Cutting the muscle again

When it suits their purpose, government bureaucrats can run a con that even the most accomplished grifter would envy.

One con bureaucracies like to employ when they are confronted with painful budget cuts they are loath to make is to recommend spending reductions they know that the public strongly supports.

Critics call this cutting the muscle instead of the fat. Bureaucrats know such proposals will result in a public uproar demanding that the "muscle" be left alone, thereby creating a more hospitable climate for deficit spending or raising taxes -- instead of making cuts

One wonders if this scam isn't at work in the Bush administration's plan to slash $182 billion in Medicare funding over the next five years -- 60 percent of it to come out of funds that have traditionally gone to teaching hospitals to help defray the cost of training residents.

You can see how this would have a devastating impact on plans to expand medical education at institutions such as the Medical College of Georgia. It could make it difficult for many of them to stay in business.

Health and Human Services Secretary Michael Leavitt even came to MCG last week to discuss the proposed cut. He acknowledged that Medicare and Medicaid have for years been medical education's primary funding source. But that, he said, was never supposed to be a permanent arrangement.

This came as stunning news to the Association of American Colleges, headed by Darrell G. Kirch, former dean of MCG's School of Medicine, who, in a classic understatement, said "the timing could not be worse."

"I'm not aware of anything in the last 10 years (where) the federal government has given money (with) the sense that it would be a temporary influx ... that it would go away," added Karen Fisher, an AAC senior associate.

Leavett said the states should pick up more of the costs themselves or look for ways to spread the costs around, perhaps to hospitals that don't take many Medicare or Medicaid patients. What bunk. The reason most of those hospitals don't take more such patients is because they can't afford to -- the government doesn't reimburse them enough to meet their costs of treatment.

Scores of scholarly, independent studies both inside and outside the government have pointed to the loss of tens of billions of dollars in waste, fraud and abuse in the Medicare and Medicaid programs -- nearly all of them because of inefficient billing and administrative practices that cheating hospitals and crooked doctors find easy to exploit.

Nowhere in those studies could we find any charge that federal funds flowing into medical education is corrupt or wasteful -- or temporary, for that matter. Indeed, those funds have contributed mightily to developing a marvelous nationwide pool of physicians.

Now at a time when the aging baby boomer generation is creating an acute shortage of doctors in Georgia and elsewhere, along comes HHS Secretary Leavitt to say the feds are planning drastic cutbacks in contributions to medical education.

This looks like a perfect example of a government bureaucracy cutting out the muscle while leaving the fat alone. We're all for the government cutting waste; there's certainly enough of it. But get rid of the real waste, like the $17 billion in pork-barrel spending that the Senate voted last week not to cut -- and leave the good programs alone.

Medical education benefits virtually every U.S. taxpayer -- not just narrow, parochial interests. That makes it the exact opposite of pork-barrel spending. In fact, it's one of the best expenditures the government can make. It would be a crime to slash it as Leavitt suggests. He must not get away with it.