Deficits matter

"Reagan proved that deficits don't matter."
--Karl Rove

Deficits do matter. They are not the end of the world. Since 1980, Republicans have run up huge annual deficits. Except for the last two years of Bill Clinton's presidency, when the federal government had a budget surplus and began paying down the national debt, Democrats haven't been able to offer a coherent solution.

There are only two ways to reduce the national debt: raise taxes or cut spending. Most politicians would like to promise us lower taxes without significant cuts in government services. There is no such animal.

Tuesday, February 22, 2011

All Health Care Has to be Paid For

One of the great American myths is that we can have something for nothing. Sarah Palin indulges in it, so does Nancy Pelosi. Voters demand it of them. What is missing from the health care debate is, it all has to be paid for by someone.

If every visit to a doctor's office is covered by medical insurance, then monthly premiums have to include enough money to pay for the office visit, and the lab tests. INSURANCE originally meant a small payment to share the risk of an unlikely event. If one out of every one hundred people will have a heart attack, in thirty years, then the premiums paid by one hundred people over thirty years have to be enough to pay for the full cost of treating one heart attack: ambulance, emergency room, CCU, ICU, hospital bed, medications, lab work... We don't know which of those 100 people will get the heart attack, so everyone pays 1/30th of 1% of the estimated cost each year, and whoever is "the lucky one" is covered.

If it doesn't come out of premiums, then it is paid for out of pocket by patients at time of service (deductibles and copays), from tax revenue, or medical staff pay for it by taking a cut in their compensation, or the insurance company eats the difference. It is in the nature of insurance companies to charge premiums that provide them more revenue than the total cost of all the bills they pay. That's how they make money. If they are making too much, we need to know the numbers.

If Sarah Palin chooses to denounce every cost-saving on "end of life" care as "death panels," she should be honest about the burden she is asking taxpayers to carry. If Barack Obama wants to outlaw lifetime caps on medical insurance coverage, he should offer facts and figures on how much this will cost insurers, and whether their current operating profit is larger than the new costs. If the money isn't there, how much are taxpayers on the line for? Maybe it is the right thing to do, but let's be up front about what we are each willing to pay.