The clock is tick­ing

Debt talks put bull’s-eye on health spend­ing, but how much pain is nec­es­sary?

Modern Healthcare - - Opinions Editorials - DAVID MAY As­sis­tant Man­ag­ing Edi­tor/fea­tures

The dead­line draws closer. Judg­ing by the grow­ing in­ten­sity in the de­bate last week over the na­tional debt ceil­ing, one might think we have a new Dooms­day Clock to mon­i­tor with trep­i­da­tion. But that’s not the case. While it’s true that time is tick­ing away for lawmakers to reach an agree­ment, de­fault can’t be an op­tion. Cer­tainly the debt load has ex­ploded over the past decade—no, it hasn’t hap­pened only dur­ing the Obama ad­min­is­tra­tion—and ef­forts to re­assess our nation’s spend­ing pri­or­i­ties are long over­due. But the true risk of catas­tro­phe lies more in some of the pro­posed so­lu­tions to the prob­lem than in the debt it­self. Will too much be cut too fast for our frag­ile econ­omy to han­dle?

As we all know, health­care ex­pen­di­tures are al­ready cen­ter stage in this drama. The hun­dreds of bil­lions of dol­lars in an­nual Medi­care and Med­i­caid spend­ing make an en­tic­ing tar­get be­cause the subto­tals have been ris­ing at rates un­sus­tain­able in the long term.

Late last week, the White House sig­naled a sur­pris­ing will­ing­ness to make deeper cuts to Medi­care and So­cial Se­cu­rity than pre­vi­ously in­di­cated. But such cuts will prove un­palat­able among many lawmakers. And they cer­tainly will be un­pop­u­lar with the nation’s se­niors, who will let their feel­ings be known at the polls next year if the pro­pos­als ad­vance.

Then there’s Med­i­caid, sup­pos­edly the nation’s safety net specif­i­cally de­signed to en­sure health­care for cit­i­zens at their most vul­ner­a­ble, also left with a large bull’s-eye on its bud­get. The debt hawks have been cir­cling here for a long time, and Med­i­caid cov­er­age has al­ready been tar­geted in state Leg­is­la­tures, both Repub­li­can-and Demo­crat-con­trolled.

With the econ­omy con­tin­u­ing to sput­ter, such ac­tions could most cer­tainly prove cat­a­strophic for a sig­nif­i­cant num­ber of Amer­i­cans. Too many of our fel­low cit­i­zens have nowhere else to turn. Ef­fi­cien­cies can be found to help con­tain costs, but for a nation with our eco­nomic re­sources, even in the tough­est times such bud­get-cut­ting pri­or­i­ties are shame­ful.

The need for cuts in fed­eral health­care spend­ing and en­ti­tle­ments were high­lighted in the fi­nal re­port from the pres­i­dent’s na­tional debt com­mis­sion last year. But so was tax re­form and tax fair­ness. In re­cent ne­go­ti­a­tions on the debt ceil­ing, the idea of clos­ing tax loop­holes and end­ing some fed­eral sub­si­dies were deemed non­starters with GOP rep­re­sen­ta­tives, this at a time when the same par­ties said that ev­ery­thing should be “on the ta­ble.” Such stub­born­ness also could prove dev­as­tat­ing if the specter of these talks be­ing pushed to the 11th hour spooks the fi­nan­cial mar­kets.

There’s still time to set­tle this, but the clock is tick­ing. Loudly.

Staying on the sub­ject of health­care spend­ing, there’s never a short­age of re­ports, stud­ies and analy­ses of just where the money goes and how much is con­sumed.

Ear­lier this year came a study show­ing the over­all cost of obe­sity in Amer­ica to­taled nearly $300 bil­lion an­nu­ally, in­clud­ing lost pro­duc­tiv­ity, ac­cord­ing to the So­ci­ety of Ac­tu­ar­ies. Of that to­tal, the cost of health­care ser­vices to treat the epi­demic was pegged at $127 bil­lion.

An­other study, this one re­leased last month by the Amer­i­can Med­i­cal As­so­ci­a­tion, re­ported that claims er­rors among com­mer­cial in­sur­ers were adding $17 bil­lion in un­nec­es­sary ad­min­is­tra­tive ex­penses.

And a cou­ple of weeks ago, the In­sti­tute of Medicine is­sued a re­port call­ing for changes in treat­ment of chronic pain, which the IOM said costs the U.S. up to $635 bil­lion an­nu­ally in treat­ment ex­penses and lost pro­duc­tiv­ity.

Such costs can never be elim­i­nated, but pay­ers, providers and pa­tients need to chip away at them as much as pos­si­ble. They’re cuts that ac­tu­ally make sense.

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