I Know Your Are, but What Am I?

Left Coast Rebel suggested on Sunday that Nancy Pelosi was "stupid" for suggesting that substantial savings could be wrung out of Medicare and Medicaid. I am a little surprised that someone who wants to eliminate Medicare is so dubious about the possiblity that the program has substantial wastage. In any event, I sent the following response, which has not been posted on his site, and likely never will:



It looks like you have misinterpreted what Ms. Pelosi said, which is completely consistent with the President's proposals. Ms. Pelosi said that substantial savings could be achieved throughout the entire health care system, not just Medicare and Medicaid. That is what the President has said all along, so I am not sure why you find this so shocking. For example, there is no reason for the size of current government subsidies to Medicare Advantage plans. But it requires a system in which everyone is brought under the health care umbrella. For example, when families have health insurance, they do not need to use hyper-expensive hospital emergency rooms as primary care clinics. Public exchanges can exert pressure on provider groups to adopt the "medical home" service model in place of fee for service arrangements. There are dozens of savings ideas that flow out of trying to create a rational system that covers all Americans. This isn't fanciful speculation - the ideas were reviewed in depth in the Dartmouth Atlas medical cost project that was reviewed in the February 26, 2009 New England Journal of Medicine. So, as far as "stupidity" is concerned, seems to be more up to date in the academic research on health care economics than others one might name.