That’s where the (Medicare) money goes!

SATURDAY, MARCH 16, 2013

Do average folk need to feel pain: As the cognoscenti know, one of the nation’s top happy hours is conducted right inside Baltimore’s Penn Station!

You can drink margaritas for $1 while watching people run for the train. And we do mean run!

Yesterday, we took some reading material along as we headed off to engage in this local folk tradition. Specifically, we took the Business Day section from the February 27 New York Times.

We wanted to read Eduardo Porter’s weekly Economic Scene column. On that day, his column bore this hard-copy headline: “No Need For Urgency In Fixing Medicare.”

We’d been tugging the column around for two weeks. Now we planned to read the whole thing—and we were glad we did!

Do average people need to feel pain if we reduce future Medicare spending? Consider the highlighted passage about Medicare spending in two well-known cities:

PORTER (2/27/13): Prodded by President Obama's Affordable Care Act, which offers providers a share of savings reaped by Medicare from any efficiency gains, many doctors are dropping the costly practice of charging a fee for each service regardless of its contribution to patients' health. Doctors are joining hundreds of so-called Accountable Care Organizations, which are paid to maintain patients in good health and are thus encouraged to seek the most effective treatments at the lowest possible cost.

This has kindled hope among some scholars that Medicare could achieve the needed savings just by cleaning out the health care system's waste.

Elliott Fisher, who directs Dartmouth's Atlas of Health Care, which tracks disparities in medical practices and outcomes across the country, pointed out that Medicare spending per person varies widely regardless of quality—from $7,734 a year in Minneapolis to $11,646 in Chicago—even after correcting for the different age, sex and race profiles of their populations.

We don’t know how you create a statistic like that. But according to Porter, there is an extra $4000 per person being spent on Medicare in Chicago, even after adjusting for demographics.

If we took back that $4000 per person, couldn’t we sharply reduce future costs without making average people feel pain? So a person might sensibly think, especially at happy hour.

Porter continued:

PORTER (continuing directly): He [Fisher] noted that if hospital stays by Medicare enrollees across the country fell to the length prevailing in Oregon and Washington, hospital use—one of the biggest drivers of costs—would fall by almost a third.

''Twenty to 30 percent of Medicare spending is pure waste,'' Dr. Fisher argues. ''The challenge of getting those savings is nontrivial. But those kinds of savings are not out of the question.''

If thirty percent of Medicare spending is “pure waste,” why was a telegenic child of the upper class appearing on network TV last Sunday, asking to hear people scream in pain as we reduce future Medicare spending? See our previous post!

At this point, we might add this note: Many liberals seem to be under the impression that Medicare is already quite cost effective. We have been scripted to advance this impression as we propose “Medicare for all.”

We need to become less scripted. Beyond that, we ought to push for more information about per person costs in this program.

On a per capita basis, how much does the U.S. spend on health care for seniors as opposed to other developed nations? We have never seen that figure. We don’t even know if the figure exists.

We do know this: Our public discourse is largely composed of short, pithy scripts. In one such script, telegenic children plucked from the finest schools go on TV and repeat elite claims about the need to hear people screaming in pain as we reduce health spending.

On TV, these discussions tend to last sixty seconds, just long enough for the scripts to be voiced. This represents the “imitation of public discussion” we have been talking about.

Final question: In our imitation discussions, have you ever heard anyone complain about the $4000 per person that disappears in Chicago each year? Why do you never hear that script voiced?

We can't answer your question.

Concerning yesterday’s happy hour: Concerning yesterday’s happy hour, we received a bonus. A group of roughly twenty young people were waiting, with substantial gear, to clamber aboard some train.

It was like the scene from Wild Strawberries! The scene where the aged professor picks up the lively young hitch-hikers!

Could they be waiting for the Crescent, we incomparably wondered. And sure enough! As it turned out, that was their train!

We don’t know where they disembarked. But the Crescent rolls, extremely slowly, all the way to New Orleans. If they stayed all the way to the end, they enjoyed some extremely colorful station stops. Or they will, by this afternoon.

Who wouldn’t want to take that train? The last six stations stops are these: Tuscaloosa, Meridian, Laurel, Hattiesburg, Picayune and Slidell.

People! At how many happy hours can you hear an announcer rattling those famous old names?