We went to Marietta, GA over the Thanksgiving weekend to see my folks and spend time with my sister and her family. The highlight was getting to watch the LSU – Arkansas game with my dad, but also fun was spending time with the rest of my family. My brother-in-law is unusual in Metro Atlanta in that he has managed to maintain his home building business despite horrible economic conditions. He would describe himself as a compassionate conservative if asked and we always have interesting conversations. This weekend we had long discussions about reducing government spending  and the consequences of focusing on “waste.”

I have to admit that I often have trouble with the wasteful label given to government programs  by “conservative” groups. My brother-in-law is a thoughtful individual and in fairness he did not bring up specifics of wasteful spending in our discussion. In looking I found one such list published by the Heritage Foundation that identified the following among “wasteful” healthcare programs targeted for elimination:

  • Maternal Child Health Care Block Grants – these funds help target and provide services to low income and at risk mothers and children with special health care needs
  • Health Professions Grants – As I have written here and here this funding is vital to redirecting training towards a primary care focus
  • Title X Family Planning – From the website: The only Federal grant program dedicated solely to providing individuals with comprehensive family planning and related preventive health services.
  • National Health Service Corps – Offers financial and other support to primary care providers and sites.
  • Rural Health Outreach and Flexibility grants – The Medicare Rural Hospital Flexibility Grant Program (Flex) provides funding to States who in turn award the dollars to rural hospitals.  For example, the Flex grants have helped over 1,300 small rural hospitals secure higher payments from the Medicare program under cost-based reimbursement.

Eliminating these programs would be a net gain of $1.5 billion dollars to the federal government and a further increase in infant mortality, reduction in chronic illness care (due to loss of primary care workforce) and the elimination of care in many rural areas.

Might I suggest another approach? In searching for definitions of waste in healthcare I ran across this tale from 2002. It is the story of cardiologist and a cardiovascular surgeon in a for-profit hospital system in Redding, CA. Both were paid handsomely for being “Directors, ” together accounted for 50% of the business of the hospital, and facilitated their hospital’s billing almost $1 billion in fraudulent charges. How, you might ask? This is from the investigation:

If the angiogram failed to document treatable disease or, as frequently was the case with Dr. Moon, was unreadable, he would perform an intravascular ultrasound which at the time was quite new and unfamiliar to many cardiologists. By improperly setting the gain on the ultrasound too high, Dr. Moon guaranteed the appearance (but not the reality) of significant arterial blockages. Dr. Moon would then lean over the supine patient and tell him in dire tones that without immediate bypass surgery he would die. In such a stressful situation, few Redding Medical Center patients were sufficiently confident, rational, or sophisticated to ask for a second opinion. For the few who did, Dr. Moon typically referred the patient to Dr. Realyvasquez, who would then confirm Dr. Moon’s diagnosis. Dr. Realyvasquez would rely on Dr. Moon’s recommendation and perform surgery

The report, written in 2008, offers ample evidence that these practices are ongoing as well as solutions which have not been implemented.

My brother-in-law and I agreed that government has a role in regulation, in particular under circumstances where the average person lacks the knowledge to make an independent analysis of the situation. If asked, I would suggest to the Heritage Foundation that more attention to regulating the health care “market” might be a wiser investment.