘hey, I wonder what we could cut from ‘x’ approach.’ I do think we need to go beyond the end of life, however, in thinking about rationing.
It seems to me this question is never asked: What do the American people want from government that they are willing to pay for? The question is not what percentage of GDP government spending should be. It is what people reasonably want from government. If Americans want cradle-to-grave health care of the highest quality, and they are willing to pay extremely high taxes to get it, then America should have cradle-to-grave health care of quality and quantity commensurate with what they are willing to pay.
Coming up with cuts in federal spending of the kind that was done in the budget deal and is planned by the new commission doesn’t really even begin to address the problem. And a balanced-budget amendment is a colossally stupid idea. One of the major problems is that Americans do not understand the economics of federal spending, and it doesn’t seem to be in the political interest of either the Republicans or the Democrats to have educated voters, and neither side is willing to present an honest plan for our economic future.