News Health Care Reform - almost a done deal? DONE

[mheslep]

Do you have a reliable independent study supporting that assertion (and how many "middle class Americans" are you talking about: 100 or 100 million)? The last CBO analysis on premiums, from Nov 30, says that most people will see a decrease in costs. I don't believe they've redone that analysis more recently.

http://www.politifact.com/truth-o-m...-care-reform-does-not-increase-premiums-and-/

www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

I'm inclined to look to the 2006 Massachusetts reforms as the best guides for what is to come, as they're similar. Mass has by far the highest premiums in the country and the longest wait times to see a GP. They had high premiums before reform too, but they've continued to increase since 2006, the WSJ op ed says 30%/year for individuals.
http://online.wsj.com/article/SB10001424052748703444804575071294139286892.html?mg=com-wsj
Boston.com says, about 10%/year for the overall market.
http://www.boston.com/business/healthcare/articles/2009/09/16/health_insurers_plan_10_rise_in_rates/
Meanwhile the state's spending on health has increased dramatically, with Gov Patrick recently threatening price controls.

http://www.boston.com/bostonglobe/e...9/03/02/mass_healthcare_reform_is_failing_us/

 

[Gokul43201]

Yeah, it's possible this may end up similarly, but I'm not sufficiently aware of the details to comment. Nevertheless, I find it odd that a plan that is supposedly so similar to the one implemented by the Republican front-runner for the next Presidential election is being heckled so savagely by the Republican Party.

On a somewhat related note, I'd never heard of the position and role of Senate Parliamentarian until today.

http://en.wikipedia.org/wiki/Parliamentarian_of_the_United_States_Senate

 

[Gokul43201]

Snowe as you may know voted to forward the Senate bill out of here Finance Committee with some reservations. After that the bill went behind closed doors it came out completely differently; she and every other R. voted against that. Today she went on the floor and attacked the final bill in detail, describing how it went completely off the rails after committee.

There was an op-ed in the Times a couple weeks ago, written by Snowe's Health Policy adviser.

Here it is: http://www.nytimes.com/2010/03/16/opinion/16pewen.html

Some interesting snippets:

...Republicans rightly note that their role was minimized in four of the five Congressional committees charged with drafting the legislation. Yet many Republicans had decided even before Inauguration Day to block reform, including policies that their party had previously supported. In 2003, for example, Republicans enacted legislation that financed end-of-life counseling — yet in town halls last August they claimed a similar measure would create “death panels.”

Republican cries for fiscal responsibility also ring hollow when you consider the party’s record of establishing higher-cost private Medicare plans and enacting a drug benefit that wasn’t paid for. The fact is that under the Republicans’ watch, critical problems of escalating health costs and access to affordable coverage were largely ignored.

Yet Democratic leadership worsened the erosion of bipartisanship.
...
Democrats later merged legislation from the two Senate committees into a single bill.

In that merging, the focus shifted to a one-sided political calculus, and away from critical questions like just how much it would cost Americans to carry the minimum amount of insurance coverage required under the emerging bill. Rather than address such concerns, the Democratic leadership, in the interest of political expediency, expanded the scope of the legislation, adding more regulation, spending and taxes. Soon health care reform, which had been achievable, became endangered.
...
No less embarrassing was the way the majority leadership killed a bipartisan amendment to establish an F.D.A.-regulated system for importing prescription drugs. Safe importation would have produced nearly $100 billion in savings, $19.4 billion of which would have been realized by the federal government. But the amendment conflicted with the deal Democrats had made with the pharmaceutical industry.
...

 

[mheslep]

Yeah, it's possible this may end up similarly, but I'm not sufficiently aware of the details to comment. Nevertheless, I find it odd that a plan that is supposedly so similar to the one implemented by the Republican front-runner for the next Presidential election is being heckled so savagely by the Republican Party.

Two reasons, as Romney and others have often responded when asked that question:
1. Mass/Romney care admittedly didn't attempt to address cost head on. The main idea was simply to get people covered. Romney now admits the beast doesn't work for costs. Then, the Mass legislature, in an all too predictable hand-out-the-bacon move for politicians, piled on a heap of benefits and requirements into the state plans that Romney didn't want.
2. Mass/Romney care is a _state_ based solution. At the state level, the plan is customized for Mass needs, the politicians have a higher degree of accountability for the problems, as do the local bureaucratic implementers, and fixes are far easier to make than it ever will be for a federal plan.

On a somewhat related note, I'd never heard of the position and role of Senate Parliamentarian until today.

http://en.wikipedia.org/wiki/Parliamentarian_of_the_United_States_Senate

Neither had I.

 

[Nebula815]

Yeah, it's possible this may end up similarly, but I'm not sufficiently aware of the details to comment. Nevertheless, I find it odd that a plan that is supposedly so similar to the one implemented by the Republican front-runner for the next Presidential election is being heckled so savagely by the Republican Party.

Well just because Mitt Romney enacted the program doesn't mean that conservatives were in agreement with it.

One thing to keep in mind on Romney as well is most conservatives have always been suspicious of him, but are willing to go along with his current policy choices, not vote for him based on his past, in which he was first a Democrat, then became a pro-choice Republican who created Romneycare in Massachusettes, then changed to being pro-life and against government-mandated healthcare.

On a somewhat related note, I'd never heard of the position and role of Senate Parliamentarian until today.

http://en.wikipedia.org/wiki/Parliamentarian_of_the_United_States_Senate

A lot of people hadn't heard of reconciliation until this bill either. Or deem-and-pass.

 

[MotoH]

At birth, Houston Tracy let out a single loud cry before his father cut the cord and handed him to a nurse.

Instantly, Doug Tracy knew something was wrong with his son.

"He wasn't turning pink fast enough," Tracy said. "When they listened to his chest, they realized he had an issue."

That turned out to be d-transposition of the great arteries, a defect in which the two major vessels that carry blood away from the heart are reversed. The condition causes babies to turn blue.

Read more: http://www.star-telegram.com/2010/0...orn-with-heart-defect.html#tvg#ixzz0jaHceHC8"

I can't believe it. It's a baby! How could a health insurer deny coverage for something like this.

 

[NeoDevin]

How could a health insurer deny coverage for something like this.

Same reason they deny coverage for anything else they think they can get away with: Profit.

 

[Char. Limit]

Can't we all just get along?

Wait... looking at the way things are in this country, that's never going to happen.

Obviously, considering that the no pre-existing conditions clause doesn't take effect until september, we should boycott health insurance companies until september. Of course, this plan has many fundamental flaws, but then, so did the Bay of Pigs, the Iraq War, and Oprah, and we did that, right?

 

[edpell]

A technical point. People are using the word risk but this is only valid when talking about one person. When we talk about a pool of 1 million people it is no longer risk it is a highly predictable amount of money we will spend each year for medical care (i.e cost). Just as talking about one gas molecule is a different subject then talking about a volume of gas with 10^23 molecules.

So a pool of 1 million healthy people has an annual cost of X dollars for medical care and a pool of unhealthy people has an annual cost of Y dollars for care and a pool of mixed healthy and unhealthy has a cost of Z dollars per year. It is safe to say

X<<Y
X<Z
Z<Y

 

[mheslep]

I can't believe it. It's a baby! How could a health insurer deny coverage for something like this.

http://www.star-telegram.com/2010/0...born-with-heart-defect.html#tvg#ixzz0jaHceHC8
I think this is a case of the uninsured, not denial. To have a denial, there had to be an insurance policy in place. There was no insurance as I read the story, nothing to deny. I wonder what happened to Medicaid, if the problem here was affordability.

 

[Ivan Seeking]

Obama signed the Reconciliation Act this morning. The biggest piece of legislation to pass in 40 years, is now the law.

Who knew it was still possible to get something big done in Washington?

Congratulations to President Obama, VP Biden, SOH Pelosi, and SML Reid, who dared to tackle America's unfinished business, and won! And it only took 100 years. The first President to attempt this was Teddy Roosevelt.

Bully Bully!

 

[turbo]

Obama signed the Reconciliation Act this morning. The biggest piece of legislation to pass in 40 years, is now the law.

Who knew it was still possible to get something big done in Washington?

Congratulations to President Obama, VP Biden, SOH Pelosi, and SML Reid, who dared to tackle America's unfinished business, and won! And it only took 100 years. The first President to attempt this was Teddy Roosevelt.

Pretty impressive achievement, since there was NO bipartisanship, even on such an important issue. Rounding up Democratic votes in Congress is like herding cats, so Pelosi and Reid deserve extra credit.

 

[edpell]

Obama signed the Reconciliation Act this morning. The biggest piece of legislation to pass in 40 years, is now the law.

Ivan, I still have virtually no idea what IT is.

I of course have read lots of commentary those who like it say it is the best thing since sliced bread and those who do not like it say the sky is falling. I have not and will not read 2000 pages of legal speak myself.

I take it you are on the like it side. What are some of the things it does?

 

[rootX]

So Dems will start implementing the new reform. It will take few years before the reform will start showing some benefits. However, the Reps will come into office for the next term (which I am confident about unless it's Sarah Palin again :P) and change all what Dems started?

 

[Ivan Seeking]

Ivan, I still have virtually no idea what IT is.

I of course have read lots of commentary those who like it say it is the best thing since sliced bread and those who do not like it say the sky is falling. I have not and will not read 2000 pages of legal speak myself.

I take it you are on the like it side. What are some of the things it does?

That's why, imo, it is so important to find reliable and balanced pundits, like David Gergen, and stick with them. They are paid to be experts and have the experience to provide the proper perspective. As with most any subject, one cannot become an expert by reading a document.

A few highlights, general expectations, and achievements:
Insures 30 million people who currently have no insurance, through a low-cost insurance pool
Eliminates lifetime limits on insurance plans
Eliminates "prexisting conditions" as a basis to refuse insurance to an applicant
Penalizes those who could afford insurance but have none.
Mandates that insurance companies disperse 80% of funds collected, for claims.
50% tax credit [credit, not a deduction] for small business medical insurance costs
Reduces deficit by $1.2 trillion over the next twenty years

There are many cost-saving features, the impact of which cannot be accurately estimated, so the CBO assumes a zero benefit. In fact we should see significant reductions in medical costs.

Philosophically, we have defined that health care is now a right, not a privilege.

David Gergen: an American political consultant and presidential advisor during the administrations of Nixon, Ford, Reagan, and Clinton. He is currently Director of the Center for Public Leadership and a professor of public service at Harvard Kennedy School.[1] Gergen is the Editor-at-large for U.S. News and World Report and the Senior Political Analyst for CNN.[2]
http://en.wikipedia.org/wiki/David_Gergen

 

[Char. Limit]

That's why, imo, it is so important to find reliable and balanced pundits, like David Gergen, and stick with them. They are paid to be experts and have the experience to provide the proper perspective. As with most any subject, one cannot become an expert by reading a document.

A few highlights, general expectations, and achievements:
Insures 30 million people who currently have no insurance, through a low-cost insurance pool
Eliminates lifetime limits on insurance plans
Eliminates "prexisting conditions" as a basis to refuse insurance to an applicant
Penalizes those who could afford insurance but have none.
Mandates that insurance companies disperse 80% of funds collected, for claims.
50% tax credit [credit, not a deduction] for small business medical insurance costs
Reduces deficit by $1.2 trillion over the next twenty years

There are many cost-saving features, the impact of which cannot be accurately estimated, so the CBO assumes a zero benefit. In fact we should see significant reductions in medical costs.

Never talk about the future as fact before it's happened.

We don't KNOW that, whatever the CBO says. After all, the CBO is part of government, and government is made up of people, and people are often wrong. What I'm trying to say is that the CBO might be wrong.

 

[Ivan Seeking]

Never talk about the future as fact before it's happened.

We don't KNOW that, whatever the CBO says. After all, the CBO is part of government, and government is made up of people, and people are often wrong. What I'm trying to say is that the CBO might be wrong.

There are never guarantees in Washington, but the CBO is highly respected by both parties and is considered the judge and jury. The fact is that the CBO tends to be very conservative in its estimates. That is why, for example, none of the cost reducing features were given any consideration. If they can't be quantified in concrete terms, then then don't get counted at all.

To argue that we can't look to analysis for guidance is to make us like blind men in a mine field. What I would not pay ANY attention to are people like Limbaugh or Beck, who have no basis for an opinion. The one certainty here is that the CBO is infinitely more qualified to comment that most anyone on television or the radio; or anyone else, for that matter.

 

[Char. Limit]

There are never guarantees in Washington, but the CBO is highly respected by both parties and is considered the judge and jury. The fact is that the CBO tends to be very conservative in its estimates. That is why, for example, none of the cost reducing features were given any consideration. If they can't be quantified in concrete terms, then then don't get counted at all.

To argue that we can't look to analysis for guidance is to make us like blind men in a mine field. What I would not pay ANY attention to are people like Limbaugh or Beck, who have no basis for an opinion. The one certainty here is that the CBO is infinitely more qualified to comment that most anyone on television or the radio; or anyone else, for that matter.

Now I wasn't suggesting not listening to the CBO at all. I was trying to imply that we shouldn't take the fact that you posited as, well, fact.

And please... I know better than to listen to people like Limbaugh and Beck... didn't you see my earlier post? Actually, FOX News is my favorite comedy channel.

 

[mheslep]

David Gergen: an American political consultant and presidential advisor during the administrations of Nixon, Ford, Reagan, and Clinton. He is currently Director of the Center for Public Leadership and a professor of public service at Harvard Kennedy School.[1] Gergen is the Editor-at-large for U.S. News and World Report and the Senior Political Analyst for CNN.[2]
http://en.wikipedia.org/wiki/David_Gergen

Eh? Are you saying Gergen is your reference for all the above? If so is that your synopsis of one of his broadcasts or is there a link?

 

[mheslep]

Reduces deficit by $1.2 trillion over the next twenty years

Never talk about the future as fact before it's happened.

We don't KNOW that, whatever the CBO says.

The CBO didn't say that. The actual text:

[...]
Effects of the Legislation Beyond the First 10 Years
Although CBO does not generally provide cost estimates beyond the 10-year budget projection period, certain Congressional rules require some information about the budgetary impact of legislation in subsequent decades, and many Members have requested CBO’s analyses of the long-term budgetary impact of broad changes in the nation’s health care and health insurance systems. Therefore, CBO has developed a rough outlook for the decade following the 2010-2019 period by grouping the elements of the legislation into broad categories and (together with the staff of the Joint Committee on Taxation) assessing the rate at which the budgetary impact of each of those broad categories is likely to increase over time. Our analysis indicates that H.R. 3590, as passed by the Senate, would reduce federal budget deficits over the ensuing decade relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of gross domestic product (GDP).3 The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10-year budget estimates.

In today's terms, that's $35 to $70B per year of deficit reduction, given their assumptions (see below).
That's it for the letter. There is no 2029 tabulated dollar figure hiding somewhere in an appendix.
http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf

In his http://cboblog.cbo.gov/" , CBO director Elmendorf has some caveats about that long term estimate:

[the second ten years] calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress. The current legislation would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time.

 

[edpell]

Mandates that insurance companies disperse 80% of funds collected, for claims.

Ivan, thanks for the insight. This is the first time I have heard about the above 80%. I like it.

 

[mheslep]

Ah, here's an example of why the health law's deficit estimates from CBO are likely bogus through no fault of their own, as exactly warned about by the CBO.

From the CBO director again:

[the second ten years] calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress. The current legislation would maintain and put into effect a number of policies that might be difficult to sustain over a long period of time.

The point being that CBO is obligated to estimate from what's written down on the books, not how Congress perennially behaves. In this case http://www.cms.hhs.gov/SustainableGRatesConFact/01_Overview.asp#TopOfPage" says Medicare doc payments will be cut. CBO estimated accordingly. Later, either Congress or the executive calls an audible, as they have done for years.

http://www.businessweek.com/news/2010-03-29/doctors-get-reprieve-from-21-decline-in-payments-from-medicare.html"

March 29 (Bloomberg) -- Doctors slated to have their Medicare reimbursements cut 21 percent on April 1 got a reprieve from the Centers for Medicare and Medicaid Services, which is delaying lowered payments until after Congress reconvenes.

We'll see what happens when Congress gets back on the 12th.

 

[Sea Cow]

So Dems will start implementing the new reform. It will take few years before the reform will start showing some benefits. However, the Reps will come into office for the next term (which I am confident about unless it's Sarah Palin again :P) and change all what Dems started?

Not if (when) it proves popular, they won't.

As an observer looking in from a country with universal health care provided free at the point of need, I find the US debate rather mystifying, I must admit. I would hope and expect many of those who opposed the legislation to come to rather like the idea of healthcare as a universal right. It's quite a modest reform, really, but it's a start.

 

[Char. Limit]

The only problem with America is that even when a party has a supermajority, this is all they can get done. Two thngs that I would have liked to see included:

1. Public Option. Seriously Dems, biggest mistake you've made this term is taking that off.
2. Sell insurance across state lines. I'm not sure why this is a Republican idea (I thought the Republicans were FOR monopolies, not against them), but there's no reason not to put it in. Shame, congress, shame.

 

[mheslep]

Not if (when) it proves popular, they won't.

As an observer looking in from a country with universal health care provided free at the point of need,

Is it? Is it universally slow? Should it be called universal at all if the government decides that some tests or treatments won't be done, that, say, an MRI really isn't needed?

 

[mheslep]

The only problem with America is that even when a party has a supermajority, this is all they can get done. Two thngs that I would have liked to see included:

1. Public Option. Seriously Dems, biggest mistake you've made this term is taking that off.

You understand that the public option would never have passed?

 

[Char. Limit]

You understand that the public option would never have passed?

We don't know that. If Democrats were loyal to party (a bad trait normally, but here it's a good thing), it could have passed. Plus, if the FOX News Disinformation Machine (trademark) hadn't done so much, I think it would have passed...

 

[mheslep]

We don't know that.

Yes we do. People went on record saying they would not vote for it. Lieberman comes to mind - said he would join a filibuster against the original Senate bill.

If Democrats were loyal to party (a bad trait normally, but here it's a good thing), it could have passed. Plus, if the FOX News Disinformation Machine (trademark) hadn't done so much, I think it would have passed...

What do these hypotheticals have do with your original assertion?

 

[Char. Limit]

Yes we do. People went on record saying they would not vote for it. Lieberman comes to mind - said he would join a filibuster against the original Senate bill.

Lieberman might as well be a Republican, and I count him firmly in that camp. I also count him in the same camp as Arlen Specter... if you know which camp that is, as, being an intelligent person, I'm sure you do.

What do these hypotheticals have do with your original assertion?

You're right... my original assertion is that the public option should have been in the bill, and when you challenged that by saying it wouldn't have passed, I created the hypotheticals. Nevertheless, I believe that FOX News was the reason the public option didn't pass despite majority support for it.

Washington Post Poll
Talking Points Memo Poll
http://blogs.abcnews.com/theworldnewser/2009/09/majority-of-americans-support-a-public-option-in-health-reform.html
http://blog.american.com/?p=4754
Wall Street Journal Poll

 

[Sea Cow]

Is it? Is it universally slow? Should it be called universal at all if the government decides that some tests or treatments won't be done, that, say, an MRI really isn't needed?

In the US, it is not 'the government' but private insurance companies that make that decision. So yes, heath care is rationed here in the UK and there in the US. Here in the UK, the decision how to ration care is taken by a board of health care professionals (not 'the government' – there is a difference) according to clinical criteria. There in the US, the decision is taken by profit-making companies according to the financial situation of the individual concerned.

I know which situation I prefer. I don't have to worry about health care. If I'm ill, I go to a doctor – and I'm seen, for free, that same day. There may then be a waiting period as I'm referred to a specialist for free – the system in the UK is by no means perfect, although waiting times have come right down in the last decade – it used to be much worse. But life expectancy in the UK is higher than the US. They're doing something right.

ETA: A lot of lies were told about the UK system in the run up to these reforms in the US. All I can say is, come here, stand in the street and ask people whether they favour the system we have or some kind of private insurance scheme. You'll be hard-pushed to find anyone, rich or poor, who does not favour our system. Every political party falls over itself to appear the most keen on the National Health Service. Even Thatcher did. Universal health care provided free at the point of need is great. Really. You'd like it.

You're not banned from going private, btw, if you so wish. But if you do go private, you still have to pay for the NHS for the rest of us through your taxes. In just the same way, you in the US are free to send your children to private schools, but still have to pay for the state schools that everyone else uses through your taxes. Certain provisions, such as health and education, can and should be considered a universal right and responsibility of citizenship. It's called society.