• New CNN piece on Rep. Ryan’s budget

    I have a new piece up at CNN.com that spells out my thoughts on Rep. Ryan’s budget proposal in more detail. I encourage you to go read it.

    As an FYI, you will note that the piece has been edited in a way that violates my rule on respecting the office to which members of government are elected. I wrote the piece to say “Rep. Ryan” each time; CNN edited it to “Ryan” in many cases. I asked them to fix it, but it may be CNN official style just to use the last name. If that’s the case, then there’s not much I can do about it. I just want you to know that I tried.

    UPDATE: I’ve gotten some email about the title, too. I didn’t write that either.

    • I really apreciate the article you wrote. It addresses one of the issues that I find most disturbing, the fact that no one is trying. Everyone screams about how the deficit needs to be reduced but no one is willing to put their neck out for a plan that could possibly work. Thank you again for your time and effort.

    • I’ve found the cut off ages Rep. Ryan’s plan suggests very interesting. The over 65 group would have his head on a platter if any changes were suggested and the 55-65 group, the ‘boomers’, if you will, would provide the knife. This subtle pandering to two blocks that vote and tend to be conservative is a smart, well caculated move on Ryan’s part. It quells and opposition from those groups who face minimal changes in benefits I am in the 65+ group, but not nearly as conservative as my fellow Wisconsinite, Rep. Ryan.

      I agree with your basic premise: Rep. Ryan has teed the ball up. Now it’s time to begin the debate on club selection.

      Thanks for CNN article!

    • I applaud you on your call to not to just criticize someone else’s proposal, but give your own fixes for things you disagree with. If Congress were expected to do this, we might actually get somewhere! Our congressmen and senators seem more concerned with public perception of how important they are than in actual problem solving. Come up with a plan, put your name on it and go public! If there were multiple public plans then that opens up true debate on actual ideas instead of posturing and blustering. The wisdom of crowds might actually have a chance to work. Imagine what these bright people could come up with if they actually worked together for a common cause instead of fighting against each other’s political labels…

    • Dr. Carroll’s opinion piece reads like it came straight from the pen of a liberal politician. A bit surprising given that he is a practicing physician, but maybe not so surprising given that much of his pediatric population is likely insured by US taxdollars (or more truthfully, US debt). As someone who daily cares for our aging population as a physician, I can tell you WE SPEND TOO MUCH ON HEALTHCARE. Much more, in fact, than nearly anyone would spend if they were having to pay for their care out of pocket. Although Rep Ryan’s plan is drastic, the fact that we are drowning in 14 trillion dollars of debt and are headed for bankruptcy, calls for drastic changes. Sending block grants to the states will in fact FORCE spending cuts which is apparently what’s needed as history has shown over and over that politicians won’t make the changes necessary to seriously curtail spending. Oh, and Dr. Carroll’s suggestion that eliminating fraud is the foundation of curtailing spending on both Medicare and Medicaid is at best wishful thinking. Yes, fraud does occur and we should go after it, but there won’t be any huge cost savings by doing this. Any real solution to healthcare spending needs to include physician groups who make the hard and difficult decisions about what spending is likely to reap significant healthcare benefits and what spending is not. This could be done at the state or even county level – block grants would define the (yes, painful) parameters by which we all practice the profession.

    • Doctor Carroll, you seem to believe that a great deal of money could be saved by fraud prevention. Where do you stand on the publishing of individual doctors billings to Medicare and Medicaid? A 1979 court decision based on an AMA’s suit has said that the information is private. The Wall Street Journal and other news organizations have sued to get the permanent injunction overturned. Where do you stand? Two Senators (bipartisan) have introduced a law that would specificallyexempt Medicaid and Medicare billings from privacy protection. Many people think that this would be a great tool in rooting out billing fraud. Your thoughts?

    • Our options are to correct the ridiculous spending or go broke.
      Ryan idea is a move in a positive direction.
      I’m retired and will have to sacrifice like everyone else . It needs to be done or our grandchildren will suffer.

    • Dr. Carroll:

      Thanks for the article. Good to give Ryan credit – and – to offer constructive criticism. Hopefully he will learn from it ant not simply build a bunker and hide. I think he will do the former, over time. This is a starting point. Always good to have one or you get nowhere.

      You wrote: It’s time for other politicians to join.

      True, but how do we get Hospitals and Doctors and Nurses to weigh in? Or, are they sufficiently weighed in already? I’d love to hear less from politicians and more from the medical community. That is why I appreciate your articles. Are there other blogs I should frequent to hear opinions of other medical professionals? NEJM?