Has A Government Entitlement Program Ever Come In Under Budget?

Stanley Feld M.D.,FACP,MACE

President Obama’s healthcare reform plan will not repair the healthcare system. It will not provide universal coverage, it will not provide affordable coverage and it will not increase the quality of care.

Not repairing the healthcare system is unacceptable. I have proposed an ideal medical saving accounts that will align all the stakeholder’s interests while not letting any stakeholder take advantage of the other. It is dependent on appropriate, enforceable state and federal rules and regulations that permit the market system to flourish and maintain freedom of choice.

Government should make rules to level the playing field for all stakeholders and then get out of the way. An efficient healthcare system can be created by permitting the consumer to drive the healthcare system.

Many employers have adjusted to the present healthcare rules and regulations. The result has been greater dysfunction in the healthcare system .

As healthcare insurance premiums increased employers could not afford full coverage for their employees. They changed to providing partial insurance coverage. Employees are required to pay for a significant portion of their insurance policy. The money comes out of the employee’s salary with pretax dollars. .

Other employers have provided high deductible insurance for their employees. The initial deductible costs are paid for with after tax dollars and have been an unaffordable burden to employees. Some cannot afford to pay the deductible and avoid care.

This scheme has the same effect on employees’ purchasing power as a federal tax increase. It should be viewed as a hidden tax increase.

There are many ways to fix the inequities to consumers in the present healthcare insurance system. .

“Substantial improvements to private insurance markets can be much more targeted and straightforward.

1. These include changes to HIPAA and COBRA provisions to ensure portability between employer insurance plans,

1. Measures to prevent higher premium upticks for customers moving from group to individual insurance markets,

1. Ensuring that market entrants only face a single risk evaluation,

1. Opportunities for the uninsured to opt back in to the system under new protections.”

1. Correct accounting standard for incurred claim and Medical-Loss ratio.

1. Instituting ideal medical savings accounts with patients owning and controlling their healthcare dollars would result in consumers being educated purchasers of healthcare services. Permitting consumers to retain the unused portion of the deductible in a tax retirement trust account would motivate the consumer to have a healthy lifestyle.

1. Developing rules and regulations that calculate healthcare insurance premiums for the entire population and not rates determined by age or pre-existing illness.

1. Taxing employers appropriately so that they provide adequate healthcare insurance for their employees with tax deductible dollars.

    9. Creating malpractice reform that has caps on liability. It will decrease defensive medicine and over testing by physicians in order to avoid malpractice suits. This simple rule could decrease healthcare costs by $750 billion dollars a year.

“STEPHANOPOULOS: The president has drawn one other very red line in the sand, that he won’t sign any health care bill that increases the deficit.”

“OBAMA: I will not sign a healthcare reform plan that adds one dime to our deficits, either now or in the future.”

However the history of government entitlement programs estimates has consistently contradicted President Obama’s statement. With the CBO’s estimates changing weekly and a large bureaucracy being set up, President Obama’s estimates are certain to be underestimates.

Next let’s examine the record of Congressional forecasters in predicting costs. Start with Medicaid, the joint state-federal program for the poor. The House Ways and Means Committee estimated that its first-year costs would be $238 million. Instead it hit more than $1 billion, and costs have kept climbing.

In many states a person living in poverty but earn more than the poverty level defined in 1955, does not qualify for Medicaid coverage.

Medicaid now costs 37 times more than it did when it was launched—after adjusting for inflation. Its current cost is $251 billion, up 24.7% or $50 billion in fiscal 2009 alone, and that’s before the health-care bill covers millions of new beneficiaries.

The bureaucratic process for Medicaid coverage requires reapplication every six months. Moises’ reapplication was rejected by bureaucratic error without explanation. He and his wife do not have coverage. Now his children are uncovered. So much for bureaucratic efficiency in Medicaid.

Medicare has a similar record. In 1965, Congressional budgeters said that it would cost $12 billion in 1990. Its actual cost that year was $90 billion. Whoops. The hospitalization program alone was supposed to cost $9 billion but wound up costing $67 billion. These aren’t small forecasting errors. The rate of increase in Medicare spending has outpaced overall inflation in nearly every year (up 9.8% in 2009), so a program that began at $4 billion now costs $428 billion.

Even if one gave President Obama the benefit of the doubt on his budget estimates his plan will not repair the real defects in the healthcare system.

There is strong historical precedent that his new entitlement program will create large deficits no matter what tricks he plays with the numbers.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.