Several of the frequent commentators to this blog took issue with my characterization of Americans being a confused and contradictory lot when it comes to their views of the federal budget.
But the fact is—and yes, I am talking about fact, not opinion— that most Americans have no clue about how the federal government spends their taxes and the trade-offs involved in balancing the budget. Yesterday’s Washington Post fact-checker blog goes as far as to give the American people four "pinnochios" (the site’s worst possible rating for accuracy) "for not knowing the basic facts about how the U.S. government spends taxpayers' money." I know, some of you are going to say that the Washington Post can’t itself be trusted because it is part of the Washington establishment. I ask, though, that you first read the fact-checker post, in its entirety, because the bloggers support their assessment by citing extensive evidence from surveys and studies. Most Americans, for instance, think that the federal government spends more than one out of four dollars collected on foreign aid, but the real number is less than three percent.
The fact-checker blog does more than decry Americans state of blissful ignorance about the budget; it also offers a nice interactive webpage to help people understand where their money is really going now compared to 1981. You can click on any programmatic area of spending and get a nice graphical illustration of how much spending has increased.
And guess what? The biggest increases, by far, have been spending on Medicare (more than 400% increase) and all health care spending combined (more than 500% increase). Nothing else comes close.
The answer to the federal budget deficit, then, ultimately will come down to getting a handle on health care costs. Whacking away at discretionary programs that largely benefit the poor, as the House of Representative’s Continuing Resolution would do, will not get us there. Nor will circling the wagons to protect Medicare from cuts, as liberal Democrats are prone to do, get us there. We have to spend less on health care, period, end of story. And this can only be done if physicians take a leadership role in explaining to their patients and the public the consequences if we allow unrestrained spending on health care to continue. Physicians must also be willing to take responsibility to reduce unnecessary, inefficient, duplicative or marginal care.
ACP’s is trying to do its part. ACP has released a major new paper on why and how the United States must make decisions about conserving and allocating limited health care resources, rationally and effectively. It is also asking its members to participate in the High Value, Cost Conscious Care initiative, which will help identify the benefits, harms and cost of different tests and procedures.
If you care about the deficit—as we all should—then help ACP start a national conversation about controlling health care costs. And help us disabuse the public that deficit reduction can happen by cutting foreign aid or funding for education or assistance to the poor, while leaving Medicare and other health programs untouched and without asking anyone to pay more with higher taxes.
Today’s question: What is your reaction to the evidence presented in the Washington Post’s fact-check blog about Americans “not knowing the basic facts” about the budget and the trade-offs involved, the fact that health care spending trumps all other parts of the budget in terms of increased spending over the past thirty years, and ACP’s efforts to address the cost problem with the public and with its members?