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By Dr. Christopher Hughes
. 1 Comment(s)

Andrew Sullivan's tag line, via George Orwell, is that "It is a constant struggle to see what is past the end of one's nose." One of my favorite lines is from Upton Sinclair, "It is difficult to get a man to understand something if his livelihood depends upon his not understanding it."

When I say "favorite," I mean I like it because it says a lot about the human condition in general, and about our political struggles in particular. Unfortunately, in these times, this myopia in our world views has the potential to lead to human misery, and to continue America on the road to tragedy, as we already have passed farce. I consider myself an optimist, but recent events including our world class embarrassment of a debt ceiling "deal" have left me pessimistic for our short term prospects of reinvigorating our priorities as a nation and consequently our intermediate term prospects of leaving the nation better than we found it.

We have been at our best as a nation when we have had visionary leadership, from Teddy Roosevelt's "Square Deal," to Franklin Roosevelt's "New Deal," to LBJ's "Great Society." Even Eisenhower's more mundane Interstate Highway System and JFK's goal to put a man on the moon represent aspirational goals for America. ("We chose to do these things, and the others, not because they are easy, but precisely because they are hard!") Now, our political will has been demeaned to the lowest common denominator: how will I keep more of my meager income for myself in the short term?

Paul KrugmanRobert Reich, and others have been banging this drum for over a decade now: investing in human capital is the way to grow the economy and keep us a great country. Many wish to continue the defunding of our societal investment in human capital: reducing investments in education and research, reducing money spent on the health of the population, demolishing our social welfare programs like Medicare, Medicaid, SCHIP and Social Security. This is short sighted and a recipe for disaster (with all the ingredients mise en place).

We now have plugged in a small group of Congress Persons in the wildly inappropriately named "Super Congress," with the stated goal of resolving our budget stalemate. I am skeptical, to say the least, and two articles in this week's New England Journal of Medicine reinforce my pessimism.

Jonathon Oberlander points out that "austerity politics" are now in force, and there are real potential dangers that Medicare and Medicaid funding could be cut substantially, including reduced payments to providers, reductions in federal funds for state Medicaid programs, increasing cost-sharing for enrollees, repealing the long term care insurance provisions in the ACA, and - per Paul Ryan's plan - changing Medicare into a voucher plan.

While Oberlander doesn't say it, I will: the "austerity politics" manufactured in Washington by power brokers with lots of money behind them are designed to take an axe to the programs that provide medical care to those who need it and prevent expansion to those who need it even more. We at DFA are all too aware of deficiencies in our current health care system and are not shy at all about pointing them out. But we also know that reforming health care requires a greater intellectual effort than unthinking cuts born out of myopic political calculations.

In the same NEJM issue, Christopher Jennings notes that many stakeholders in health care are coming to realize that there is almost no good that can come out of the work of the Super Committee. Because of the construction of the debt ceiling deal, if the Super Committee reaches no deal and the "automatic cuts" are enacted, Medicaid is exempt from cuts and Medicare would face "only" a two percent cut. As he explains, it is hard to imagine a deal crafted by the twelve that would so good to health care funding:

From the current vantage point of these stakeholders, the choice is therefore not a close call; the automatic cuts are by far the best poison to be forced to take, particularly in comparison to the concoction they fear the super committee could produce. It would meet the requirement of the law, protect against unknown and much larger cuts, and preserve resources and bargaining chips for the next big deal, which will probably take place in 2013 after the presidential election.

So, there is hope, if I ditch my own myopia and hope and pray and work for a new, better Congress in 2013, we may be able to get on the path to becoming a great country again, instead of the "dollar store" nation that so many seem to believe is our destiny!

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  1. Lucas Restrepo

    Dr Hughes, I admire your optimism. What you are referring to is a more advanced ocular malady: blindness. More precisely, what we are dealing with is “blind leaders of the blind. And if the blind lead the blind, both shall fall into the ditch.” (Matthew 15: 14)

    If these words did not elicit an image in your mind, this painting by Pieter Brueghel the Elder surely will:Ä._025.jpg

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