Healthcare reform

[NorthSideSox72]

An honest question here. Does anyone here actually think this bill will lower the deficit? If we can cut the 80-100 billion in Medicare waste now, why haven't we already started? How will we pay for the SEPARATE doc fix? And on a completely different subject can someone explain why, if FNM and SLM are in conservatorship, their 1.4 trillion in debt is not counted in the Federal debt numbers? Carry on.

I think parts of the bill will help reduce costs, but other parts will add to it, and I don't know enough to say confidently what the final balance would be.

 

[Rex Kickass]

Well to be fair, they used to be against it, until they needed it...

 

I was wondering if you could show an example of when Democrats opposed the idea of using reconciliation as a legislative tool available to the Senate to modify existing legislation that already was passed through Cloture?

 

Although they may have opposed the bill and voted against it, I don't recall hearing Democrats yell and scream about using reconciliation in a general sense. But maybe I'm wrong.

[RockRaines]

When Oh When are we going to get more political parties so its not one way or the other.

[BigSqwert]

When Oh When are we going to get more political parties so its not one way or the other.

Send your donations to www.bigsqwert2012.com

 

Fighting to Win!

[RockRaines]

Send your donations to www.bigsqwert2012.com

 

Fighting to Win!

I've supported less qualified candidates.

[Balta1701]

An honest question here. Does anyone here actually think this bill will lower the deficit? If we can cut the 80-100 billion in Medicare waste now, why haven't we already started? How will we pay for the SEPARATE doc fix? And on a completely different subject can someone explain why, if FNM and SLM are in conservatorship, their 1.4 trillion in debt is not counted in the Federal debt numbers? Carry on.

Genuinely, yes, I believe it will lower the deficit.

 

We can't cut $500 billion from Medicare without this bill because:

 

1. We haven't set up any system to put any downward pressure on prices, only upwards. This bill starts to turn that around.

2. Medicare as set up is taking on the highest-cost individuals who often need more treatment or are uninsured beforehand, because lower-cost individuals can get private insurance while high-cost individuals can't

3. Preventative care remains cheaper than responsive care, and people who aren't getting preventative care coming into Medicare will have it more often with this bill

4. Medicare has been barred by the 2003 drug and insurance company bailout bill from negotiating drug prices by a Congress/Senate/White House that really likes their campaign contributions. Doing that would save even more than what we're talking about so far, but it's not in this bill because the White House felt like they couldn't take on 2 enemies at once so they made a deal with the drug companies for $75 billion in savings in exchange for no drug price negotiations. That's a full 1/4 or so of the tallied savings.

5. This bill establishes a number of other cost-savings options, which could be done on their own but which will never get through this Congress, like end-of-life planning (DEATH PANELS!) which provides significant savings but which is seemingly easy to demagogue, comparative effectiveness research (actually asking whether or not the more expensive drug/surgery works better than the cheaper version, which is the equivalent of putting a bureaucrat between you and your doctor), it strips pricing power away from Congress (Which can be easily bought in exchange for higher reimbursement rates) and gives it to an independent panel, which is where it should lie anyway.

 

Especially over the long term this does cut the deficit. It could be better with a public plan, it could be significantly better on deficit reduction just by opening up "Medicare for everyone", but it absolutely takes a chunk out of it.

[Balta1701]

I was wondering if you could show an example of when Democrats opposed the idea of using reconciliation as a legislative tool available to the Senate to modify existing legislation that already was passed through Cloture?

 

Although they may have opposed the bill and voted against it, I don't recall hearing Democrats yell and scream about using reconciliation in a general sense. But maybe I'm wrong.

You can find plenty of stuff on the Democrats defending the filibuster's existence from 2005-2006, but if there was commentary on reconciliation specifically, it never made it to the point where anyone reported on it.

And yet, in the weeks leading up to the reconciliation vote, the media didn't portray the Republicans as ramming tax cuts through Congress via unprecedented use of an obscure procedural gimmick to circumvent Senate rules. In fact, they didn't say much of anything at all about reconciliation.

 

The Senate reconciliation vote occurred on May 23, 2003. In the month of May, only one New York Times article so much as mentioned the use of reconciliation for the tax cuts -- a May 13, 2003, article that devoted a few paragraphs to wrangling over whether Senate Republicans could assign the bill number they wanted (S.2) to a bill approved via reconciliation. The Times also used the word "reconciliation" in a May 9, 2003, editorial, but gave no indication whatsoever of what it meant.

 

And that's more attention than most news outlets gave to the use of reconciliation that month. The Washington Post didn't run a single article, column, editorial, or letter to the editor that used the words "reconciliation" and "senate." Not one. USA Today, the Los Angeles Times, and the Associated Press were similarly silent.

 

Cable news didn't care, either. CNN ran a quote by Republican Sen. Chuck Grassley about the substance of the tax cuts in which he used the word "reconciliation" in passing -- but that was it. Fox News aired two interviews in which Republican members of Congress referred to the reconciliation process in order to explain why the tax cuts would be temporary, but neither they nor the reporters interviewing them treated reconciliation as a controversial tactic.

 

And ABC, CBS, NBC? Nothing, nothing, nothing.

 

Even the insider publications that tend to cover legislative minutia paid little attention to the Republicans' use of reconciliation. National Journal made passing mentions on May 3 and May 10, 2003, neither of which so much as hinted that reconciliation was unusual, inappropriate, or controversial. And Roll Call mentioned reconciliation exactly once: a May 14, 2003, article about Republican angst over having committed a "procedural snafu" that delayed their use of reconciliation. The article quoted Grassley saying of Senate parliamentarian Alan Frumin: "He could be technically right. ... But there's no need to have a strict interpretation of the rules like that." And, Roll Call noted, "Some GOP aides even hinted that Frumin's position as parliamentarian could be in danger if he continued to make rulings that disadvantaged their political goals."

[Texsox]

When Oh When are we going to get more political parties so its not one way or the other.

 

 

Imagine the grid lock when either party needs the third to pass anything. Imagine the deals that would need to be cut to get those votes.

 

I'll pass on a third party with any power.

[Balta1701]

How this doesn't immediately unify the entire Dem Caucus I have no idea.

I’ll just tell you this, if this passes and it’s five years from now and all that stuff gets implemented — I am leaving the country. I’ll go to Costa Rica.

 

(FWIW, the WHO already ranks Costa Rica's health care system ahead of ours. And it's a Public, universal, socialized system.)

[Balta1701]

Back to CK's question about whether there is acutally really any deficit savings here...I'm sure I'll get called out for outsourcing commentary to a dirty blogger since obviously they can't interpret anything correctly, but whatever.

Harvard economist (and former Obama campaign adviser) David Cutler runs through the 10 most promising cost control ideas of the past few decades and notes that six of them are fully included in the bill, three of them are at least partially present, and only one of them -- the public option -- is totally absent. "No one knows precisely how much medical spending increases will moderate," Cutler concludes. "But one cannot doubt the commitment to try. What is on the table is the most significant action on medical spending ever proposed in the United States."

 

One addendum to Cutler's op-ed: Cutting health-care costs is hard. And it needs to be distinguished from simply capping spending. When liberals say that single-payer will save a bazillion dollars, or conservatives point to Paul Ryan's plan and say that will save a bazillion dollars, they're talking about capping spending. Liberals do it on the provider side, saying that government will only pay so much for medical services people need, and the system will just have to adjust. Conservatives do it on the consumer side, saying that government will only give individuals so much for the coverage they need, and if that proves insufficient, then tough. But voters haven't evinced much appetite for either proposal.

 

So smart people have spent the past few decades trying to figure out softer ways to cut costs without cutting things that people need. One popular idea is to change payment systems so that they don't reward doctors for volume. That's in the bill. Another is to build more competitive insurance markets so that insurers have a more direct incentive to keep costs down in comparison to one another. That's in the bill. Another is to try to bring individuals closer to the true cost of the insurance coverage, which is currently hidden by employers. That's in the bill. And so on.

 

The problem, of course, is that no one knows how well this stuff will work. So the legislation is careful in implementation. It takes time to build up enough evidence so that doctors can confidently say what is unnecessary, and for whom. It takes time to figure out how to create new payment systems such that doctors don't find their practices in sudden chaos. It takes time to phase in taxes such that they nudge people rather than shove them, and it takes time to develop a new IT infrastructure and get doctors to use it effectively, and so on. We think a lot of this will work, but maybe it won't. So the bill is careful to move slowly. It tries a lot of different things on a fairly small scale in the hopes that some of them will pan out (hence the legislation's length).

 

That, of course, makes it harder to explain and less impressive when CBO looks at the savings it can predict with high levels of confidence. But until we decide to be radical with cost control, this is what moving forward looks like. As Cutler says, this is the most ambitious cost control bill Congress has ever passed. And that's a commentary both on the ambition of this bill and on the system's resistance to legislation that's yet more ambitious.

 

[lostfan]

By the way, again for s***s and giggles, the words "reconciliation" and "filibuster" don't appear in the Constitution because the Senate and House make their own rules - see all the things the Republicans changed when they took over in 1994. Was that stuff illegal or did it violate the Constitution? Some of the things they did might've been ethically questionable, but the answer is no.

[Balta1701]

By the way, again for s***s and giggles, the words "reconciliation" and "filibuster" don't appear in the Constitution because the Senate and House make their own rules - see all the things the Republicans changed when they took over in 1994. Was that stuff illegal or did it violate the Constitution? Some of the things they did might've been ethically questionable, but the answer is no.

Is it worth noting here that Tom Delay was admonished by the House Ethics committee for basically trying to bribe and threaten Congressmen to get their vote for GWB's Medicare 2003 drug and insurance company bailout?

[kapkomet]

We need to pass the bill so you all can see what's in it. -- Nancy Pelosi.

 

 

What a f***ing joke. The thing is, I think she meant it.

[bmags]

I agree with her though. As it stands now the media continues to follow the horserace, I guarantee that as soon as they pass it the media switches to "here's what's in the bill that we should have told you about months ago but continued to follow death panel threats and government takeover statements to appear balanced"

[lostfan]

Is it worth noting here that Tom Delay was admonished by the House Ethics committee for basically trying to bribe and threaten Congressmen to get their vote for GWB's Medicare 2003 drug and insurance company bailout?

Yes and you can probably write entire books on Delay being a slimeball and it wouldn't be all hysterical manufactured character accusations like the books that got written about Bill Clinton, it'd be about stuff he actually did... but he did more than just change the rules. You may as well throw in Gingrich being a scuzzbag too, to my knowledge Hastert wasn't anything like those other 2.

 

 

I agree with her though. As it stands now the media continues to follow the horserace, I guarantee that as soon as they pass it the media switches to "here's what's in the bill that we should have told you about months ago but continued to follow death panel threats and government takeover statements to appear balanced"

This is what I mean when I say they cover the process and not the substance

[NorthSideSox72]

I agree with her though. As it stands now the media continues to follow the horserace, I guarantee that as soon as they pass it the media switches to "here's what's in the bill that we should have told you about months ago but continued to follow death panel threats and government takeover statements to appear balanced"

That's not a reason to agree with Pelosi, whose point in this case is vapid and obnoxious. Vote for it to see what's in it? Seriously? That's a load of crap, no matter what you think of the bill or its parts.

 

What this is, is a reason to be frustrated with the media.

 

[Balta1701]

That's not a reason to agree with Pelosi, whose point in this case is vapid and obnoxious. Vote for it to see what's in it? Seriously? That's a load of crap, no matter what you think of the bill or its parts.

 

What this is, is a reason to be frustrated with the media.

Poor choice of words, but there's a legit point in there. If you poll "do you support or oppose the health care plan moving through Congress right now" it has a plurality of opposition. If you add in even a brief description of what is in the bill to the polling question, support skyrockets and a majority supports it.

[southsider2k5]

We need to pass the bill so you all can see what's in it. -- Nancy Pelosi.

 

 

What a f***ing joke. The thing is, I think she meant it.

 

In other words, give me your rights, your records, and your wallet, so I can take what is in them.

[Balta1701]

In other words, give me your rights, your records, and your wallet, so I can take what is in them.

[lostfan]

This graph is kind of hard to read without someone doing percentages but go to page 152 and it shows you the data of how public spending (i.e. Medicare, Medicaid, state payments) used to be about 40% in 1990 and today it's close to 50%, because the growth of public spending outpaces private spending, mostly due to an aging population. It also shows how much total healthcare spending increased in general, it's kind of staggering. This trend isn't going to stop even if no reform passes at all. Most of this is inevitable, but it's not like the people in charge during that time did anything to stop it, actually Medicare Part D (along with a tax cut of course) helped that situation along which is something to think about when you hear someone squawking about government takeover of healthcare (which is not happening as a result of this legislation no matter what anyone says).

 

http://www.cdc.gov/nchs/data/hus/hus09.pdf

[lostfan]

That's not a reason to agree with Pelosi, whose point in this case is vapid and obnoxious. Vote for it to see what's in it? Seriously? That's a load of crap, no matter what you think of the bill or its parts.

 

What this is, is a reason to be frustrated with the media.

Eh it came out retarded and it doesn't help that Pelosi is a lightning rod, but it has to go through a brutal amendment process and we won't see the final version of the bill until it's actually passed, basically by definition.

[Balta1701]

I think you and I see the graph in question and come to an opposite conclusion

 

1990 expenditures (all values approximate):

 

Private insurance: $200 billion

Medicare: $100 billion

Out of Pocket: $130 billion

Medicaid (Federal + State) $75 billion

 

2007 expenditures:

Private Insurance; $670 billion

Medicare: $400 billion

Out of Pocket: $275 billion

Medicare + Medicaid: $300 billion

 

There are a few trends I get from that. Yes, the government share has gone up, but the slope of "Private insurance" is higher than the slope of Medicare by quite a bit. Private insurance has gone up by a lower percentage, but that's only because the starting values were so different. Medicare has gone up by quite a bit less than private insurance overall and per year.

 

The thing that has really, really shot upwards other than private insurance is Medicaid. In other words, it's the cost of covering the uninsured, which is, as I keep saying, a big reason to motivate this, because there are cheaper and better ways to do that.

[lostfan]

I think you and I see the graph in question and come to an opposite conclusion

 

1990 expenditures (all values approximate):

 

Private insurance: $200 billion

Medicare: $100 billion

Out of Pocket: $130 billion

Medicaid (Federal + State) $75 billion

 

2007 expenditures:

Private Insurance; $670 billion

Medicare: $400 billion

Out of Pocket: $275 billion

Medicare + Medicaid: $300 billion

 

There are a few trends I get from that. Yes, the government share has gone up, but the slope of "Private insurance" is higher than the slope of Medicare by quite a bit. Private insurance has gone up by a lower percentage, but that's only because the starting values were so different. Medicare has gone up by quite a bit less than private insurance overall and per year.

 

The thing that has really, really shot upwards other than private insurance is Medicaid. In other words, it's the cost of covering the uninsured, which is, as I keep saying, a big reason to motivate this, because there are cheaper and better ways to do that.

I didn't mention the bolded but I said that the main reason the total cost of Medicare is going up is because of the aging of the population and adding numbers of uninsured, and by now it should be a pretty well-established fact that the United States spends more per capita than just about everyone else and gets less out of it. I think my point bringing that up was to ridicule the "government takeover of healthcare" being some kind of evil Obama plot to turn us into Communist Nazis when the system is already halfway socialized to begin with and nobody that says that did anything to change it when they had the chance.

[Y2HH]

Medicare has a forced cost control mechanism that private doesn't have, thus any comparisons between the two are null and void -- as you are comparing apples to oranges.

 

IE, the government often just decides it's not paying what it promised to the doctors via Medicare, or pays less...and there isn't anything they can do about it. The private industry, however, doesn't get away with that.

[southsider2k5]

Medicare has a forced cost control mechanism that private doesn't have, thus any comparisons between the two are null and void -- as you are comparing apples to oranges.

 

IE, the government often just decides it's not paying what it promised to the doctors via Medicare, or pays less...and there isn't anything they can do about it. The private industry, however, doesn't get away with that.

 

It is also going to prove a lot towards what government run health care would look like, as fewer and fewer medical facilities and doctors are willing to accept Medicaid patients because of the lower payouts The idea that the medical profession will do a lot more work, for a lot less money is the central pillar of this plan, and it is false.