I'm going to de-shrillify the central argument of a Paul Krugman column, so that we can all try to get the point, minus the extra two-minute-hate adrenaline rush:
- The budget crisis is due to Medicare and Medicaid cost increases over time.
- Medicare and Medicaid cost increases are due to the rising cost of health care.
- Therefore, if you want to do something about deficits, do something about the rising cost of health care, ie. services.
- Health care reform of 2010 did a number of things on that front, like trying to pay for value/quality rather than volume of care.
- And if it's deficits that are the problem, you have two options:
- cut outlays or
- increase revenues.
And now might be a good time to show a pie graph of the federal budget.
The big chunks are Social Security, Defense, unemployment, Medicare, and Medicaid.
And now a graph of Medicare/health care spending increases — note that Medicare/Medicaid slopes basically track with the general increase in health care costs:
So, conceptually, this problem is not hard to understand. Politically, it is difficult. But the discussion on Capitol Hill right now is simply not addressing it at all. If you think you can make a dent in the federal budget without looking at those big chunks, you're kidding yourself. Or someone's kidding you.