The un­bear­able light­ness of politi­cians deal­ing with bulbs and deficits

Modern Healthcare - - Front Page - NEIL MCLAUGH­LIN Man­ag­ing Edi­tor

While the clock ticks on a debt-limit deal, Congress de­bates ... light bulbs

The U.S. House last week de­bated leg­is­la­tion in­tended to re­peal ef­fi­ciency stan­dards for light bulbs man­u­fac­tured in the fu­ture. Some char­ac­ters who dwell in cable TV land have con­tended that these stan­dards amount to gov­ern­ment elim­i­na­tion of our sa­cred right to burn old-style in­can­des­cent bulbs.

The mea­sure failed to se­cure the needed votes to ad­vance, but in the sur­round­ing cov­er­age there were pre­dictable quips about con­gres­sional dim bulbs de­bat­ing light bulbs, how many politi­cians does it take to change a light bulb, etc., etc. Some lawmakers com­plained that Congress ought to wres­tle with much big­ger prob­lems fac­ing the nation. But maybe there’s some­thing po­et­i­cally ap­pro­pri­ate to the ac­tiv­ity. Af­ter all, if there’s any venue in des­per­ate need of il­lu­mi­na­tion, it’s Wash­ing­ton.

While the House was tack­ling the light bulb is­sue, Pres­i­dent Barack Obama and con­gres­sional lead­ers were try­ing to hash out an agree­ment on fed­eral spend­ing and deficits. This was aimed at avert­ing a Repub­li­can threat to not raise the debt ceil­ing in the ab­sence of mas­sive spend­ing cuts (no tax in­creases al­lowed), a move that could plunge the nation into credit de­fault with all the un­pleas­ant con­se­quences.

These ne­go­ti­a­tions have cre­ated a bud­get-cut one-up­s­man­ship. The Repub­li­cans de­mand tril­lions in cuts, and the ad­min­is­tra­tion says, “I see your tril­lion and raise you a gazil­lion (but with tax hikes).” And ev­ery­thing sup­pos­edly was on the ta­ble, in­clud­ing deep cuts to Medi­care, Med­i­caid and So­cial Se­cu­rity. It was even re­ported that Obama floated an idea pro­posed by Sen. Joseph Lieber­man (I-Twi­light Zone), for rais­ing the Medi­care el­i­gi­bil­ity age.

Be­fore these politi­cos do any­thing dras­tic, es­pe­cially on health­care, they ought to re­tire to a clean, well-lighted place with a his­tory book or two. Un­der the glow of any num­ber of bulbs, they can read about the Great De­pres­sion and how spend­ing cuts and tight money nearly choked off the re­cov­ery. (Mas­sive spend­ing on World War II saved the day.) Or how Ja­pan failed to spend enough in the 1990s to lift it out of an eco­nomic ditch.

Health­care has proven to be the 150-watt bulb in the dark­est U.S. econ­omy since the 1930s. June’s em­ploy­ment fig­ures showed that health­care added 13,500 jobs, while the over­all econ­omy grew by a net 18,000 new po­si­tions. Slash­ing at Medi­care, Med­i­caid and other health pro­grams with a ma­chete will only dampen an ane­mic, job­less re­cov­ery. Reck­lessly snatch­ing re­sources from the peo­ple who can af­ford it least and from providers who care for them will hurt the eco­nomic and phys­i­cal health of the nation.

As we have said be­fore, there is plenty of fat to trim from health­care spend­ing. Amer­i­cans pay the world’s high­est prices for care, but the over­all re­sults lag well be­hind those of other de­vel­oped na­tions. But there are ra­tio­nal and grad­ual ways to go about cur­ing the ail­ment with­out killing the pa­tient. Ditto for the over­all deficit. When GOP Rep. Paul Ryan’s pro­posed bud­get was be­ing de­bated this year, nearly 200 prom­i­nent econ­o­mists signed let­ters urg­ing con­gres­sional lead­ers to re­frain from a nu­clear at­tack on Medi­care and Med­i­caid. They said the coun­try ought to stick with the pro­vi­sions in the Pa­tient Pro­tec­tion and Affordable Care Act de­signed to eval­u­ate spend­ing pri­or­i­ties and elim­i­nate waste.

Iron­i­cally, the re­form law—based on pro­pos­als from con­ser­va­tive thinkers years ago—is be­ing at­tacked by the lawmakers barking the loud­est about soar­ing deficits. The In­de­pen­dent Pay­ment Ad­vi­sory Board pro­vi­sion is the spe­cific tar­get du jour, prov­ing once again that pol­i­tics trumps pol­icy and logic.

Let’s hope our pub­lic of­fi­cials don’t cause too much dam­age be­fore they see the light.

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