I haven’t been posting much. I have been trying to figure out
why. Probably it is because all I want to say is that Bush is
an idiot, and I guess I have said that already. More than
But this latest gig is a particularly egregious case. I would
like to comment upon the situation, because it illustrates something
about health care policy that is not obvious.
Granted, this is only a proposal. Congress sets the budget.
But the opening proposal sets the tone for the negotiations.
Presumably, it reflects the values and the priorities of the
The programs will see almost $200 billion in cuts
over the next five years, about three times the savings proposed last
year but rejected by Congress. Much of the savings would come from
freezing reimbursement rates for most health care providers for three
years and from cutting payments to hospitals serving large numbers of
the uninsured poor.
The most obvious aspect of this is that the Administration does not
think reimbursement for health care providers is important.
They especially dismiss the importance of having hospitals
that provide care to poor people.
What is less obvious is this: many of the hospitals and clinics that
provide primary care are already in rough shape, financially.
Inflation alone will cause some to close entirely, if they do
not at least get some increase. Energy costs, in particular,
are going to be tough for hospitals to deal with.
Thus, cuts in Medicare and Medicaid will affect a lot of people, not
just poor and/or elderly people. Health care will be less
available in general.
Because hospitals are required to provide at least basic emergency
care, the cuts will lead to an unfunded mandate. That is
something that already occurs. It leads to cost shifting.
Thus, health care for paying patients will become more
To put this in perspective, consider what items in the budget are
slated for increase:
The Pentagon would get a $35 billion increase to $515
billion for core programs, about 7 percent, with war costs additional.
Another $21 billion would go to the Energy Department for nuclear
weapons programs. A $70 billion “bridge fund” for the wars in Iraq and
Afghanistan would give the next president time to consider options,
with tens of billions of dollars more needed regardless of any strategy
Overall, the budget for homeland security programs will increase by
almost 11 percent, with a 19 percent increase for border security and
immigration enforcement efforts, including new money to secure the
border with Mexico.
The paradox here, the thing that shows how idiotic it is, is that we
know that cuts in health care will lead to more disease and death.
It will lessen are ability to withstand disease outbreaks.
Thus, cuts in health care have the same effect as a threat to
national security. But national security threats are
not guaranteed to occur, whereas disease outbreaks are
certain to occur. So it makes no sense at all to cut health
care for the sake of national security.