The Corpus Callosum

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 once.  

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.

The budget proposal put forth by the Administration calls for $200 billion in cuts to Medicare and Medicaid over the next five years.  

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 Administration.

According to an AP story, syndicated by Yahoo:

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 expensive.

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 shift...

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.