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Monday, January 29, 2007
Give With One Hand, Take With The Other
The Center on Budget and Policy Priorities has an big-time paper out on entitlement costs and the budget, where they both move forward the debate over future fiscal problems, and move it back.
Laudably, they dispel the myth that there is an "entitlement" crisis. Many entitlement programs are actually going down in costs and getting more efficient. Just because the program is an entitlement doesn't mean it's got problems.
But they then go on to include Social Security among the entitlement programs that are in crisis. That's misleading. A fiscal crisis is when costs are rising much faster than revenues can keep up. CBPP accurately makes the distinction that health care costs are projected to rise much faster than social security costs. But it fails to make the crucial distinction that built-in revenues will not keep up with health care costs, but will keep up with social security for at least the next 40 years. That's not a crisis in my book.
The report then states clearly that increased health care costs, irrespective of demographics, is the main driver of future fiscal problems. Great! But then they go on to downplay how much inefficiencies within the health care system have driven up costs across the public and private sector. Rather, they argue, innovations in heath care provision, and patient demand for these new goods and services, account for the rate of growth in health care costs, both in government programs and in the private sector.
Kudos to CBPP for recognizing the systemic nature of the problem, and for dispelling the myth that demographics are mostly or even solely to blame. Still, this analysis has the same-old, wrong-headed, focus on trade-offs. It suggests that the nation must deal with a dilemma: do we want more health care or less health care? More health care or less of something else? And it suggests inevitability: we can't avoid these hard choices. And it ultimately suggests that costs are too high to pay for all the health care we might want: we'll have to make cuts somewhere, because if we don't, it'll mean a reduction in living standards somewhere else.
I feel like I've heard that one before. It's pretty much the same old story about entitlement programs, isn't it?
CBPP still isn't thinking about this stuff the right way. Health care provision, for all intents and purposes, is not just a zero-sum game. The alternative here is to focus on creating a more efficient health care system.
In other words, let's talk about the elephant in the room: universal health care and its power to contain costs. In the spirit of bi-partisan, high-minded, wonk-style fairness, shouldn't we have a conversation about it, too?
Posted by Matt Lewis
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