Is any “federal budget” proposal realistic without a specific plan to reduce the growth rate of healthcare costs?
Both House and Senate leaders have revealed their federal “budgets.” No one expected much agreement between the two and there was not. No one expected that either would be a real budget, and they are not.
Most expected the budgets to shed light on the different political visions of the Republican controlled House and the Democrat controlled Senate, and this was accomplished.
A few held out hope that these budgets would constructively propose a plan to address the relentless growth of American healthcare cost, but neither did.
Federal spending—regardless of who is President or which party controls the House and Senate—will grow at unsustainable rates unless the growth in healthcare costs is dramatically reduced.
In different ways the House and Senate budgets deal with the growth rate of healthcare costs by ignoring them and pretending that somehow the federal government will just pay a smaller and smaller share of these costs.
The House proposes killing the Affordable Care Act, turning Medicare into a voucher system and turning Medicaid into a “block grant program.” Apparently, the idea is that these general concepts will somehow reduce federal spending on healthcare.
The Senate just proposes to chop off about $300 billion in federal spending on Medicaid.
Here’s a problem: Let’s just assume that the federal government spends less on healthcare, but the cost of healthcare continue to escalate. Who pays the healthcare providers’ bills as increasing numbers of Americans just cannot afford to pay them?
Budgeting becomes easier the further away from reality it moves. For example, let’s propose that the federal government not pay one thin dime from this point forward on healthcare. That would take a giant step in decreasing federal spending and meet the full expectations of those who want to downsize the federal government. Was that not proposed because it is unrealistic?
It is equally unrealistic for any “budget” to assume decreased federal healthcare spending rates without a real plan to dramatically decrease the growth of American healthcare costs.
Can a single state provide humane healthcare for its citizens without receiving significant federal help? No. This harsh reality will only compound without a significant and sustainable decrease in the growth of healthcare costs.
So go ahead and debate the budget.
Yet, the public discussion we really need is quite different. We need to address the problem at its source. We need to reduce the cost of healthcare without unduly sacrificing its quality. Unless we can accomplish this reduction, budgets are meaningless, because the states will need federal funds to maintain the basic necessities of a politically acceptable healthcare system until it too is unable to so do.
© Jack Edward Urquhart March 13, 2013