I finally had a chance to sit down and look at the 2010 fiscal year budget summary for the Department of Health and Human Services, being somewhat curious about how they planned on spending 630 billion dollars. After a considerable amount of swearing, I calmed down enough to write a post about it.
The short answer is I have no &#@** idea on what exactly they plan to with most of it. Maybe the soon to be rapidly growing number of HHS employees don't know either. If you add up the figures given, it comes out to about 65 billion, two thirds being a Medicaid supplement which will be handed out to the states. Here's how some of the other expenditures break down:
Indian Health Service 4 billion
NIH cancer research 6 billion
FDA 1 billion
Head Start/child programs 4.2 billion
HILEAP (energy subsidy for low income) 3.2 billion
Under served area health/recruiting 400 million
Autism support 211 million
Other areas mentioned but no dollar amount specified: health IT development, HIV/AIDS prevention and treatment, teen pregnancy prevention.
The budget makes a number of nebulous statements about Medicare, such as "strengthening program integrity and expanding the research agenda" as well as "encouraging high quality and efficient care, and reducing excessive Medicare payments". Sounds great. How will that be done exactly, and for how much money?
We can account for 10% of the total budgeted. This is being sold as a reserve fund for over 10 years. Forgive me, but I think that a year with a 1.8 trillion dollar deficit is hardly the best time to be setting up a reserve fund. Why pay interest on money you don't plan on using right away? You can't even make a stimulus argument as most of the spending isn't front loaded. What's the rest of the money to be used for?
Let's consider this section for a minute
Makes a down Payment on health Care Reform.
The Budget establishes a reserve fund
of more than $630 billion over 10 years to finance
fundamental reform of our health care system
that will bring down costs and expand coverage.
The reserve is funded half by new revenue and
half by savings proposals that promote efficiency
and accountability, align incentives toward
quality, and encourage shared responsibility. In
addition, the Budget calls for an effort beyond
this down payment, to put the Nation on a path
to health insurance coverage for all Americans.
Ah, a possible answer to our question. It eludes to the creation of a Universal Health plan, securing partial funding for it, and spells out the need for additional, unspecified funds at some point in the future. Fortunately, with a wave of the bureaucratic magic wand, half of the initially needed resources will materialize from "savings proposals that promote efficiency and accountability, align incentives towards quality, and encourage shared responsibility." I'm not sure what the hell that means (I can guess), but it's going to get us 315 billion.
Tell you what. You put in to place these wondrous programs that will conjure 300 billion without placing a crippling regulatory burden costing billions in forced compliance on the rest of the health care system and you can spend it anyway you want without a peep of complaint from me. Until then, I'm going to assume your budgeted items will be paid for almost entirely from tax dollars or deficit spending.
More disturbing is the lack of details concerning the remaining 500 billion dollar plan. Can I sell you my car hiding under the canopy? 15 thousand will starting paying for it, but I won't tell you what kind of car it is, or what the final price will be. It's an awesome car, though, trust me...
Does anyone else find this troubling? If we want a program of Universal coverage, then let's come up with a specific program and debate it on its merits. Giving the government an open tab for 500 billion with no specific instructions or benchmarks to start an improvement in our health care system isn't quite the best way to go about it.
Putting my personal libertarian bias aside for a second, it's still clear we simply don't have the money to do this. Looking 10 years in the future, we don't even have the money to honor our current commitments to Medicare and Medicaid. It's building a lovely garden and patio while your house is in flames. Since the start of this financial crisis, our government has been throwing money around with no regard to fiscal sanity. 500 billion real is quite a bit of money, or seemed to be many eons ago. I hope we haven't become so deconditioned that we let this pass without discussion.
This administration understands fully that it cannot fund health care reform as proposed without addressing costs. And they understand completely what eventually will fund this system.
They are interested only in establishing universal coverage at low cost. Period. No physician should miss this. Everything else is secondary.
Just look what they did to mammography, which is the only thing in all of medicine regulated by its own federal law (http://tedstumor.blogspot.com/2009/03/mqsa-mussolini-and-mammography.html)
After 16 years of regulation mammograms are affordable, and there is universal access; however, you have to wait up to 6 months for a mammogram in some places (breast cancer can double in 120 days); radiology residents eschew the subspecialty (70% of residency positions not even applied for); women's imaging centers are closing at a rate of 20 per month (so women will be headed back to the hospitals for mammograms); radiologists everywhere refuse to interpret the images; technology (digital imaging and MRI) has been slammed and innovtions are few and far between.
Yet malpractice in mammography still is #2 in all of medicine; and, the sensitivity and specificity of mammography in unchanged from 1992 to 2009.
So the government will move in, regulate, control your price then twist your arm with regulations while compelling you to treat all comers.
The cost comes out of you -- the doctor and hospital--and the system.
Posted by: Dr.T | 04/04/2009 at 06:10 AM
Sorry, that post was:
http://tedstumor.blogspot.com/2009/03/mqsa-mussolini-and-mammography.html
Posted by: Dr.T | 04/04/2009 at 06:11 AM