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We are all showered with annoying telemarketing phone calls, pop-up advertisements, and email spam.

We are too fat. We are too bald. We are too lazy or certainly not sufficiently attractive. We are stupid for paying too much for our home mortgage or an auto loan. We need to buy the latest cream, device or pill that will guarantee that we will become better lovers. Then, there is the TV pitchman who implies that his goo or spray is so magical that it defies the laws of physics and common sense.

It is amazing that we are not all schizophrenic, confused, or, at best, deeply insecure.

So, now you know why I have been watching the painful Senate Finance Committee meeting where one of the healthcare reform proposals is being “marked up,” a legislative term for revised and amended. If creating legislation is like making sausage, this is the part of the process where it gets really messy and sometimes a little personal. At least this painful but important part of our convoluted democratic process takes my mind off our struggling economy, the jobless recovery, and the multiple global threats.

What did surprise me Wednesday night is which Senators discussed cutting some Medicare benefits. Some Democrats, who created Medicare but failed to adequately fund the program in the 1960s as the nation’s population was ballooning, wanted to make $500 billion in cuts they say will come from waste and inefficiency. The Republicans, who passed the Part D pharmacy benefit, but did not provide funds for its operation, opposed the cuts that involved the Medicare Advantage program, arguing it will deprive seniors of services.

At least someone had the courage to even discuss “cutting” specific Medicare benefits in a political environment still raw from those August town hall meetings where many seniors and others, who apparently did not realize Medicare was government healthcare, screamed down anyone who said almost anything.

We seem to have reached a point in the legislative process where any bill or summary that you have read is now irrelevant because we have now reached the part of the legislative swamp when lines are drawn in the sand, and where what was originally proposed will not be what Congress finally passes.

If you want to monitor whether a particular healthcare reform bill will actually accomplish anything outside a hollow political win for the President, then focus on these key elements:

• Does the bill effectively reduce Medicare spending? Note: reductions in spending increases does not count as a spending cut. They MUST be net reductions year over year.
• Does the bill improve quality of care and patient safety? This is a serious problem in America and it contributes significantly to our increasing healthcare costs.
• Does the bill change the payment incentives so that hospitals, physicians and other healthcare providers are realigned in a way that will reduce over utilization and the most expensive (profitable) treatments when a lower cost alternative would work as well or better?

Reductions in Medicare spending are critical. If we do not control this piece of our federal spending then we cannot control the spiraling deficits. It is that simple. That fact is another of Washington’s inconvenient truths that no one wants to discuss. But the truth is that if we fail to control Medicare spending – and other programs as well — one day the treasury department will hold an auction to sell bonds (borrow more money) and no one, including the Chinese, is going to show up.

At that point, those irritating emails, telephone calls and screaming television advertisements will simply disappear.