Monday, January 21, 2008

What If We Had Privatized Social Security?

My proposed headline, Privatizing Medicare: Another “Great” Idea From Those Wonderful Folks Who Gave You The Iraq War, was way too long but I’ve always been a
Jerry Della Femina fan.

East Valley Tribune, Jan. 20, 2008

After reading Dr. Tom Patterson’s
column from last Monday casting scorn on the American public for liking Medicare, I take it he doesn’t much like the program. That’s OK, not everybody has to like everything, so all pizzas don’t come with anchovies. But if Medicare’s future financing is such a mess, why did Republicans waste time trying to privatize Social Security instead?

Just imagine if Bush had gotten his way with Social Security as he did with Iraq. We’d have invested our private accounts in AAA-rated obligations that -- surprise! -- were actually stinking piles of bad mortgages. Not only would your house’s value be dropping by double-digit percentages, but so would your retirement plan. Bush and the Republicans are pitch-perfect market timers; they wanted us to buy at the exact top, just before the crash.

How frequently do these guys get to be so spectacularly wrong before we stop swallowing their claims? Think about it before you sign on with the latest right-wing plan to “improve” your life.

All of Dr. P’s problems with Medicare -- rapidly-increasing costs, daunting demographic trends, too few primary care physicians, no time to talk with patients, and “futile, end-of-life procedures” -- aren’t problems of Medicare, they’re problems of the U.S. health care system.

Doctors not taking new Medicare patients? It’s not a Medicare problem. Has Dr. P tried the private insurance market, where “your” doctor may or may not remain on your health insurer’s list of approved providers, or where, after lining up physicians for all your family members, your employer suddenly switches plans and you have to start all over?

No reimbursement for “cognitive” care, talking with patients and working through problems? Does Dr. P really think it’s better in the private sector?

Too many specialists, and too few primary care physicians? It’s not just Medicare, the entire system is providing those wrong-headed incentives. If we actually thought the imbalance between primary and specialist care was a serious problem, then we’d pay for more medical schools. Second, can’t pro-market guys fix the problem pretty easily by paying primary care doctors more and specialists less? (I’m curious if that sentence will make it past the editors; the concept of “paying a specialist less” is, to many, an obscenity unsuitable for a family publication.)

Rapidly-increasing costs? Well, you’ve got to sort through the two types of cost increases in health care. Costs go up because some things cost more today than yesterday, like paying nurses more because that’s the only way to hire enough (that’s health care inflation) and because we use more health care now than last year, both because we’re older and because of treatments and technology that weren’t available previously (that’s utilization).

As you get older, you tend to need more care; reducing your age isn’t usually a viable option. But it does raise the question about those “futile, end-of-life procedures” encouraged by Medicare’s financial drivers that so upset Dr. P. Few patients get admitted to the hospital with a chart that says “6 months to live, max.” When it’s your life on the line, you tend to err on the side of more treatment. But if Dr. P is so worried about our country’s financial health and Medicare’s pernicious incentives, I’m happy to tell everybody if he’s hospitalized, don’t hesitate, pull the plug!

What Dr. P doesn’t mention is the unfunded cost projections also affect the private health care system. What’s looming isn’t just Medicare,
but all health spending. Merely shifting people from one side to the other through (highly regressive) tax-advantaged accounts won’t make the problem disappear; it’ll just get it off the government’s books -- and help relieve ‘wingers from any sense of obligation to their fellow citizens who fall ill.

Privatizing Medicare with “Health IRAs” makes as much sense as did invading Iraq or attempting to privatize Social Security. It’s the same people and the same result -- and with their track record, it’s a good bet that if they get their way, the next day you’ll get really, really sick.

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