News How do people envision cutting medical cost?

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Skyhunter

Holy crap you guys move fast.

@SkyHunter:
I apologize for missing the per capita thing, I guess I missed it.
No worries.

As for things like MRIs and such increasing the cost, yes this is true, but it's better to be in debt than dead or unable to have the opportunity to repay said debt.
Costs being quadrupled, I'm sure is offset by the amount of lives saved to a degree, but shifting the bill to someone else really isn't reducing the cost of the bill at all.
If we are ever to rid ourselves of the need of such expensive equipment, newer stuff must first be invented. This is ultimately my point that I'm trying to articulate here. (which is what I thought the whole point of the thread was about, not debating whether or not we should pass the health care bill, but attempting to find other ways.)
It is the system and the diet of Americans that are the major contributors to the rising cost of healthcare. Changing the system will help some, but until and unless Americans are willing to change their lifestyle... healthcare costs will remain high.

I sympathize with those people who are in a bind, being stuck with gigantic, unpayable bills, I really do, but demanding that burden on others is just as cruel as being stuck with the bill yourself. It's a harsh world and we need to find ways to make it better, not shifting blame and setting yokes.
But the problem is that the burden is already distributed to the rest of us. The idea of reform is to make it more equitable.

I am 50 years old, and enjoy the health of a 25 year old because of lifestyle choices I have made. I share the burden others who have not chosen wisely and suffer chronic diseases. I pay for their mistake everytime I write a premium check, I am also paying for the insurance company to tell me how great they are on my TV, and one out of every $700 dollars goes to the CEO. I would much prefer to have a cheap public plan that does not pad the coffers of the insurance industry.

I am by no means alone in this, and that is the reason why the insurance industry spent more to fight reform than was spent in the presidential elections.
 
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I completely agree about lifestyles.

Evidently the decision is reduced to either padding the coffers of insurance CEOs who are responsible to keep the business afloat or the coffers of career politicians who are responsible to keep their power.
(a bit of sarcasm there :P)

The rationality of that perspective makes sense, but I think from the other facet people see things that the government has no incentive to reduce the expenditure cost which has shown to happen time and again, whereas the private insurance company does.
I know this is the case in Massachusetts, the public option has only (statistically) helped those who are already living off of welfare checks, and the majority of those people are simply lazy.
 

Al68

Can you provide a link to any proposal for unsubsidized public insurance to compete with private companies?
Read the House version of the bill. The public insurance plan would have to pay for itself from premium revenues and follow the same rules and regulations as a private company. The reason it is feared is because like electric cars, once people realize how much better it is, the private insurers would go out of business.
It creates a public option to "compete" with insurance plans that are part of the government "exchange". Yes, the companies that provide the policies are private companies, but the house plan forbids them from selling any policy that isn't a part of the government system, ie private insurance policies. The contents of the policy are controlled by government, not privately determined. I apologize for not making that clear.

The private companies involved would only be acting as participants in the government controlled system, and forbidden to sell private policies outside of the system. That's not competition.

If Democrats really thought they could offer a better deal, they would do so without trying to control the deals offered by private companies.
It's not "government run healthcare" for the government to make the decisions? This is the kind of statement that completely precludes anything resembling honest debate.
Then why are you making such absurd statements.
It's absurd to call it government run healthcare when government creates the system, spells out the content of any policy that is allowed in the system, and outlaws non-system policies? I think most people would consider that "government run", but it's a purely semantical argument.
When the issue is government exercising this kind of power to force people to buy the insurance industries most expensive version of their product against their will, NO is the only strategy for any decent politician.
If you simply want to make hyperbolic and unrealistic claims, in order to progress your conspiracy theory, I will withdraw from this discussion with you.
I'll admit to some hyperbole here, the policies in the proposed system may not be the "most expensive", and a tax penalty doesn't actually force anyone to buy it, since they can choose to pay the penalty instead (like I will). But I think anyone reading my post knew exactly what I was talking about.

After all of this, I still can't believe a Republican with a campaign strategy consisting primarily of "just say NO" to this would ever win the Senate seat held by a Kennedy for over half a century. :eek:
 

mheslep

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So you're alright with having a huge state bureaucracy and pushing huge amounts of funds through state programs, but whenever the federal government becomes involved it's suddenly unnecessary, extravagant, and overly selfish? What if states were to increase your taxes and provide universal healthcare coverage, would you be alright with it then? My point is that government is government and arguing that one branch of government shouldn't provide a service because it might be construed as selfish is silly.
All government is not the same. Federal expenditures are far greater than the states; the two are not comparable. Also, a founding tenet of the country is federalism, based on the idea that the authority of the government should be kept as close as possible to the people to keep government responsive and in touch. It's a great idea, one of our best.
 
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Skyhunter

Please support this statement.
I don't need to.

It is in response to the unsupported claim that they are.
Bankruptcy -- a federal law Whereby a person's assets are turned over to a trustee and used to pay off outstanding debts; this usually occurs when someone owes more than they have the ability to repay.

another definition...

bankruptcy -- the legal process in which a person or firm declares inability to pay debts. Any available assets are liquidated and the proceeds are distributed to creditors. A person or firm may be declared bankrupt under one of several chapters of the federal bankruptcy code: Chapter 7, which covers liquidation of the doubter's assets; Chapter 11, which covers reorganization of bankrupt businesses; or Chapter 13, which covers work-outs of debts by individuals. Upon a court declaration of bankruptcy, a person or firm surrenders assets to a court-appointed trustee, and is relieved from the payment of previous debts.

another definition...

Bankruptcy -- The condition of a legal entity that does not have the financial means to pay their incurred debts as they come due. In the U.S. this status is established through legal procedures involving a petition by the bankrupt or by its creditors.
None of those conditions exist for Medicare or Medicaid.
 

Skyhunter

It creates a public option to "compete" with insurance plans that are part of the government "exchange". Yes, the companies that provide the policies are private companies, but the house plan forbids them from selling any policy that isn't a part of the government system, ie private insurance policies. The contents of the policy are controlled by government, not privately determined. I apologize for not making that clear.
I understood the corollary you were making. I see from your further explanation, part of your confusion.

There is already an exchange like the one you describe. It is the one all federal employees choose their plans from. If a company wants to compete in that exchange, they must meet the minimum requirements. No exclusions for preexisting conditions, no cap on care, etc. The national exchange will allow any insurance company to participate, provided they meet the minimum requirements. The Public option would be like the baseline policy in the exchange. And since it provides incentive for medicare and medicaid providers to also accept the public plan. It will work so well that in order to compete insurance companies would have to get creative and offer something better than basic insurance.

I don't know if the House version will work this way. I'm sure I have not kept up with all the changes It but my point is that it is nothing like what you are describing.

The private companies involved would only be acting as participants in the government controlled system, and forbidden to sell private policies outside of the system. That's not competition.
That is patently false. Participation in the exchange is voluntary. The individual mandates are going to increase the risk pool and put a lot of money into the industry. If a company wants to compete for this, they must follow the rules. Establishing the and enforcing the rules is the governments job. Since healthcare like food (IMO) is not a privilege, then having the choice of a public provider is a no brainer to me.

Why should I be forced to give my money to a private entity?

If Democrats really thought they could offer a better deal, they would do so without trying to control the deals offered by private companies.It's absurd to call it government run healthcare when government creates the system, spells out the content of any policy that is allowed in the system, and outlaws non-system policies? I think most people would consider that "government run", but it's a purely semantical argument.
I'll admit to some hyperbole here, the policies in the proposed system may not be the "most expensive", and a tax penalty doesn't actually force anyone to buy it, since they can choose to pay the penalty instead (like I will). But I think anyone reading my post knew exactly what I was talking about.
Healthcare will still be privately delivered, even with a single payer system.

The Democrats are doing their job. (albeit poorly) They are using the legislative process to enact legislation to address the problem of healthcare consuming 1/6 of our GDP. Republicans decided from the very beginning to fight any reform. They inflamed their base with talk of death panels and the government killing Grandma. Now they claim they were shut out of the process.

After all of this, I still can't believe a Republican with a campaign strategy consisting primarily of "just say NO" to this would ever win the Senate seat held by a Kennedy for over half a century. :eek:
I think you are mischaracterizing Brown's campaign strategy, and since MA has universal coverage... I don't think healthcare reform was the top issue.
 

mheslep

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Republicans decided from the very beginning to fight any reform....
No, the Republican legislators opposed the Democratic plans for reform; they repeatedly proposed many of their own, some of them in form of actual draft bills.

...Now they claim they were shut out of the process.
They were, still are.
 

Skyhunter

Here is a message for the Democrats.
https://www.youtube.com/watch?v=<object width="425" height="344"><param name="movie" value="http://www.youtube.com/v/IMlPE1lV_5Y&color1=0xb1b1b1&color2=0xcfcfcf&hl=en_US&feature=player_embedded&fs=1"></param><param [Broken] name="allowFullScreen" value="true"></param><param name="allowScriptAccess" value="always"></param><embed src="http://www.youtube.com/v/IMlPE1lV_5Y&color1=0xb1b1b1&color2=0xcfcfcf&hl=en_US&feature=player_embedded&fs=1" type="application/x-shockwave-flash" allowfullscreen="true" allowScriptAccess="always" width="425" height="344"></embed></object>

Whatever happens with healthcare they're gonna own it.
 
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Al68

I understood the corollary you were making. I see from your further explanation, part of your confusion.
How am I confused, then?
Al68 said:
The private companies involved would only be acting as participants in the government controlled system, and forbidden to sell private policies outside of the system. That's not competition.
That is patently false. Participation in the exchange is voluntary.
My statement is true. Non-system insurance policies would be outlawed. Have you read the bill? Voluntary? What definition of voluntary would that be?
Establishing the and enforcing the rules is the governments job.
So, now you admit you think it's government's job to "establish the rules" for my personal health care? That certainly precludes the use of the word "private".
Why should I be forced to give my money to a private entity?
You shouldn't be. I'm not the one advocating any such thing.
Healthcare will still be privately delivered, even with a single payer system.
Privately delivered? Seriously?

The house bill version linked on the Speaker's web page is exactly the way I described. Participation isn't voluntary by any normal definition.

But fortunately this assault on liberty isn't going to happen now, from the way it looks.
 

mheslep

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Privately delivered? Seriously?
Actually yes, in single payer the medical practitioners do not explicitly work for the government. However, since the government pays the bills for everyone in the system, the government can set prices and methods throughout the system. It therefore by and large acts and behaves as an employer.
 
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The Canadian system I believe is one where government pays for, sets prices, etc...but the practitioners are private. The British system is one where the government owns and operates everything (hospitals are government-owned, doctors are government doctors, etc...). The military's VA system is also socialized medicine.
 

Al68

The Canadian system I believe is one where government pays for, sets prices, etc...but the practitioners are private.
This is obviously a very different definition of "private" than I would use. I would use the word "private" to mean free from government involvement.

I don't even think that would meet the criteria for "quasi-private".
 

Skyhunter

How am I confused, then?My statement is true. Non-system insurance policies would be outlawed. Have you read the bill? Voluntary? What definition of voluntary would that be?
Your confusion stems from a basic misconception.

There are already laws regulating the insurance and health industries.. If you read the bill, you realize that it is 2000 pages of amendments to existing law.

Like this:
(2) REDUCTION IN PERMITTED PREEXISTING
CONDITION LIMITATION PERIOD.—Section
9801(a)(2) of such Code is amended by striking ‘‘12
months’’ and inserting ‘‘3 months’’, and by striking
‘‘18 months’’ and inserting ‘‘9 months’’.

So, now you admit you think it's government's job to "establish the rules" for my personal health care? That certainly precludes the use of the word "private".
The government has already established the rules. And the system under those established rules is not working. Time for the government to change the rules.

Your argument is typical of the rhetoric coming from the republican party. That is one of the many lines of evidence that lead me to the conclusion that Republicans only want to obstruct for political gain, instead of governing. The 101 filibusters is another solid line of evidence.

Republican leadership brought us to the brink of disaster. Anything good for America while DEmocrats are in power, is politically bad for Republicans. Their strategy is clear, obstruct the Democrats from enacting any serious reforms until they get their power back. That is the primary difference I see in todays politicians. Democrats are willing to compromise. Republicans are not, and like Grover Norquist said: "Bi-partisanship is like date rape."

I'm not the one advocating any such thing.
I never said you were. I was asking why we should have a personal mandate without a public option.

In the Senate version, that is what would happen, and unlike driving a car... I may someday need healthcare. Why should I be forced to buy, but denied the choice of a public health plan?

The house bill version linked on the Speaker's web page is exactly the way I described. Participation isn't voluntary by any normal definition.
Since you are so familiar with the bill... why not give us the page and line numbers of the section that forces insurance and healthcare providers to participate.

But fortunately this assault on liberty isn't going to happen now, from the way it looks.
LOL
 

Al68

Your confusion stems from a basic misconception.

There are already laws regulating the insurance and health industries..
Yes, there are. The type of insurance policy I want is already illegal. Again, where is my confusion or misconception? You seem to be mistaking my opposition to increased government control with an ignorance of existing government control.

Do you think it's a "misconception" or "confusion" to oppose a law because it has similarities with previously enacted laws that I also opposed? :uhh:
Your argument is typical of the rhetoric coming from the republican party. That is one of the many lines of evidence that lead me to the conclusion that Republicans only want to obstruct for political gain, instead of governing.
I don't really care what the motives of Republicans are at this point. They have historically failed to protect economic liberty in this country. But in this case, they have succeeded so far. Even if your hateful accusations about their motives for doing so are true.

And it's quite a coincidence that every time a politician actually takes my side against infringements on liberty, they are accused of having bad motives. Yeah, coincidence. :uhh:

But ad hominem arguments are logical fallacies and irrelevant to the issue anyway.
I was asking why we should have a personal mandate without a public option.
We shouldn't.
Why should I be forced to buy, but denied the choice of a public health plan?
You shouldn't.
Since you are so familiar with the bill... why not give us the page and line numbers of the section that forces insurance and healthcare providers to participate.
LOL. By "participation isn't voluntary", I was referring to individuals, not insurance companies. That's section 501. That's what I thought you were referring to in the above two questions as if I were advocating such a thing.

What I said about insurance companies was that they would be "forbidden to sell private policies outside of the system". That's section 202.
Al68 said:
But fortunately this assault on liberty isn't going to happen now, from the way it looks.
LOL
I'll take that to mean that you have no respect for the reason many of us oppose this kind of law. Or that you're shocked or can't believe that the reason could be something other than being "for the rich" or some other hateful delusion typical of Democrats.

Dismissing arguments in favor of individual liberty won't make them go away. Neither will hatefully misrepresenting them. :frown:
 
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Skyhunter

I get it.

You are generally hostile to any government involvement in healthcare or any other industry. You are therefore susceptible to the "government takeover argument."

But to quote James Wilson: "Civil liberty is natural liberty itself, divested only of that part, which, placed in the government, produces more good and happiness to the community than if it had remained in the individual."

I don't support the individual mandate. In my opinion, healthcare should be single payer, and it should be payed for with a tax on the wealth produced by our nation. If someone is sick or injured, they should receive care without fear or worry about financial ruin. Providers are free to compete for patients, insurance companies can sell enhanced plans for those wanting vanity and elite care.

I would argue that healthcare should not be a for profit industry. Life and death decisions should not be made by insurance companies concerned over their bottom lines.

I don't know what kind of illegal policy you want to purchase. but if it is one from a company that would rather deny your claim than suffer a quarterly loss... Well, if not the government... Who you gonna call?
 

CRGreathouse

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I don't know what kind of illegal policy you want to purchase. but if it is one from a company that would rather deny your claim than suffer a quarterly loss... Well, if not the government... Who you gonna call?
Why buy a policy at all? I wouldn't, if not for the current structure of tax law. Health *insurance* is a poor way to provide health *care*.

I'm not automatically opposed to catastrophic insurance -- though I'm not presently interested -- but the current system has much of the inefficiency of a public plan (thanks to regulation and paperwork), all the rent-seeking of an oligopoly, and even more distortion than the moral hazard would suggest (thanks to aforementioned tax policy).
 

Al68

I don't support the individual mandate. In my opinion, healthcare should be single payer, and it should be payed for with a tax on the wealth produced by our nation. If someone is sick or injured, they should receive care without fear or worry about financial ruin. Providers are free to compete for patients, insurance companies can sell enhanced plans for those wanting vanity and elite care.

I would argue that healthcare should not be a for profit industry.
I won't bother making a case against single-payer, since that's not on the table in the U.S., anyway. And it looks like we agree on what I consider to be the most oppressive part of this plan, the mandate to buy. And the plan's supporters pretty much say the rest of the plan is unworkable without the mandate.

For the rest, we just fundamentally disagree on the legitimate role of government in society.
I don't know what kind of illegal policy you want to purchase
The type of insurance policy I buy is high-deductible, major medical insurance-only. Basically, similar to car insurance, it only covers major unexpected medical expenses, and has a large deductible. No coverage for routine medical costs, etc.

This type of policy is relatively very cheap, even for a top-rated and trustworthy plan, since it is only insurance, not a comprehensive (Cadillac) health plan that amounts to paying a "middleman" to pay for routine physicals and other expected medical costs in addition to "insurance".

This type of policy would be outlawed under the house bill.

I'm not saying there's anything wrong with those comprehensive health plans. I'm just saying government shouldn't force me to buy one, or outlaw the alternatives.
but if it is one from a company that would rather deny your claim than suffer a quarterly loss... Well, if not the government... Who you gonna call?
LOL. I don't buy the kind of insurance where those decisions are made after the fact. The policy is in writing and covers what the policy says it covers, period.

If you're referring to fraud or default by the insurance company, I don't know anyone who thinks fraud or contract default should be legalized, so I assume we agree on that one, too.
 

mheslep

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[...] I wouldn't, if not for the current structure of tax law. Health *insurance* is a poor way to provide health *care*.

[...]
but the current system has much of the inefficiency of a public plan (thanks to regulation and paperwork), all the rent-seeking of an oligopoly, and even more distortion than the moral hazard would suggest (thanks to aforementioned tax policy).
Yes. Per Milton Friedman in this debate a few years ago, commenting on the pitfalls of the huge third party payer systems brought on by the current tax policy:

(Milton Friedman and R. Kuttner debate)

MF: We have the worst of all of all worlds on that score. [third party system]

RK: I couldn't agree with you more. We have the worst mix of government and private, I could not agree with you more.

MF: We ought to have much more private or much more government.

RK: Well, to the extent that government is involved at all it ought to be doing a better job than its doing now. I am entirely in agreement.

MF: But there is no formula for doing it. Every area where the government gets involved, whether its education, whether its medicine. If government were to take over the industry of running retail grocery stores, that would be a major problem. The post office is a problem. And if Medicare and Medicaid had never been passed, it may well be, probably would be, that expenditure on health would have gone up, maybe to seven, eight, nine percent of GDP, because as we get to be a richer country, it's a product that people want to have more of. And there is nothing wrong with that. In fact there's nothing wrong with medical spending being 20 percent of national income.
 
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I personally think its about money. The republicans know their base hates even the hint of any additional taxes, and the R's yell that loudly; but, that's only part of it.

Normally some bills have some D's and some R's voting differently; but I think one of the MAIN reasons why the R's vote so solidly together: They get more money from those institutions IF and only IF they all (the R's) vote the same.

The money from the lobbyists has to be split among ALL the R's--and the longer they keep the bill from being passed WHILE still keeping alive to a certain extent (re-set/re-start the bill), the more money that the lobbyists will pay money to the R's to stop the bill. The people who want and need the bill passed are the poor; they don't have money to hire lobbyists.
 
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Hi folks. The original question is how will we lower the cost of medical care in the US. Does anyone support a lifetime limit to the dollar amount of medical care we give to one person? Say $100,000 per lifetime? Or some other number?
 
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What is the point of digit records? Is it just fraud detection?
There's a lot of potential upside to health information exchange: cost savings from administrative simplification, error reductions, quality improvement. A great deal of the delivery system reforms on the horizon are possible only if electronic records are in use.

No, the Republican legislators opposed the Democratic plans for reform; they repeatedly proposed many of their own, some of them in form of actual draft bills.
This is true but many of the elements in http://rules-republicans.house.gov/Media/PDF/RepublicanAlternative3962_9.pdf [Broken] appear in some form in the Democratic proposals (e.g. allowing dependents to remain on their parents' coverage into their mid-20s, encouraging the interstate sale of insurance policies, high-risk pools, wellness promotion programs, some sort of pooling mechanism to allow buyers in the individual and small group markets to leverage greater purchasing power, etc). However, with these Republicans, winning policy concessions doesn't necessarily translate into voting for legislation. But don't be fooled into thinking the Democratic bills aren't heavy with conservative or Republican ideas.

There is no way to increase coverage and increase spending and simultaneously shrink the deficit and no healthcare bill has ever shrank the deficit.
Of course there is: accompany those things with a revenue source that more than pays for the coverage expansions. Both the House and Senate bills do this, which is why they reduce the deficit.

While the Republicans were not kind to the Democrats when in power, to say they have refused to participate in honest debate over this current bill is incorrect.
They've purposefully distorted the bills' contents and attempted to make a joke of the legislative process at every turn. So it doesn't seem too incorrect to say that.


Remove the law preventing people from being able to purchase health insurance across state lines
There's no federal law that does this. State laws are what prevent interstate insurance sales.

end the WWII-era price control that is the tax credit for employer-provided health insurance
Politically this would be exceptionally difficult to do, even if it is a good idea. The Senate bill's excise tax effectively caps this tax exemption at a fairly high level and even that's been very unpopular among the public.
 
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mheslep

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...This is true but many of the elements in http://rules-republicans.house.gov/Media/PDF/RepublicanAlternative3962_9.pdf [Broken] appear in some form in the Democratic proposals ...
Zefram said:
[...] encouraging the interstate sale of insurance policies, high-risk pools,
This one in particular - interstate sale of private insurance policies by any insurance company to any individual regardless of borders - is not in the Democratic bills (Senate or House). The http://www.opencongress.org/bill/111-h3962/text" empowers the individual, allowing "each individual to use the refundable tax credit toward the purchase of health insurance in any State", end of story.

Zefram said:
[...] However, with these Republicans, winning policy concessions doesn't necessarily translate into voting for legislation. But don't be fooled into thinking the Democratic bills aren't heavy with conservative or Republican ideas.
I'll try not to be fooled by anyone, and I'm still looking for the conservative ideas in the Democratic bills.

Zefram said:
Of course there is: accompany those things with a revenue source that more than pays for the coverage expansions. Both the House and Senate bills do this, which is why they reduce the deficit.
My reading of the CBO scoring (Senate bill) is the opposite: for a given year of actual benefits and spending (when indeed it starts), the revenues in the same year fall short.

Zefram said:
There's no federal law that does this. State laws are what prevent interstate insurance sales.
Correct, but the federal government has the authority via the commerce clause to trump the state laws in this regard. Republicans favor the idea, Democratic legislators rejected it.
 
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mheslep

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...Politically this would be exceptionally difficult to do, even if it is a good idea.
Agreed. But there have been attempts at more pallatable solutions. McCain in the '08 campaign proposed moving the tax break dollar for dollar away from the employer-employee to the individual, a start at least to eliminate the madness of being forced to get high price health care only through an employer. The 08 Obama campaign, especially Biden, demagogued the idea heavily, so now for Congress to even mention the idea the political barrier was much higher.

Zefram said:
The Senate bill's excise tax effectively caps this tax exemption at a fairly high level and even that's been very unpopular among the public.
http://www.nypost.com/p/news/national/unions_get_pecial_treatment_in_health_AB053CwqPIJlIxXAm37DOM" [Broken], then you get a pass on the Cadillac plan tax.
 
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This one in particular - interstate sale of private insurance policies by any insurance company to any individual regardless of borders - is not in the Democratic bills (Senate or House). The http://www.opencongress.org/bill/111-h3962/text" empowers the individual, allowing "each individual to use the refundable tax credit toward the purchase of health insurance in any State", end of story.
The House bill contains financial assistance to states that enter into such compacts. If they choose to, fantastic. Each state entering such a compact will get to decide whether the regulatory floor in the compact is desirable for its residents. The Republican alternative--the Shadegg proposal--doesn't allow states to have a say in the insurance policies sold within their borders. That is, the Republicans call for states to cede sovereignty to other states. It's one thing to impose a federal floor on states but to pull the floor our from underneath states and allow the lowest common denominator to dominate the regulatory environment is irresponsible and potentially dangerous.

The Democratic bills encourage states to decide the level of interstate insurance sales they're comfortable with and provides funding for planning and implementation to states that enter into compacts. You don't believe that's a reasonable compromise?

I'll try not to be fooled by anyone, and I'm still looking for the conservative ideas in the Democratic bills.
I've already specifically mentioned ideas from the Republican substitute that appear in the Democratic plans:

  • Allowing dependents to remain on their parents' policies into their mid-20s.
  • Ending rescissions.
  • The elimination of annual or lifetime spending limits for insurance policies.
  • An expansion of high-risk pools.
  • Incentives for wellness programs.
  • Again, encouraging interstate insurance sales.

Are these proposals identical in every respect between the bills? No. As we've gone through, the Democratic proposal for interstate insurance sales is designed to preserve state sovereignty over insurance markets. The high risk pools in the Democratic bills are designed to be temporary and eventually people in those pools will be transitioned to the health insurance exchange. But these are ideas that vary in the details but have common roots.

Other ideas that are conservative or at least have been endorsed by conservatives:

  • Elimination of pre-existing conditions as a pre-text for denying coverage (mentioned in Bobby Jindal's op-ed)
  • The individual mandate (Republican leaders have since reversed themselves on this). For example, the lead Republican negotiator on the Senate Finance Committee, Chuck Grassley, supported this into the summer: "As recently as a month ago, Chuck Grassley, the same senator bashing the idea of a mandate yesterday, announced that the way to get universal coverage is 'through an individual mandate.' He told Nightly Business report, 'That's individual responsibility, and even Republicans believe in individual responsibility.' Earlier this year, Grassley told Fox News that there wasn't 'anything wrong' with mandates even if some may view them 'as an infringement upon individual freedom.'"
  • The creation of health insurance exchanges (these figured heavily into the Republican Patient's Choice Act of 2009).
  • Continuing the stimulus bill's support of health information exchange
  • Subsidies to low income buyers in the individual private insurance market. Here's the http://www.heritage.org/Research/HealthCare/wm2448.cfm [Broken] (from before the Democratic bills were released): "Moreover, as a general principle, Congress should provide tax relief for those who purchase coverage on their own and redirect other health care spending to help low-income individuals and families purchase private health insurance coverage." This also appears in the Republican Study Committee's H.R. 3400.
  • An employer mandate to offer insurance. This appeared in the bipartisan "Crossing Our Lines: Working Together to Reform the U.S. Health System" proposal released by Howard Baker, Bob Dole, and Tom Daschle.
  • Support for comparative effectiveness research. This, too, appeared in "Crossing Our Lines: Working Together to Reform the U.S. Health System."
  • A tax credit aimed at encouraging small businesses to offer their employees health insurance.
  • The excise tax in the Senate bill.
  • Increased funding to fight waste, fraud, and abuse in Medicare.

I'm sure there are more but it's exceedingly late right now. The bottom line is that the pillars of the Democratic proposals (insurance market reform, the creation of health insurance exchanges, and assistance to lower income Americans to buy private insurance in the individual market) have been embraced by conservatives. There may be disagreement in the details but philosophically (or ideologically) there are no real conflicts at the core here. There are numerous compromises built into these bills. Indeed, the entire premise of the Democratic proposal is a compromise between the liberal and conservative positions. To overgeneralize a bit: liberals prefer a universal public system, conservatives prefer a non-universal private system. The Democratic bills build a near-universal (mostly) private system.

My reading of the CBO scoring (Senate bill) is the opposite: for a given year of actual benefits and spending (when indeed it starts), the revenues in the same year fall short.
The CBO score of the Senate bill (the table on Page 3 is what you want to look at here) shows two oppositely directed influences on the budget: increases in the deficit caused by coverage expansions and decreases in the deficit caused by reductions in outlays. The former is larger than the latter. But then you factor in the new revenue stream and in nearly every individual year this leads to a net reduction in the deficit. Over the first decade the aggregate net reduction in the deficit is sizable and CBO projects it will be even larger in the second decade.


Agreed. But there have been attempts at more pallatable solutions. McCain in the '08 campaign proposed moving the tax break dollar for dollar away from the employer-employee to the individual, a start at least to eliminate the madness of being forced to get high price health care only through an employer. The 08 Obama campaign, especially Biden, demagogued the idea heavily, so now for Congress to even mention the idea the political barrier was much higher.
Yes, they shouldn't have done that. But Congress has mentioned the idea before and since; Wyden-Bennett has been around for 3 years now and never seems to get much traction. The reality is that politically it's exceedingly difficult because people are afraid of anything that will alter their coverage, even if it involves a transition to a better system.

http://www.nypost.com/p/news/national/unions_get_pecial_treatment_in_health_AB053CwqPIJlIxXAm37DOM" [Broken], then you get a pass on the Cadillac plan tax.
...for four years after the opening of the exchanges. I hope you didn't mean to imply a pass in perpetuity.
 
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