McLaugh­lin’s al­ter­nate uni­verse

Modern Healthcare - - Opinions Letters -

Neil McLaugh­lin’s lat­est editorial (“Close en­coun­ters,” Feb. 7, p. 26) can­not go un­chal­lenged. To have some ob­tuse ref­er­ence to a his­tor­i­cal event—“An Act for the Re­lief of Sick and Dis­abled Sea­men”—be of­fered as prece­dent in light of se­ri­ous con­tem­po­rary con­sti­tu­tional dis­cus­sions, sim­ply points out that the legal crit­ics you cite have too much time on their hands and should back off of the science fic­tion.

Rather than add com­plex­ity to the al­ready com­pli­cated world, some of us in the real world try to fo­cus on a few sim­ple truths. Sim­ple truth No. 1: Health re­form is the most par­ti­san piece of so­cial en­gi­neer­ing leg­is­la­tion since the So­cial Se­cu­rity Act of 1935.

A cor­rect read of his­tory is sim­ple truth No. 2: When an op­pres­sive gov­ern­ment at­tempts to ap­ply its will against the lib­erty of an em­pow­ered peo­ple, there will be hell to pay. The Novem­ber elec­tions sent an un­equiv­o­cal mes­sage in this re­gard. A re­veal­ing dis­cus­sion be­tween two for­mer ma­jor­ity lead­ers of Congress (Dr. Bill Frist and Tom Daschle) dur­ing last year’s Amer­i­can Hos­pi­tal As­so­ci­a­tion an­nual meet­ing in Wash­ing­ton, noted that some years ago, the Repub­li­can ma­jor­ity briefly con­sid­ered us­ing the “rec­on­cil­i­a­tion process” to pass a piece of leg­is­la­tion not tied to the bud­get. Re­call that this was the ex­tra­or­di­nary leg­isla­tive tech­nique in­voked by last year’s Demo­cratic ma­jor­ity to even­tu­ally pass health re­form along party lines (since they could not get it done by fol­low­ing tra­di­tional rules). This so-called “nu­clear op­tion” was pre­vi­ously re­jected by the Repub­li­can ma­jor­ity, noted Frist, as it was de­ter­mined that it would be too dis­rup­tive to the gov­ern­ing process.

A cor­rect in­ter­pre­ta­tion of this “de­bate” is sim­ple truth No. 3: It is not a de­bate at all, but rather nu­clear fall­out, and fall­out is toxic. In col­lu­sion with the White House, the last Congress set off this par­ti­san bomb by im­pos­ing its will on a mi­nor­ity, against strong ma­jor­ity pub­lic opin­ion. The re­sult is that de­spite some pos­i­tive and needed pro­vi­sions in the health re­form leg­is­la­tion con­cern­ing health in­surance, the method by which it ex­panded be­yond all rea­son and was even­tu­ally passed was sim­ply un­con­scionable. Many of us feel it is bet­ter to re­peal this toxic law and start all over. There is truly con­sen­sus opin­ion re­gard­ing a num­ber of im­por­tant items that should be en­acted, but not like this. It seems likely that you might also buy into the no­tion that to re­peal health re­form is to add to the fed­eral deficit. This is truly the most vac­u­ous ar­gu­ment of all. It de­fies logic to be­lieve that cov­er­ing an ad­di­tional 30 mil­lion-plus peo­ple is free.

This leads to sim­ple truth No. 4: If you have no money, any ad­di­tional spend­ing adds to a deficit. It should be noted that for the first time in his­tory, we are now in a neg­a­tive cash sit­u­a­tion with So­cial Se­cu­rity—in other words, the de­clin­ing num­ber of peo­ple who are pay­ing for the grow­ing num­ber of re­tirees no longer cov­ers the full cost of this en­ti­tle­ment. The great Ponzi scheme that is So­cial Se­cu­rity has caught up with us. To make mat­ters worse, the bor­row­ing of So­cial Se­cu­rity re­serves over the years to meet other ex­cess fed­eral spend­ing must now be paid back. This in­ter­nal debt now amounts to more than $2 tril­lion. Sure, if you leave out physi­cian cost ad­just­ments and as­sume some­thing that has never hap­pened be­fore (bend­ing the Medi­care cost curve down— “sav­ings,” not just bend­ing the rate of in­crease) you can get the Con­gres­sional Bud­get Of­fice to give you a cor­rect an­swer to a silly ques­tion. For­tu­nately, the Amer­i­can pub­lic trusts their gut more than gov­ern­ment and rec­og­nizes sim­ple truth No. 5: Adding to the cost of health­care dur­ing a re­ces­sion is a re­ally bad idea and does not lead to em­ploy­ment growth.

Per­haps us­ing your editorial space to share some of these con­cerns would be bet­ter than “Close en­coun­ters.” I con­fess I am not re­ally hopeful for such editorial en­light­en­ment. Un­til then, may the force be with you as you con­tinue to in­voke science fic­tion into real life dis­cus­sions—“Nanu, nanu,” as Mork would say. For the rest of us, we would pre­fer to get about the busi­ness of real health re­form.

Scott A. Ma­son Man­ag­ing Part­ner SKM En­ter­prises

Po­tomac, Md.

Ma­son

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