Monday, December 08, 2008

First, Ignore the Harm

Those debating public policy often find ways to ignore inconvenient facts, but Drs. David Blumenthal and James Morone take brazen irresponsibility to rarely seen levels while arguing in favor of major health care reform in a report in the New England Journal of Medicine. The piece goes into a fair amount of detail in describing how President Lyndon Baines Johnson fought for creation of the Medicare program before stating:

Cavalier as Johnson may sound here, especially in light of the huge subsequent costs of these programs, his comments signal an unpleasant reality worth pondering: Johnson underestimated the numbers and evaded economic projections to smooth the passage of Medicare and the rest of his Great Society program. An accurate economic forecast might have sunk Medicare. Moreover, Francis Bator, a national security aide to Johnson at the time, recently asserted that during 1965 Johnson also suppressed news of the escalation of the Vietnam War and its attendant costs so that Congress would not question whether the nation could afford the president's Great Society initiatives.

They then proceed to urge the Obama administration and lawmakers to take a similar approach to health care reform in 2009:

The expansion of health care to large populations is expensive, and presidents may need to quiet their inner economists. Johnson decided, in effect, to expand coverage now and worry about how to afford it later. Accurate cost estimates might very well have sunk Medicare. In fact, this generalization holds across every administration from Harry Truman to George W. Bush. Major expansions of health care coverage rarely fit the budget and generally drew cautions (and often alarms) from the economic team.

There is a legitimate debate in the United States over the role of the U.S. government in providing health care. That debate requires honesty on the part of all participants regarding the costs of all options, including the cost of doing nothing. The United States already faces a looming generational crisis over entitlement programs. It would be grossly irresponsible to add cavalierly to that crisis. The approach taken by Drs. Blumenthal and Morone can not be accepted by anyone who cares about the future of American health care.

Hat Tip: Joe Paduda


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