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Bowles-Simpson is no match for the sequester

February 22, 2013 at 12:52 PM Leave a comment

Erskine Bowles and Alan Simpson announced this week another proposal to right the budget over the next decade, proposing both spending cuts and revenue increases.  There are many striking things about it, but one of them is that it actually demands cuts to Medicare.  As it is, the sequester will cut domestic programs, but leave Medicare and Social Security untouched.

And so while it is not being framed this way, what we are watching is de facto a question of how much we are willing to give up now in order to preserve the illusion that Medicare is an unlimited entitlement, for another year or two.  In Bowles-Simpson, discipline is imposed, provider fees are cut, higher efficiency is demanded.  None of this would be popular with doctors, hospitals, or other providers in the industry, and their lobbies I’m sure would work hard to defeat this proposal, should we ever give it serious consideration.  In the sequester, we cut virtually everything else, but Medicare in all its inefficient, fee-for-serviceness remains a happily overgrazing sacred cow. 

The process of making that choice would be hard enough in a calm, rational environment.  In that hypothetical world, we’d understand the consequences of each choice, we’d listen to those who would be affected thoughtfully, and we’d make tradeoffs and compromises so that every constituency would be mildly unsettled but not threatened with nonexistence. 

But we don’t live in a calm, rational environment.  We live in a world where poorly informed votes are prized (since they count the same as well-informed ones), emotion sells air time, rationality is often defeated by fear, and the short-term arbitrage almost always trumps long-term investment.  In this environment, my sad suspicion is that the fear of a catastrophic future loses to the prospect of a painful present most of the time.  Through our continued inability to address Medicare decisively, we are increasing the odds of both, year by year. 

Entry filed under: Uncategorized. Tags: #healthcare #healthcare reform.