The writer is a former director of the Congressional Budget Office and was an economic adviser in the Reagan administration.

Oh.

I asked because he wrote an editorial in the Washington Post on How to Fix Health Care today.

...Social Security today is the chief topic of conversation, but it's no secret that health care costs for the elderly will increase much more than retirement payments and much more quickly.

If we are to provide health care for seniors in superior and ultimately cheaper ways, we must face critical facts that point the way to effective, long-term Medicare reform:

"Superior" means "cheaper." Keep that in mind so you know what to expect from this crew.

First, the lion's share of Medicare spending is going for a relatively small number of people.

This would be GOOD news if pricing was rational.

Second, we are wasting time and money by not having a coordinated care system for these big users.

Sounds like a call for a single payer system. I am with that.

Third, we lack the information needed to guide our caregiving.

Um, that's why we have doctors rather than former directors of the CBO doing the caregiving.

Fourth, we continue to drive up costs by overusing hospitals and preventing nurses and technicians from doing routine work that doctors now needlessly perform.

To prevent overuse of hospitals, they'll be issuing home surgery kits.

Let's start with the cost breakdown. Just 10 million of the 40 million Medicare beneficiaries are burning through 90 percent of the program's costs every year.

Wait a minute...10 million people is a "relatively small number?" One quarter of the people on Medicare is a relatively small number?

I don't think so.

These relatively healthy people don't cost enough for the government to be following them around with a rulebook or forcing their physicians and pharmacists to file mountains of paperwork. Instead, for the majority of them, we should introduce "smart cards" to serve as virtual medical coordinators.

But unfortunately this wouldn't save much money and possibly could cost a little more.

Why do all Republican money saving suggestions wind up costing money?

But most of the program's costs are for patients who are chronically ill and in need of extensive care. They typically have multiple chronic conditions such as diabetes, heart disease, high blood pressure and lung disease. They routinely consult a dozen or more doctors and fill 50 prescriptions per year. They are often hospitalized at least once a year. And no one is in charge of coordinating their care, which results in overuse of medical services and conflicts in treatments and drugs.

And these people are the problem.

Let's kill them.

Man, I've seen a lot of folks in this condition, including my father. Anyone that thinks these folks are abusing anything, anyone that thinks their problems are voluntary (and I include medical costs in those problems) is so full of shit they leave brown stains wherever they go.

Much of the past three decades has been spent trying to modify patient behavior by changing deductibles and co-pays -- with only marginal effects on health costs.

You know why?

Because your health care costs largely depend on your health. Demand is not the issue...NEED is the issue. And prices are set accordingly.

But here's an admission on the level of George Will's admission that GM is best viewed as a nation-state...The the efforts of the last thirty years have NOT been directed toward improving health care or even controlling costs.

Isn't that nice to know?

And another significant admission:

The truth is that most of the high costs incurred in Medicare are for procedures that patients do not consider discretionary -- hospitalization and inpatient procedures and testing. When a doctor tells my father he needs to be hospitalized for a series of cardiac tests, my father doesn't think about his deductible and co-pays -- he goes to the hospital.

Demand is not the issue...NEED is the issue.

Doctors should have incentives to assume the role of care coordinators for the chronic users of Medicare in an effort to improve care and hold down costs.

They already do this. I'm watching it happen with my father, I've seen it happen over decades. It's done with an eye toward medical treatment rather than balancing the Federal budget...and it is absurd to expect budget considerations to play into the health care planning for chronically ill people that were productive, contributing citizens for the majority of their lives.

We should start reducing the utilization of hospitals to curb costs without lowering the level of care provided.

I'd like to see evidence that prove...or even information that suggests...reducing utilization of hospitals, in and of itself, can be done without lowering the level of care provided. THEN we can look at if it curbs costs as opposed to shifting them.

The current revolving door between nursing homes and hospitals is unnecessary, expensive and a burden to patients.

There's a revolving door? First I've heard of it, and I'm not inclined to take Dan's word for it. See, Dan opened the editorial with his real concern (as he should have, by the way).

In just 25 years, federal spending for Social Security, Medicare and Medicaid (which was originally designed for the poor but increasingly also supports long-term care for the elderly) will about equal what we now spend on the entire federal government. Paying for those programs, without reform, will take tax increases of nearly 10 percent of gross domestic product -- the equivalent of payroll taxes of 30 to 35 percent.

I really feel we should be taxing wealth rather than income because wealth is both privileged and protected in our economy in ways income simply isn't.

But that's an opinion.