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Old 03-19-2010, 11:37 AM   #61
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Well, gee, my two loaves fed twice as many people at the same cost but the program is worthless because we didn't spend less (meanwhile my original argument was that it was worthless because it would drive up the price of bread, but forget I said that).
The flaw in your argument is that you are postulating that the 30 plus million people are getting no healthcare. I think they are getting a good amount, but not paying for it. Maybe not what you and me get, but it is not like 30 million people get NO healthcare now and after the bill becomes law they will all be getting some....

So, yes, I would like to see a reduction in the cost of health care... to less than 15% of GDP... heck, from what you see with other countries spending I would like to see 10%.... but that will not happen in my lifetime...
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Old 03-19-2010, 11:42 AM   #62
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The main reason we are having a "crisis" in health care is failure to control costs and the price of health care spiraling out of control.

To that end, cost control should be priority one. If that occurs, we'd have a lot more wiggle room to discuss universal coverage options. I'd like to see universal coverage -- done right. And that, to me, means stopping the double-digit annual increases in health care costs first. If we can tame the cost beast, we'd have a lot more flexibility in implementing universal access.
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Old 03-19-2010, 12:08 PM   #63
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The main reason we are having a "crisis" in health care is failure to control costs and the price of health care spiraling out of control.
Exactly right, and I'm afraid that this bill does little, if anything, to bend down that cost curve. The only reason it doesn't add to the deficit in the first 10 years is because the benefits (e.g. subsidies to buy insurance, etc) don't start until 2014 while most of the tax and other revenue increases start next year. So we have ten years of revenues paying for six years of benefits.
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Old 03-19-2010, 12:39 PM   #64
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The flaw in your argument is that you are postulating that the 30 plus million people are getting no healthcare. I think they are getting a good amount, but not paying for it. Maybe not what you and me get, but it is not like 30 million people get NO healthcare now and after the bill becomes law they will all be getting some....
Exactly. I happen to know of two individuals, with zero net worth and zero funds at the time, who got treated for non-emergency conditions. Totally free to them, and they felt they got excellent treatment.

The downside was that they stood in the Cook County Hospital waiting room for a long time, while several GSW victims got treated ahead of them. But they all got treated, free of charge.

I know of another individual, this time an emergency case ( but effectively 'self inflicted' due to a stupid action), free treatment.

I'm not saying that we should continue that system, but if we look at costs of coverage it is not an all-or-nothing thing.

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Old 03-19-2010, 12:52 PM   #65
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... the benefits (e.g. subsidies to buy insurance, etc) don't start until 2014 ... .
I would love to know:

A) What % of the voting public understands that point.

B) What % of the voting public who feels that they are reasonably well-informed about the HC debate, understands that point.

C) What % of the voting public who showed up at a pro-HC rally, understands that point.

D) What % of members of Congress who voted "Yes" have made that point to their constituents.

There have been a number of TV/radio news blurbs with some harried pro-HC bill person saying ' my relative came down with some terrible disease, and now they can't get insurance! We need to pass this bill!!!!'. I have yet to hear the news person say, 'and they won't even if this bill passes - not until 2014'.

I mentioned this before, but back around the holidays at a dinner party, only one of the three other guys that I mentioned this to was aware of it.

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Old 03-20-2010, 02:25 PM   #66
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It now looks like the "Deem and pass" strategy has been abandoned by House leaders. Apparently, some legislators can still have the ability to feel shame if the offense is especially egregious and public scrutiny is high enough.

It's still not clear to me how the House will vote to amend a law that is not yet a law, but there's probably a slicky-way to get it done.

The amazing thing to me is that all the reporting is obediently quoting the CBO's numbers concerning the impact on the deficit, without calling out the extreme set of "givens" that they were directed to use. If we look at the impact on the debt, then the real magnitude of the spending, the required borrowing, and the huge burden it will impose in the future becomes very clear.

If/when it passes, there will be challenges in the Supreme Court and there will certainly be re-votes as amendments are offered to the pending legislation. As this drags out, it will be interesting to see if the public sees the Republicans as obstructionists, or if the bill/idea itself drops further in popularity as other national issues get put on the sidelines.
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Old 03-20-2010, 02:47 PM   #67
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It now looks like the "Deem and pass" strategy has been abandoned by House leaders. Apparently, some legislators can still have the ability to feel shame if the offense is especially egregious and public scrutiny is high enough.
That would be a welcome, if unexpected change in Congress.

From the 95th to 98th Congresses (1977-1984), there were eight self-executing rules, or "deem & pass", making up 1 percent of the 857 total rules granted. In the 99th Congress under Speaker Tip O'Neill there were 20 self-executing rules, for 12 percent. In the 100th Congress under Speaker Jim Wright there were 18 self-executing rules, for 17 percent. Use of the self-executing rule ramped up a bit to 30 under Speaker Tom Foley in the 103rd Congress for 22 percent of all rules.

Use continued to rise in the next several Congresses. In the 104th Congress under Speaker Newt Gingrich the self-executing rule, or "deem & pass", was used 38 times for 25 percent of all rules. The 105th Congress, again under Gingrich, used the self-executing rule 52 times for 35 percent of all rules. The 106th Congress under Speaker Dennis Hastert used the rule 40 times for 22 percent of all rules. The 107th Congress again under Hastert used the rule 42 times for 37 percent of all rules, and the 108th Congress under Hastert used the rule 30 times for 22 percent of all rules.

The 109th Congress used the self-executing rule, or "deem & pass", at a modest 16 percent portion of all rules.

I am delighted to see the population at large taking such a keen interest in the parliamentary procedures and processes used by our elected representatives. It's rare to see such an interest in the fiddly, intricate details by which legislation is moved through the House and Senate.
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Old 03-20-2010, 02:49 PM   #68
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It now looks like the "Deem and pass" strategy has been abandoned by House leaders. Apparently, some legislators can still have the ability to feel shame if the offense is especially egregious and public scrutiny is high enough.
More likely, Pelosi now has enough votes to pass the Senate bill as it came to the House, without the need for "deem and pass".
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Old 03-20-2010, 03:23 PM   #69
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I am delighted to see the population at large taking such a keen interest in the parliamentary procedures and processes used by our elected representatives. It's rare to see such an interest in the fiddly, intricate details by which legislation is moved through the House and Senate.
It's rare that Congress passes a bill affecting 1/6th the GPD (I think that is the number tossed around) that could touch so many people in so many ways.

I've seen some of the stats you mentioned. It is a good point, but I wonder what kind of legislation was passed by those methods? I really don't know, are there examples where they passed bills that had polls showing over half the people were opposed to them?

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Old 03-20-2010, 05:08 PM   #70
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It's rare that Congress passes a bill affecting 1/6th the GPD (I think that is the number tossed around) that could touch so many people in so many ways.

I've seen some of the stats you mentioned. It is a good point, but I wonder what kind of legislation was passed by those methods? I really don't know, are there examples where they passed bills that had polls showing over half the people were opposed to them?

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The Congressional Research Service reports that it was originally used to expedite House action in disposing of Senate amendments to House-passed bills.

Significant or controversial uses in recent years include:

* On August 2, 1989, the House adopted a rule (H.Res. 221) that automatically incorporated into the text of the bill made in order for consideration a provision that prohibited smoking on domestic airline flights of two hours or less duration.

* On March 19, 1996, the House adopted a rule (H.Res. 384) that incorporated a voluntary employee verification program — addressing the employment of illegal immigrants — into a committee substitute made in order as original text.

* H.Res. 239, agreed to on September 24, 1997, automatically incorporated into the base bill a provision to block the use of statistical sampling for the 2000 census until federal courts had an opportunity to rule on its constitutionality.

* A closed rule (H.Res. 303) on an IRS reform bill provided for automatic adoption of four amendments to the committee substitute made in order as original text. The rule was adopted on November 5, 1997, with bipartisan support.

* On May 7, 1998, an intelligence authorization bill was made in order by H.Res. 420. This self-executing rule dropped a section from the intelligence measure that would have permitted the CIA to offer their employees an early-out retirement program.

* On February 20, 2005, the House adopted H.Res. 75, which provided that a manager’s amendment dealing with immigration issues shall be considered as adopted in the House and in the Committee of the Whole and the bill (H.R. 418), as amended, shall be considered as the original bill for purposes of amendment.


http://www.rules.house.gov/Archives/98-710.pdf
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Old 03-20-2010, 06:40 PM   #71
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OK, thanks for digging those up M Paquette. Yes, I don't think those measures were equal to the public interest and scrutiny of this current HC bill. It's hard to say if sometimes that process is just an expedient way to get non-controversial bills through with some agreed to changes, or if it was used as a 'trick' to avoid further debate on controversial changes.

Add the historically low approval rating for Congress, and the public disapproval of this bill, I just don't think this is the time to be doing anything that isn't 100% transparent (wait, where have I heard 'transparent' used before?).


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Old 03-21-2010, 10:33 PM   #72
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And the balance will come from higher taxes.

So yes, the deficit reduction claim is based on higher taxes offsetting higher spending.
I explained it to DW this way: Yes, I'm going to take $300 out of your paycheck to buy some techno-gizmo for myself. But not to worry, I'm going to take out an additional $400 and put in in our savings account. So you see, by me buying this techno-gizmo, we have actually saved $100! Aren't you proud of me!

That's a proper analogy, right? The 'higher spending' is on the American public, and it is the American public paying the higher taxes. I call BS on this 'deficit reduction', just as my wife would call BS on me claiming I'm 'saving' by 'spending'.

If that is wrong, pls explain.

BTW, Karl Rove hit David Plouffe with that Q on "This Week" today. Would have been a great opportunity for Plouffe to set the record straight. His response: something about the previous administration spending money ().... IOW, he sure didn't say "No, you are wrong". So that gives a pretty good idea where the truth is.



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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.
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Some use the word "ludicrous" instead of "debatable." ...
Health care: Democrats own whatever happens next. - chicagotribune.com
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That dubious conclusion rests on a Congressional Budget Office guesstimate that Washington can spend nearly $1 trillion more on health care over 10 years — and also cut the deficit by $138 billion. Writing in Sunday's New York Times, former CBO director Douglas Holtz-Eakin profoundly disagreed: "(T)he budget office is required to take written legislation at face value and not second-guess the plausibility of what it is handed. So fantasy in, fantasy out. In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion."
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Old 03-22-2010, 08:44 AM   #73
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I explained it to DW this way: Yes, I'm going to take $300 out of your paycheck to buy some techno-gizmo for myself. But not to worry, I'm going to take out an additional $400 and put in in our savings account. So you see, by me buying this techno-gizmo, we have actually saved $100! Aren't you proud of me!

That's a proper analogy, right? The 'higher spending' is on the American public, and it is the American public paying the higher taxes. I call BS on this 'deficit reduction', just as my wife would call BS on me claiming I'm 'saving' by 'spending'.
It seems there is confusion about the terms "savings" and "deficit reduction". These are different things. The $600B "savings" number was one economist's estimate of the amount we, as a nation, would not spend because of the legislation versus what we will spend under the status quo. Perhaps the confusion is that the "savings" estimate is not strictly government savings, but national savings.

The deficit reduction estimate is strictly a question of whether revenue increases will more than offset spending increases. The CBO says they will.
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Old 03-22-2010, 09:00 AM   #74
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Exactly right, and I'm afraid that this bill does little, if anything, to bend down that cost curve. The only reason it doesn't add to the deficit in the first 10 years is because the benefits (e.g. subsidies to buy insurance, etc) don't start until 2014 while most of the tax and other revenue increases start next year. So we have ten years of revenues paying for six years of benefits.
But in the second decade the CBO says it reduces the deficit by $1.2T.
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Old 03-22-2010, 09:13 AM   #75
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The flaw in your argument is that you are postulating that the 30 plus million people are getting no healthcare. I think they are getting a good amount, but not paying for it. Maybe not what you and me get, but it is not like 30 million people get NO healthcare now and after the bill becomes law they will all be getting some....
That is certainly true, the uninsured are getting some care. But study after study has shown that the uninsured have worse health outcomes than those with insurance. So while they might get some care, they are clearly not getting sufficient, or maybe more importantly timely, care. So if we're going to spend ~20.8% of GDP on health care regardless of whether this bill passes or not, aren't we getting more for our money (a.k.a. "saving") if those 30MM people have insurance they wouldn't have otherwise had?
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Old 03-22-2010, 09:17 AM   #76
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It seems there is confusion about the terms "savings" and "deficit reduction". ...

The deficit reduction estimate is strictly a question of whether revenue increases will more than offset spending increases. The CBO says they will.
I realize that my wording could have been better for this example. Let me try again, w/o the word 'savings' in there:

Quote:
I explained it to DW this way: Yes, I'm going to take out $300 on our HLOC to buy some techno-gizmo for myself. But not to worry, I'm going to take $400 out of your paycheck and put it towards our HLOC. So you see, by me buying this techno-gizmo, we have actually reduced our deficit by $100! Aren't you proud of me for deciding to buy this techno-gizmo!
So the deficit reduction claim is a matter of increasing government revenue more than increasing government spending. Fine, but mostly that is a shifting of money from within the same pile.

I think the govt reps know that when they say 'deficit reduction' to the general public, that public hears 'savings'.

Now, if there are really other savings to the public outside of the govt arena, fine. But the CBO would not count those in the deficit reduction number, would they? It is the deficit reduction claim I'm focusing on for the moment. This thing is complex, we need to break it down a step at a time, unless the intent is to daze & confuse.

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Old 03-22-2010, 09:21 AM   #77
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aren't we getting more for our money (a.k.a. "saving") if those 30MM people have insurance they wouldn't have otherwise had?
That is a great question that I am hoping you can answer.

Just remember, many of the pro-HC bill people point out that the insurance cos are just greedy profit making, overhead creating, no-value-added slime. So lets add whatever % number was used in other arguments to their cost of HC, and do we still save money by covering them this way? When those uninsured go to the ER, there was no ins co overhead, profit, etc.


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Old 03-22-2010, 10:05 AM   #78
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I was in the ER about a month ago for 5 hours of emergency treatment. My bill, which was $2,800 was paid in full by UnitedHealthcare (with the exception of a $100 copay). I believe that my insurance premiums are substantially higher than they would be otherwise because the hospital probably used a portion of this $2,800 to help pay for some of the people who showed up in the same ER that night who had no insurance coverage.
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Old 03-22-2010, 10:11 AM   #79
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That is a great question that I am hoping you can answer.
I don't think anyone has the answer to that question, but it is a reasonable conclusion from the following points (which I think are relatively uncontroversial).

1) People without health insurance have worse health outcomes than those that do
2) The legislation extends insurance to 30MM people who don't currently have it
3) The article Samclem linked to says that we'll spend the same amount of GDP on healthcare in 10 years regardless of whether the legislation passes or not.
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Old 03-22-2010, 10:13 AM   #80
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So the deficit reduction claim is a matter of increasing government revenue more than increasing government spending. Fine, but mostly that is a shifting of money from within the same pile.
We agree.

But I'd add that by definition reducing the deficit means moving money from the "borrowed" pile to the "not borrowed" pile. Most people see that as a positive.
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