David Broder calls Harry Reid on his cost-hiding tricks. If The Big Democrat has lost Broder he has trouble.
David S. Broder - David Broder: Fears of health-reform cost are justifiable - washingtonpost.com:
First, the public is opposed:
The day after the Congressional Budget Office (CBO) gave its qualified blessing to the version of health reform produced by Senate Majority Leader Harry Reid, a Quinnipiac University poll of a national cross section of voters reported its latest results.Costs? Big problems.... It read: "President Obama has pledged that health insurance reform will not add to our federal budget deficit over the next decade. Do you think that President Obama will be able to keep his promise or do you think that any health care plan that Congress passes and President Obama signs will add to the federal budget deficit?"
The answer: Less than one-fifth of the voters -- 19 percent of the sample -- think he will keep his word. Nine of 10 Republicans and eight of 10 independents said that whatever passes will add to the torrent of red ink. By a margin of four to three, even Democrats agreed this is likely.
That fear contributed directly to the fact that, by a 16-point margin, the majority in this poll said they oppose the legislation moving through Congress.
While the CBO said that both the House-passed bill and the one Reid has drafted meet Obama's test by being budget-neutral, every expert I have talked to says that the public has it right. These bills, as they stand, are budget-busters.You pay increased fees and taxes for 4 years before you receive increased benefits. That's how dinghy Harry keeps the costs down - front load the revenues and back load the costs, so the first ten years don't look so bad.Here, for example, is what Robert Bixby, the executive director of the Concord Coalition, a bipartisan group of budget watchdogs, told me: "The Senate bill is better than the House version, but there's not much reform in this bill. As of now, it's basically a big entitlement expansion, plus tax increases."
Here's another expert, Maya MacGuineas, the president of the bipartisan Committee for a Responsible Federal Budget: "While this bill does a better job than the House version at reducing the deficit and controlling costs, it still doesn't do enough. Given the political system's aversion to tax increases and spending cuts, I worry about what the final bill will look like."
... Republican budget experts such as former CBO director Douglas Holtz-Eakin amplify the point with specific examples and biting language. Holtz-Eakin cites a long list of Democratic-sponsored "budget gimmicks" that made it possible for the CBO to estimate that Reid's bill would reduce federal deficits by $130 billion by 2019.
Perhaps the biggest of those maneuvers was Reid's decision to postpone the start of subsidies to help the uninsured buy policies from mid-2013 to January 2014 -- long after taxes and fees levied by the bill would have begun.
Even with that change, there is plenty in the CBO report to suggest that the promised budget savings may not materialize. If you read deep enough, you will find that under the Senate bill, "federal outlays for health care would increase during the 2010-2019 period" -- not decline. The gross increase would be almost $1 trillion -- $848 billion, to be exact, mainly to subsidize the uninsured. The net increase would be $160 billion."They never have." He concludes:But this depends on two big gambles. Will future Congresses actually impose the assumed $420 billion in cuts to Medicare, Medicaid and other federal health programs? They never have
The challenge to Congress -- and to Obama -- remains the same: Make the promised savings real, and don't pass along unfunded programs to our children and grandchildren. [and the states]Posted by Ron Hebron at December 02, 2009 08:46 AM | Email This
Broder's piece is very flimsy. Not a single expert quoted by Broder claims that the deficit will increase. Not one. The CBO says that the deficit will be reduced over the first ten years, over the ten years after that, and then over the forty years after that.
On substance, his experts say that medical spending will go up. Of course, but so will coverage. Broder ignores that during the 2020-2029 decade, Federal health spending will actually decrease from planned levels. That's even with new insurance subsidies, because the Medicare payment reforms are real and substantial.
I'm usually a fan of Broder, but he quotes people saying sentences that do not agree with his sentence and his analysis is fairly weak on this point. But I agree with the conclusion, the promised savings should be real and we cannot pass along unfunded programs.
Posted by: John Jensen on December 2, 2009 09:39 AMSorry, but you're delusional. Broder (and most Americans) don't "ignore" that cuts are coming, they simply don't believe it. The model assumptions don't pass the straight-face test. Go back and look at the original Medicare cost projections. It's not like people don't have good reasons to be skeptical of the estimates.
Posted by: MOR on December 2, 2009 11:40 AMI think the young people have made up their minds which way it will go.
Posted by: Gary on December 2, 2009 12:07 PMIf we cannot reduce Medicare cost growth, the country is going to go broke. If Congress is incapable of it, then this country is going to fall apart within 20 years. Why don't we just give up now?
You think that just forcing cuts of that magnitude down the throats of health care providers will be acceptable to those providers?
First of all, the biggest savings are from Medicare Advantage which is basically a giant payment to private insurance companies. Providers are completely, entirely unaffected.
And the premise of this question is false. We are not accountable to providers, they are accountable to us since we are paying them. Hospital-borne infections should not get full Medicare rates because we should discourage them. We should not pay for MRIs that are totally unnecessary. If a hospital doesn't fix a patient the first time, we shouldn't reward them by paying full fees the second time. We pay more for health care in this nation than any other western nation, yet they have the same or better medical results. Hospitals and doctors have to have different motivators if we expect to contain costs.
The idea is not to simply cut payment rates -- that's what the GOP did with the SGR that both parties now reject. The idea is to change how things are done so hospital infections are more rare and the job is done right the first time. Medicare pays for certain services, like specialists, when it could pay more for primary care physicians. Nearly all health care economists agree that these incentives have to change. Which changes do you disagree with?
They already lose money on Medicare patients, which they make up on other patients with private insurance.
Just like beef makers lose money to McDonalds, and charge us all more for hamburgers, right?
Sorry, but you're delusional. Broder (and most Americans) don't "ignore" that cuts are coming, they simply don't believe it.
Why not? Broder gives no evidence that the various Senate ideas are flawed and will be dismissed in the future.
The model assumptions don't pass the straight-face test.
Based on what?
Go back and look at the original Medicare cost projections.
Everyone says that here. I am convinced they do not exist for anything beyond a ten year period.
It's not like people don't have good reasons to be skeptical of the estimates.
There are no broad cuts like the SGR -- all of the ideas are actual proposals and not simply payment cuts. If you have a particular proposal you're skeptical of, I'd like to talk about it.
But say the Medicare fixes are canceled. If we adhere to PAYGO then we'll still have a deficit-neutral bill. If the fixes continued to be canceled, Medicare will bankrupt this country.
Let me summarize: It is possible that some of the Medicare fixes won't work if this bill is passed. But it's impossible for them to work without this bill. We should try everything we can, and according to the health care economists I've read the Senate bill includes many, many Medicare reform ideas. Many are not even scored by the CBO -- that is, not all of them have a monetary value that contributes to the paying for the bill and are there simply to try new and novel ways of saving money that might work.
We have to try everything we can to fix Medicare. It is dangerously irresponsible for some in the GOP to argue that these are Medicare cuts that'll affect seniors. This bill is the most serious attempt ever to get Medicare spending growth under control.
rjk, If the Senate knows how to cut hundreds of billions of dollars from Medicare, why do we need a huge federal health program to accomplish it?
You mean, "Why be moral if we don't have to?" Sure, we don't have to. But expanding insurance coverage is the moral, right thing to do. It's been a Democratic priority for generations and our party won the elections by a pretty large margin. Americans support universal coverage, and we should get it.
Gary, Either we cut $400 billion from Medicare and really make rationing a hard reality for the elderly, or we don't make the cuts just like we haven't been making for many years already, and bankrupt the nation.
That is a completely false choice. We do not need to "ration" anything. Half of that $400 billion is savings from Medicare Advantage plans which pay for gym benefits and tanning salons. The government should not subsidize that. No rationing at all is legal under this bill nor current law.
But you're half right, if we don't fix Medicare the nation will go bankrupt. And if we cancel Medicare like the GOP has always argued for, we will go personally bankrupt from health care inflation. Health care costs in this country need systematic reform. The reforms that Medicare will pursue after this bill will likely be the model on which private insurance reforms its own payment systems. Medicare isn't the only unsustainable insurance plan in the country: all insurance plans are unsustainable. The difference is that insurance plans can raise premiums without a vote of Congress.
Posted by: John Jensen on December 2, 2009 12:36 PM
The largest senior group in the country supports health reform.
Posted by: John Jensen on December 2, 2009 02:27 PMIf doctors are going to face harsh cuts, why does the AMA support the bill?
Posted by: John Jensen on December 2, 2009 02:44 PMDo you know?
Posted by: Gary on December 2, 2009 03:17 PM"And if we cancel Medicare like the GOP has always argued for"
That's not true. You got that out of thin air.
"If doctors are going to face harsh cuts, why does the AMA support the bill?"
The AMA represents less than 20% of the MDs and seems to have the "beltway" state of mind. Rank and file MDs don't support the bill. Hugh Hewitt has been taking their calls on-air and posting their letters by the dozen.
Posted by: Ron Hebron on December 2, 2009 04:59 PM@12 you said it well John Jensen is once again attempting to indoctrinate. He seldom if ever states his sources - reason for suspicion right there. He is either; 1) A lobbyist for universal health care or 2) Will benefit by personal gain if Obamalosi-Reid care passes.
Posted by: KDS on December 2, 2009 08:23 PMBaucus Admits Reid Bill Costs $2.5 Trillion Over 10 Years "Depending On Where You Start"
Senate Republicans highlight this line from Senator Max Baucus's (D-Mont.) floor remarks today:
"Just for a second -- health care reform, whether you use a ten-year number or when you start in 2010 or start in 2014, wherever you start at, so it is still either $1 trillion or it's $2.5 trillion, depending on where you start..."
Jeffrey Anderson pointed out in this post that Reid's bill would cost $2.5 trillion from 2014 to 2023.
Posted by: KDS on December 2, 2009 08:43 PMI agree, at least in theory. But...if doing it a certain way is going to hurt us ALL...then we will be worse off as a society, and the ones we meant to help will not be better off either. Why is this an improvement? Why does ANYBODY think this would be an improvement, hurting the totality in the long run, for the sake of a minority in the short run?
Posted by: Angela in Bothell on December 2, 2009 11:26 PMWhether the panel was right or wrong (which is it?) it appears that political pressure was applied to make them change their minds.
This is a result of government-run health care. As with climate science, politics will trump science. The Senate is even adding an amendment saying that women can be assured of mammograms with very low co-pays and such... so everybody else has to pay the co-pay for that.
I *thought* we were told government wasn't going to run health care.
Posted by: Gary on December 3, 2009 07:59 AMYou're right, that is my motive. Everyone will benefit form a healthier and more sustainable country. In other words, I support this policy because it's good policy. I hope that's not too nefarious.
Jeffrey Anderson pointed out in this post that Reid's bill would cost $2.5 trillion from 2014 to 2023.
Yeah, and it's $3 trillion if you started in 2024 and counted for five years. But we don't just measure things arbitrarily. The question is where the bill is paid for? It is. Does it reduce Medicare costs over time? Yes. Does it reduce net government spending over time? YES.
How exactly does reducing government spending over time, compared to no bill, translate to "cost"? We're saving more on Medicare than we'd be spending on insurance subsidies.
Posted by: John Jensen on December 3, 2009 09:08 AMYou bring up an interesting point, Rae. But to wit: if it'd be cheaper to not discharge the patient in this scenario -- for Medicare, the hospital, and the patient -- maybe the interests should align this way. Obviously I don't know the ins and outs of every sort of hospital payment reform, but the statistics show that some hospitals re-admit more than others even when correcting for social and economic differences (and even where none exist). This is a market and Medicare should be a competitive payer, not a blind payer. If I took my car in to get repaired and the problem didn't get fixed, I'm not going to pay full price when I go to the mechanic next time. But you certainly bring up an interesting point about patient responsibility and I agree with the hope that your scenario is handled properly.
Angela, Why does ANYBODY think this would be an improvement, hurting the totality in the long run, for the sake of a minority in the short run?
Your frame is pretty wrong. The bill is paid for and mostly through Medicare savings. The average family will make $700 more in income by 2019 because of the bill. The individual market will be vastly improved and what people will pay on the individual market will fall, and premiums for small business and group markets will also fall according to the CBO.
Sure, there's something like $300bn in new taxes of the next ten years -- mostly on the wealthy and from the new income I discussed above. That's $30bn a year, or about as much as sending 30,000 troops to Afghanistan that no one here seems concerned to be paying for.
This doesn't help just a trivial "minority," it dramatically helps a large group of 30-40 million Americans. And it helps all of us by making Medicare more sustainable and providing far more protections from losing coverage. Who here wants to continue denying coverage for pre-existing conditions? And that can't happen without universal coverage, otherwise folks can game the system.
Posted by: John Jensen on December 3, 2009 09:22 AMNo reliable sources, no trust.
Posted by: KDS on December 3, 2009 10:26 AMFor those arguing that this is a massive government expansion in spending, check out what the CBO says about the decade following this upcoming one:
CBO expects that, during the decade following the 10-year budget window, the increases
and decreases in the federal budgetary commitment to health care stemming from this
legislation would roughly balance out, so that there would be no significant change in that commitment.
That is, federal health care spending will not increase in the decade after this one because of the appropriate Medicare savings. That is, the Medicare savings have dramatic impacts over time and all of the revenue raised will go solely toward reducing the deficit. This is not a multi-trillion dollar unfunded commitment. It's funded over the next sixty years, according to the CBO, and does not increase the federal spending on health care as time goes on as some would have us fear.
Now, I'll be honest, I'd support the legislation even if it increased spending over the status quo because I believe it's morally right to expand coverage. But it happens to be that we can do something moral and responsible to Medicare at the same time.
Posted by: John Jensen on December 3, 2009 11:02 AMSome interesting info from a piece by Dr. David Glazer in the NY Daily News.
President Obama's health-care reforms depend on them - up to $400 billion worth over 10 years.
Congress reversed planned cuts in 1999. And 2005. And 2004. And 2006. In fact, since 1997, when members of both parties agreed to automatic cuts if spending rose faster than population and economic growth, the program has been cut just once, in 2002.
At one point, Congress voted to postpone a 10% cut in Medicare doctors' fees from December 2007 until mid-summer 2008. Just weeks later, House Speaker Nancy Pelosi attacked the rescheduled savings as "exactly the wrong medicine."
So how can we have unspecified cuts, when it's only happened once. In the article, it also states that the 2010 cuts have been repealed and supported by Pres O. Hmmm. Strange.
Read more: http://www.nydailynews.com/opinions/2009/12/03/2009-12-03_medicare_cuts_and_other_dc_fairy_tales.html#ixzz0YfInag34
One final thing....why is it morally right? And where does teh Government get support moral rights? Would killing the unborn be against morals? and since this morally right bill allows for abortion is it still morally right?
Posted by: Dengle on December 3, 2009 12:50 PMAll of the votes you talk about are about putting off one stupid cut: the sustainable growth rate introduced by the GOP, which is not what this bill relies on. Your focus on this is like saying the annual AMT extension proves that Congress is incapable of raising revenues through taxes.
Half of the savings comes from ceasing to send public money to Medicare Advantage plans that cover gym benefits and tanning salons and those savings require zero difficult choices (this subsidy was introduced by the GOP's Part D bill which did not attempt to be deficit neutral).
I've talked about many of the cost savings here before, and it's annoying to have the exact same conversation. It sounds like a populist distraction to me. The CBO estimates show there are real savings, but you're telling me that no matter what our elected officials are incapable of fixing Medicare. Okay. If your highly intelligent opinion is that Medicare savings are impossible to produce, why did John McCain's entire health plan during the campaign get funded by "reducing Medicare and Medicaid waste"? More to the point: If your well-informed opinion is that Medicare savings are impossible to produce, why don't you just give up on our country? America is going to go bankrupt unless something changes with Medicare.
No one is proposing broad-based cuts like the sustainable growth rate proposed by the GOP in 1997 that has been dismissed on a bipartisan basis. President Obama has advocated and budgeted for permanently removing the SGR since it doesn't work. The difference between the SGR and this bill's cost savings is the difference between a saw and a scalpel.
Posted by: John Jensen on December 3, 2009 01:45 PMGood point, though I linked to the report originally in our last conversation. You can find the the report here.
My job is to cite sources, by the way, not to direct you to them. I do research for my own posts, not so I can teach you how to argue against me. I'm fine with backing up my arguments, but I'm going to provide a link for every comment I write in a post. I know a lot about health reform and don't keep a mental list of links.
Posted by: John Jensen on December 3, 2009 01:47 PMAs for McCain taht was for fraud and waste. Yes. That is a good thing. Why are we not doing that now? Save money. But the government is all about fraud and waste. That's the problem. Again based on past actions.
Also....if Medicare is Billions over its projected costs, why will this crappy bill fair better in either current or past costs?
How do you feel about the pay 3 years before the program starts, and only focus the CBO for 10 years. Thus not showing the true 10 year cost of the program.
Posted by: Dengle on December 3, 2009 02:46 PMyour answer;
"No one is proposing broad-based cuts like the sustainable growth rate proposed by the GOP in 1997 that has been dismissed on a bipartisan basis. President Obama has advocated and budgeted for permanently removing the SGR since it doesn't work. The difference between the SGR and this bill's cost savings is the difference between a saw and a scalpel.
A hollow answer. Your definition of morally right is that of the progressive left and different from mine. How do you know what Obama is going to do or what the final form of this bill will be or if it even becomes a final bill ? You don't and if it is because of what the politicians said, you are being misled by his political expediency, which there is no shortage of.
Based on past actions, I don't believe Congress will make the cuts or any the matter. I don't see $400B being the number.
Posted by: Dengle on December 3, 2009 02:50 PM-
John, is this what you want? Really? Why did the Senate do this? What dos this have to do with people who don't have insurance? Why didn't they also pass an amendment making my prostate screenings free?
Free? Wow. Free... nobody has to pay for it? Hey, John, does this expense not have to be made at all? Will the doctors do this for free?
I won't have to make up the difference with my premiums will I? President said my plan would stay the same.
The Medicare savings proposed by Democrats are for "fraud and waste," too. Which proposals exactly do you have problems with?
Here's what I'm implying: you don't know what you're talking about, in any specific detail, and are reading GOP talking points. None of the proposals are like the SGR.
Also....if Medicare is Billions over its projected costs, why will this crappy bill fair better in either current or past costs?
I reject the premise of your question. Prove that Medicare is over its projected costs.
Why will this bill do better? Do some reading and find out. And much of its savings is from low-hanging fruit like Medicare Advantage over=payments introduced in 2003 and not needing much untangling from our current system. It's not hard work to stop over-paying insurance companies.
You're arguing that Congress can never fix Medicare, so we'll have deficits from this health care bill. But if Congress refuses to address Medicare, like you're arguing, the paltry deficits that this bill adds to the deficit will be nothing in the face of a wave of Medicare costs. The outcome is a bankrupt America because of Medicare. If Congress is ineffective as you argue, then we should simply give up on the country right now. That is the outcome.
And maybe you're right, maybe the cost savings won't materialize. But these efforts are serious and real -- the most serious attempts ever at beginning to fix Medicare. They're just the first steps, not the last, but the response from the elected GOP is to fear-monger and argue that these cost savings are unnecessary. That is a deeply irresponsible position.
How do you feel about the pay 3 years before the program starts, and only focus the CBO for 10 years. Thus not showing the true 10 year cost of the program.
I wish the program started earlier, but life is full of compromise. Which Republicans are willing to support moving the program up earlier? Do you want the program to start earlier?
KDS, JJ - your assertions are based on these links. Our job is not to rubber stamp anything you say, but to research it and either agree or take issue with your comments. You are not above being scrutinized nor is anyone else.
Fine, so I linked you the data and you've scrutinized it and were apparently unable to find substantive disagreement with me.
One final thing....why is it morally right? And where does the Government support moral rights?
Medicare and Social Security are examples of programs that are the morally right thing to do, to prevent poverty and death amongst the elderly. Both parties seem willing to keep these programs around, and they are politically popular. It is morally right to have nearly every American covered through health insurance, in my opinion. I understand there are going to be disagreements about the role of government, I was just being honest about my thoughts on the bill. My point was I'd support it even if it wasn't funded through mostly savings, but the fact that it is means I can support it can be more fiscally conservative than those who oppose it.
Would killing the unborn be against morals? and since this morally right bill allows for abortion is it still morally right?
The Supreme Court of the United States of America says that the Constitution of the United States of America protects a woman's right to choose. This bill does not affect that right, of course, because Congress cannot modify the Constitution without an Amendment.
The free market in insurance allows for abortion. Both bills prevent public funds for being used for abortions. If you disagree with that assertion, please provide a link to a report that backs up your claim.
How do you know what Obama is going to do or what the final form of this bill will be or if it even becomes a final bill ?
I don't know what the final form of the bill will be, but I'm also allowed to change my opinion on it before the final vote. How can anyone ever know what the final bill will look like, exactly? Did the GOP have time machines? What is your point? Um, and yes, I also don't know if the bill will pass. Do you have a time machine right now? What is your point?
ajday, The proposed health care reform is so wonderful that the Senate and Congress specifically exempted themselves (and their staffs) from participating init.
In fact, the Senate bill requires all members of Congress to switch from their current health care (FEBP) to the health care exchange. That is, you are completely and entirely wrong.
Gary, John, is this what you want? Really? Why did the Senate do this? What dos this have to do with people who don't have insurance? Why didn't they also pass an amendment making my prostate screenings free?
No. Yes. Politics. Nothing. Politics.
You make compromises in the political process. I'm willing to take a populist mammogram amendment for a bill that saves hundreds of billions on Medicare and funds near-universal coverage. But this is exactly why an Independent Medicare Payment Commission that removes Congressional politics from Medicare payments is a good idea that will save tens of billions over the next decade, according to the CBO (the same report I linked KDS to).
Posted by: John Jensen on December 3, 2009 04:28 PMMedical decisions are all going to be made by DC for political reasons.
Posted by: Gary on December 3, 2009 04:40 PMIt's a medical decision because the Senate claims they're doing this so that women can get cancer screening.
And when the hell did Congress get the power to make insurance pricing decisions?
This movie is gonna end badly.
Posted by: Gary on December 3, 2009 06:11 PMANSWER THE QUESTION COWARD!
Have you ever served in this nation's military?
Posted by: pbj on December 3, 2009 09:14 PMCBO: Senate's Health Care Reform Bill Would Cause Individual-Market Insurance Premiums to Rise meaning people like me get to pay more - a lot more - for the insurance we currently purchase. That's the fact, it's from the CBO.
Most Democrats are opposed to giving up their health care plans - Congress doesn't want to participate in the public option. It's good enough for some people, and most likely will be the only choice for many of us (you know, people like me who currently buy catastrophic insurance to go with our HSAs) but Congress doesn't want to play that game...
Posted by: Shanghai Dan on December 3, 2009 09:25 PMOn abortion...yes we have roe wade....but my question to you was the morality of it? Health care a moral right? really? Is killing a unborn child a moral right? Or is healthcare a choice as abortion is? If it's a choice should the government mandate it? What else is morally right? What is the line on morals? Is gay sex morally right or wrong? I don't care how someone gets their rocks off, but I believe it's morally wrong. However, I believe folks can make that choice for themselves and have the sex life they wish. Again....morals are a moving target and defined by the person in the mirror. (I know tangent).
No one WANTS to see folks die or be in poverty and I understand the "want" for taking care of folks that need a helping hand, but politicians don't give a rats ass (most not all) about the people just their vote. As for helping folks, why do we need to help folks making 300+ above poverty line? That was the number I remember reading earlier, but I might be mistaken. (tied to this, would illegal aliens be covered morally....sure all people should, but should our governement do that? NO!!! they are not citizens. I think maybe you'd say it's the illegal aliens government that is morally responsible...and I'm fine with that since they are not covered by the Constitution). Before anyone gets into the Emergency room takes all comers....I know we take anyone at emergency rooms regardless of ability to pay and that is a good law....it costs, but those costs can be reduced by reducing illegals in teh country or reducing costs on insurance for folks to make the choice to by insurance. Or hey....make them pay something for services.
As for fraud and waste....I think it is good to tackle that and it would reign in costs. (aside:I'm glad to see the lip service, but again past actions speak volumes...this isn't a partisan complaint, but one of gov in general).....but why should the government take over heathcare to do that? Why not enforce the laws? Why not enact laws that make getting insurance easier and less expensive? The plan as stated will make it more expensive and care less accessible.
Again I beleive that we will always disagree on the right of heath care. IMO....It isn't a right...either is having a house or a job. However, I hope you do see what is going on and will see that the bills are total horse pucky and work toward ones that solve the issue of high costs.
Posted by: DEngle on December 3, 2009 10:42 PMThe CBO does not support what you're saying. I already corrected you in the other thread, and you're just wrong. I'll repost it here:
1. If everyone kept the same quality plan they had today, their payments will be cheaper after Obama's reforms, according to the CBO: CBO and JCT estimate that the elements of the legislation that would change the price of providing a given amount of coverage for a given population would, on net, reduce the average premium per person for nongroup coverage in 2016 by about 7 percent to 10 percent relative to the amount under current law. And that doesn't include subsidies, which would bring the price down further.
2. Since we are offering subsidies to half of the individual market, those people will get better insurance coverage for the same or less as they pay today.
The net impact is that most people will get better insurance for less money. This is the CBO data. Argue with them, not me.
For those who won't receive subsidies, like you, the changes will be undramatic, if any: Among nongroup enrollees who would not receive new subsidies, the average actuarial value of their coverage would not differ as sharply from the average for the nongroup market under current law. Some would choose to enroll in a �young invincibles� plan to be offered under the proposal; that plan would have relatively high deductibles and a relatively low actuarial value (estimated to be less than 50 percent), and the premium would be correspondingly low. (That plan would generally not be attractive to individuals who could receive premium subsidies for more extensive coverage.) Moreover, if they wanted to, current policyholders in the nongroup market would be allowed to keep their policy with no changes, and the premiums for those policies would probably not differ substantially from current-law levels.
Congress doesn't want to participate in the public option. It's good enough for some people, and most likely will be the only choice for many of us
No one will be forced onto the public option, ever. And there will always be plans besides the public option. Why would private insurance companies disappear? You're inventing stuff.
(you know, people like me who currently buy catastrophic insurance to go with our HSAs)
Um, you don't seem to understand that private insurance would operate side-by-side on the health insurance exchange. I think everyone should be able to pick their own insurance, including members of Congress, and not have it dictated to them by employees.
Posted by: John Jensen on December 4, 2009 02:04 AMBut if I don't want, then I'm forced to buy it anyway.
"Why would private insurance companies disappear?"
I don't know. Why would private college loans go away?
Posted by: Gary on December 4, 2009 02:36 AM
When Medicare was enacted in 1965, official government projections foresaw hospital spending -- the program's largest component -- reaching only $9 billion in 1990.
I don't mean to be technical, but that was not an "official government projection" but an estimate from the House Ways and Means Committee, which is a lot different than the non-partisan CBO.
On substance, it is nearly impossible to estimate costs 25 years out. And Medicare changed substantially between 1965 and 1990, of course. It wasn't just the same program for 25 years.
But this bill reduces Medicare spending. If you believe the future is even worse than predicted now, we have literally years before the nation is spinning into bankruptcy. We should fix Medicare spending now. This bill is the first step.
Also, you're wrong the government always underestimating health care costs. The CBO predicted Medicare Part D would be more expensive than it is. The CBO predicted Medicare Part D's savings would be smaller than they were. And this was just years ago that the bill was passed.
Dems are even saying that the senate bill is more like 2.5T or more and not the CBO number.
There is no inconsistences. That is the cost from the CBO itself. The normal CBO number is a different timetable. Both numbers reduce the deficit.
They might have a angle they are working, but as you can see no one knows what this will cost, but it will cost more than the projected numbers. I don't need a time machine to know that.
This entire sentence is bullshit. The CBO uses data and analysis to conduct their estimates, and you just dismiss them. If you're not going to discuss evidence then it's not really exploring this fully.
I've asked you numerous times to name a specific program that will fail to save money. You seem to not know. You refuse to acknowledge that a great deal of the savings comes from Medicare Advantage plan subsidies being cut. I'm not going to believe that you "know" anything on this subject, with all due respect.
Whatever in your loony scenario where evidence doesn't matter and if it's all deficit spending, it's a drop in the bucket that'll be swept up by Medicare bankrupting the country. And since you feel the country will do nothing to fix it, why not just be a nihilist about everything else in the world? America is going to go bankrupt because of Medicare, you say, and there's nothing we can do to fix it.
But there is something, I argue. We can pass bills to control spending. This is what this bill tries to do.
On abortion...yes we have roe wade....but my question to you was the morality of it?
This has nothing to do with the health care bill.
Health care a moral right? really?
It's a morally right thing to do. Right as in "good" not "free speech."
Is killing a unborn child a moral right? Or is healthcare a choice as abortion is?
This makes no sense. At all.
If it's a choice should the government mandate it?
No one really wants a mandate, they just want to end pre-existing conditions and other serious ills. That is impossible without a mandate. On net, a mandate with subsidies to help those who can't afford it brings down costs for nearly all of us according to the CBO and insures 30 million more Americans
No one WANTS to see folks die or be in poverty and I understand the "want" for taking care of folks that need a helping hand, but politicians don't give a rats ass (most not all) about the people just their vote.
No one wants to see people die, but the fact is that tens of thousands do because of a lack of access to health care in this country. Politician's care about our votes, and a lot of us care about providing nearly-universal health care.
As for helping folks, why do we need to help folks making 300+ above poverty line?
It's a sliding scale, so those at 300% get much less help than those at 100%. 300% is basically the working lower-middle class that could use a bit of help, but not too much.
(tied to this, would illegal aliens be covered morally....sure all people should, but should our governement do that? NO!!! they are not citizens. I think maybe you'd say it's the illegal aliens government that is morally responsible...and I'm fine with that since they are not covered by the Constitution).
Yes, I think it'd be morally right to help illegal immigrants but I understand but the practical and political reasons for not doing so. Sometimes what we morally aspire will not work in the real world. This bill, though, is something we can do because its costs are relatively modest.
Before anyone gets into the Emergency room takes all comers....I know we take anyone at emergency rooms regardless of ability to pay and that is a good law....it costs, but those costs can be reduced by reducing illegals in teh country or reducing costs on insurance for folks to make the choice to by insurance.
Or require folks to have insurance, so we don't have to pay their hospital trips for them. (You say "reducing costs on insurance," but that is something the government cannot force the private sector to do. What the government can do is provide help so the price to obtain insurance is cheaper.)
Or hey....make them pay something for services.
People who go into emergency rooms are charged. They usually cannot pay, and we have to pay for them.
As for fraud and waste....I think it is good to tackle that and it would reign in costs. (aside:I'm glad to see the lip service, but again past actions speak volumes...this isn't a partisan complaint, but one of gov in general).....
For the record, I was being tongue-in-cheek. Everyone talks about Medicare waste to describe the problems they personally find wasteful. Medicare is very wasteful, but what Democrats call waste the GOP calls "cuts" this time around.
but why should the government take over heathcare to do that?
We have been speaking about Medicare. And the government isn't taking over health care. Almost every American would have private insurance, all doctors and hospitals and device providers would be private. There is no government takeover.
Why not enact laws that make getting insurance easier and less expensive?
You mean, like this bill does?
The plan as stated will make it more expensive and care less accessible.
That is really not true. Do you want to cite something here?
Again I beleive that we will always disagree on the right of heath care. IMO....It isn't a right...
It's a right if we make it one. Funding health insurance for the less well-off is a noble entitlement, all the more if we do it in a deficit-reducing way like this bill does.
However, I hope you do see what is going on and will see that the bills are total horse pucky and work toward ones that solve the issue of high costs.
It seems like I'm following the process a lot closer and I'm not as disappointed with the bill. Can you name a provision for cost savings you don't like?
While the cost savings battle will just begin once this bill passes, it is the most serious step for health care cost reform ever. I hope you read that article I linked to about reducing health care cost growth. Serious things are being tried.
I'd love to see malpractice reform. Give us a single GOP vote and you can probably get it -- that's what compromise is.
Posted by: John Jensen on December 4, 2009 02:37 AMThey haven't. Private college loans funded by the government have, though.
Private insurance companies will not be funded by the government. Any sort of radical change like this would require another, dramatically more controversial bill which is not what Dan is arguing. He's saying this current bill would end private insurance, which is inconsistent with every single study done on the bill.
Posted by: John Jensen on December 4, 2009 02:55 AMAny sort of radical change like this would require another, dramatically more controversial bill which is not what Dan is arguing.
You're lying about my position. Prove I said that or apologize, liar.
Posted by: Shanghai Dan on December 4, 2009 03:23 AMYou wrote most likely will be the only choice for many of us, which is certainly false. The entire sentiment requires the entire private insurance sector to disappear. And what you really don't seem to understand is that the most fundamental reform is this: If an insurance plan is available to one person on the exchange, it will be available to all of them. CBO notes that the public option premiums will likely be higher than private insurance options which gives plenty of room for private companies to operate. Also, not all valid plans live on the exchange, so plenty of insurance plans can be offered privately and fulfill the mandate.
Grow up, Dan, and stop with your irate tone. Your fake outrage is getting ridiculous.
Posted by: John Jensen on December 4, 2009 10:14 AMI don't speak for Dan, but after reading through these contentious posts from you and he, I don't see that his outrage is fake.
We are pissed that you would be generally OK with the Government takeover of health care, which it will lead to in 5-10 years after inception, as clearly stated by Pres. teleprompter himself.
Posted by: KDS on December 4, 2009 10:56 AMFirst of all, competition between insurance companies is not the problem in relatively populous states, what we need is competition between providers who set the price of treatments. The problem is that an insurance company in Vermont cannot get a good price out of a Seattle hospital since its market-share here will be so small.
The bill does not prevent insurance companies from competition across state lines. State laws do, because states want to regulate the insurance sold within their borders. The Senate bill allows for states to enter compacts -- so Washington and Oregon could merge together for insurance plans -- but for the bill to force all states to accept plans from other states tramples on the concept of federalism.
If we did overrule state laws on this matter, the only reason we'd have lower prices is because all insurance companies would move to the one state with the least amount of mandated coverage requirements. That is, we'd pay less to get less security. It's ultimately a bad deal for most consumers. States, and the voters in states, should be able to regulate their own insurance companies if they so choose. I support the idea in the Senate bill of inter-state compacts, but Washington voters shouldn't told by DC that we must accept plans from Vermont or Kentucky if we don't want to. The bill also allows for larger, national plans which are ones that comply with all of the state's regulations. That sounds like a good idea to promote competition, too.
I just think it's a race to the bottom in terms of plan quality, it doesn't really fix the underlying problems of cost growth, and it disallows the states and voters from choosing which plans to accept.
Posted by: John Jensen on December 4, 2009 11:05 AMThe real answer is that; There is no political will or incentive to include this measure from the Dems and their lobbyists even though the GOP is solidly behind it.
BTW- Deregulation can lower costs, but increased regulation does not.
Posted by: KDS on December 4, 2009 11:53 AMYou kind of ignored every point I made, so I'll repeat them.
1. A lot of insurance competition does not reduce premiums for the same level of benefits, because smaller insurance pools pay higher rates to providers.
2. Cross-state competition may reduce premiums, but only because it reduces the level of benefits.
3. Congress should not remove the right for a state to mandate the level of benefits for insurance sold within their state.
4. This bill allows for inter-state compacts to allow cross-state competition when states' interests align.
Posted by: John Jensen on December 4, 2009 12:17 PM- Lower premiums will result in reduced benefits.
Soon this CBO report will be obsolete, as this Senate bill will look quite different. The other caveat about the CBO report is that the authors of the bill are able to hide costs elsewhere like in other bills (an accounting gimmick used by Congress). and the CBO only focuses on the legislation provided. The CBO's hands are tied in effect, so that is why I look at the CBO analysis and wait until I hear what other unaccounted costs that were hidden before I assess how much it will really cost. Trust but verify...
Posted by: KDS on December 4, 2009 02:23 PMI think what you're mostly talking about is this: On the other end, very expensive Cadillac plans would be taxed and that would move some people toward less-generous plans. The difference is that we wouldn't be stripping routine doctor visits like moving an insurance company from WA to MI could do but generally making an MRI a $15 co-pay instead of free. If lowering these benefits represents rationing, then what about the tens of millions right now with no insurance and no benefits at all? This is exactly why there is extreme rationing in health care based on income -- not need -- right now.
We need to have insurance plans that are not too generous, otherwise they waste money. And we need to have insurance plans that are somewhat generous, so poor people aren't still denied access to health care even with insurance. I think you can see why this is a pretty complex problem. And it's one that the private sector is not solving.
The other caveat about the CBO report is that the authors of the bill are able to hide costs elsewhere like in other bills (an accounting gimmick used by Congress). and the CBO only focuses on the legislation provided. The CBO's hands are tied in effect, so that is why I look at the CBO analysis and wait until I hear what other unaccounted costs that were hidden before I assess how much it will really cost. Trust but verify...
That's definitely true, but have you seen the pace that the Senate operates on? It requires 60 votes to pass a bill. There's no way Democrats could slip something under the radar, even if they wanted to. We do have an election in November, so there will be consequences for any sort of silly trick like that.
Posted by: John Jensen on December 4, 2009 02:55 PMI am beginning to believe that a "trigger" on the public option might be one way this beast passes. The public does not perceive this as being a high priority (rated below economy, war in Afghanistan and jobs, but above Cap and Tax). I have a big problem with how this important piece of legislation is being enacted by Congress. With that said all legislation is sloppy, but this piece has hit a new low on such a significant issue. The fact is between 75% and 90% of the people (depending on which poll you believe) are satisfied with our insurance the way it in. 31 million new insurees will be affected if Health care reform passes, which is only about 10% of our population and it will be financed on the backs of the 85% +/- who have it and by the Medicare cuts of approx. $400 billion.
I am cynical enough to not believe that Medicare fraud and waste would actually be significant, in spite of what the legislation says because enforcement is also required and all Government programs of this size have far exceeded original estimates. The bureaucracy is too large to do anything but have costs far exceed the original estimates, in spite of the heavy-handed regulations. That is my gut feeling and it wouldn't matter whether a Republican or Democrat administration passed this beast - case and point the Medicaid Prescription drugs bill that was signed into law by Bush 43 will also well exceed original estimates.
Go back and listen to video clips or newspaper archives for kicks and you'll hear similar rhetoric that was used back in the '60's when Medicare was passed and you will find it strikingly similar in a number of areas to what has been used here.
The efficiency of Government has not improved much so that I could believe anything but a similar fate with respect to spending occurring if Health Care Reform with the Government option is passed. It should have improved with the advent of the new technology since then, but the overall trend of reality does not show it - sure there are always exceptions.
ANSWER THE QUESTION COWARD!
Have you ever served in this nation's military?
Posted by: pbj on December 4, 2009 10:44 PM