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The Doctor Won’t See You Now

What controlling health care costs really means.

4:59 PM, Jan 7, 2010 • By STANLEY GOLDFARB
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“There's an alarming pattern among some legislators who want to see reform of Medicare (and Medicaid) as an irrelevant aside in the debate over how to restructure health care. How is it possible that an entitlement program that's already paying out more in benefits than it's taking in — that has saddled us with over $38 trillion in unfunded obligations — is unrelated to our efforts to reform health care? With our urgent need to corral health care costs, how can we glibly speak of a Medicare "fix" that would add $247 billion to our deficit over the next ten years — and maneuver to exclude this cost from the Senate Finance Committee Bill? This is a prima facia case of fiscal irresponsibility.


“Medicare is a program that is wholly unsustainable right now and its problems, if not addressed soon, will make a mockery of the fiscal integrity of any health care reform effort.”
Single payer advocates are truly in denial. Medicare for all in its current iteration would end up like Bernie Madoff: Not enough new money to pay off the old bills.


Affordable, accessible and high quality health care for our nation may be a puzzle without a solution. One thing is sure, however, and that is that the bills in the House and Senate are not going to accomplish it and may not even get us started on the path. Approaches that provide the patient and physician with individual economic incentives to keep down costs ought to be considered. (These cannot be found in the current bills). It is a great deal more likely to control costs in this approach than to create a huge bureaucracy to try to impose cost controls. By the way, no industrialized country in the Organization for Economic Cooperation and Development has done a much better job than the United States in controlling the growth rate of the cost of health care; the United States just starts at a much higher baseline of cost per person.

The current debate about cost control has been profoundly misleading. We need some straight talk from our leaders.

Stanley Goldfarb MD is associate dean of clinical education at the University of Pennsylvania School of Medicine and a nephrologist.

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