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The Boston Globe, April 18, 2014
If any agency should be protected from thoughtless budget cuts, it's the Internal Revenue Service, upon which the rest of the federal government depends. The agency collects 91 percent of federal receipts but costs less than half of 1 percent of the budget. Some IRS enforcement efforts return $4 to the government for every $1 spent. Such programs are a classic case of how expanding government funding can actually reduce the deficit.
Alas, the overzealous crusade against government spending cut $600 million from the IRS budget with the sequester law of 2011, and the agency has never recovered. Although some funding has been restored, the IRS budget has not kept pace with new responsibilities. It will cost the agency $440 million to enforce penalties in the Affordable Care Act, but Congress hasn't obligated any new funding in that area. According to IRS Commissioner John Koskinen, budget woes have caused the IRS workforce to shrink by 10,000. As a result, 18 million calls from taxpayers have gone unanswered. The IRS will do 100,000 fewer audits this year, which could result in the loss of more than $1 billion in revenue.
As an ideological measure, starving the IRS might make sense. But as a strategy to reduce the deficit, withholding needed funding for the IRS is penny wise and pound foolish.
The Journal Inquirer of Manchester (Conn.), April 14, 2014
The state of Washington has initiated a simple approach to emergency care that is saving it millions of dollars in Medicaid expenses.
A central database has been created listing the medical experience of patients who have visited emergency rooms. It allows an emergency room doctor to utilize the database to discover the past history of a patient's medical condition.
When a doctor taps into the database to determine a patient's past treatment, it can save time and help to provide an easier method of diagnosis. To quote Dan Lessler, the chief medical officer of Washington's Medicaid program, "All of a sudden it changes the whole nature of the conversation with the patient."
The Medicaid system can be abused by patients who visit an emergency room when they have the slightest pain or concern. The database allows doctors to keep track of a patient's history. If a patient has been treated with aspirin, for example, the doctor will save a great deal of time by reviewing the patient's history to see if the prior treatment has been successful.
The American College of Emergency Physicians, to quote from a Business Week article, calls the Washington effort a "model for the nation." Oregon is setting up a similar program and doctors involved have been receiving queries from emergency room colleagues in California, Texas, Ohio, New York, and Florida.
The powers that be in the Connecticut Hospital Association, and possibly the governor's office, should investigate this kind of database as a help to all hospitals and emergency rooms in Connecticut.
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