Before we can start talking meaningfully about health care reform, we have to understand the nature of the problem.
The biggest national problem is the entitlement gap. Over the next seventy-five years, we have a shortfall in our entitlement programs of about 50 trillion dollars, give or take ten trillion. Most of that gap is in Medicare and Medicaid. The gap is based on extrapolating current trends in health care expenditures, but current trends are not sustainable. Diabetes, obesity, and heart disease are increasing at a frightening rate, and we are not detecting these diseases early, when they can be prevented or treated more cheaply. The problem is particularly bad at lower income levels, where people away away from doctors until conditions become obviously life-threatening. Treatment is then sought at emergency rooms, where it is most expensive. There should be no deductibles or co-pays, therefore, for routine, diagnostic, and preventive care. That’s the only way we can control the spiraling cost of treating chronic disease.
The same logic demands that coverage be universal and life-long. Portability must be automatic. Gaps in coverage will result in billions of dollars for unnecessary treatment for chronic disease. A child born today has a ONE IN THREE chance of developing Diabetes during their life. If that doesn’t wake you up, I don’t know what will. Cutting into those numbers will reverse the rising cost trend more effectively than any other measure.
The fastest-growing component of costs is in pharmaceuticals. We need to close the “no negotiations” loophole in Medicare Part D. If we are the industry’s largest customer, they will negotiate with us or face cuts in pharmaceutical spending. It’s not the taxpayer’s job to put money in the pockets of Big Pharma shareholders. We’re paying the highest drug prices in the world and it is time we stopped.
We also need to stop pretending there is some artificial dividing line between agricultural policy and health care. We are subsidizing the production of astronomical quantities of refined carbohydrates that are converted directly to glucose in the blood-stream, overwhelming the body’s capacity to absorb them. This is why obesity and diabetes are out of control. We evolved in an environment where fats and sugars were rare. Our bodies are optimized to process them as efficiently as possible. When placed in an environment where fats and sugars are the most plentiful foods, that efficiency kills us. The dietary habits of humans are very sensitive to considerations like convenience and cost. Artificially subsidized fats and sugars are helping to make us sick.
