Tuesday, April 20, 2010

Reeling, Writhing, ‘Rithmetic, and Health Reform

“Reeling, and Writhing, of course, to begin with, the Mock Turtle replied, ‘and the different branches of Arithmetic – Ambition, Distraction, Uglification, and Derision.’ “

Lewis Carroll, 1832-1898, Alice’s Adventures in Wonderland

Lewis Carroll was a mathematician in real life.

Maybe the time has come for us to think like mathematicians and to do the math on health reform.

For examples, the nonpartisan Congressional Business Office, says,

• the budget shortfall this year will be $1.5 trillion – a post-World War II record at 10.3 % of the national economy

• Obama’s proposed budget will grow to more than $9.7 trillion for the next decade to 90% of the economy

• by 2030, health care will add $3 trillion or so to the debt.

• Medicare is scheduled for bankruptcy by 2016, or sooner, if the economy does not pull itself out of its present ditch.


Furthermore is an appropriate word to use in explaining these projections. We know further that 78 million more baby boomers will start qualifying for Medicare in 2011 at the rate of 13,000 a day. These further numbers add more fodder to the national debate about unsustainable national debt, passing this debt onto our grandchildren, and overgrowth of a “socialistic” government.

Furthermore, we know these numbers lead to all sorts of political arithmetic – ambitious politicians saying we need more or less government, distracting us with budgetary gimmicks, uglifying their arguments by accusing the other side of inflammatory extremism, and using derision to demean opponents.

No More Furthermore

We cannot continue on this furthermore course. We must look at the math and make fundamental decisions to reverse the numbers – such as, moving the entry age of Medicare from 65 to 67 or even 70, acknowledging the reality that most Americans will soon live to 80 or beyond; means testing Medicare so that affluent elders pay more; allowing private contracting between patients and doctors so that patients of means can access care outside of Medicare; giving more leeway to health saving accounts with catastrophic caps so consumers can use their own money to decide what care they want and can afford; and recognizing that “free” government entitlement programs have always and will always exceed government projections.

Otherwise, we will continue reeling, writhing, and defying the rules of ‘rithmetic. Otherwise, furthermore may become forevermore.

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