Obama, Romney Ignored Key Health Care Issue During Debate

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I wasn't really surprised when Jim Lehrer did not use my suggested question on healthcare in last week's first presidential debate. For those who didn't read that column, or don't remember the question, here it is: How is it possible that the U.S., the richest country in the world, is the only developed country on this planet that has not figured out how to provide basic health insurance for all its citizens?

However, I was truly surprised that this issue did not come up at all!

In fact, I am astounded that the plight of the 40 to 50 million uninsured was mentioned in passing only once, if I recall correctly. So it looks like I will have to answer this question on my own without the help of the two candidates. And I will do so in this series of columns.

But first, while the debate is fresh in our minds, I want to mention two other issues that did come up many times during the debate.

The first is the now infamous $716 billion that President Obama proposes to cut from Medicare over the next 10 years. Not surprisingly, Governor Romney made it sound like that cut would mean less needed care for seniors on Medicare. In fact, Obama prefers to characterize those cuts as "savings." And I agree with him on this one.

As I said in my previous column, a recent Institute of Medicine analysis estimates that almost a third of what we spend on healthcare is wasted; they analyzed the year 2009 for that estimate and almost all health economists agree that is the percent we waste every year in modern times.

And one of the few items both parties agree on is that current Medicare growth rates are "unsustainable."

So clearly we are going to have to find savings in future Medicare budgets. The only real question is how – and that's a question for legitimate debate.

Which leads to another whipping horse in the first presidential debate – the panel of "unelected experts" proposed in the Obama plan.

Named the Independent Advisory Payment Board, IPAB, this panel of healthcare experts is supposed to advise on ways to cut waste. But they have quickly become demonized, much like the "death panels" before them, as heartless bureaucrats who would come between patients and doctors and deny needed care.

In fact, the Obamacare law specifically prohibits such decisions – but nobody seems to care about that fine print.

I personally believe that Congress, in essence the current board of trustees for Medicare, is utterly incapable of making the tough decisions needed to save the program. Remember, they couldn't even agree on which military bases to close and had to appoint an outside group of experts to do so.

So if it isn't this board, it will have to be some other mechanism that can get around the gridlock in Congress.

In my next column I will get back to the question of why we waste so much healthcare money and what we can do to attack this critical problem. I say "critical" because if healthcare inflation continues at the rate of the last several decades – two to three times the general inflation rate – we will face national bankruptcy sooner than we might think!

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