Sunday, July 28, 2013

A Note for Advocates of Single Payer

When thinking about government programs, it is always wise to remember that government is controlled by politicians and therefore can be counted on to respond to political considerations.

I was reminded of that by a July 21 Op-Ed piece in The Boston Globe reciting the recent experience of columnist Robert Kuttner.  It seems that Kuttner’s 99 year old mother suffered a bad fall.  She was taken to the Mass General where she stayed for four days.  Upon her discharge, Kuttner was surprised to find that his mother’s stay had been classified as “for observation.”  This meant that the services she received were paid for as an outpatient service under Medicare Part B in which the patient’s co-pay is much larger than it would have been had she been classified as a regular inpatient, payable under Medicare Part A. 

According to Kuttner, this stratagem has been devised by Medicare as a cost reduction measure which results in paying the hospital less and requiring the patient to pay more.

None of this should come as a surprise.  Whatever political benefit attaches to new programs is at its peak at the time of enactment.  Thereafter, from a political point of view, it becomes a drain on resources that could otherwise be used to generate political benefit by financing other new programs.  That helps to explain why the financing of public programs tends to diminish over time.

Single payer advocates take note.

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