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Old 03-14-2010, 03:22 PM   #21
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I don't think we are at a state of equilibrium yet. When we get there the yowls of the injured will drown out the scare tactics of the vested interests.
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Old 03-14-2010, 09:56 PM   #22
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So the fix is to make it more like what is being proposed at the Federal level?

Somehow I don't think that was the point mark500 really wanted to make, but sometimes it helps to read the article and not just the headline.
I think mark500 (and the article) made the point just fine. Regardless of what fixes are being proposed, MA got further involved in health care, and cost went up for a lot of people.

We keep hearing, "costs keep going up, we have to do something", but if that "something" also comes with increased costs, well, that is a hollow argument.

-ERD50
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Old 03-15-2010, 09:32 AM   #23
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We keep hearing, "costs keep going up, we have to do something", but if that "something" also comes with increased costs, well, that is a hollow argument.

-ERD50
Cost is just one argument. Another argument is that people who are sick may not be able to get health insurance under the current system. Another argument is that 10% of the U.S. population doesn't have health insurance. Another argument is that the ranks of the uninsured grows every year. Another argument is that uninsured people have worse health outcomes than people with insurance.

So there are lots of arguments to change the current system. But even with respect to cost, it isn't enough to say "costs are rising in MA" and ignore that costs are also rising pretty dramatically everywhere else too. Do we have evidence that costs are rising more quickly in MA than elsewhere . . . that would be useful data.**

But even then, the MA comparison ignores the things in pending legislation that at least have the potential to control costs. This from the WSJ opinion section (no friend to "Obamacare") Health Reform Passes the Cost Test - $600B in Savings Over the Next Decade. We can argue as to whether those savings will be realized, and people certainly do. But how much savings are the opponents projecting to realize from the status quo?

** Looking for data on relative health care inflation among states I found this from the Boston Globe based on a study commissioned by Blue Cross Blue Shield . . . State mandates not driving health coverage costs

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On the third anniversary of Massachusetts' landmark health insurance overhaul, a new report shows that employers, consumers, and state government paid the same, proportionately, for health coverage after 2006 as they did the year before the initiative started.
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Old 03-15-2010, 10:25 AM   #24
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BTW, wasn't the MA reform signed into law by Republican presidential hopeful Mitt Romney and voted for by recent star Senator Scott Brown?

Those evil socialists. (disclaimer for the sarcasm impaired, this is obviously sarcasm)

Here's the Socialist-in-Chief, Romney, explaining in a 2006 WSJ oped why mandates and subsidies are Grrreat! Health Care for Everyone? We found a way.

And who said this legislation isn't bi-partisan.
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Old 03-15-2010, 10:36 AM   #25
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Gone4Good - while those may all be valid points, it does not invalidate the point that mark500 made. HC costs in MA are going up.

My point in posting that was that you seem to want to distract from that with other points. But ..., HC costs in MA are going up.

Or, for the Monty Python fans - "Fine Plumage that Norwegian Blue!" does not change the fact that the "The Parrot is Dead!" If only I could say the same about the current HC proposals. But they seem only to be on life support.

Not to worry, Speaker Pelosi says we should pass the bill, and then we can find out what is in it.

Speaker Nancy Pelosi | News Room | Press Releases

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“You’ve heard about the controversies within the bill, the process about the bill, one or the other. ....

“But we have to pass the bill so that you can find out what is in it, away from the fog of the controversy.
Plenty of blame to go around, but I'm trying to stick to some facts rather than call anyone an 'evil socialist', and the fact is ..., HC costs in MA are going up.

And, CONGRATS on the status change!

-ERD50
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Old 03-15-2010, 10:44 AM   #26
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HC costs in MA are going up.
I concede that point. But it is also irrelevant. Nobody is claiming that the proposed legislation, or any other plan, will cause health care costs to fall. So congratulations in winning a point against an argument no one is making.
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Old 03-15-2010, 11:02 AM   #27
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I concede that point. But it is also irrelevant. Nobody is claiming that the proposed legislation, or any other plan, will cause health care costs to fall. So congratulations in winning a point against an argument no one is making.
Maybe so -- but the point is a valid one, and the point is that no significant overhaul is even worth undertaking, IMO, unless costs are controlled first. It does no good to ensure universal coverage if we continue to have unaffordable double-digit increases in health care costs year after year.

Cost control FIRST. That will give the "breathing room" to allow serious reforms, IMO. Anything that doesn't stop the runaway growth in cost is doomed to insolvency *very* quickly no matter how good it feels in the here and now.
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Old 03-15-2010, 12:21 PM   #28
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Maybe so -- but the point is a valid one, and the point is that no significant overhaul is even worth undertaking, IMO, unless costs are controlled first. It does no good to ensure universal coverage if we continue to have unaffordable double-digit increases in health care costs year after year.

Cost control FIRST. That will give the "breathing room" to allow serious reforms, IMO. Anything that doesn't stop the runaway growth in cost is doomed to insolvency *very* quickly no matter how good it feels in the here and now.
I agree. In a perfect world we'd all be able to come together on an optimal strategy to control costs. But, unfortunately, we live in a world where every effort to control costs is demagogued in the most horrific language. As a result of that demagoguery, the cost control initiatives have been watered down. Instead of big, impact-full proposals, we have smaller pilot programs and less ambitious measures. But they still exist. Meanwhile the status quo has nothing at all to offer on the cost control front.

Here's what the moderate/conservative commentator David Brooks said:

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The authors have thrown in a million little ideas in an effort to reduce health care inflation. The fact is, nobody knows how to reduce cost growth within the current system. The authors of this bill are willing to try anything. You might even call this a Burkean approach. They are not fundamentally disrupting the status quo, but they are experimenting with dozens of gradual programs that might bend the cost curve.

If you’ve ever heard about it, it’s in there — improved insurance exchanges, payment innovations, an independent commission to cap Medicare payment rates, an innovation center, comparative effectiveness research. There’s at least a pilot program for every promising idea.
So cost control is a feature of the plan, and while it doesn't go as far as I would like, it does more than has ever been tried before in the U.S. And probably more than we can expect for another decade if this effort fails.

But after watching this debate for the past year, it's hard not to detect a bit of cynicism in the "control cost first" crowd. It seems like an effort to set the bar for acceptable reform at "politically impossible" while simultaneously doing everything imaginable to raise ever higher the political costs for serious health care reformers. If that is in fact what we are witnessing, then the right path forward is to "jam this bill through" along with the modest cost control initiatives it has and then work to expand the most promising of those initiatives in the years ahead.

I fear you offer a false choice. One between the current bill with some cost control measures and a non-existent, and likely politically impossible, alternative.
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Old 03-15-2010, 12:53 PM   #29
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So if I understand correctly, you want to kill my grandmother.
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Old 03-15-2010, 12:58 PM   #30
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One of the problems I have with the CBO and the politicians etc... and the people who want to insure everybody...

They talk about the new bill 'saving' X number of dollars... well, that is just a lie... it takes a huge tax increase to get there... we can do that tax increase and NOT insure everybody... that will 'save' a lot more money than what they propose..

And even if you agree with them on their spin of 'savings'... that is the federal budget... they do not say how much total costs of healthcare will go down...

As an example... if I do not get any savings in my insurance... and have to pay more taxes... I am worse off no matter how much the gvmt saves...

The plan is mostly a universal coverage plan... with gvmt subsidies... not a 'fix' for health care costs...
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Old 03-15-2010, 01:15 PM   #31
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They talk about the new bill 'saving' X number of dollars... well, that is just a lie... it takes a huge tax increase to get there... we can do that tax increase and NOT insure everybody... that will 'save' a lot more money than what they propose..
Maybe not exactly a lie, but probably confusing.

If the legislation is enacted the government will spend more money than they otherwise would. Some of that is being paid for by cutting funding to Medicare Advantage (so no net increase in spending, just a shift). And the balance will come from higher taxes.

So yes, the deficit reduction claim is based on higher taxes offsetting higher spending.

But the $600B cost savings estimate linked above is a reduction in medical costs versus what we would spend without the legislation. This estimate is debatable, of course. The CBO doesn't project as much savings because they simply can't model many of the initiatives that are in the bill with any confidence.
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Old 03-15-2010, 02:34 PM   #32
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Maybe not exactly a lie, but probably confusing.

If the legislation is enacted the government will spend more money than they otherwise would. Some of that is being paid for by cutting funding to Medicare Advantage (so no net increase in spending, just a shift). And the balance will come from higher taxes.

So yes, the deficit reduction claim is based on higher taxes offsetting higher spending.

But the $600B cost savings estimate linked above is a reduction in medical costs versus what we would spend without the legislation. This estimate is debatable, of course. The CBO doesn't project as much savings because they simply can't model many of the initiatives that are in the bill with any confidence.
The best explanation I've seen yet as to why the health care bill must be defeated.

The feds have no money to spend except what is confiscated in the form of taxes.
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Old 03-15-2010, 03:20 PM   #33
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The feds have no money to spend except what is confiscated in the form of taxes.
Abolish the Federal Government!!!!
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Old 03-15-2010, 03:59 PM   #34
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Maybe not exactly a lie, but probably confusing.

If the legislation is enacted the government will spend more money than they otherwise would. Some of that is being paid for by cutting funding to Medicare Advantage (so no net increase in spending, just a shift). And the balance will come from higher taxes.

So yes, the deficit reduction claim is based on higher taxes offsetting higher spending.

But the $600B cost savings estimate linked above is a reduction in medical costs versus what we would spend without the legislation. This estimate is debatable, of course. The CBO doesn't project as much savings because they simply can't model many of the initiatives that are in the bill with any confidence.

I guess you did not understand my point... just because the government 'saves' money does not mean 'we' will save money.... ('we' meaning everybody in total...)

I have not seen a projection showing the cost of health care as a percent of GDP will be going down... if it is not, then there is no savings no matter what is done... it is just shifting who is paying for health care..


The problem is the total cost of health care for America is to high... just paying for more people to have health insurance is not fixing the total costs... either the cost structure must change, or the amount of service we get must change. Doing what is proposed is just moving around the deck chairs on the Titanic...
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Old 03-15-2010, 04:05 PM   #35
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I guess you did not understand my point...

I have not seen a projection showing the cost of health care as a percent of GDP will be going down... if it is not, then there is no savings no matter what is done... it is just shifting who is paying for health care..
I think I did understand . . .

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But the $600B cost savings estimate linked above is a reduction in medical costs versus what we [as a nation] would spend without the legislation.
That $600B is an estimate of how much less the country, in total, will spend because of the cost saving initiatives in the current legislation. Not shifted from one person to another, but lower total outlays.
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Old 03-15-2010, 04:52 PM   #36
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But the $600B cost savings estimate linked above is a reduction in medical costs versus what we would spend without the legislation. This estimate is debatable, of course.
Some use the word "ludicrous" instead of "debatable."
- The $600B includes cuts to Medicare that Congress has already steadfastly refused to make for many consecutive years (via the "doctor fix). To include it now as cost savings is laughable. ("No, this time we really mean it! )
- It includes lots of projected savings to be gained by reducing Medicare and Medicaid waste. This highlights the incompetence of government to administer this entire project. If there's a lot of waste in government Medicare, Medicaid, and the VA system, then no new special legislation should be required to fix that--they should do it tomorrow, in fact it should have been done decades ago. Instead of being ashamed of the waste in the portion of the medical system the government already runs, proponents tell us (without any hint of irony) that this handy ballast is really a source we can leverage so the government can do more things incompetently. Amazing.
- Now the legislators favoring the "reform" have decided that student loans are somehow related to health care, and are converting some of that program to be government-run and citing the cost savings as attributable to health care reform (since it will be in the same bill). I expect next that the federal school lunch program will be cut 25% and the savings dumped into the bin, thereby reducing the red-ink of the bill and also cutting childhood obesity. A win-win for the nation's health!
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Old 03-15-2010, 05:31 PM   #37
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That $600B is an estimate of how much less the country, in total, will spend because of the cost saving initiatives in the current legislation. Not shifted from one person to another, but lower total outlays.
Can you show me this?

The CBO scores a bill based on the cost to the government, not the nation... so I am dubious that they are saying total costs for the nation will go down $600B...

But I could be wrong...
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Old 03-15-2010, 07:20 PM   #38
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Can you show me this?

The CBO scores a bill based on the cost to the government, not the nation... so I am dubious that they are saying total costs for the nation will go down $600B...

But I could be wrong...
It's not the CBO projection. It's from a Harvard Economist, David Cutler.
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Old 03-15-2010, 07:29 PM   #39
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Can you show me this?

The CBO scores a bill based on the cost to the government, not the nation... so I am dubious that they are saying total costs for the nation will go down $600B...

But I could be wrong...
I think you are right. The $600 Billion figure comes from Mr Cutler's own secret sauce calculations, not from the CBO

But even the CBO numbers, though technically accurate, are meaningful only after one understands the assumptions the CBO is forced to use, and after reading all the footnotes.
From this CNN/Fortune article:
-- The bill would force the Treasury to borrow 40 cents of every dollar in new spending the bill requires.
-- The bill counts on new taxes to help reduce its annual impact on the deficit. But, those new taxes can't, by law, be used to pay for the massive new health spending required by the bill--the money can only go into their respective "trust funds" (Medicare and SS). The major new revenue sources:
--- Fees for the government's LTC insurance plan (the CLASS Act). The CBO is counting these fees as revenue now, even though they are to be used to pay LTC costs down the road. Further, they are insufficient to even accomplish this--"The American Academy of Actuaries warns that the program will be insolvent by 2021. The HHS actuaries conclude that it faces "significant risk of failure."
So, all we're doing is creating another future morass of spending, like SS and Medicare. But, since in the first years the tax payments exceed the liabilities, the CBO has to say that it reduces the deficit in those early years.
Quote:
Hence, using the CBO report, the administration is, in effect, touting the $70 billion the CLASS Act raises between 2010 and 2019 as money that's available to spend on subsidies for premiums and coverage for the uninsured.
Does anybody think this is honest accounting?
--- Higher Medicare and SS taxes (due to the tax on"Cadillac" health insurance plans, which is anticipated to cause companies to reduce the value of these benefits and increase pay, which is subject to Medicare and SS taxes. So--more money.). By law, all of the funds raised through these taxes must go back into the Medicare and SS "trust funds," none can be used to pay for the huge spending required by this bill. The money to pay for that will come from increased federal borrowing. The CBO does not include the interest for this borrowing in their computations.

-- The bill drastically understates costs. Example (emphasis added):
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A law dating from 1987 sets strict limits on total physician payments for Medicare. The main mechanism for restraining costs is a formula that lowers the fees Medicare pays for everything from angioplasties to checkups. But since 2002, Congress has been postponing those cuts and allowing modest increases in reimbursements instead. The official budget assumes that Congress made the cuts every year, and hence starts with a far lower spending number. But that's fiction. Each year, Congress passes what it calls the "Doc Fix," which today requires spending about $25 billion a year more than the budget projects. The House included the "Doc Fix" in the bill it presented in July, but not the Senate. And now it's reappeared -- but in a different piece of legislation. The administration estimates that the Doc Fix will cost $371 billion over 10 years. Yet the CBO doesn't talk about that cost when it comes to health care -- because it can't. It's not in the bill it's scoring.
Okay, so what's the real bottom line?
Quote:
How the math adds up
So how much must the government borrow to pay for reform? That's the true measure of future deficits. Let's start with the CBO's "deficit reduction" estimate of $118 billion.
First, we'll subtract the Doc Fix of $371 billion, which Obama does not pay for and must be borrowed. That wipes out all of the theoretical decline in the deficit and leaves a shortfall of $253 billion.
Then we'll subtract the tax revenues that are owed for entitlements, and therefore excluded from paying for the bill: $70 billion from the CLASS Act, $52 billion for Social Security, and $113 billion for Medicare. That subtotal: $235 billion.
So the full amount that must be borrowed by 2019 is $488 billion. (That's 39% of the total cost, composed of the $875 billion official estimate plus the Doc Fix of $371 billion, for a total of $1.25 trillion.) Add in interest, which is excluded from the official CBO cost, and the total amount approaches $600 billion. So the U.S. will need to borrow an additional $600 billion to pay for a new medical system -- one that won't be up and running until 2014.
Only by using the crazy math of health care can a bill both "lower deficits" and enormously raise debt. America's struggling households know what real deficit reduction looks like, and this isn't it.
This bill would not reduce the federal deficit. It certainly will vastly increase the national debt. And there's no way that it will decrease US spending on health care.
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Old 03-15-2010, 07:54 PM   #40
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Okay, so what's the real bottom line?
Wow, talk about funny accounting.

The "Doc Fix" (which accounts for 2/3 of the presumed $600B hole) is part of the status quo. This isn't something that springs into being as a result of health care legislation and won't go away if the legislation fails. All you're saying is that current budget estimates are understated by the amount of the doc fix (which I agree with) but that understatement has nothing to do with health care legislation.
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