In today’s NYTimes, there is an article in which Mr. Obama discusses his views on healthcare reform http://www.nytimes.com/2009/06/04/health/policy/04health.html?hp

The part that scares me is:

To help pay for coverage of the uninsured, Mr. Obama called for additional cutbacks in the growth of Medicare and Medicaid, beyond the savings he proposed in February as “a down payment on health care reform.”

In his earlier request, Mr. Obama proposed savings of $316 billion in the two programs over 10 years. On Wednesday he said he wanted to work with Congress to reduce projected spending on Medicare and Medicaid by an additional $200 billion to $300 billion over the next 10 years.

A few facts:

• The Medicare and Medicaid programs do not now currently cover the cost of providing the health care services that these populations demand.  In 2008, the South Carolina Hospital Association reported the unpaid cost of care for Medicare and Medicaid patients at close to $1 billion dollars – and that number only accounted for the 65 South Carolina hospitals that responded to its Community Benefit survey http://www.palmettohealth.org/documents/Community%20Programs/PH%20CB%20inventory%20fy07%20web.pdf
• In a 2007 survey, nearly half the doctors survey had stopped accepting new Medicare and Medicaid patients http://elderplanner.blogspot.com/2007/07/growing-number-of-doctors-refuse-to.html
• Medicare and Medicaid annual provide increases in their reimbursement that is less than the cost increases that hospitals and other providers incur, thereby increasing the unpaid cost of these programs.

Now, a simple question, Mr. Obama – how is a system that is already underfunded going to sustain  a $500 to $600 billion decrease in payments (another way of expressing your term “savings”)?  The simple answer – it can not.

There are multiple problems in the current health care system.  Amongst these problems, and in no particular order, I list the following:

1. Too little attention is paid to preventive care.
2. Insurance companies are too involved in medical decision making – a perfect example is the fact that states have had to pass prudent layperson legislation requiring insurance companies to pay for emergency room services, even though it turns out the condition was not life threatening.
3. Too many people are using the Emergency Department as a primary care physician.
4. Perhaps, most importantly, as a society, we have difficulty accepting the fact that death is a function of life.  Studies have shown that over 60 percent of a Medicare beneficiary’s lifetime costs are incurred in the last six months of life.

There exists but one answer to the problems facing our health care system in implementing reform, but no one wants to utter the word – RATIONING.   In order for this society to be able to afford health care for all citizens (and the illegals in this country, who are a tremendous drain on the system), we have to make some rational decisions regarding what is and is not considered the responsibility of the government mandated health care system.

Economists refer to two types of goods – social goods, those items that society is obligated to insure access to, and economic goods, those items that you need to be able to pay for yourself.  Housing (Section 8 ) and nourishment (food stamps) are two examples of social goods.  Owning an automobile is an example of an economic good.

But look at health care – what in health care is considered an economic good?  Cosmetic surgery is the only example that I can come up with.  Virtually everything else – even erectile dysfunction medications – are considered social goods in government programs.

Should government programs pay for everything?  I say no, simply because it can not afford to pay for everything.  We must engage in a substantive debate as to what constitutes a social good and what consititutes an economic good.

If a former professional athlete requires a total joint replacement, should a government funded health program pay for such treatment?  In my opinion, no – the athlete engaged in a profession that resulted in unnatural stresses on the joint that ultimately led to the need for surgery.

What about trauma care?  Absolutely a social good in most people’s opinion.  Now, add the idea of the foolish motorcycle rider who chooses not to wear a helmet to protect himself when he lays his bike down and cracks his skull on the curbing.  Should society be obligated to cover that individual’s care for the remainder of their life?  I have trouble answering yes to that question, as, again like the professional athlete above, the individual placed him/herself in that position.

These questions are tough questions – but no one wants to even raise the questions.  Our politicians believe that if they throw enough money at the problem, the problem will simply go away.

The truth is that our health care system requires material, fundemental reforms that can not be accomplished by blustering talk.  We must engage in a discussion that identifies those services that should be available to all individuals, regardless of ability to pay and funded by the government in a manner that approximates costs.  Only then can true health care reform even begin to happen.