Growing health care costs have put health care out of reach for many individuals, and even as it is doing so, federal, state and local governments are struggling with the costs. While social safety nets are sacrosanct to liberals, as they should be, as President Obama said, progressives must be the primary stewards of making that compact work better and keep the confidence of the taxpayer. One such basic and essential social safety net is the one that we as a society provide to people with disabilities. Whether a disabled person is your everyday American or a veteran who has left a limb on the field of battle, as a country that is great because it is good, we have said that it is our social responsibility to care for them. And it is a liberal concept that should never be lost on anyone.
Yet, a study that will be published in tomorrow's Health Affairs issue (that I was able to obtain an advanced, embargoed copy of) will report that health care public spending growth for the disabled population is far outstripping our GDP growth. In 2008, health expenditures for people with disability, federal and state combined, were at least $235 billion, and between 2002 and 2008, the federal expenses had grown by 34%, adjusted for inflation. This is a low end estimate, given the study did not account for the added expense to care for people with disabilities in programs that are not specifically designed for disabled Americans (such as Medicare and Medicaid). In Medicare alone, fully 20% of the growth in spending for beneficiaries with a disability is attributable to growth in cost per beneficiary.
Even given the massive spending on the wars that inflated the GDP in those years, the share of federal expenditure for services for people with disabilities managed to climb. Granted, of course, that part of this expenditure was to care for disabled veterans returning from Iraq and Afghanistan.
The federal government spends nearly as much on income assistance for the disabled as it does providing health care, each consuming about 47% of total federal spending on the disabled. The rest, less than 6% are left for important services like education, housing and food assistance, training and employment, etc. While all of those other things have also been growing in size, they have grown at a much smaller rate: food assistance in the same period for disabled Americans grew only by 18%, for example. There was no increases in education, training and employment services for the disabled, making the transition to work for Americans with disabilities that much more difficult.
What does all this mean? The growth in health care spending in general is not sustainable, and given that it is a major part of services for the disabled, containing its growth is majorly important to protect services for the disabled. The disabled are the most vulnerable of populations when states are forced to cut back on services during a recession, and when the federal government looks for ways to save money. If liberals don't think of concepts to contain health care costs now, conservatives, I guarantee you, will think of it later, and come up with voucharization plans ala Paul Ryan.
As the Health Affairs study suggests, we do not have the luxury to assume efficiency increases will not work. They have to. The medical miracle of an ever expanding lifespan brings with it the need to transform our system into a truly health care system rather than just treatment and disease care. There is a significant opportunity that hides within this challenge, especially when it comes to the disabled community, who can be productive members of society with the right training and assistance and thus not only remove the cost of public assistance but become taxpayers themselves. Exercise programs, integrated into the care of disabled individuals, can often work wonders, for example.
The Affordable Care Act already makes important investments towards transforming Medicare into a system where the payment incentives are based on care and treatment, and not based on number of services used. We need to expand that to the private sector, to state programs, and to the medical profession in general. Remember, the more we are able to save on medical care (without sacrificing quality), the more we are able to invest in education, training and other assistance programs.
Beyond just improving the health care system and its efficiency, though, there is one thing we can all do - as groups and as individuals - to help build a better environment for employment for disabled people. Challenge assumptions of others who think a disabled person cannot be productive. If you own a small business, include disabled people in your talent search; you might be surprised at what you find. Let's remove the social stigma from disability.
As I said before, if we liberals don't put our thinking caps on and find innovative solutions to this problem, conservatives will be sure to subject the disabled to their axe.The conservative idea of simply capping spending is idiotic, and it is nothing more than a plan to tear apart our social contract. That's also their goal. But our goal is to keep the social compact. How do we do it? If our solution is to simply throw more money at it, I guarantee you that at some point we will run out of money to throw at it, even if the conservatives didn't stand in the way of even necessary spending. So here's my invite: put your thinking caps on. Let's come up with some ideas for solid solutions focused on caring for the disabled.
NOTE: The study is embargoed until tomorrow morning. When it is published on Health Affairs, I will link here.