How is this tax break a bad thing?

[BaliBabyDoc]

But what typically happens is this:
Party 1: Program X is forecasted to grow another 7% next year. Let's cut that to a 3% increase instead. (Program X is federally-funded school lunches)
Party 2: Aaaah!! Party 1 wants to starve our kids! Evil!

Let me guess . . . there's always fewer children in the school lunch program year over year and food gets less expensive to purchase and prepare?

The Bush admin (and the tail end of Clinton) have tried similar BS with the VA Mental Health system. They are providing care for 40% more people over the past 5-10 years but they are attempting to do it by spending 30% less per patient. If that was actual efficiency I would say hurrah but typically it just means curtailing services. The net effect is the VA spends more money each year but due to the increase in patients and dramatic increases in the costs of medication (psychotropics have been increasing in cost faster than other medications) the quality of care is significantly lower.

After the murders following Afghanistan, the US military has mandated certain "re-acculuration" to help servicepeople. Assuming Tricare actually uses competent clinicians they will CERTAINLY find some pathology (could be incidental and not necessarily associated with the deployment). If Tricare's budget increases to match inflation some services MUST be cut in order to provide augmented mental health care. The military has some of the worst prenatal/maternity care of any organization I've observed but considering the patient population I bet it would be the first area curtailed.

 

[Quixfire]

Originally posted by: BaliBabyDoc

But what typically happens is this:
Party 1: Program X is forecasted to grow another 7% next year. Let's cut that to a 3% increase instead. (Program X is federally-funded school lunches)
Party 2: Aaaah!! Party 1 wants to starve our kids! Evil!

Let me guess . . . there's always fewer children in the school lunch program year over year and food gets less expensive to purchase and prepare?

The Bush admin (and the tail end of Clinton) have tried similar BS with the VA Mental Health system. They are providing care for 40% more people over the past 5-10 years but they are attempting to do it by spending 30% less per patient. If that was actual efficiency I would say hurrah but typically it just means curtailing services. The net effect is the VA spends more money each year but due to the increase in patients and dramatic increases in the costs of medication (psychotropics have been increasing in cost faster than other medications) the quality of care is significantly lower.

After the murders following Afghanistan, the US military has mandated certain "re-acculuration" to help servicepeople. Assuming Tricare actually uses competent clinicians they will CERTAINLY find some pathology (could be incidental and not necessarily associated with the deployment). If Tricare's budget increases to match inflation some services MUST be cut in order to provide augmented mental health care. The military has some of the worst prenatal/maternity care of any organization I've observed but considering the patient population I bet it would be the first area curtailed.

So what you are saying is that there is no waste in the current VA programs? That they need every penny to resolve the medical issues that current veterans of foriegn wars?

Or is it the Medical industry as a whole is driving up the cost of serivces and if allowed to go unchecked our veterans will suffer do to the lack of funding?

 

[BaliBabyDoc]

So what you are saying is that there is no waste in the current VA programs? That they need every penny to resolve the medical issues that current veterans of foriegn wars?

Well I cannot attest to the overall quality of VA programs except to say it is one of the few organizations that does not have significant disparities in care based on race. From my experience, they are reasonably good at controlling costs by economizing the distribution of chronic medication (3 month renewals) for general medical conditions. But in order for current trends to make any sense the VA would have to be the most mismanaged organization in the history of bureaucracy (before Clinton came to office) AND the providers have gone from being lowly retreads to the absolute cream of psychiatric and internal medicine.

Or is it the Medical industry as a whole is driving up the cost of serivces and if allowed to go unchecked our veterans will suffer do to the lack of funding?

Well the costs of services are certainly being driven up by various elements of the medical industry but of course who would dare interfere with the capitalist system parasitizing off American goodwill towards its veterans, elderly, and the poor?

Psychiatry has the sole advantage of lacking a common "procedure" or test for which providers could charge a premium. I hope it remains specious to diagnose psychiatric conditions by positron emissions tomography (PET scan) or magnetic resonance spectroscopy (MRS). Unfortunately, common neurological conditions that may mimic or have psychiatric elements (stroke, Parkinson, Alzheimer) are reasonable indications for MRV/MRA (MR of the arteries or veins), CT scans, etc. An aging population accesses such resources more frequently hence the system will trend towards being more expensive.

slightly dated report on expensive medications
Older men have the highest rate of suicide in the nation. One of the few (if not only) medication proven to reduce suicidality is the antipsychotic Clozaril. Although it is sold generically abroad as clozapine . . . it still has patent protection in the US . . . and an annual cost of $3600 +/1. Invariably, these older men will have some other health condition such as high blood pressure, high cholesterol, diabetes . . . all managed by medications which are not free.

Pub Citizen from 1998

The U.S. price for a month?s supply of the antipsychotic drug clozapine (Clozaril, Novartis) was $317.03, six times higher than the $51.94 charged in Spain. For a year?s treatment, this amounts to $3,184 more in the U.S. than in Spain. For fluoxetine (Prozac, Lilly), the U.S. cost was $72.16 for a month?s supply, almost three times higher than the $25.93 charged in Spain. For a year?s treatment, this amounts to $554 more in the U.S. than in Spain."

Clozaril is often used after a patient has failed adequate trials of 2-3 other antipsychotics. Prozac is now off patent but of course Lilly is working on extended release versions and selling fluoxetine as Sarafem (treatment for Premenstrual Dysphoria Disorder) for which it has patent protection.

Community Mental Health Centers say the skyrocketing prices of some psychoactive drugs are putting a severe strain on community health centers around the country, and the prohibitive costs of the newer medications put them out of reach for some Medicaid programs.

One mother whose son has been diagnosed with schizophrenia says he is taking Haloperidol, a cheaper alternative to the effective Risperdal, despite its severe side effects. "Risperdal offers my son the ability to lead a functional life as opposed to when he is on Haloperidol, but I am continually told that the costs would be too high for him to afford it," she said.

As I noted previously, the VA has been facing the same issue with cost inflation due to medication. Accordingly, they have curtailed costs by curtailing access, while Clinton/Bush brag about how much they support veterans.

In sum, tax breaks are a bad thing if the money is diverted from keeping our promises to veterans and the elderly . . . amongst various other reasons.