LETTERS TO THE EDITOR
In Can We Afford It? (editorial, Dec. 13), you remark that Republican critics oppose the currently proposed health care reform on the grounds that the nation cannot afford to add this new trillion-dollar entitlement in tough economic times.
Here we should recall that in 2003, barely out of the recession of 2000-2, President George W. Bush and his then Republican Congress passed the Medicare Modernization Act of 2003, a huge new entitlement.
Unlike serious attempts to make the current health reform deficit-neutral, however, the entire cost of the Medicare drug bill simply has been deficit- financed since the inception of the program in 2006. Current projections are that the legislation will add in excess of $1 trillion to the federal deficit over the period 2010 to 2019.
Foreigners have bought many of the new United States Treasury bonds sold to finance this largess. Our children will have to service these bonds and ultimately redeem them.
There is something quite untoward for people who went along with that glaring fiscal irresponsibility to now belatedly discover the virtue of fiscal probity.
Uwe E. Reinhardt
Princeton, N.J., Dec. 13, 2009
The writer is a professor of political economy at Princeton University.
To the Editor:
As a dermatologist in practice for 30 years, I read Can We Afford It? with interest. You state that the House and the Senate have a lot of ideas that could bring down costs over time. To the contrary, all of the ideas you cited would actually increase costs to me and my patients.
Electronic records are expensive, take far too much time away from patient care and dont have any influence on the number of tests I do.
Standard claims forms and automated claims processing have been around for years and have reduced costs as much as they are going to.
As for replacing fee-for-service with fixed payments for a years worth of service, Ill retire before falling for this boondoggle. How else other than fee-for-service are you going to pay me for caring for patients who have such diverse needs as the kid I see once every few years for a wart to the elderly person with a melanoma that requires half a day in the operating room and follow-up visits every few days or weeks?
Your readers should ask themselves what it would be like trying to see a doctor when that doctor has already been paid for seeing you and would have a strong financial incentive not to see you again.
Provo, Utah, Dec. 13, 2009
To the Editor:
You acknowledge that for many, $1 trillion is unimaginably more than we can pay for expansion of health care, yet as you point out, its less than the $4 trillion unfunded Bush tax cuts.
Lets look at it another way:
Over 10 years, $1 trillion is $100 billion a year. Given an estimated 308 million people in the United States, thats $325 a year per person. The $325 breaks down to $27 a month, or roughly $6 a week, or less than 90 cents a day for each of us, man, woman and child, for 10 years, during which we would be providing health insurance to over 30 million people not covered today.
Yes, health care reform is fiendishly complex and expensive. Can we afford a trillion dollars? Yes.
Bloomfield, Conn., Dec. 13, 2009
To the Editor:
You seem to be looking past the reality and track record of health care reform finances when you posit that the country can, in fact, afford the current legislative initiative.
Yes, Congress estimates that the proposed legislation will cost in the neighborhood of $1 trillion over 10 years with a net reduction of the deficit of about $100 billion to $200 billion. So whats the problem? Congressional budgetary ineptitude.
Sally C. Pipes, president of the Pacific Research Institute, had it right when she argued that with the advent of Medicare in 1965: The cost was about $3 billion and it was projected to cost $12 billion in 1990. Well in fact it cost $107 billion. Last year it cost $427 billion; its estimated in 2017 to cost $884 billion.
Just imagine what a similarly misestimated $1 trillion program will actually cost just 10 years out $10 trillion?
Ronald F. LaValle
Patchogue, N.Y., Dec. 13, 2009
The writer is a former associate director at the University Hospital and Medical Center at Stony Brook.
To the Editor:
Re Lieberman Says He Cant Back Current Health Bill (news article, Dec. 14): Senate Democrats should force Senator Joseph I. Lieberman, independent of Connecticut, and his Republican allies to filibuster the health care bill throughout the holiday season rather than letting them hold the American people hostage to their tactics.
Moreover, the filibusters should be shown live in public hospital emergency rooms throughout the United States, so that the uninsured people waiting for primary care can understand exactly who is preventing them from obtaining affordable health insurance. (Better yet, make the filibusters take place in emergency rooms, but the Capitol Police might object.)
Jonathan I. Ezor
West Hempstead, N.Y., Dec. 14, 2009