Why is this the one thing?


When the terrorist attacks of 9/11 hit the United States, and then suddenly we were plunged into war, first in Afghanistan and then in Iraq, I don’t remember anyone demanding that the wars be “deficit neutral.” No one talked about whether we could afford them. They were things we just had to do.

When George W. Bush proposed giving vast sums to rich people in the form of tax cuts, no one argued that it would be “deficit neutral.” Rather, it was argued that cutting taxes wouldn’t bring in less tax revenue at all, it would bring us more tax revenue, because the economy would grow so much faster. And besides, it was somehow terribly urgent, something we just had to do.

When the banks tottered and needed to be shored up with taxpayer money to the tune of nearly $1 trillion, there was no way to argue this would be “deficit neutral.” We might get the money back, we might not. Whether we could afford it was not the question, we just had to do it to save the banking system. Similarly, the “Stimulus Bill” was terribly urgent, and something we just had to do, whether we could afford it or not.

Then we come to health care reform, and suddenly, it seems, this is where we draw the line. The president says that health care reform must be “deficit neutral.” It can’t actually cost us anything in tax funds. And everyone nods sagely and argues over how to do this. Why?

Why is this the one thing that we can only do if we can prove ahead of time that it will not actually cost anything? Our current system costs us an estimated 44,000 lives and impoverishes millions of Americans every year, and causes untold suffering – why is this the one huge national problem that everyone agrees we can’t afford to solve?

With nearly 30 years’ experience, Joe Flower has emerged as a premier observer on the deep forces changing healthcare in the United States and around the world. As a healthcare speaker, writer, and consultant, he has explored the future of healthcare with clients ranging from the World Health Organization, the Global Business Network, and the U.K. National Health Service, to the majority of state hospital associations in the U.S. He has written for a number of healthcare publications including, the Healthcare Forum Journal, Physician Executive, and Wired Magazine. You can find more of Joe’swork at his website, www.imaginewhatif.com, where this post first appeared.

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11 replies »

  1. The Congressional Health Care Bills are nothing less than a Bait and Switch. The Con in the Conservative vernacular is just that “a Con Job.”There angle is I’m against everything that does not Cater to Corporate Welfare and profitability. Wars are acceptable without justifiable cause in exchange for unjustifiable blood shed and lost of life of our Armed Forces for personal Gain. Health Care or more accurately Health Insurance Reform is no different. Catering to Corporate interests of manipulation and exploitation of the sick for personal Gain. Can you see the similarities?
    Since the Two wars ,we have already exceeded the 1 Trillion dollar mark not to mention the expansion of Government in last 8 years. Where were these voices of Fiscal responsibility Then? Especially when it came to Iraq! How about the trillions of dollars of debt to China? Still No call for Fiscal Responsibility?
    Now we speak of almost 1 Trillion dollars in ten Years and now we have the call for fiscal conservatism? This is Nothing more than selective Morality. The same mindless people who blow with the political winds will rise against inclusion of the uninsured but will latter accept it. These folks who are so against government run anything,but they will not oped out of Social Security, Medicare and other Government Programs. Why ? Their excuse is;I pay into it and In the same breathe deny others of their chances. How narcissistic and selfish of them!
    The Congressional Health Bill has become a Circus of money laundrying form our premiums into the politicians Back Pocket. This Bill adds Millions to the rolls for insurance exploitation and fails to control costs , Cap premiums and out of pocket expenses. Its everything that a closed market syndicate would wish .

  2. Yes I want my money back from the bastards at Halliburton who pushed us into war & occupation without end in Iraq and Afghanistan. Yes I want a punitive tax on the super rich who forced through a 50% cut in taxes on dividends (dividends!) which went only to the very very rich and was paid for by forcing other taxpayers to borrow and pay more (it was like buying your mistress an apartment and forcing your wife and kids to pay the mortgage).
    But there’s $2.5 trillion in the health care system now and at least 25% or more likely 35% is wasted. That’s give or take $1 trillion a year. All Baucus is looking for is under $100 billion a year. (Talking about it in 10 year totals is effing stupid if you ask me).
    That money is so easily findable in the rest of the health care system that talks about new spending are ridiculous. So I agree with Joe that it’s a stupid argument, but I dont agree that we should spend more money. We should re-allocate money we’re already spending.

  3. Peter said —
    “Where were the fiscally responsible Republicans then, saying they were looking out for our childrens’ future?”
    Republicans can’t claim superiority on fiscal responsibility. That is exactly my point. But there was then and is now a large and growing constituency comprised of both Democrats and Republicans who fear that we have incurred a debt that will destroy our country. I cited Pete Peterson and the Concord Coalition who have been talking about this for years.
    Why is it that no one can advocate fiscal responsibility without being labeled a Republican and then lambasted for Bush administration’s excesses? What political party represents the large and growing constituency that blame BOTH Obama and Bush for setting us on an unsustainable path? What would you recommend we do to have our voice heard by politicians rather than dismissed as right-wing radicals?

  4. Joe, I agree with you that it seems ridiculous this is the focus. However, I’m looking at it from a different angle. We all knew Republicans would be mad about some aspect of this bill – they would find something to pick apart. So why not give them something (like being deficit neutral) as a “bait” of sorts? Boy, have they taken it! I’d like to think this is the strategy of those implementing this bill, as I don’t think the concerns over its effect on the deficit will ultimately prevent anyone from supporting it.

  5. Healthcare costs zero until an individual decides he wants some. With 300 million individuals wildly accessing the healthcare system, because they can, there will be such a hole in the budget as to make the subprime crisis look miniscule.
    War was chosen by 536 people. It can be curtailed, won or lost, or abandoned. Once the healthcare system as it exists today is hobbled, it will cost a political fortune to get it back. Just like the economy which is spiraling down undr the weight of socialist BS, healthcare will become smaller and inefficient and a shadow of its former self, at least until the parasites are evicted from the halls of power.
    There is no “general welfare” in healthcare. The federal government could not enter the benefit business directly when soc. security and Medicare were hatched, so they created “trust funds” for each. A lot of BS, but not directly extablishing a federal benefit. Neither can healthcare be a direct benefit under the Consitution. If we are ceasing to be the United States of America, then just say so. For we will not be the USA once we are destitute financially. We will be the IOUSA.

  6. How about: “9 trillion in debt over ten years is not sustainable and we’d better not make commitments we cannot afford to keep”? No-one is going to want to own dollar denominated assets or buy our bonds. This is how empires, or worthy republics, come to an end.
    Is that California you said you live in? Is there something in the water out there that causes people to spend more than they take in?

  7. “Of course in this era of partisanship, people assume that anyone who advocates fiscal responsibility today must be a die-hard Republican and Bush supporter.”
    As an accused “liberal” who advocates “free” healthcare I was for using a tax on gasoline (it was a war about oil after all) to pay-as-you-go for the Iraq War. Where were the fiscally responsible Republicans then, saying they were looking out for our childrens’ future? They were too busy engratiating their war machine private contractor$ with deficit dollars and too busy lying to Americans. Republicans now claim they hold the higher ground in looking out for our and our childrens’ pocket books even after they presided over a $5 Trillion dollar addition to the national debt under Bush, yet they don’t have a better plan either that will control healthcare costs. The only responsible method that has been proven in other industrial countries to control healthcare costs is to have massive government control with price and access/use controls – paid for largely through taxes, a liberal’s plan. Many here think that as a “liberal” I can’t grasp paying as you go yet no Republican I have heard from has been willing to institute any pay-as-you-go solutions for healthcare, and no Republican has been willing to get the money for paying for universal affordable care from where it should come, and that is from the people who have made billions so far and want to continue to make billions – their (and the Democrats) funding benefactors – corporate healthcare providers. Republicans are too engaged using their mantra fighting taxes, any taxes, even ones necessary to pay for and control healthcare costs. Instead of giving us Republicans we can be proud of and use as examples for real healthcare reform, we get the grinning face of Congressman Billy Tauzin (a former Blue Dog Democrat) holding up his million dollar check from the drug lobby after he successfully got them billions through passage of the Medicare Prescription Drug Bill. Yea, their on our side.
    In my state Republicans launched an anti gas tax campaign which they won and then decried the condition of the state’s roads. Life is expensive, and needs to be paid for as we can afford it, not paid for with, deregulation leading to massive government corporate bailouts, tax concessions, and lower taxes for those Americans who can easily afford to pay more so that we can have a decent, moral, healthcare system that doesn’t rob people of their savings, dignity, and even their health.

  8. Unlike the other examples you gave, health care is not a “one time” expense. Accountants treat known, recurring expenses (healthcare) differently than non-recurring expenses (war). They must be budgeted for, year after year. It has to be budget neutral because Obama promised he wouldn’t raise taxes on the middle class. If you don’t get this, then your real question is, why bother with a budget?

  9. You make a good point. It’s a question that should have been asked in each of those instances. Deficits and soaring debts are the biggest threat to our nation today, and have been for years yet the problem has either been underestimated or ignored by almost everyone. It’s hard for people to grasp that this threat is just as real and dangerous as the threat of bombs or healthcare shortages, and should transcend party lines.
    Of course in this era of partisanship, people assume that anyone who advocates fiscal responsibility today must be a die-hard Republican and Bush supporter. There are huge numbers of people who opposed the expansionism of the Bush administration as vigorously as they now oppose Obama’s profligacy. Peter G. Peterson of the Peterson Institute has been warning people for years about this threat to our nation.

  10. Joe – Good points, but Congress is missing the bigger point. The Baucus bill does nothing material to change the forces that cost us $2.4T in healthcare costs every year. Doctors still get reimbursed the same, patients still don’t care about the actual costs because they are insulated by insurance (public AND private) and we are still obese, ridden with diabetes and other preventable ailments. We want and need change, but the $900B Baucus bill is a sham at best.