Health Care Reform - 1/6 of the Economy Up for Grabs

[LynahFan]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

I've noticed that much of the course of this discussion has been centered on "who pays." Should healthcare for those who can't afford it be subsidized by people who choose to buy healthcare? Should it be subsidized by those who use the most healthcare services? Should it be subsidized by all taxpayers? By only taxpayers who have health insurance of their own? etc...

This ignores the elephant in the room of "how do we bring costs down?" If the % of GDP that we spend on healthcare continues to rise as much faster than inflation as it has been, then it won't matter WHO is paying. The collective bill will drag down the entire economy. Who pays? is just a shell game that spreads the costs around differently than they are today. If we want to avoid a long-term economic crisis, then the costs themselves have to be addressed instead, but I see precious little discussion of that, here or in the news.

 

[trucker]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

I've noticed that much of the course of this discussion has been centered on "who pays." Should healthcare for those who can't afford it be subsidized by people who choose to buy healthcare? Should it be subsidized by those who use the most healthcare services? Should it be subsidized by all taxpayers? By only taxpayers who have health insurance of their own? etc...

This ignores the elephant in the room of "how do we bring costs down?" If the % of GDP that we spend on healthcare continues to rise as much faster than inflation as it has been, then it won't matter WHO is paying. The collective bill will drag down the entire economy. Who pays? is just a shell game that spreads the costs around differently than they are today. If we want to avoid a long-term economic crisis, then the costs themselves have to be addressed instead, but I see precious little discussion of that, here or in the news.

How we bring costs down is critical and no one on either side of the aisle seems to have a good answer. However, giving everyone the option of Medicare would help, since their costs are lower than private insurers and they have had slightly lower increases over recent years.

Here is a link to an interesting article that makes the point that private insurers spend a significant amount enrolling and dis-enrolling clients from their systems while people in Medicare stay there.

http://www.thehealthcareblog.com/the_health_care_blog/2006/06/policy_why_medi.html

But it’s not just the cost of marketing, advertising, lobbying and providing profits for investors that makes a private insurer’s overhead so much higher. Insurers also have higher administrative costs because they are constantly enrolling and disenrolling customers as people change plans. (The average turnover in an employer-sponsored insurance plan is 20% to 25% a year. By contrast, Medicare patients stay put. Even if they could switch, most prefer Medicare’s coverage to the coverage they had under a private insurer.)


In Money-Driven Medicine, I quote former Medicare chief Bruce Vladeck who points out that:


“. . . even very efficient insurers must spend roughly 5 percent of their premiums just to enroll and disenroll customers . . . . This is why, when I was in Washington, some of us talked about giving people age 55 to 65 the opportunity to voluntarily enroll in Medicare –letting them pay premiums to the government in exchange for full Medicare coverage . . Donna Shalala, who was Secretary of Health and Human Services at the time, said to me, ‘You really want to compete with the insurance companies, don’t you?’


And I said, ‘You bet,” Simply because our costs were so much lower, I knew I could beat them.’”

 

[leswp1]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

trucker- I am glad you have joined in the discussion. I feel like I don't need to type anything anymore. Just nod yes.

 

[leswp1]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

And why do they have limited skills? I certainly could have limited skills if I had chosen to take a different path.

Obviously it can be harder for some people than others, but the beauty of this country is that everyone has a chance to move up the ladder.

Why must the taxpayer be the one to pick up the tab? If there are people like you who care so much about these less fortunate people then you can help them out. Let me keep some more of my money and I'd be much more likely to help them out directly. I just have a hard time trusting gov't to do more of what is beyond its original mandate and it has already shown it is horrible at doing.

I was originally speaking to what is necessary to fix the system. I see no other way out that doesn't cripple this country.

Wow. You need a reality check. There are plenty of people that are scraping to make ends meet, working 2-3 jobs and barely making it. They have no time to do anything to change that skill set, get further training etc. There are plenty of kids now that are unable to stay in school because of finances. They can't stay in school because they need to work 2 jobs to eat. I think I would like to live in your rosy world where everything was just about will and grit and nothing about circumstances you were born into.

 

[busterman62]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Mayo Clinic - Glendale stops accepting Medicare

FYI, this was prior to Medicare no longer paying for consultations (they now require billing as a new or repeat visit....about a 30+% decrease)

 

[MinnFan]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Wow. You need a reality check. There are plenty of people that are scraping to make ends meet, working 2-3 jobs and barely making it. They have no time to do anything to change that skill set, get further training etc. There are plenty of kids now that are unable to stay in school because of finances. They can't stay in school because they need to work 2 jobs to eat. I think I would like to live in your rosy world where everything was just about will and grit and nothing about circumstances you were born into.

You are talking about where they are. Not how they got there.

There are countless self-made millionaires that have come from extremely poor circumstances. I'm not saying that its not a lot harder for those people, but I think its perfectly reasonable to think that with effort they can make it into at least the middle-class. Handouts are just going to keep them where they already are.

 

[MinnFan]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Obama approves tax on "Cadillac" health plans

A big assumption the CBO used in making its estimates was that the number of these types of plans would increase 10-15% over the next 10 years accounting for the majority of revenue to cover this plan.

Does anyone actually believe that if you tax these plans 40% you won't get less of them?

 

[Rover]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Obama approves tax on "Cadillac" health plans

A big assumption the CBO used in making its estimates was that the number of these types of plans would increase 10-15% over the next 10 years accounting for the majority of revenue to cover this plan.

Does anyone actually believe that if you tax these plans 40% you won't get less of them?

I think that's the point. Taxing them higher = less of them = less frivilous usage of the system = less costs.

 

[MattS]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

I think that's the point. Taxing them higher = less of them = less frivilous usage of the system = less costs.

Yeah, but if MinnFan is correct, and I am too lazy to look it up, then how does the CBO make this accounting claim?

A big assumption the CBO used in making its estimates was that the number of these types of plans would increase 10-15% over the next 10 years accounting for the majority of revenue to cover this plan.

So either you or the CBO is incorrect. I wonder which one?

 

[Rover]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Matt,

I think the best approach is to get a combined bill and let the CBO score it again. Looks like there will be some mix of the two revenue raising approaches.

 

[MattS]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Matt,

I think the best approach is to get a combined bill and let the CBO score it again. Looks like there will be some mix of the two revenue raising approaches.

A sure sign of the Apocalypse!!!! A Rover post that I agree with!!!

 

[Rover]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

A sure sign of the Apocalypse!!!! A Rover post that I agree with!!!

Funny! Love or hate my postings, but I'm saying the CBO determination is the best # to run with however it comes out, as opposed to some other posters who seem to think the RNC or the Teabaggers "in depth" analysis of the costs of the bill should be taken at face value.

 

[Bill]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Matt,

I think the best approach is to get a combined bill and let the CBO score it again. Looks like there will be some mix of the two revenue raising approaches.

And the "Doc Fix" should be added back in to the combined bill rather than put in a separate bill.

 

[MinnFan]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

I think that's the point. Taxing them higher = less of them = less frivilous usage of the system = less costs.

Any cost savings will not be nearly as much as the revenue shortfall = greater deficits. Also, just because they are paying more for care how does that increase costs to everyone else?

The problem with the CBO is that the do a static analysis. They are not allowed to take into account what is likely to happen. They simply take how things are today and then keep those same assumptions into the future. This explains how they horribly underestimate gov't costs and overestimate revenue throughout history.

 

[Rover]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

Any cost savings will not be nearly as much as the revenue shortfall = greater deficits. Also, just because they are paying more for care how does that increase costs to everyone else?

The problem with the CBO is that the do a static analysis. They are not allowed to take into account what is likely to happen. They simply take how things are today and then keep those same assumptions into the future. This explains how they horribly underestimate gov't costs and overestimate revenue throughout history.

The cost increase is that because everything is covered, people can run to the doctor all day ordering tests, etc knowing all they need do is pay the co-pay.

Next, while anybody can say the CBO estimate won't be exact, its the most trusted source to use because they don't have a dog in this fight, and are presumably experts in assessing a bill's impact on the federal budget as their job is to do this analysis.

Lastly, I'll answer a question before its asked. Want me to name one time they underestimated the favorable budget impact of a bill? That would be the Clinton deficit reducing bill in '93, where they forecasted a reduction the debt, but not the 4 years of surplus the country enjoyed at the end of the decade.

Bill - until/unless Doc Fix is passed, it doesn't apply. Congress will have to come up with some other $$$ to pay for that if it happens.

 

[Bill]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

The cost increase is that because everything is covered, people can run to the doctor all day ordering tests, etc knowing all they need do is pay the co-pay.

Next, while anybody can say the CBO estimate won't be exact, its the most trusted source to use because they don't have a dog in this fight, and are presumably experts in assessing a bill's impact on the federal budget as their job is to do this analysis.

Lastly, I'll answer a question before its asked. Want me to name one time they underestimated the favorable budget impact of a bill? That would be the Clinton deficit reducing bill in '93, where they forecasted a reduction the debt, but not the 4 years of surplus the country enjoyed at the end of the decade.

Bill - until/unless Doc Fix is passed, it doesn't apply. Congress will have to come up with some other $$$ to pay for that if it happens.

The Doc Fix is an acknowledged cost (by both parties) that is part of the health care problem in this country. The dual prime purpose of the health care bill is to address health care costs and to provide health care to more people via insurance. The Doc Fix was put in a separate bill as a shell game to remove it costs from the main health care bill. It's deceptive politics pure and simple. Both sides play the game and I don't have a very high opinion of either party. But the Doc Fix belongs in the main health care bill. Will it happen? Not likely, but that's where it belongs. Any legitimate estimate of the health care bill costs should include the Doc Fix. One of the principal shortcomings of CBO estimates is that they have to use what Congress provides as input and what Congress says. Congress can easily play its shell games and be otherwise less than truthful and the CBO can't currently do anything about it.

 

[MinnFan]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

The cost increase is that because everything is covered, people can run to the doctor all day ordering tests, etc knowing all they need do is pay the co-pay.

Which is paid for by a private plan. It doesn't cost taxpayers a dime. Again, how does this increase or decrease costs to everyone else? If anything, it makes healthcare cheaper for everyone else since it makes up the shortfall in Medicare reimbursement.

If I buy a BMW does it make your car more expensive?

 

[Rover]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

The Doc Fix is an acknowledged cost (by both parties) that is part of the health care problem in this country. The dual prime purpose of the health care bill is to address health care costs and to provide health care to more people via insurance. The Doc Fix was put in a separate bill as a shell game to remove it costs from the main health care bill. It's deceptive politics pure and simple. Both sides play the game and I don't have a very high opinion of either party. But the Doc Fix belongs in the main health care bill. Will it happen? Not likely, but that's where it belongs. Any legitimate estimate of the health care bill costs should include the Doc Fix. One of the principal shortcomings of CBO estimates is that they have to use what Congress provides as input and what Congress says. Congress can easily play its shell games and be otherwise less than truthful and the CBO can't currently do anything about it.

And it will need to be dealt with, and paid for separately. For all the talk about runaway spending out of righties, I find it fascinating that not only is the health care bill paid for, but the doctor fix hasn't happened yet because of Dem concern about keeping that deficit neutral also.

MinnFan, less people frivilously accessing the system eases up the constraints on a finite resource (doctors and hospitals). To use your odd car analogy, if a billion people buy huge SUV's the cost of my new car does go up because they will be consuming two finite resources, steel to make the larger cars will go up in cost, as well as gas as more of it is being consumed.

 

[Bill]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

And it will need to be dealt with, and paid for separately. For all the talk about runaway spending out of righties, I find it fascinating that not only is the health care bill paid for, but the doctor fix hasn't happened yet because of Dem concern about keeping that deficit neutral also.

You're playing along with the shell game. The health care bill is only "paid for" because the Doc Fix costs were removed and put in a separate bill. Even the way it is now, the cost of the health care bill being anywhere close to being deficit neutral is highly dependent upon the projected Medicare cuts staying as designated in the bill. When Congress has proposed Medicare cuts in the past, they always got cold feet once their constituents started complaining, and as result they backed off from the cuts. There's a good chance the same thing will happen this time and that would mean the bill will significantly add to the deficit. As far as the separate Doc Fix bill not happening yet, it's interesting to note that it only failed in the Senate (after being passed by the House) because a dozen centrist Dems voting against it for not being deficit neutral.

 

[Rover]

Re: Health Care Reform - 1/6 of the Economy Up for Grabs

As far as the separate Doc Fix bill not happening yet, it's interesting to note that it only failed in the Senate (after being passed by the House) because a dozen centrist Dems voting against it for not being deficit neutral.

Ummmm.....that's what I wrote Bill?