Why wait on health care savings?

By Matthew Hennessey

In his health care speech before Congress earlier this month, President Obama promised quite a bit: universal insurance coverage, a new focus on preventive care, an end to the practice of denying coverage due to preexisting conditions, and better health outcomes for all.

All of this sounds fine to me, as I think it does to many Americans, subject to one condition: Can we pay for it?

On that question, Obama made what was perhaps his most ambitious promise of all. “[W]e’ve estimated that most of this plan can be paid for by finding savings within the existing health care system – a system that is currently full of waste and abuse,” he said.

Okay. I’m willing to believe this as well. There is some amount of waste, fraud, and abuse in just about every company or organization. It shouldn’t be surprising that in an industry as big as health care that there would in fact be a great deal of waste.

Here’s my question: If there is indeed waste, fraud, and abuse in quantities so great that merely by finding and eliminating it we can finance a brandy-new, government-funded, public health-care option, then why aren’t we realizing these cost savings now?

I don’t have an accountant, but if I did, and he or she said to me, “Mr. Hennessey, you are wasting an awful lot of money living the way you are. If you simply found ways to save on some of your unnecessary purchases and patched up those holes in your pockets, why, you could afford to live a much richer lifestyle,” I don’t believe I would wait a year, a month, or even a day to start cutting back and stitching up. I think I would get right to it.

Wouldn’t it also be logical for the president and the congress to begin shaking out these savings immediately?

So, here’s an idea that just might solve all of the partisan battling going on over this issue. Why don’t the Republicans make a “put up or shut up” deal with the president? Target that waste, fraud, and abuse right now. Find those cost savings and stash the recovered monies in a trust fund. If in one year the amount of money in the trust fund appears on track to meet the Congressional Budget Office’s estimates for the annual cost of the Obama plan, then it’s on. We do the health care bill exactly as the president wants it. We just do it a year from now.

There isn’t any downside here. Say we find all that missing cash and stash it in the trust fund only to realize that it’s not nearly enough to pay for the Obama plan. Well, then all we’ve done is clean up our current system and create a nice little rainy day fund that could be used for stimulus projects, education, infrastructure, tax rebates, or any number of other items on Obama’s wish list. Everybody goes home happy.

The Democrats in congress should love this. The way things stand right now, many of them are going to lose their jobs in November 2010. Cut the deal I’m proposing and they just might be able to deliver health care reform before those “midterm” elections.

That is — if they can actually “put up.” If not, well, then there’s only one other option.



  1. You forgot one important element in that equation – 44 000 people will die during the one year you propose to wait and see if there are real savings from targeting fraud. I doubt you would suggest that any of the millions of uninsured or underinsured wait for treatment until they save up enough money to pay for it. Health care reform if not now in the US a question to which one can honourably ask “can we pay for it?”. The only question should be “why havent we guaranteed universal healthcare before?”.

  2. Matthew Hennessey says:

    I normally prefer to ignore provocations like this, especially when they come from people I care about, but this is my blog and I will defend it.

    First, I’m sure I’ve forgotten many important elements of the equation. I’m not an expert on health care (neither are you) and I don’t pretend to be (you shouldn’t either). I’m simply a citizen pointing to what I see as an inconsistency in the rationale for this new plan. It wasn’t that long ago that dissent was patriotic. All of a sudden it’s something else.

    Second, 44,000 seems like an awfully precise number. Where did you get it? As a general rule, you shouldn’t wave numbers and statistics around without links to reputable sources that explain and support them. Now, a great many people will die in the United States this year, I am sure, who are covered to the hilt by top-shelf health insurance. Coverage is no guarantee of health (or long life, for that matter) and as I’m sure you know, there is a great deal of debate about the exact number of uninsured, and their demographics. I was uninsured myself for most of my twenties, which suited me just fine. I was lucky enough to be healthy, of course, and lots of people aren’t, but under the plan I heard the president describe in his speech, the twenty-two year old me would be required to buy insurance. That’s not liberty and, I will point out, in Massachusetts, where this is already the law, it hasn’t worked.

    Third, you should read this for an explanation of some market-based reforms that would dramatically expand insurance coverage in New York State and that could be a model for the country: http://www.manhattan-institute.org/html/mpr_10.htm

    Fourth, and most important, how dare you question my honor, in public, for asking a good-faith question about a high-profile public policy? Have you lost your mind? Was I rude to the president or his supporters in my post? Have I ever been rude in this way to you? Have I ever used language like this to disparage your politics?

    It’s not honorable to ask “Can we pay for it?” Who says and how dare you? If money was no object, well, gee, we could do just about anything we wanted, couldn’t we? We could have universal transportation, in which everybody got a car and all the gas they needed. We could do universal higher education, universal dental care, universal day care. We could have universal gym membership, universal employment, universal ice cream parties, universal happiness, etc. & etc & etc..

    Of course it’s fair, and entirely honorable, to ask “Can we pay for it?” To say otherwise is a low-down, ad hominem kind of thing to do and I’m surprised that you would resort to it. Maybe I shouldn’t be surprised. Maybe you’ve just gotten used to describing those who disagree with you in rude terms because you don’t meet many who do disagree with you (or it makes you feel better about yourself to believe that those nasty, angry, deceitful people on the other side have no honor).

    Then again, maybe you were just a bit careless in choosing your words. If so, you should be more careful. Words matter.

    And another thing, if you truly believe that the only honorable question is “why haven’t we guaranteed universal healthcare before” then why don’t you start your own freakin’ blog and ask it?

    Just leave mine alone.

  3. Talk about knee-jerk reactions – since when is questioning someone’s opinion and engaging it in debate “suppressing patriotic dissent”? Isnt that why it was put in a public place?

    1. I am not a health care industry expert – and my point is precisely that this is not a healthcare expertise issue – its a moral issue which goes to the heart of how American society defines itself and, indeed, how we understand the preamble of our Constitution.

    2. http://www.reuters.com/article/healthNews/idUSTRE58G6W520090917 – points out that some 45 000 deaths annually are directly attributable to a lack of health insurance. Also, although its great that you were able to “choose” not to buy health insurance when you were 22, you knew darn well that you had informal “family insurance” and that if you were ill you would be taken care of. Should we really fight to preserve the liberty of 22 year olds to choose bankrupting their parents in order to care for them? You dont have the choice of buying or not buying car insurance, but only of having a car or not.

    3. I will read it, but again, I think some things should not be left to market forces – we have a public education system (which by the way does not destroy the private education sector) because we believe that it is in our national interest that everyone in the country receive a minimum standard of education (level of that standard is another debate) regardless of their income, citizenship status or social status. I believe, and I believe that a majority of Americans support this view, that the same national interest applies to health care.

    4. I have not brought your honor into anything. I specifically did not use the pronoun “you”, but referred to a wide public debate with a generic, neutral pronoun “one”. I specifically avoided personal aspects because I am sure that everyone, you, me and Michelle Bachman would object to the question “can we pay for it” if the question referred to life-saving medical intervention for their loved one, the question is only ever asked in conveniently non personal terms. Open heart surgery is not the same thing as buying a car – as in you should stick to what you can afford. America loves capitalism, for sure, but it also loves equality – specifically that the fruits of liberty are for everyone and not only for those “blessed” with wealth. Its a question of priorities – Can we afford a space program, nuclear weapons, invading two countries, Haliburton, pollution?
    5. I could turn the question around and ask you – why have a public blog if you dont want to accept any reactions to it which dont suit you? If you want to preach to the choir, post your blog on Fox.

  4. Just so you dont think I was copying, I just read this and found that Nicholas Krifstof and I apparently share the same general ideas about the issue. http://www.nytimes.com/2009/10/08/opinion/08kristof.html?_r=1&ref=opinion

  5. Matthew Hennessey says:

    1. The preamble of the Constitution is lovely, but has no legal standing in the United States.

    2. Okay, what do you want me to say? It’s awful that people die. All things equal, I’d rather take my chance in the United States than in a place (and I can think of a few) where there may be universal access to medical care, but the chances of truly pursuing happiness are pretty slim.

    Calling me out for the “family insurance” option is pretty rich considering you’ve already admitted to me that you and your children are covered by an insurance plan offered by your employer rather than the universal health care plan offered by the government in your country.

    The auto insurance analogy doesn’t go very far. Auto insurance is significantly cheaper than medical insurance, for a variety of reasons – some of which are outlined in the report I suggested you read. Namely, you can purchase it across state lines – not currently possible in the private health insurance market, and you are free to tailor your plan to include the coverage that suits you. In my state, I’m not free to purchase a plan (and my employer is not free to offer me one) that doesn’t cover things like sex-change operations & etc. I don’t need that coverage. Why should my insurance company be forced to sell it to me? Reform of the private insurance market is, to be sure, a difficult policy question. I don’t pretend to have all (or any) of the right answers.

    3. Saying that something should not be left to market forces does not make it true. This seems to me to be the last resort for purveyors of a certain world view: Declare something a human right and then dare any one to suggest otherwise. Of course, thusly defined, no one can honorably take any position other than in support of this new human right.

    I say “Bollocks.”

    4. Great. Except I was the only “one” in this immediate vicinity asking the “dishonorable” question of the day. I absolutely love the Michelle Bachmann reference, though, as it seems to reveal something about your thinking on this. Why would you bring her up in such an ostentatiously casual way? Of all the people in the world that could have completed the random and illustrative threesome of you, me, and so-and-so, you picked her. Why? She is an inconsequential member of Congress from an out of the way state known chiefly for triggering apoplexy in certain (mostly female) corners of the left-wing politcal universe. She is not a leader of the Republican party, at least not one that I pay any attention to. She has no real clout in any congressional committees that I know of. She’s a straw- woman. What are you doing? Talk to me. Engage my idea. Don’t get carried away. Don’t appoint Bachmann, Halliburton, the Iraq war, or any other bogey-man as my surrogate and then attack it. Focus on the person you’re speaking to.

    While you and I clearly have different ideas about what the fruits of liberty are and how they should be shared, I agree that, of course, we can’t have all those things. I never said we could. On the contrary, I only asked “can we pay for it.” Life is about trade-offs (among other things). We can’t have everything we want, no matter how much we think we deserve it or ought to have it. It’s right and proper to ask 1) Can we do it, 2) Should we do it, 3) Can we afford it, and 4) Should we afford it. That doesn’t make me a bad person, does it? You seem to be saying that it does.

    5. My public blog if for me to do with as I like. I am the publisher, editor, writer, designer, head waiter, and chief of police all rolled into one. If I tell you to scram, scram. I wouldn’t have even bothered except for the execrable attack (perceived or otherwise) on my honor.

    What I’m really suggesting is that YOU need to examine your core assumptions. I do it every day because I’m forced to. Where I live, not many people see the world the way I do. It’s an environement that constantly challenges me to refine and justify my ideas. I try to get away from the Daily Me where possible (http://www.nytimes.com/2009/03/19/opinion/19kristof.html?_r=1&scp=1&sq=the%20daily%20me%20and%20kristof&st=cse). Do you do that? Because I get the sense from your casual impugning of my honor, and your follow-up game of guilt-by-association with several conservative ideas and personages, that you think it’s A-OK to question the motives of people like me.

    So, what’s FOX got to do with it, again? Since I don’t have cable, I rarely see it.

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