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April 3, 2011 in Opinion
Smart Bombs: The price is always right
One reason why U.S. health care costs have raced far ahead of the rest of the industrialized world was mentioned in an Associated Press article about how Medicare will now cover an expensive prostate cancer drug that extends the average patient’s life by four months.
“We tend to put our health care dollars into very high-tech interventions that produce marginal improvements,” said Dr. Steven Miles, a professor at the University of Minnesota’s Center for Bioethics. “The problem is that we have created a health care system that is uniquely inadequate in terms of access to primary health care, which is where you get the most bang for your buck.”
You want to complain about government spending? Here is the perfect opportunity. The cost of this therapy for incurable prostate cancer is $93,000. By law, Medicare cannot consider price when deciding to pay for treatment. Attempts to change this law would be labeled “rationing.”
In America, we prefer to ration by access, except if a person is about to die. Then we switch to universal care and spread the high costs to everyone, all in the name of freedom.
Math is cruel. When “Clintoncare” was being debated in 1993, the common cry from Rush Limbaugh and company was that government would take over one-seventh of the economy. “Obamacare,” we’re now told, would mean government control over one-sixth of the economy.
If it’s repealed and nothing else is done, health care spending will double by 2019, according to projections by the federal Centers for Medicare and Medicaid Services. At that point, would-be reformers would face the argument that a government solution would entail taking over one-fifth of the economy.
See a pattern here? The longer we put off a solution, the greater the share of health care spending in the overall economy. That would at least be defensible if it meant a higher percentage of people had coverage, but that’s not true. It means health care costs are metastasizing like an aggressive cancer.
Using Limbaugh Logic, this prognosis is an even stronger signal to do nothing.
Revenue filtered. Because it needs to fill a $92 million budget hole, the Idaho Legislature is set to finance higher education at its lowest level in 11 years and cut millions more from K-12 budgets, on top of the $128.5 million that it whacked last year. Be nice if there were a way to raise revenue that had solid public support.
Well, actually, there is. Raise the cigarette tax.
A proposal to raise the levy by $1.25 a pack is being stubbed out in Boise, but lawmakers can’t claim to have tried everything before enacting draconian cuts. They are, in fact, forgoing $50 million that would limit the chopping and provide more money for future budgeting.
Idaho’s cigarette tax of 57 cents a pack is the ninth lowest in the nation and well under the national average of $1.34 a pack. Montana’s levy is $1.70 a pack; Washington’s is $3 a pack.
In addition, the public health benefit is significant. A USA Today article notes, “For every 10 percent price increase, cigarette consumption drops by 3 percent to 4 percent among adults and double that among youth.”
Instant karma. Wouldn’t it be great if we could somehow reward civility and punish incivility in everyday life? This would be especially gratifying in politics.
Guess I’ll just have to settle for what happened to a rude customer purchasing a Mega Millions lottery ticket in Albany, N.Y. Seems this guy cut in front of Mike Barth, who was waiting to buy tickets for himself and six co-workers who pooled their money. Barth let this pushiness slide and got the next ticket.
It ended up being worth $319 million.
Smart Bombs is written by Associate Editor Gary Crooks and appears Sundays on the Opinion page. Crooks can be reached at garyc@spokesman.com or at (509) 459-5026.
Smart Bombs: Greatest generation? Not us 
rhondahenry on April 03 at 12:16 a.m.
You know what You guys should stop complaining because, one the health care we have now isnt as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price by searching online for “Wise Medical Insurance” If you have health insurance and do not care about cost just be happy it and trust me you are not going to loose anything!
Orphan on April 03 at 6:19 a.m.
Of course health care spending will double by 2019 thats when the most of baby boomers will be old. As Crooks pointed out the most medical expenses occour later in life.
This is an excelent example of only telling part of the story to get a desired result. Pretty poor reporting, if I were grading this I would send it back as incomplete.
Jeffrey_Grey on April 03 at 7:51 a.m.
Orphan,
Isn’t the salient point here that medical spending will increase?
Yes, the increase might be tied in part to the factor you cite. But how does separating out that cause mitigate the underlying problem? Baby-boomers will age. It’s not like identifying that rather obvious fact will somehow prevent it from happening or from being a factor.
You accuse Gary of omitting part of the story to get the desired result. Aren’t you doing the same thing by omitting the side of the story that doesn’t agree with the point you’re trying to make?
berrybestfarm on April 03 at 8:44 a.m.
As a baby boomer I take it as a matter of civic duty to use health services sparingly. We seem to have created a culture of over use. For example, when I was young, people were embarrassed to admit they were on a prescription drug. Now even young people “wear them like a badge of honor”. I’m diligent about having an annual check up. When issues have come up such as high blood pressure I do not rush for the pill but instead ask my doctor for help in identifying effective life style and diet changes. With patience and committment these two changes can turn around an enormous number of ailments. At least I can reserve the expense for those things ahead that do need outside treatment. I do not in any way begrudge those who have conditions that are beyond their control.
Dennis Patterson—Deer Park
gmorton on April 03 at 8:59 a.m.
Gary Crooks wrote,
“You want to complain about government spending? Here is the perfect opportunity. The cost of this therapy for incurable prostate cancer is $93,000. By law, Medicare cannot consider price when deciding to pay for treatment.”
Yes indeed – it is a perfect opportunity. That is the sort of decision you get when some third party is paying your bills, especially when the 3rd party is government – pols trolling for votes and spending other people’s money. Do you imagine that his family would spend $93,000 to extend Granddad’s life by 4 months? Mortgage their houses? Raid the kids’ college fund? Do you think Granddad would let them?
And your solution? More 3rd party payments!
“Be nice if there were a way to raise revenue that had solid public support … Well, actually, there is. Raise the cigarette tax.”
Ah. And what, pray, makes smokers peculiarly liable for educating other people’s kids? I know – that doesn’t matter. There is no need to establish any connection between who pays and who benefits from gummint programs. We give benefits to whoever whines the loudest or promises the most votes, and send the bills to whoever has money and is politically too weak to resist. “Public support” is the key, not actual liability or any other principle of fairness. Might makes right!
hawken on April 03 at 9:15 a.m.
Well,,,, this will take some work to unravel this spider web of an article!
Crooks is becoming quite consistent in basing his fallacious argument on a false premise, which he creates to justify his faulty conclusion. Although, in this case, he has no logical conclusion. He’s like a man dying of thirst, wandering around in circles in the desert of Death Valley.
His article is a “non sequitur.” It logically does not follow.
He starts with medicare, prostate cancer and slamming Limbaugh on national health care,,, and then immediately shifts to the funding of Idaho public schools and the cigarette tax in Idaho! Then to civility in political discourse. Then ends with a lottery winner in New York. Hugh?
Crooks apparently doesn’t understand the simple rules of literary context.
*The content and context of sentences lead to the point/conclusion of a paragraph.
*The content and context of paragraphs lead to the point/conclusion of a chapter (in this case, the article).
*The content and context of chapters lead to the point/conclusion of the book.
Content, Context, Conclusion
What on earth does national health care, prostate cancer and Limbaugh have to do with cigarette taxes, state funding of Idaho public school, civility in political dialog and lottery winners in New York? The whole article is a “non sequitur.” Simply stated, it logically does not follow from part to part.
As for prostate cancer and Obama Care:
1- Nobody is suggesting that we should “do nothing” concerning health care reform.
2- Limbaugh has never suggested that we “do nothing.”
The truth of the matter is that “everyone” agrees we need reform, soon.
The problem, which Crooks does not even mention, is that Limbaugh and the majority of Americans, oppose “Hillary Care” and now “Obama Care” because it is designed to be “single payer, socialized, government care.”
Opponents want a “free market” based reformation of health care. Not socialized medicine that would account for 1/6 of our economy.
Republicans have a whole list of “market based” reformation, such as: Buying insurance “across” state lines. Thus, greatly enlarging competition. Tort reform is huge in cutting health care costs. Various health care savings accounts have been suggested, only to name a few…. all for not, since Republicans were locked out of the process, start to finish, when the liberals controlled the house, senate and white house during the previous, two calendar years.
Just consider the “pure stupidity” of ,,,, “We have to pass it before we know what’s in it!” Which of course, the liberals did.
Crooks’ fallacious argument stated succinctly:
[false premise] If you oppose “Hillary Care” and “Obama Care,” (premise) you are in favor of “doing nothing” concerning health care reform (conclusion).
As for Idaho Public Schools and the Cigarette Tax:
Ok. What’s that got to do with prostate cancer and Limbaugh?
As for civility:
Ok. What’s that got to do with prostate cancer, Limbaugh and Idaho Public School Funding?
As for lottery winnings:
Ok. What’s that got to do with prostate cancer, Limbaugh, Idaho Public School Funding, the Idaho cigarette tax and civility?
Any good, High School English teacher would have given him at best a “D” with the following advice.
1- Stay on topic and context concerning the point you want to make.
2- Make sure your points following logically to support your conclusion.
3- Decide what the single topic of your paper will be.
A. Is it prostate caner and national health care?
B. Is it Idaho Public School Funding as it relates to Idaho’s cigarette tax?
C. Is it “civility” in political dialog?
D. Is it a state lottery winner in New York.
4- Now go back and start over, Gary.
Jeffrey_Grey on April 03 at 9:22 a.m.
gmorton,
Another of those rare confluences when you and I can see at least somewhat eye-to-eye.
$93,000 to extend the life of a terminal patient for four months is such an appaling example of the system run amok that you’ve finally found at least one narrow example to justify your otherwise overly-sweeping dogma.
Though I’d first insist that extremes make a poor basis for general policy - so I still reject your dogma - that doesn’t mean that policy shouldn’t be made with an eye toward eliminating excesses like this. So to that limited extent, we agree.
I’m also skeptical of pinning hopes for a fix on increasing taxation. Haven’t we already seen that this is ultimately a losing proposition - at least when the tax is on something discretionary like cigarette smoking? While I grant you that driving isn’t always discretionary, haven’t we seen that raising the gasoline tax inspires more people to drive fewer miles, thus driving demand for gas down and thus decreasing the revenue? Which, in turn, seems to make limited-thinking politicians only raise gas taxes higher in order to maintain the level of income, thus causing even more people to drive even fewer miles?
Won’t it probably be the same with increasing the cost of smoking? Won’t that ultimately just make fewer people smoke thus reducing the income from taxation?
It’s a quick fix for a long term problem. Real solutions lie elsewhere. Solutions like getting medical costs - all costs, not just blatantly extreme examples - under control!
gmorton on April 03 at 10:36 a.m.
Jeffrey_Grey wrote,
“Real solutions lie elsewhere. Solutions like getting medical costs - all costs, not just blatantly extreme examples - under control!”
I agree. But as long as you thump for a system in which all the normal market mechanisms for controlling costs – free entry into the market to maximize competition, comparison shopping, and cost-benefit analyses – are inoperative, as they are in 3rd party payer regimes laden with free lunches, you’ve effectively rendered that goal impossible. It is like asking asking a farmer to grow some corn, then deny him land, water, and seed.
hawken on April 03 at 11:22 a.m.
Crooks’ liberal left bent can be seen at least weekly, on this blog. Along with his typical, convoluted, intellectual gyrations in his failed attempt to promote the liberal world view.
Don’t get me wrong. He has the right and SHOULD post his liberal opinion, when it’s an opinion.
“Opinion” assumes a “conclusion,” which is lacking in this article.
Even a clear, opinion/conclusion would be appreciated. Which is void, lacking, in this article. Apart from his liberal innuendos.
This article is nothing more than a spider web of liberal innuendos as I have demonstrated above.
He get’s paid for this?
richard on April 03 at 12:42 p.m.
“”Isn’t the salient point here that medical spending will increase?”
No, that isn’t the salient point when we all know that medical costs will increase. The commentary merely took one tiny slice of the overall issue of rising medical costs and inflated it beyond its overall impact.
Yes, it is too expensive to spend $93,000 to extend one’s life by a mere 4 months; so what is the alternative? And where do you make the cutoff point in dollars spent or life extension?
And perhaps more importantly, who makes those decisions? Of course we know Gary would say government … panels made up of “experts”. But I don’t want to go there, some people have had scorn and riducule heaped upon them by the mere mention that this approach would seem kind of like having … “death panels.”
Who, Jeff? Who makes those decsions if we have the technology?
And it is a false premise put forth by Gary when he claims that, “In America, we prefer to ration by access … ”.
One can only make that claim if one accepts the premise that medical care is a “right” which should be determined by government. It is a clever way to marginalize all the other alternatives to lowering medical costs and expanding access. You simply do not even contemplate any other solution.
Same semantical argument when he cleverly mentions “Rush Limbaugh and company” in an attempt to some how conflate repealing Obamacare with health care costs doubling.
I guess consideration of any other health care plans are somehow verboten to Gary. It is either Obamacare; or it is a void which will double the costs of medical care. There are no other options.
Again, there is much data - including the CBO - that would suggest this is another false premise (many of the cost savings of Obamacare are “smoke and mirrors” type accounting).
Jeffrey_Grey on April 03 at 5:06 p.m.
That is indeed an important question, richard - though it still relates back inevitably to costs. If that decision involved ‘only’ $50,000, it might be a little easier to make. Easier still if it was $25,000. Easier still if only $10,000. Only $5,000. Only $1,000. See how it works?
But you say it’s isn’t the cost that’s where we must concentrate. It’s on who gets to make the decision. And you balk at letting the government decide. All right. Fair enough. As I mentioned back at the start, when the decision is to spend $93,000 to extend the life of a terminally ill patient for four months - as precious as those months might be, I admit I balk at the government’s decision.
So who does get to make that decision?
I’m sure you’d say ‘the individual’. Am I right?
But see, again it comes back to costs. The individual doesn’t get to make the decision if the cost of the treatment preempts the choice. Or if it’s the insurance carrier who says, ‘No. Too expensive. Claim disallowed.’
There are already ‘panels’ out there who make the decisions, richard. And until you admit that, like Orphan it’s you who is also telling only the part of the story that fits the agenda you’re trying to pedal.
Orphan on April 03 at 5:15 p.m.
Thanks Richard you sagved me some typing. Well stated.
garyc on April 04 at 10:28 a.m.
Hawken,
Each item is a separate commentary. Been that way ever since I’ve been writing it.
I’ll post the column on the blog, if anyone wants to discuss it there.
hawken on April 04 at 1:39 p.m.
Gary:
What you suggest,,,, namely:
“Each item is a separate commentary. Been that way ever since I’ve been writing it,” ,,,, is “garbage bagging” used to imply a conclusion that is not “stated” in the article and which is void of logical progression from sentence, to paragraph, to chapter (article), to book. All based upon content, context and conclusion.
While I oppose American Liberalism, I would, at least, expect form a professional writer, the basic standards of literary content, context and conclusion.
If you give me this, we can then debate the conclusion.
If you do not clearly state your conclusion, based upon the confused, “non sequitur” content and context of your article, I’m left only with responding to your innuendos and the gross failure of normally, acceptable, “literary standards.”
“…. Been that way ever since I’ve been writing,,,,” does NOT justify, nor defend, the abandonment of basic, literary, standards.
“Everything out of context,” is a “pretext.” As demonstrated by your article. That is my learned conclusion.