- The Washington Times - Friday, June 13, 2003

Not all medical choices should be subsidized

Robert Goldberg’s warning about a “Dangerous drug plan,” (Op-Ed, Wednesday) proves again that the first and foremost principle of U.S. health care politics remains, “Posture on behalf of the poor, but feed the middle class first.”

Nevertheless, one can overstate the current income and wealth of the majority of Medicare beneficiaries. According to the Medicare Current Beneficiary Survey for 2000, 42 percent of Medicare beneficiaries had annual incomes below $15,000, and 64 percent (nearly two-thirds) had annual incomes below $25,000. If one measures annual income at the “household” level for the elderly, the Centers for Medicare & Medicaid Services estimates that about 58 percent have annual incomes below $20,000. Median asset calculations also overlook the skewed distribution of wealth among Medicare seniors. One recent estimate (by Moon, Friedland and Shirley in June 2002) concluded that 60 percent of all Medicare beneficiaries have countable assets of $43,900 or less.

One of the main reasons there are diminishing returns to lower-income individuals from across-the-board expansion of taxpayer subsidies for health care services is that reductions in the price of health care, or expansions in the overall demand for health inputs, disproportionately benefit the well-educated. As noted by economists Dana Goldman and Darius Lakdawalla of the Rand Corp., better-educated people are more productive at managing their own health, and they are the first to adopt and benefit from new, intensive technologies. Indeed, government subsidies for health care research, technological progress and, ironically, even universal health insurance, may worsen health inequality over time.

In the context of Medicare reform and prescription drug coverage, we should realize that publicly financed entitlement programs cannot pay full price for every drug on the market in every instance, and they should not attempt to do so. Price controls will be inevitable in any plan to offer prescription drugs as “defined benefits” within an unreformed Medicare structure, and the current Senate Finance Committee’s Medicare plan provides virtually no reform.

Even the president’s revised framework for Medicare reform resembled a Potemkin village constructed out of incomplete and inconsistent concepts. The shallow effort at means-testing in the pending House Republican legislation gets things backward. Instead of raising the spending threshold needed for higher-income beneficiaries to gain access to full catastrophic insurance coverage for drug expenses, it should substantially increase the very modest front-end deductible (proposed at $200 annually) that they face before they receive any new drug insurance benefits.

Real market-based reform would step away from this mug’s game and provide beneficiaries a bundled amount of taxpayer assistance as a “defined contribution,” remove balance-billing price ceilings on Medicare services across the board and allow Medicare seniors (or their voluntarily chosen agents) to decide which kinds of health care benefits, at which prices and from which sources, they value most. Some seniors still might mistakenly, or habitually, choose to take advantage of the rigid price controls offered by the traditional Medicare program, but that program would be constrained by the requirement that it operate on the same per-beneficiary defined contribution limits as competing private-plan alternatives.

Protecting freedom to make medical decisions is very important, but it does not require taxpayers to subsidize the entire cost of every medical choice ever made by a doctor and patient.


Director of health policy studies

Cato Institute


Split atoms, not hairs

Our energy future has indeed received “A Needed Nuclear Boost” (Editorials, Thursday) with the defeat of an amendment that would have stripped loan guarantees for new plant construction from the omnibus energy bill.

Nuclear power is, in fact, an environmentally friendly way to solve our energy crisis as part of a national energy policy that puts the United States in full compliance with the Kyoto Treaty and significantly reduces so-called greenhouse gas emissions.

Between 1973 and 1999, U.S. nuclear power plants reduced the cumulative amount of carbon emissions by 2.61 billion tons of carbon dioxide. A Nuclear Regulatory Commission study found that if the United States used nuclear power to the extent that France — yes, France — does, it could in one fell swoop achieve the goals of the Kyoto Treaty.

France gets 80 percent of its energy from nuclear power and has demonstrated that the problem of nuclear waste is political, not technological. France reprocesses its spent nuclear fuel (as do Great Britain, Germany, Japan and Belgium), allowing France to reduce the volume of nuclear waste to one-fifth its size while generating even more energy, making nuclear power a “renewable” resource.

Our technology-based economy is going to need more power, not less, and it won’t come from windmills. It has been estimated that some 13 percent of U.S. power output is used to manufacture and run computers and our sprawling information technology infrastructure.

The phantom risks of nuclear power are small compared to the real health risks posed by air pollution from fossil fuels, which the World Health Organization estimates cause 3 million deaths a year, with 15,000 deaths in the United State from particulates alone.

All energy technologies produce waste. Burning fossil fuels generates waste that cannot be contained, as nuclear waste is, but is released into the environment and ultimately into our lungs. We can fear the imaginary dangers of nuclear power or deal with the real dangers of fossil fuel production. Let’s split atoms and not hairs.



Untruthful newspapers are tabloids

Paul Greenberg’s “Mythmakers in newsland” (Commentary, Thursday) hit the nail squarely on the head. How a major newspaper could allow its journalists to get away with lies (Jayson Blair), plagiarism (Jayson Blair, again) and the politically motivated editing of presidential quotes (Maureen Dowd), speaks volumes about its management. The fact that these articles ever saw the light of day raises more questions about the New York Times’ top management than it does about the journalists who authored them.

Any newspaper that fails to maintain discipline over its renegade writers simply becomes a tabloid. It happened in Great Britain, where formerly respected newspapers competing for subscribers and newsstand sales ignored the basic rules of journalism, including honesty in reporting. Sensationalism became the hallmark of their craft, not factual reporting.

So, Howell Raines steps down, and the problem is solved, right? Wrong. The stench emanating from the New York Times goes all the way to the top. Hiring prerequisites that mandate a certain political pedigree serve only to obliterate the newspaper’s objectivity. Those practices are also discriminatory. Jayson Blair was able to rise through the ranks, not on merit, but in the name of diversity. It’s truly ironic when you consider that the quest for diversity at the New York Times has moved it so far to the political left that, editorially, it promotes but a single point of view.

The New York Times has lost the most important credential any newspaper has: credibility. Carefully leaving out key elements in a news story so the author can demonize a political enemy isn’t journalism; it’s propaganda. The New York Times regularly engages in this practice, and it will continue, albeit with some new faces calling the shots. Mr. Raines is gone, but the liberal bias that drives the New York Times’ newsroom is alive and well. Does anyone think the Times will hire a conservative to replace Mr. Raines? No? Well, then, I guess that makes the case, which is that nothing will really change and the newspaper will continue its journey toward becoming the nation’s largest tabloid.


North Olmsted, Ohio

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