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Nov. 23, 2009
JWisdom.com: Actually, it really is all about you with Rabbi Lawrence Hajioff
Nov. 20, 2009
Rabbi David Aaron: How to make every second of your life come first
Caroline B. Glick: Whither American Jewry
Nov. 19, 2009
Binyamin L. Jolkovsky: Please Listen to this Godcast (5 minutes)
Jonathan Tobin: ADL Crosses the Line with Report Bashing Obama Critics
Nov. 18, 2009
Rabbi Yonason Goldson: What Judaism has to say about the secret of the Mona Lisa's smile
JWisdom.com: The (Jewish) Dating Game with Rabbi Lawrence Hajioff (8 minutes)
Nov. 17, 2009
Steven Emerson: How Does the 4th Amendment Impact Terror Finance Investigations?
JWisdom.com: If Frank Sinatra married Edith Piaf with Rabbi Y.Y. Rubinstein (2 minutes) Life lessons from what would be regarded as the most inappropriate lyrics ever sung
Nov. 16, 2009
The Jewish Ethicist by Rabbi Dr. Asher Meir : When borrowing is stealing
JWisdom.com: Deconstructing faith with Rabbi Warren Goldstein (9 minutes)
Nov. 13, 2009
JWisdom.com Sarah's subjective reality with Rabbi Sroy Levitansky ( 6 minutes)
Caroline B. Glick: Obama's failure, Netanyahu's opportunity
Nov. 12, 2009
The Kosher Gourmet By Marialisa Calta : A sweet sweet potato treat
JWisdom.com Does God get tired? with Rabbi Harvey Belovski ( 5 minutes)
Nov. 11, 2009
Rabbi Avi Shafran: Jews and money: When anti-Semitism isn't
JWisdom.com Marriages are not made in Heaven with Rabbi Lawrence Hajioff (VERY fast 15 minutes)
Nov. 10, 2009
Michael Doyle: Author of book exposing CAIR ordered to remove supporting documents from Web
JWisdom.com If the creation so loudly shouts the existence of the Creator, why aren't more people believers? with Rabbi Naftali Brawer (9 minutes)
Nov. 9, 2009
Mark Steyn: Shooter exposes hole in U.S. terror strategy
JWisdom.com It's never too late to have a happy childhood with Sarah Chana Radcliffe (5 minutes)
Nov. 6, 2009
Rabbi Berel Wein: Choosing to hear
JWisdom.com Zero to 1/60th: How to Empower An Hour with Gavriel Aryeh Sande (7 minutes)
Caroline B. Glick The mullahs' big week
Suzanne Fields A Fallen Wall for Fallen Man
Nov. 5, 2009
The Kosher Gourmet: Three scrumptious -- but simple -- butternut squash dishes
JWisdom.com Hidden Hints: Unlocking Faith & Prayer with Rabbi Jay Yaacov Schwartz (10 minutes)
Nov. 4, 2009
Tom Hamburger and Kim Geiger: Should prayers be covered?
JWisdom.com When God played peacemaker With Rabbi Sroy Levitansky (5 minutes)
Nov. 3, 2009
Martin Peretz: Beware, Barack. Beware, Rahm. Beware, Axelrod
JWisdom.com Are you are closet idolater? With Sara Yoheved Rigler (10 minutes)
Nov. 2, 2009
Paul Greenberg: The Holocaust is now on Facebook
JWisdom.com Abraham's Strange Change With Rabbi Yitzchok Fingerer (5 minutes)
Oct. 29, 2003
Mortimer B. Zuckerman: Graffiti On History's Walls (MUST-READ!)

Jewish World Review June 29, 2009 / 7 Tamuz 5769

No excuse for Dems' sticker shock on health care

By Michael Barone


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http://www.JewishWorldReview.com | Democrats' plans to pass major health care legislation have been stymied, at least for the moment, by the Congressional Budget Office's cost estimates. To the consternation and apparent surprise of leading Democrats, the CBO scored Senate Finance Chairman Max Baucus' latest offering at $1.6 trillion over 10 years, while it scored the completed sections of Sen. Christopher Dodd's bill at $1 trillion. Presumably, the incomplete sections would cost more.


The senators and the Obama administration might not have been so unpleasantly surprised had they paid closer attention to CBO Director Douglas Elmendorf's testimony to Baucus' committee delivered back on Feb. 25. Elmendorf, by the way, is no leftover hack from the Bush administration — he is a Harvard-trained Ph.D. economist formerly at the Brookings Institution and appointed to his current position by congressional Democrats. My soundings indicate he is highly respected by economists associated with both political parties.


Elmendorf's February testimony, in crisp language punctures some of the balloons that have been sent aloft in Democrats' campaign talk about health care. One is the idea that since a lot of health care spending seems to be ineffective, it can be easily reduced by government action.


"The available evidence also suggests that a substantial share of spending on health care contributes little if anything to the overall health of the nation," Elmendorf said, agreeing with the first half of the proposition. Then he added, disagreeing with the second half, "But finding ways to reduce such spending without also affecting services that improve health will be difficult." It's like advertising: Half is wasted, but we're never sure which half.


Then there are the assurances by Office of Management and Budget Director Peter Orszag that by using the results of comparative-effectiveness research — studies of the results of treatments in different regions and facilities — we can easily identify the most cost-effective health care procedures and, using the power of government, force all practitioners to do things that way.


Elmendorf admitted that the benefits of such research "suggest a role for the government in funding research on the comparative effectiveness of treatments, in generating measures of quality, and in disseminating the results to doctors and patients." But then he threw some cold water on the proposition that such research could be used by government to jam down costs. "Absent stronger incentives to control costs and improve efficiency, the effect of information alone on spending will generally be limited."


And what about savings from moving away from "from fee-for-service design to providing stronger incentives to control costs or reward value"? In Elmendorf's view, "their precise effects are uncertain." He suggests testing options "to see whether they work as intended or to determine which design features work best." And maybe we should reform Medicare before we try to reshape the entire health care private sector. "Changes made in the Medicare program can also stimulate broader improvements in the health sector."


What about improved information technology? "Requiring that hospitals adopt electronic health records would reduce their costs for treating Medicare patients, but the program's payment rates would have to be reduced in order for the federal government to capture much of those savings." Preventive care? "Those efforts may still fail to generate net reductions in spending on health care because the number of people receiving the services is generally much larger than the number who would avoid expensive treatments as a result."


There are two more general problems, one of which Elmendorf spotlights: "Studies attribute the bulk of cost growth to the development of new treatments and other medical technologies," and so "reducing or slowing spending over the long term would probably require decreasing the pace of adopting new treatments and procedures or limiting the breadth of their application." If you pay less, you get less.


Second, and perhaps beyond the ambit of a data-driven CBO director, is the more general observation that the cost projections for government-run programs like Medicare and Medicare tend to come in low, while the cost projections for programs involving private-sector competition like the 2003 Medicare prescription drug benefit have turned out to be high.


Private-sector competition produces efficiencies and innovations that government bureaucracies almost never produce and can seldom keep up with. As Democrats scamper to reduce the projected costs of their health care bills, the rest of us might want to keep that in mind.

Every weekday JewishWorldReview.com publishes what many in the media and Washington consider "must-reading". Sign up for the daily JWR update. It's free. Just click here.

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JWR contributor Michael Barone is senior political analyst for The Washington Examiner.




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