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The sudden effectiveness of central planners (or not)

A study by Danish economists in 2002 looked at 258 government transportation projects in the United States and abroad. They found that cost overruns are routine, and they concluded that overruns stem from government deceit, not honest errors. Ninety percent of the projects they examined had cost overruns, with an average overrun of 28 percent. The study concluded that lying, or intentional deception, by public officials was the source of the problem: “Project promoters routinely ignore, hide, or otherwise leave out important project costs and risks in order to make total costs appear low” in order to gain initial project approval.

Government Cost Overruns by Chris Edwards at Downsizing the Federal Government

Our guys in D.C. love popularity with the folks back home. It’s what keeps them in D.C., living the life they love. Oh, and “fighting for us” – almost forgot about that. They love to make us think they are responsible for giving us goodies, but they’re more like the gregarious ne’er do well who elicits cheers throughout the bar by saying the drinks are on him…then is nowhere to be found when it’s time to pay the bill.

I know that guy

Where we are already providing government health care – Medicaid – we have waste, fraud and abuse estimated to cost over $100B annually, and part of the ObamaCare plan involves expanding Medicaid. Yes, they talk of expanding it with dollars that they’ll have after eliminating waste/fraud/abuse, but I’m skeptical of the government’s ability to achieve substantial reductions. The abuse is inherent in this sort of a centralized system; history bears that out.

Politicians who swear they’ll “root out waste, fraud and abuse” cite examples of how a certain state, city or organization used the system to their advantage, but they – the political class – set up the rules that made it happen. Now, because they’re motivated by this administration’s “showpiece” legislation, they claim a sudden ability to write rules that will reduce waste/fraud/abuse to an extent that produces savings that we should use to buy health insurance for everyone.

While I would appreciate this newfound capability if it actually existed, I know the guys making those claims. They’ve never, ever come up with all the money to pay the bill. I’ll give you that they fail in varying degrees, but they keep promising us stuff and we keep believing. Maybe when the bar shuts down because it can’t cover costs, and everyone is forced to sober up, they’ll realize the ne’er-do-well ne’er actually gave them a thing he didn’t first take from someone else.

It’s not “paid for”

Medicaid expansion is.not.free. If we could purge waste/fraud/abuse from the system we would still need a crap-ton of money on top of that to cover the cost of putting more people on the Medicaid rolls. And that’s just to give them some sort of assurance that we’ll take care of them if they need it…a promise of a thing, but not the actual thing. That’s extra.

Even if you support some kind of expansion to free or subsidized health care, let me remind you that health insurance is not health care. Medicaid is not health care. “Health care” is a phrase whose meaning has become twisted for political and corporate welfare reasons such that it is now synonymous with “health insurance” in the minds of many.

What are we getting for the money?

“Health” means being free from illness or injury, and has its roots in the word “whole.” “Care” means providing what is necessary for someone’s health, welfare, maintenance, and protection. The phrase “health care” properly and honestly means providing what is necessary for someone to be free from illness or injury. “Provide” means to supply – not a mere promise to supply. Health care is care for your health provided by your doctor, nurse or other practitioner, or by you yourself. Money and time that you spend on it goes directly to care…and hopefully to your health.

Health insurance is a contract you pay an organization for – either directly by paying with your money or indirectly with money from your employer or a government agency – and that organization promises to take some of the money you gave them and pay for all or part of your health care. This is not itself health care. There’s a constant balancing act to try to take in enough in funds to pay for the care people want or need without making the costs so high on the part of the insured that they don’t see the value in having a policy.

On the government-provided side of insurance, as costs to cover people keep climbing, the government takes what is probably the path with the least amount of political fallout, and cuts payments to providers for their services. Providers accepting government plans like Medicaid have shrunk in number as a result. This makes it harder to get care even if you’re covered.

The problem as I see it is that administration of health care has grown in size and cost, which we subsidize every time we pay into any part of the current system except when we simply pay a provider for what we receive from him/her. Which makes me wonder why the hell we don’t go back to just paying the doctor or nurse instead of diverting a huge chunk of our pay into a system that charges us $5.00 and gives our provider maybe $0.67.

Anyone have better solution?

This has all been mucked up for years, and I personally do not see how a preponderance of third party administrators could ever help us have better health and keep costs in check. I realize that cheaper doesn’t necessarily mean better, but if we have to pay less out of pocket we are disinclined to forego needed medicine or a doctor visit when it’s affordable to take care of ourselves.

I think we need insurance for major, major things but that is it. The rest should be on individuals. Where people insist on publicly-provided care, it should be care – not insurance.

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