Public Option, where do you stand?

[burnzee06]

---

Members don't see this ad.

I will be covered by the health insurance of my parents when I enroll in dental school and will be covered until age 24 (or 27, I believe, with this new bill).

If you feel you need/want health insurance during that gap, get a job and pay for it. Depending on your age/health status/preexisitng conditions, this is more or less a waste of money.

I will be employed full time after graduation but I certainly don't want/need to spend a significant portion of my paycheck on insurance that is more costly than my monthly rent. I'm just pointing out that my parents fall into the $75k+/year income and if $370/month isn't doable for them then it certainly isn't doable for me with my temporary job. I would prefer to save the money to offset the cost of dental school. I am sure there are others in the "able to afford" category that feel the same way.

 

[chessknt]

Now imagine if you HAD to pay for it because the govt would penalize you if you didnt.

Thats what will be reality if (by some miracle) the House bill becomes law. The House bill does absolutely nothing to control costs/share risk, it just covers more people with pretend insurance that has the same extremely limited access as medicare. This means that everyone's premiums have to go up to pay for these new people (unless the govt taxes something/someone).

It is wreckless and stupid to introduce millions of people into an already strained system (without expanding it/having anywhere for these people to go) and promise them high quality care, then not implement limitations on usage/costs. Yet this is what they decided to do.

 

[Parts Unknown]

The House bill does absolutely nothing to control costs/share risk,

Actually over three quarters of the bill (about 1600 pages) are dedicated to reforms aimed at effecting cost and quality. Timothy Jost of the journal Health Affairs sums up these changes on on the HA website:

Improving The Health Care Delivery System
First, the Medicare amendments contain a laundry list of virtually every idea for improving the delivery, enhancing the quality, or controlling the cost of medical care now current. It is like they read through the table of contents of every Health Affairs for the past five years. (See, for example, Bending The Cost Curve, The Crisis In Chronic Disease, and Overhauling The Delivery System.) Accountable care organizations, bundled payments for hospitals and physicians, medical homes, incentives to reduce hospital readmissions, increasing payments for primary care, quality and efficiency incentives for Medicare Advantage plans, comparative effectiveness research, promotion of shared decision-making, gainsharing, reporting on infections acquired in hospitals and ambulatory surgical centers, and more—it is all in there. While some of these programs are funded as demonstration projects, a number of them like accountable care organizations and medical homes are authorized as "pilot programs," meaning that HHS can extend and expand them if they prove successful.

The legislation would also expand health information technology, and, as always, fight waste, fraud, and abuse. The CBO credits few of these measures with cost savings, and indeed projects that some will increase costs. The innovations are also not explicitly extended to the private sector. But they are the state of the art in health care improvement and some may work.

One of the bill's initiatives is the creation and funding of a Center for Medicare and Medicaid Innovation in CMS, which would research, develop, and test new payment and delivery models. These could then be expanded if they proved successful at improving quality or controlling cost. Another new idea is to commission the Institute of Medicine to do a comprehensive study of geographic variations in medical care, considering all of the factors that might influence variations. The IOM is supposed to submit a report to HHS, which is then to design an implementation program to address geographic variations. That plan will be reviewed by MedPAC and the GAO, and then sent to Congress for an up or down vote. The analogy of the base-closing commission is overused, but here is unavoidable, although here not only local but also special provider interests are at stake.

Medicare Payment Changes
The legislation includes a number of new Medicare benefits mentioned in my first post. It also makes significant reductions in payment updates or changes in payment methodologies for some providers, as well as a $154 billion reduction in Medicare Advantage rates over 10 years as they are brought back in line with traditional Medicare payments. Finally, it salves a wound that has been troubling Democrats since the Medicare Modernization Act passed in 2003, finally giving HHS the power to negotiate prices with pharmaceutical companies for Part D drugs (although the CBO does not credit this provision with any program savings.)

Prevention And Wellness Initiatives
Contained within the bill are also a number of prevention and wellness initiatives. The legislation would improve coverage and remove cost-sharing barriers to access for clinical preventive services in Medicare, Medicaid, and private insurance plans. $15.4 billion is appropriated for the next five years to fund task forces on clinical and community prevention services, prevention and wellness research, research on incentivizing healthy behaviors, and community prevention and wellness service grants.

HR 3962 contains a number of provisions addressing the needs of special populations. Several programs are included to improve Medicare services in rural areas. Other provisions are intended to provide Medicare payment for culturally and linguistically appropriate services and improve access to care for beneficiaries with limited English proficiency. The final 350 pages of the bill involve improvements of the health care services provided to Native Americans. Grants would also be provided for school-based and nurse-managed health centers.

Transparency In Industry Payments To Providers

The legislation would establish a comprehensive program for reporting,

• financial relationships with or payments (including gifts in excess of $5 in value) by,
• manufacturers and distributors of drugs, devices, biologics, or medical supplies,
• that are paid for by Medicare, Medicaid, or CHIP,
• to physicians, other health care professionals and researchers, patient advocacy groups, CME programs, or health care institutions

to a publicly searchable database. Physician ownership of hospitals and other health care facilities would also be reportable. This provision follows up on recommendations by MedPAC and the Institute of Medicine earlier this year, and is even more comprehensive than comparable provisions in the Senate Finance bill.

Workforce Initiatives
The bill would further enact important workforce initiatives. National Health Service Corps loan repayment benefits are increased. Indirect and direct medical education payments are extended for training residents in nonprovider settings. New programs are established to encourage training in primary care, dentistry, public health, nursing, cultural and linguistic competence, and interdisciplinary care, as well as for training students from disadvantaged backgrounds. Several of the workforce initiatives would go into effect immediately in hopes of having an expanded primary care workforce beginning to come on line as health coverage is expanded when most of the reforms come into force in 2013.

Food And Drug Regulation Changes
Finally, HR 3962 makes significant changes in food and drug regulation. Chain restaurants would have to put the calorie content of foods on their menus and make other nutritional information available. Settlement agreements between brand and generic drug manufacturers that result in delaying, limiting, or preventing competition would be forbidden. Finally, a new licensure pathway would be established for biosimilars, expediting the availability of "generic" biologics. These last two reforms have been under discussion for years and should lower the cost of therapies involving drugs and biologics.

Little of this will make the newspapers, evening news, or leading news websites. Nevertheless, many of these provisions will have a profound effect on health care throughout the United States. Some provisions could in fact work revolutionary changes, although others will come to be regarded as fads or narrow special interest legislation. But, in combination, they represent the most massive change in the American health care system in the past four decades. Only time will tell how many make it through the House, conference committee, and votes in both houses to the President's desk, and are actually implemented without being repealed.

 

[chessknt]

Ok I was being dramatic, it attempts to address costs. It ignores the insane array of benefits medicare patients get and the problems/costs associated with medical advancement=the crux of our growing healthcare costs. Instead it targets Medicare advantage. If that passes, it will be disasterous for hospitals since medicare advantage is the biggest thing keeping many of them afloat on their 3-10% margins. The bill also intentionally ignored fixing the 25% cut scheduled in medicare reimbursement because it would have added an extra 250-300B to the bill.

If it was actually concerned about healthcare costs it would have attacked at least one of these enormous issues. The problem is that next year is an election year and all of these issues are politically treacherous. Why do you think Pelosi refused to allow the single payer amendment to be voted on even though she promised to do so? Because it would have made people look bad!

These are all gimmicks, nobody in DC has the spine to address the real problems with healthcare because the voting elderly will destroy them.

 

[HappySlappy]

Now imagine if you HAD to pay for it because the govt would penalize you if you didnt.

Thats what will be reality if (by some miracle) the House bill becomes law. The House bill does absolutely nothing to control costs/share risk, it just covers more people with pretend insurance that has the same extremely limited access as medicare. This means that everyone's premiums have to go up to pay for these new people (unless the govt taxes something/someone).

It is wreckless and stupid to introduce millions of people into an already strained system (without expanding it/having anywhere for these people to go) and promise them high quality care, then not implement limitations on usage/costs. Yet this is what they decided to do.

Aaaaaaaaand 1 more. You're neglecting to inform this poster that,yes, he has to pay a tax between 1.5-12% of his income if he remains uninsured (depending on how much he makes, the more you make the more of your income you will have to pay if you're uninsured the less you make the closer to the 1.5% it is), but when they're already doing everything in their power to make it affordable and to even give subsidies if you cannot afford it, why would anyone choose not to be insured after this?

And so you admit this is an already strained system? Then what do we do about it? Nothing? Because it's only going to keep getting worse as the time goes on. Keeping things the way they are is going to financially ruin our nation, so imo we have to do something about it (aside from my belief that it will help the uninsured, it will also prevent us from heading towards a financial meltdown with medical care).

 

[Parts Unknown]

Ok I was being dramatic, it attempts to address costs.

Thank you for acknowledging what the bill actually says rather than your supposition of what it says.

It ignores the insane array of benefits medicare patients get and the problems/costs associated with medical advancement=the crux of our growing healthcare costs.

Did you read the first three paragraphs I quoted?

"Accountable care organizations, bundled payments for hospitals and physicians, medical homes, incentives to reduce hospital readmissions, increasing payments for primary care, quality and efficiency incentives for Medicare Advantage plans, comparative effectiveness research, promotion of shared decision-making, gainsharing, reporting on infections acquired in hospitals and ambulatory surgical centers, and more—it is all in there."

 

[chessknt]

Here you go:

"With the exception of the proposed reductions in Medicare payment updates for institutional providers, the provisions of H.R. 3962 would not have a significant impact on future health care cost growth rates. In addition, the longer-term viability of the Medicare update reductions is doubtful"

CMS Actuary report

http://republicans.waysandmeans.hou..._Financial_Impact_of_H_R__3962__11-13-09_.pdf

Its all gimmicks, dont be fooled. The AARP wouldn't have supported a bill that did anything to hurt their legion of members.

 

[Pianoman32]

I just called the VA to ask a question about my GI bill and was placed on hold for 45 minutes (no lie); enjoy the future of medicine. Oh and I have to go to the MVA/DMV next week; I hope our federal government can run healthcare as efficiently as they have this. Everyone loves how efficient the government runs the MVA/DMV right?

 

[Parts Unknown]

I just called the VA to ask a question about my GI bill and was placed on hold for 45 minutes (no lie); enjoy the future of medicine. Oh and I have to go to the MVA/DMV next week; I hope our federal government can run healthcare as efficiently as they have this. Everyone loves how efficient the government runs the MVA/DMV right?

Could you explain how expanding insurance coverage, and therefore access to private health care providers, will result in government run medicine?

 

[Parts Unknown]

Here you go:

"With the exception of the proposed reductions in Medicare payment updates for institutional providers, the provisions of H.R. 3962 would not have a significant impact on future health care cost growth rates. In addition, the longer-term viability of the Medicare update reductions is doubtful"

CMS Actuary report

http://republicans.waysandmeans.hou..._Financial_Impact_of_H_R__3962__11-13-09_.pdf

Its all gimmicks, dont be fooled. The AARP wouldn't have supported a bill that did anything to hurt their legion of members.

Interesting report, and nice use of selective quoting. I was also struck by this one (p. 14):

"Although we believe that these estimates are reasonable and fairly portray the likely future effects of this comprehensive package of health care reforms, they are subject to much greater uncertainty than normal."

The simple fact is that guesses as to the effect of the legislation are just that: guesses. The only certainty is that the status quo is unsustainable. That is why I'm pleased to see so many complimentary reform efforts included in the bill. We won't know which ones will work, and how much, until we try.

Also, I don't know how old you were in 2003, but the AARP most certainly hung itself out for the passage of Medicare Part D. Their rationale was that imperfect legislation was better than none at all, and it would be easier to amend the prescription drug coverage in coming years than start over from scratch.

 

[Parts Unknown]

The bill also intentionally ignored fixing the 25% cut scheduled in medicare reimbursement because it would have added an extra 250-300B to the bill.

It's 21%, and that issue was taken up in H.R.3961.

 

[strummin]

Everyone loves how efficient the government runs the MVA/DMV right?

Actually, I'm pretty satisfied with the way the DMV is run. Besides the occasional rude employee, I've had no problems with them. I'm also happy with our military, I'm happy with the police and the fire department for keeping me safe, the post office, the roads, the bridges etc... wait, does this make me a socialist?

 

[CoffeeCzar]

Could you explain how expanding insurance coverage, and therefore access to private health care providers, will result in government run medicine?

I would argue that we already have an (economically) facist system that is essentially run by the government (liscensing, FDA, regulations, Medicare, Medicaid, SCHIP) but still somewhat (a little more than 50%) administered by private companies. This is a large part of the reason why it doesn't work.

Subsidizing coverage to expand access will only make the problem worse unless the fundamental problems with the market are addressed, which they aren't in this bill. So when the system finally nears collapse when this bill fails to solve health care price inflation, the government will step in and take total control of it. While maybe not how you imagined, this bill will one way or another lead to larger government intervention into the most regulated sector of the economy as it is.

Like Axelrod said, never let a crisis go to waste.

 

[CoffeeCzar]

Also, I don't know how old you were in 2003, but the AARP most certainly hung itself out for the passage of Medicare Part D. Their rationale was that imperfect legislation was better than none at all, and it would be easier to amend the prescription drug coverage in coming years than start over from scratch.

Great point. The problem with further injecting politics into health care is it can be almost impossible to reform government run systems. Do you think if these coverage subsidies don't work, they will ever repeal them? Do you think if the public option doesn't work, it will ever be repealed? Of course not. You don't get elected by taking things away, you always get elected by promising something for nothing.

 

[wanderer]

Actually, I'm pretty satisfied with the way the DMV is run. Besides the occasional rude employee, I've had no problems with them. I'm also happy with our military, I'm happy with the police and the fire department for keeping me safe, the post office, the roads, the bridges etc... wait, does this make me a socialist?

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

 

[Pianoman32]

Actually, I'm pretty satisfied with the way the DMV is run. Besides the occasional rude employee, I've had no problems with them. I'm also happy with our military, I'm happy with the police and the fire department for keeping me safe, the post office, the roads, the bridges etc... wait, does this make me a socialist?

Not a socialist, just stupid.

You are not happy with the military, you are happy with our selfless serving troops. Anyone who has been in the military will tell you that it is run horribly. There is way too much micro management and hurry up and wait BS which leads to large amounts of unnecessary waste. You will find it is a system with one private mopping the floor and three sergeants standing around making sure he does the job right.

And how can be happy with how our police department has been run? We spend more money than any nation and have the least to show for it. We have the highest rates of violence, drug abuse, prostitution, theft, etc. in the world. Explain to me how our government has not let us down? I have the utmost respect for anyone serving in a uniform, but by and large the individuals who aren't doing the grunt work, ie the paper pushers, have largely let individuals in uniform down as well as the general public.

 

[chessknt]

Interesting report, and nice use of selective quoting. I was also struck by this one (p. 14):

"Although we believe that these estimates are reasonable and fairly portray the likely future effects of this comprehensive package of health care reforms, they are subject to much greater uncertainty than normal."

The simple fact is that guesses as to the effect of the legislation are just that: guesses. The only certainty is that the status quo is unsustainable. That is why I'm pleased to see so many complimentary reform efforts included in the bill. We won't know which ones will work, and how much, until we try.

You have to admit that is a pretty weak counterargument. This is a neutral government organization that performed a detailed actuarial analysis. Obviously it wont be correct to the cent and they need to put that disclaimer in so they cant get sued, but I wouldn't just automatically disqualify it simply because they can't be 100% certain. Do you honestly believe that 10 years from now the %GDP being spent on healthcare will be LOWER than predicted? Can you give any example where the government over-predicted costs (besides the medicare drug costs, which were lower than expected because *gasp* competition was allowed to occur among drug companies)?

The data are more or less what was expected by people who understand healthcare costs. This bill isnt about costs, it's about access (the CMS report and a multitude of another number-based analyses support this). The funny thing is that the uninsured % has been pretty constant for decades (until the recent recession anyways), whereas the costs have been skyrocketing. We dont need an emergency pet prototype bill to fix access, we need to fix costs. The political appeal of accomplishing that is far less than the appeal to "social justice," so, as always, they took the easy and pointless road instead of the one their country needed them to take.

I never said the medicare paycuts werent being addressed, just that they werent included in the House bill. Care to wager a guess on why they purposefully excised physician pay schedule reform from a HEALTH CARE bill?

 

[burnzee06]

Now imagine if you HAD to pay for it because the govt would penalize you if you didnt.

Thats what will be reality if (by some miracle) the House bill becomes law. The House bill does absolutely nothing to control costs/share risk, it just covers more people with pretend insurance that has the same extremely limited access as medicare. This means that everyone's premiums have to go up to pay for these new people (unless the govt taxes something/someone).

It is wreckless and stupid to introduce millions of people into an already strained system (without expanding it/having anywhere for these people to go) and promise them high quality care, then not implement limitations on usage/costs. Yet this is what they decided to do.

There are obvious problems with our current healthcare system if the cost to insure a perfectly healthy 21 year old female is $370/month. I believe this current system will not work effectively for much longer as employers cannot continue to afford to insure their employees, resulting in more having to seek their own sub-par insurance. While I may be "forced" to participate in a healthcare plan I also expect overall costs will go down.

Optimistic? Yes, of course. But anything new is probably going to be better than what we had now. I doubt many of you see the effects of health insurance costs because either your parents deal with it or your potential employer will pay for it. But as someone who has the possibility to own and operate a practice, I really don't want health insurance to break the bank.

 

[chessknt]

Aaaaaaaaand 1 more. You're neglecting to inform this poster that,yes, he has to pay a tax between 1.5-12% of his income if he remains uninsured (depending on how much he makes, the more you make the more of your income you will have to pay if you're uninsured the less you make the closer to the 1.5% it is), but when they're already doing everything in their power to make it affordable and to even give subsidies if you cannot afford it, why would anyone choose not to be insured after this?

And so you admit this is an already strained system? Then what do we do about it? Nothing? Because it's only going to keep getting worse as the time goes on. Keeping things the way they are is going to financially ruin our nation, so imo we have to do something about it (aside from my belief that it will help the uninsured, it will also prevent us from heading towards a financial meltdown with medical care).

Ah I missed this. To answer the final question (since I think my other post clearly indicated that this bill does nothing to avert financial crisis), I instead ask you this: How important is the freedom of choice to Americans?

This bill forces you to buy health insurance or be penalized otherwise, essentially asserting control over a portion of your discretionary income. Its a small control, maybe even a necessary one you might argue, but it's small sacrifices like this that can lead to total socialistic control over income and personal freedoms. Id rather not take that chance.

 

[chessknt]

There are obvious problems with our current healthcare system if the cost to insure a perfectly healthy 21 year old female is $370/month. I believe this current system will not work effectively for much longer as employers cannot continue to afford to insure their employees, resulting in more having to seek their own sub-par insurance. While I may be "forced" to participate in a healthcare plan I also expect overall costs will go down.

Optimistic? Yes, of course. But anything new is probably going to be better than what we had now. I doubt many of you see the effects of health insurance costs because either your parents deal with it or your potential employer will pay for it. But as someone who has the possibility to own and operate a practice, I really don't want health insurance to break the bank.

Everyone agrees that the current system wont work for much longer. Congress has decided to ignore this issue and expand coverage to people through an impotent public option (that has to negotiate with providers=government-run private option). This isn't going to fix anything....

 

[burnzee06]

Everyone agrees that the current system wont work for much longer. Congress has decided to ignore this issue and expand coverage to people through an impotent public option (that has to negotiate with providers=government-run private option). This isn't going to fix anything....

I disagree. It is my opinion that those making the changes to our health care system are doing the best with what they have to work with. There are so many parameters that attribute to health care from working with insurance company middle-men to dealing with the baby-boomer generation. Of course the new plan is far from perfect but, like I said, it's better than what we have now. I think we all are ignorant of many of the details to the point where only a small number can actually make an informed decision on this issue.

 

[chessknt]

Did you see the CMS report?

This kind of blind belief that Congress will somehow improve things because they cant get any worse is unbelievably irresponsible. If you feel under-informed, go out and look for information from reliable unbiased sources (like actuaries at CMS or the CBO).

Congress doesnt know what its doing either because only a select few actually understand how healthcare works (and they are supposed to be on the committees that oversee the bills conception, haha). The rest have political agendas that primarily focus on easy to understand/impossible to disprove social issues (denying illegals care, abortion funds, etc.). For those of us who prefer to operate in a more black/white world, the numbers are pretty clear--this bill isnt going to change anything from a cost perspective. You can hope/believe all you want, but understand that you are essentially prescribing to a religion where the government is your deity.

 

[burnzee06]

Did you see the CMS report?

This kind of blind belief that Congress will somehow improve things because they cant get any worse is unbelievably irresponsible. If you feel under-informed, go out and look for information from reliable unbiased sources (like actuaries at CMS or the CBO).

Congress doesnt know what its doing either because only a select few actually understand how healthcare works (and they are supposed to be on the committees that oversee the bills conception, haha). The rest have political agendas that primarily focus on easy to understand/impossible to disprove social issues (denying illegals care, abortion funds, etc.). For those of us who prefer to operate in a more black/white world, the numbers are pretty clear--this bill isnt going to change anything from a cost perspective. You can hope/believe all you want, but understand that you are essentially prescribing to a religion where the government is your deity.

But what it will change: more Americans with health insurance coverage. It's unbelievably irresponsible to approach this topic from solely a cost perspective. Of course, that's my opinion.

 

[strummin]

You are not happy with the military, you are happy with our selfless serving troops. Anyone who has been in the military will tell you that it is run horribly. There is way too much micro management and hurry up and wait BS which leads to large amounts of unnecessary waste. You will find it is a system with one private mopping the floor and three sergeants standing around making sure he does the job right.

Oh okay, shall we privatize the military too? After all, the stupid government can't run anything, can it? (Of course it can't.. these "patriotic" Republicans won't trust it in running anything). And as for the police, yeah they're not perfect, but they're MUCH better than in most other countries - I'm assuming you haven't lived in a South American/African/East Asian country. See http://www.transparency.org/policy_research/surveys_indices/cpi/2009/cpi_2009_table - We're actually the 19th least corrupt country in the world! That's not too bad, I think.

 

[Slack3r]

Oh okay, shall we privatize the military too? After all, the stupid government can't run anything, can it? (Of course it can't.. these "patriotic" Republicans won't trust it in running anything). And as for the police, yeah they're not perfect, but they're MUCH better than in most other countries - I'm assuming you haven't lived in a South American/African/East Asian country. See http://www.transparency.org/policy_research/surveys_indices/cpi/2009/cpi_2009_table - We're actually the 19th least corrupt country in the world! That's not too bad, I think.

Why the double standard? If we spend so much on healthcare and have such horrible outcomes/access, then by god we need change and we need it now! Yet when confronted with the fact that our large police budget does little to decrease crime (compared to other countries), you're content with accepting 19th most corrupt as "pretty good"?

 

[CoffeeCzar]

Oh okay, shall we privatize the military too? After all, the stupid government can't run anything, can it? (Of course it can't.. these "patriotic" Republicans won't trust it in running anything). And as for the police, yeah they're not perfect, but they're MUCH better than in most other countries - I'm assuming you haven't lived in a South American/African/East Asian country. See http://www.transparency.org/policy_research/surveys_indices/cpi/2009/cpi_2009_table - We're actually the 19th least corrupt country in the world! That's not too bad, I think.

To be fair, there is a difference between constitutionally mandated powers of government, like the military, versus ones that require a questionable interpretation of the powers of congress to regulate interstate commerce, like health care.

Not to mention I don't think anyone is calling for the privatizing of military and police forces. These are things I think we can all agree government dose well. Running the health care industry, however, is another story.

 

[CoffeeCzar]

Could you refresh my memory as to those three times? Thanks.

I would assume he is referring to Medicare, Medicaid and SCHIP. Medicare is a single-payer system for everyone over 65. In my opinion, it is a pretty good example how a single-payer system would run in America, minus the fact the population they cover is the most expensive to insure.

 

[FIREitUP]

I would assume he is referring to Medicare, Medicaid and SCHIP. Medicare is a single-payer system for everyone over 65. In my opinion, it is a pretty good example how a single-payer system would run in America, minus the fact the population they cover is the most expensive to insure.

medicare sucks. they deny claims like no other, they are run by a third party that makes it more difficult to get reimbursed, they are behind in paying physicians are completely and utterly underfunded, they pay very little.

EPIC FAIL. I agree that a single payer system would be more efficient, but this government wants a quick fix for everything, not a comprehensive solution that addresses all the issues of contemporary health care.

 

[Parts Unknown]

You have to admit that is a pretty weak counterargument. This is a neutral government organization that performed a detailed actuarial analysis.

I don't think a common sense argument based on this neutral government organization's own lack of certitude is weak. From page 4:

"The actual future impacts of H.R. 3962 on health expenditures, insured status, individual decisions, and employer behavior are very uncertain. The legislation would result in numerous changes in the way that health care insurance is provided and paid for in the U.S., and the scope and magnitude of these changes are such that few precedents exist for use in estimation. Consequently, the estimates presented here are subject to a substantially greater degree of uncertainty than is usually the case with more routine health care proposals."

That's not your standard disclaimer. Still, I do not discount their analysis, I merely see it's limitations.

Can you give any example where the government over-predicted costs

The Human Genome Project. Came in ahead of schedule, too boot.

Government has actually been successful in addressing Medicare costs in the past. The two landmark events were probably 1982-83, when they switched to prospective payment, and 1997, when Clinton and Gingrich hammered out a compromise to balance the budget. I see the current 1,600 pages of proposed reform as just another milestone in an endless series of policy revisions.

I never said the medicare paycuts werent being addressed, just that they werent included in the House bill. Care to wager a guess on why they purposefully excised physician pay schedule reform from a HEALTH CARE bill?

A paranoid individual would say it's to affect the bottom line of H.R. 3862. A slightly more reasonable individual would say it's to ensure repeal of the SGR formula regardless of the fate of H.R. 3962.

 

[chessknt]

Dean of Harvard med's stance: http://online.wsj.com/article/SB20001424052748704431804574539581994054014.html?mod=djemITP

Specifically:

In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it. Likewise, nearly all agree that the legislation would do little or nothing to improve quality or change health-care's dysfunctional delivery system.

You should check out the history of the human genome project a little closer. A fierce competition with a private company that wanted to trademark the entire thing drove it forward at blinding speed so it could be public knowledge instead of charge-for-use. I think, if anything, that supports capitalism/competition instead of single payer/govt involvement.

Do you have any other examples more along the lines of public services?

 

[Parts Unknown]

You should check out the history of the human genome project a little closer. A fierce competition with a private company that wanted to trademark the entire thing drove it forward at blinding speed so it could be public knowledge instead of charge-for-use. I think, if anything, that supports capitalism/competition instead of single payer/govt involvement.

You wanted an example, you got one.

Do you have any other examples more along the lines of public services?

You're the one who made the claim, so it's up to you to back it up. I do think it would be an excellent use of your time to perform a dry, objective analysis of as many randomly selected government spending projects as possible, contrasting projected versus actual outlays.

 

[Parts Unknown]

You should check out the history of the human genome project a little closer. A fierce competition with a private company that wanted to trademark the entire thing drove it forward at blinding speed so it could be public knowledge instead of charge-for-use. I think, if anything, that supports capitalism/competition instead of single payer/govt involvement.

P.S. I was getting my PhD in molecular biology when the genome project was still ongoing, and it was both ahead of schedule and under budget before the trademark issue arose.

 

[7starmantis]

Could you refresh my memory as to those three times? Thanks.

Hawaii tried and had it go bankrupt having to stop within a year only covering children (I think like 8 months). Tennessee tried (started like 1994) and found it unsustainable (RCP article on Tencare). Romney Care tried in Mass. is the closest to success but still a terrible failure by nearly all accounts (NY Times article on strained care because of it, haven't read the article myself yet).

Bottom line here is that anyone who thinks government can handle healthcare without drastic reductions in ... well everything positive about our healthcare system, is either lying to themselves or terribly naive. Government and bureaucracies by nature rely on and must meet budgets. When an annual budget is met, what happens? Apply that to healthcare and you get Canada (as well as all other government run healthcare systems) refusing screenings and vaccinations, and "non-emergent" care because of budget restraints. Here is an article about he Canadian Medical Association saying its unsustainable. People are not getting screenings early because its too expensive. Thats killing people and its coming here (to the US).

Think its not, it already has.....
New US Preventative Services Task Force guidelines now trying to say routine breast cancer screenings shouldn't be performed until age 50 (not 40 as it has been). Also says women should not perform self exams. The American Cancer Society disagrees by the way. Its not worth the money to perform the exams on women 41-49 to save 1 life, but is for women over 50. Get used to it if your supporting the public options.

 

[Parts Unknown]

Hawaii tried and had it go bankrupt having to stop within a year only covering children (I think like 8 months). Tennessee tried (started like 1994) and found it unsustainable (RCP article on Tencare). Romney Care tried in Mass. is the closest to success but still a terrible failure by nearly all accounts (NY Times article on strained care because of it, haven't read the article myself yet).

Meh, none of those are good examples of single payer. Hawaii's was especially laughable, since all they had to do was exclude new enrollment from children already covered.

TennCare was an attempt to provide coverage using 12 private HMO's. It failed, but perhaps TennCareII will fare better.

Massachusetts has virtually nothing to do with single payer. It essentially combined a mandate with subsidies for the purchase of private health insurance.

Think its not, it already has.....
New US Preventative Services Task Force guidelines now trying to say routine breast cancer screenings shouldn't be performed until age 50 (not 40 as it has been). Also says women should not perform self exams. The American Cancer Society disagrees by the way. Its not worth the money to perform the exams on women 41-49 to save 1 life, but is for women over 50. Get used to it if your supporting the public options.

New thread.

 

[7starmantis]

Meh, none of those are good examples of single payer. Hawaii's was especially laughable, since all they had to do was exclude new enrollment from children already covered.

TennCare was an attempt to provide coverage using 12 private HMO's. It failed, but perhaps TennCareII will fare better.

Massachusetts has virtually nothing to do with single payer. It essentially combined a mandate with subsidies for the purchase of private health insurance.

lol Not Quite. Your either uninformed or terribly committed to the "public option" talking points. Your facts are incorrect. Your statement about Hawaii is not only wrong but fantastical. They tried very hard to correct that very issue and still failed. Tencare was designed to avoid the fee-for-service model you guys hate....failed as well. They are all examples of single payer (you offered no source to prove otherwise) but even if not, they are factual examples of the public option in practice. With a campaign promise to learn from passed failed policy, Obama should be trying to avoid some of the same problems....sadly, he's not. They were each designed to be budget neutral and lower health care costs.....um sound familiar? They failed to do either.

You didn't however seem to address the issue of budgeting healthcare.

New thread.

I'm not trying to discuss the issue, simply providing proof of how government budgets and healthcare interact with one another....poorly.

 

[Parts Unknown]

They are all examples of single payer (you offered no source to prove otherwise) but even if not, they are factual examples of the public option in practice.

You have provided no evidence that they are single payer, and the onus is on you. Please spare no detail.

As for being examples of the public option, it strains me to even imagine how you are conceptualizing this. As discussed on this thread, the public option is simply a premium-funded insurance pool administered by the government.

If I'm not mistaken, Hawaii was tax-funded, and thus the enrollees had no financial stake in their care.

Tennessee's example was funded by Medicaid money, and has the same basic problem seen in Hawaii.

Massachusetts, again, utilizes private insurers with some public dollars. If anything, the lesson there is that an insurance mandate will result in a bonanza for these companies.

If you want a real example of the public option, examine a private, non-profit health insurance company. That's as close as you're going to get.

 

[7starmantis]

You have provided no evidence that they are single payer, and the onus is on you. Please spare no detail.

I love when the "onus" argument comes out. lol My point doesn't hinge on them being single payer, so believe what you will.

As for being examples of the public option, it strains me to even imagine how you are conceptualizing this. As discussed on this thread, the public option is simply a premium-funded insurance pool administered by the government.

If I'm not mistaken, Hawaii was tax-funded, and thus the enrollees had no financial stake in their care.

Tennessee's example was funded by Medicaid money, and has the same basic problem seen in Hawaii.

Massachusetts, again, utilizes private insurers with some public dollars. If anything, the lesson there is that an insurance mandate will result in a bonanza for these companies.

If you want a real example of the public option, examine a private, non-profit health insurance company. That's as close as you're going to get.

I'm sorry, but your naïveté is showing here. Premium-funded is laughable. Sorry, just not correct or feasible. Plus, we are looking at a mandate in the current bills. We can try really hard to overlook practicing examples of public options in healthcare or we can learn from our mistakes. But that would require honest discourse and research of all examples. These examples have failed and we are using the same theory and ideas in our new bills. Sad really.

 

[Slack3r]

 

[CoffeeCzar]

How can anyone actually argue that the public option, in its current form, will completely solve all our health care problems and everything will be just peachy. My guess is, if it passes, it will be the first foot in the door to a single-payer system. Premiums will continue to increase over time because the fundamental problems in our system are not addressed in the current health care bill. As premiums rise to a point where virtually no one can afford coverage, Congress will call it a crisis caused by greedy insurance companies and private sector profits and will then use the public option and government coercion to undercut all the "private" insurers left in the system. Since the premiums it collects will not cover the costs, it will be deemed "to big to fail" and it will get a bailout. Eventually, we will have a two-tired system where the majority of America is on the government plan and the wealthy elite who can afford it will buy private insurance from the few companies that will be left in the market.

If this bill passes, I would guess that 20 years out we will be a largely single-payer system. It really wont be possible to turn back. I think many people on both sides of the aisle agree with this conclusion.

 

[Parts Unknown]

I love when the "onus" argument comes out.

Translation: I cannot substantiate my claim, would you like some smoke, instead?

I'm sorry, but your naïveté is showing here. Premium-funded is laughable.

Why? If they law states the public option will be funded by premiums, am I naive for believing in the rule of said law?

 

[Parts Unknown]

If this bill passes, I would guess that 20 years out we will be a largely single-payer system.

The same argument was waged over the creation of Medicare, and they haven't budged the age of eligibility one minute in 40 years.

The simple fact of the matter is that the public may not like private insurers, but it does like private insurance, and the public is electing the politicians and footing the bill for the whole enterprise. IMHO the worst case is that we end up like Switzerland or Australia.

 

[chessknt]

Although trying to argue with you is pointless, I would like to point out that 40 years ago people in this country hated socialism and the politicians from that age had lived/served during the cold war. The lessons of the dangers of government economic controls have seemingly been forgotten today, as can be seen by the left's insistence that government control is not only the best option for healthcare, but the only one.

So it is very naive to think that the public option isnt the left's foot in the door to socialized medicine just because medicare didnt evolve into it.

 

[Parts Unknown]

The lessons of the dangers of government economic controls have seemingly been forgotten today,

So we're down to straw men, but okay. Government control hasn't been cool since Reagan uttered the nine most terrifying words in the English language. In recent history, one need look no further than the Commodity Futures Modernization Act that deregulated the over-the-counter derivatives market.

So it is very naive to think that the public option isnt the left's foot in the door to socialized medicine just because medicare didnt evolve into it.

You are certainly welcome to your opinion.

 

[chessknt]

Many would argue that the government's bailouts of the companies that were "too big to fail" did far more harm than any individual failing. But that is a digression.

You refuse to acknowledge the fiscal reality/true goals of the bill as presented by official sources (the CBO and CMS) and reputable non-official sources (the dean of Harvard med). I dont know what the latin term for that is, but I think i'll just call it denial. So you'll excuse me if I find your faith in our government to be grounded in anything but reality.

Oh yea I forgot to give you that example of a social service the government couldn't accurately predict: Medicare.
http://reason.com/archives/1993/01/01/the-medicare-monster

The cost of Medicare is a good place to begin. At its start, in 1966, Medicare cost $3 billion. The House Ways and Means Committee estimated that Medicare would cost only about $ 12 billion by 1990 (a figure that included an allowance for inflation). This was a supposedly "conservative" estimate. But in 1990 Medicare actually cost $107 billion.

Oops?

 

[CoffeeCzar]

The same argument was waged over the creation of Medicare, and they haven't budged the age of eligibility one minute in 40 years.

The simple fact of the matter is that the public may not like private insurers, but it does like private insurance, and the public is electing the politicians and footing the bill for the whole enterprise. IMHO the worst case is that we end up like Switzerland or Australia.

You do make a good point. If this bill passes, private insurers will essentially become public utilities since the benefits and prices will be set by Health and Human Services (although benefits and prices are currently highly regulated by the states). With no other option than to offer plans that HHS approves, we have government designed health care run by private companies. This may work for a while, but when HHS decides private insurers charge too much for the benefits that they have no control over modifying, they will start to go our of business. This will be deemed a failure of private insurers to control costs and the government will step in with artificially low premiums based off its leverage and power to write regulations that benefit the government plan. The government brand will never be allowed to fail.

First of all, this bill is not law yet so you cannot judge the public option as it is currently written. Plus, laws can always be changed. You think Congress will let the public option fail if it its premiums cannot cover costs? Once you give them authority to create a public plan, that power can always be used against you depending on who is in power, Republicans or Democrats. Be careful what you wish for.

 

[Parts Unknown]

You do make a good point. If this bill passes, private insurers will essentially become public utilities since the benefits and prices will be set by Health and Human Services (although benefits and prices are currently highly regulated by the states). With no other option than to offer plans that HHS approves, we have government designed health care run by private companies. This may work for a while, but when HHS decides private insurers charge too much for the benefits that they have no control over modifying, they will start to go our of business. This will be deemed a failure of private insurers to control costs and the government will step in with artificially low premiums based off its leverage and power to write regulations that benefit the government plan. The government brand will never be allowed to fail.

Nah, there is far too much political, societal, and corporate opposition to this chain of events. But the proof of the pudding will be in the eating. Shall we check in again in, say, 2029?

First of all, this bill is not law yet so you cannot judge the public option as it is currently written.

Nor can I judge an imaginary version not yet written. This discussion has clearly centered on the House version. When the Senate version comes along we turn our attention to it. Should a public option make it into the merged bill we can certainly flog that horse for all its worth. Why the rush?

 

[Parts Unknown]

You refuse to acknowledge the fiscal reality/true goals of the bill as presented by official sources (the CBO and CMS)

Hmmm, how do you feel about the vaulted CBO's analysis of the Senate bill? 10 year deficit reduction of $130 billion, eh?

and reputable non-official sources (the dean of Harvard med).

Appeal to authority. Finding disparate opinions on health care reform is only slightly more difficult than finding PhD economists who disagree.

So you'll excuse me if I find your faith in our government to be grounded in anything but reality.

Let's not pretend we know each other.

 

[Parts Unknown]

Oops?

Precisely. Between the rampant abuse of the UCR payment system and the explosion of medical technology (which was an indirect result of the Vietnam war), Medicare got real pricey real fast. I think people of the 60's can be forgiven for the technology part.

 

[7starmantis]

If they law states the public option will be funded by premiums, am I naive for believing in the rule of said law?

Yes, absolutely

 

[chessknt]

Precisely. Between the rampant abuse of the UCR payment system and the explosion of medical technology (which was an indirect result of the Vietnam war), Medicare got real pricey real fast. I think people of the 60's can be forgiven for the technology part.

But how does this inspire your steadfast faith that they can accurately project future costs now?

As for the senate bill, I dont think its been released yet so we can't really judge it. Even if it is kickass and awesome, the funding mechanism disparity between the house and senate are so radically different (at least last I heard about it last week anyways) that this is going to get murdered in reconciliation. Hell, the House bill couldnt pass again today if it were revoted on in the house because so many dems did it as a one-time favor to Pelosi in exchange for favors for their local constituents (anyone else read that article about Obama pledging to forgive Katrina debts for the New Orleans republican who voted on it?).