Thursday, October 08, 2009

The Cost of the Emperor’s New Clothes

There once was an Emperor of a prosperous country who cared more about health care costs than military pursuits or unemployment so he requested accountants provide him the finest cost estimates as he undertook health care reform.

This cost estimate, they tell him, will be to three significant digits and will account for all potential changes to the world that might occur for the next ten years, but because of how they were derived, will be invisible to anyone who was either stupid or unfit for their position.

The Emperor pretends that he understands the accuracy of the estimates so as not to appear stupid; his ministers do the same. When the accountants report that the cost estimate that was generated in record time and includes provisions for hundreds of amendments just passed, they arrive and mime a beautiful robe of cost estimates. The Emperor then goes on a procession through the Capital showing off his new "clothes".

During the course of the procession, a small doctor cries out, "the Emperor is naked!" The crowd realizes the doctor is telling the truth when they realize no one has any idea how much anything really costs in health care. The Emperor, however, holds his head high and continues the procession.



joegrind said...

"..who cared more about health care costs than military pursuits or unemployment.."

Just wondering what this sentence is alluding to.
Also, the current bills are so far from perfect and yes, some specialties and more affluent will get pissed....but there was nothing on the table with regard to healthcare reform when we were all at peace with a huge surplus.

Keith said...


I think the cost estimate is just that and a 10 year estimate is really not worth very much given the assumptions that are used to predict it.

Same occurred when congress passed the Medicare drug bill and the CBO actually withheld the final cost estimate )possibly at the urging of the white house at the time) since to see the true cost overrun would have scuttled the legislation. Bottom line; when it comes to 10 year predictions, I am not sure the emperor is ever wearing clothes.

Of course locally we have the same shenanigans where our state legislature balanced a budget based on revenue from video gambling, but we now see every municipal body outlawing video poker machines within their borders. So much for that budget.

Anonymous said...

Dr. Wes,

A little off topic and from that commie pinko outfit NPR but they just ran a terrific article that I think you might find interesting. Health researcher Jack Wennberg did some in depth investigations which led him to conclude a large portion of American medical care is unnecessary and due to the structure of the health care system. To quote NPR there were Talmudic dissections by doctors themselves as to what drove doctor decisions.
You can find the copy and/or listen to the program at: - All Things Considered 10/8 program Title: The Telltale Wombs of Lewiston, Maine

Anonymous said...

Dr. Wes,

Just wondering if you also called out the last emperor and his advisors when they were estimating the cost of a Middle East military pursuit that, last count, ran a little overbudget.

Andrew_M_Garland said...

This fictional memo has surfaced (excerpt):

Memo - Health Plan Deficit Reduction
From:   Chairman [redacted] of the [redacted] Committee
To:        Healthcare Reform Drafting Group II
Re:        Finessing the Health Plan Deficit
The estimated deficit for our health reorganization plan is causing us trouble in the press. President Obama has promised not to raise taxes on the middle class, and not to increase the deficit. Unfortunately, we have to live with this until the plan passes Congress.

After passage, we will spend what it takes, just like the last times.

Now, this is how we will "pay for it". Assign whatever fees (not taxes!) you want against insurance companies, big businesses, and "private" doctors. Make the fees big enough to cover the entire added cost of the plan. Yes, even if you think we can't raise that much money from those fees.

Memo - Health Plan Deficit Reduction

Anonymous said...

brilliant Wes. I'll bet they figure out after the 2010 elections.

re: commie pinko outfit anonymous post, most physicians agree there waste in the system and agree with reasonable change. after the 2010 medicare cuts, I think our senior citizens will be questioning "reasonable" as all the rural cardiology practices close because of the overnight 30% cut in reimbursement. Make sure you stay healthy.

Anonymous said...

disagreeing with the proposed health care plan is a different topic than the middle east war budget. try to stay on topic.