Heath Care Reform– Looking at the Glass Half-Full
Rdan
(Run 75441…h/t)
Maggie Mahar writes an essay that is now cross posted at Angry Bear with the author’s permission:
Health Beat, a Project of the Century Foundation;
November 4, 2009 Heath Care Reform– Looking at the Glass Half-Full
What Has Been Accomplished; What Still Must Be Done
These days, many progressives are expressing deep disappointment with the health reform legislation now moving through Congress. Some suggest that some legislators made deals with lobbyists and let them write the bills. Others complain that both the subsidies and the penalties are too low. Still others don’t like the fact that states can “opt out” of the public insurance option, and decide not to offer Medicare E. Finally, many ask:
Why can’t everyone sign on for the public plan in 2013? Why do we have to wait until 2013? Why cn’t they roll out universal coverage next year?”
Normally, I would be among the first to critique the bills. By temperament and training, I’m both a skeptic and a critic.
But in this case, I think it is important to recognize that we cannot expect this first piece of health reform legislation to be anything but wildly imperfect. In fact, I’m impressed by the progress Washington has made in just ten months. I’ve been watching the struggle for health care reform since the early 1970s, and compared to what has happened over the past 39 years, this is mind -boggling.
I also believe that those who favor overhauling our health care system should send a strong signal to legislators: we support you for having come this far. We realize that you have three years to strengthen, change and refine the plan before rolling it out in 2013.
What Has Been Accomplished
What is astounding is that this Congress has made as much progress as it has. We may have a new administration in the White House, but we do not have a brand-new group on the Hill. The majority of our legislators are moderates; many are conservatives. Nevertheless, a sufficient number have found the will to stand up and back changes that would make health care affordable for millions of poor, working-class and middle-class Americans.
For example, under the House bill,a family of three making $32,000 a year would pay just $1,360 in annual premiums for good, comprehensive coverage; under the Senate Finance Committee bill, the same family would be asked to lay out only $2,013. Today, without reform, if that family tried to buy insurance, it would find that the average plan costs $13,500. For this household, the current legislation makes all of the difference.
Too often, the press suggests that such a family would be expected to pay $10,000 out-of-pocket to cover co-pays and deductibles. That just isn’t true. Even if the entire family were in an auto accident and racked up $200,000 in medical bills, at their income level, the House bill caps out-of-pocket expenses at $2,000 a year. Under the Senate Finance bill, the family would have to pay $4,000. Moreover, under both bills, there are no co-pays for primary care. Even private insurers cannot put a $25 dollar barrier between a family and preventive care.
Moving up the income ladder, a median-income household earning roughly $55,000 would pay premiums of $4,300 to $6,500—depending on whether the Senate Finance bill or the more generous House bill sets the terms. Without legislation, they too would face a $13,500 price tag –and that is if they could get a group rate. If they are buying insurance on their own, coverage could easily cost $16,000.
For self-employed workers, early retirees, and those who work for (or own) a small business; the legislation offers major savings. They will be able to buy coverage on the Insurance Exchange, where they would suddenly become part of a group—which makes their premiums much lower. Whether rich or poor, this is great news for anyone who works for himself, retired early (voluntarily or involuntarily), or is part of a small firm.
Granted, the legislation now on the table still doesn’t make insurance affordable for many Americans at the upper-edges of the middle-class–-or the upper-middle-class. They don’t qualify for subsidies. But, as I discuss below, the legislation does point the way to lowering their premiums. Before reform becomes a reality in 2013, I am convinced that this will happen, in part because it must. We can no longer ignore the waste, inefficiency and pure fraud in our health care system. There is absolutely no reason why we should pay so much more for health care than any other nation in the developed world.
And at least the current legislation protects these more affluent households from medical bankruptcy. No matter how much a family earns, they cannot be asked to pay more than $10,000, out of pocket, in a given year. For households that have savings and property to protect, this means that they don’t have to worry about being wiped out by a medical disaster. Even if you and your family are in that car accident that leads to $200,000 in doctors’ and hospitals bills, you will owe only $10,000. In that situation, doctors and hospitals will let you pay off your bills over time, because they know you can. You won’t be forced into bankruptcy court. This represents an enormous step forward.
In addition, under reform, private insurers will not be able to put a cap on how much they will pay out to you and your family, over the course of a year, or over a lifetime. If tragedy strikes and a child needs six or seven years of cancer treatments, your insurance will not “run out.” For some families, this one provision will mean the difference between being able to care for their child and financial ruin (coupled with the suspicion that, if they had just had more coverage, they might have been able to save their child.)
Moreover, in the very first year of reform, the public plan will offer less expensive, higher quality coverage to millions of Americans. Congressional Budget Office director Douglas Elmendorf disagrees. He has been spreading misinformation about the government plan. First he low-balls the number of Americans who will be eligible for the Insurance Exchange where they can choose between a public plan and private insurance. . He then asserts that only 20 percent of Exchange shoppers will choose the government plan while 80 percent will pick private insurance. Here Elmendorf pretends that he can read minds:
“Elmendorf goes on to argue that despite the fact that its administrative costs will be far lower, the public plan will cost more than comprehensive private insurance. This theory is based on the unfounded assumption that very few people will select the public plan , coupled with speculation that the public plan will make no effort to control costs and utilization. This makes no sense; as reform legislation makes clear, part of the purpose of the public plan is to offer higher quality care for less. (In part two of his post, I will examine Elmendorf’s guesstimates in detail.)”
For peculiar reasons that I don’t fully understand, progressives have been listening to Elmendorf’s numbers. They seem to forget his past: a student of the Dean of Conservative Economists. Elmendorf first made his mark in Washington by helping to quash the Clinton’s hopes for health care reform.
Finally, under the House and Senate reform bills, insurers will no longer be able to deny coverage, or charge a customer more, because of a pre-existing condition. If you have begun to take that idea for granted, keep in mind the Republican’s recent 11th hour proposal for reform “gives the insurance industry more leeway” as the Wall Street Journal put it yesterday (Media Matters for America blog points out the disappearance of WSJ story; “GOP Health Bill Gives Insurers More Leeway” from the paper’s website sometime last night.) Under the Republican proposal, insurers would be able to take pre-existing conditions into consideration.
House Speaker Nancy Pelosi’s “Fact Sheet” offers two examples illustrating just how easy it is for insurers to deny coverage today:
Peggy Robertson: A Colorado mother of two who was denied health coverage because she had a c-section in 2006. The insurance company told her if she got “sterilized” she would be eligible for coverage.
Christina Turner: After being sexually assaulted in Florida, Christina Turner followed her doctor’s orders and took a month’s worth of anti-AIDS medication as a precautionary measure. She never developed an HIV infection. Months later, when shopping for new health insurance coverage, Ms. Turner was repeatedly denied coverage because of the precautionary treatment she received after being raped.
In most states today, this could happen to anyone. I live in New York where we have community ratings and I don’t have to worry about pre-existing conditions. My employer provides excellent insurance, with no annual or lifetime caps, so the current reform legislation would probably have no immediate effect on my life. But, we all should recognize that the bills on the table would change the lives of millions of Americans, giving them the security that they don’t have today.
Progressives cannot let this opportunity slip through our fingers because we are so busy critiquing the legislation–and arguing with each other. Online WS Journal reports that Senate Majority Leader Harry Reid has begun to warn that the Senate may not be able to complete the legislation by the end of this year.
Given all of the criticism he has faced, Reid could be losing heart. After all, Conservatives continue to argue that legislators like Reid will be punished at the polls. Congressmen who have been pushing for reform need our encouragement. Progressives should continue to make it clear that the majority of Americans want reform– and a public option– even if the legislation is far from perfect.
2010 is an election year. Fearful of losing, some Congressmen will begin to back away from change making it critical that broad reform legislation is passed this year. Over the next three years, it can be amended as the critical details are fleshed out. Anyone who thought that Congress would be able to overhaul a $2.6 trillion dollar industry with just one bill was, I submit, terribly naïve.
What Remains To Be Done In the Next Three Years
There is so much to be done and this is one reason why reform cannot be implemented until 2013:
– Congress must figure out how to regulate the private insurance industry. This will require enormous cunning.
– Reformers will have to find a way to stiffen the penalties for those who choose not to buy insurance, without alienating young, healthy voters. This is a job for a charismatic president.
– Legislators must map out how the Insurance Exchange will work.
– They also will need to come up with a formula that will adjust for risk if one plan winds up with a larger share of poor and sick customers. (Some fear that this will happen to the Public Plan, so this, too, is a crucial detail.)
– Finally, and perhaps most importantly, Medicare needs time to begin eliminating waste in the system—saving billions of health care dollars while simultaneously lifting the quality of care. In fact, while all eyes are focused on the legislation, Medicare already has begun putting its own house in order.
What many reformers don’t seem to understand is when the public plan begins to negotiate fees with providers in 2013, Medicare fees for some very expensive services will be significantly lower than they are today, while reimbursements to primary care doctors will be higher.
“Medicare already has announced plans to cut fees for CT scans and MRIs next year, and has proposed trimming fees to cardiologist by 6 percent . Meanwhile, it would hike fees for primary care physicians by 4 percent. Congress has just 60 days to respond to the changes in reimbursements to doctors or they will automatically take effect January 1. Over the next three years, we can expect more changes in the fee schedule. And private insurers will follow Medicare’s lead.”
As they have explained to the Medicare Payment Advisory Commission (MedPAC), they just want Medicare to provide political cover. In other words, in 2013 the public plan will be negotiating fees with providers in a very different, less expensive, and more rational context.
This is another reason why public plan premiums will be significantly lower than Congressional Budget Office (CBO) director Douglas Elmendorf suggests.
Over the next three years, Medicare will be realigning financial incentives to reward preventive care and management of chronic diseases, while reducing payments for overly aggressive tests and treatments that have no proven benefit– and penalizing hospitals that don’t pay enough attention to medical errors. In the process, Medicare will be conserving health care dollars while protecting patients from needless risks. As President Obama has promised, Medicare cuts can make healthcare safer and more affordable for everyone—including the upper-middle class. Because most private insurers will mime Medicare’s efforts to reduce overpayment, the cost of care will come down for everyone.
The Public Plan will incorporate Medicare’s reforms and it will have clout. Seven percent of Americans purchase their own insurance in the private sector market. Most of the seven percent are neither poor nor sick. If they were, they wouldn’t be able to buy insurance in the individual market.)( More than half of this group earn over $55,000. They will be able to go into the Exchange and sign up for the public plan. In addition, a large share of relatively young Americans (ages 25-34) are uninsured and relatively healthy. No one knows how many will choose the public plan; but since it will have much lower administrative costs than private sector plans, it will be less expensive and more attractive to younger Americans.
States will not opt out. It would be too difficult for politicians to try to explain to voters why they cannot have access to a government plan that will be able to offer comprehensive insurance for less.
In part 2 of this post, I will explain what Medicare is already doing to pave the way for a structural overhaul of our health care system, and why none of these cost-saving reforms need to be –or should be–spelled out in reform legislation.
Maggie Mahar pulled together quite a post.
Let’s take a closer look at the numbers. And the costs per year.
The latest House healthcare bill expands coverage for Medicaid and CHIP for an additional 23.5 million individuals. The latest Senate healthcare bills increases coverage by an additional 15 million. Both of these initiatives substantially increase government costs.
Both bills anticipate that 16-18 million individuals will not seek (or be able to afford) healthcare insurance and will be burdened with penalty taxes. And the collected penalty taxes will be used to offset costs in the bills.
While each bill contains provisions that many embrace, it’s clear that – on the front end – healthcare costs aren’t being reduced very much. Rather, the costs are being shifted. The subsidy game puts a larger cost burden back on the federal government and, in the end, taxpayers pick up that tab.
People shouldn’t be led to believe that healthcare costs are being substantially reduced when the majority of the actions thus far involve a shifting of the insurance costs and increased access to public programs already in place. Now, it may be the case that rate negotiations will reduce premium costs in the future, but we’ve seen no evidence of that action (because it hasn’t happened yet). We have no idea whether premiums will decrease, remain flat, or increase at current rate increase levels.
For all the good that the House and Senate healthcare bills intend to accomplish, it’s important to make the distinction between cost transfer and cost reduction. We’re observing more of an exercise in healthcare cost transfer than projected cost reduction.
The Senate legislation is packing a $196 billion price tag per year by 2019 plus 8 percent cost growth per year for the decade thereafter.
CBO analysis of the latest Senate healthcare bill explains, “The gross cost of the coverage expansions, consisting of exchange subsidies, the net costs of expanded eligibility for Medicaid, and tax credits for employers: Those provisions have an estimated cost of $196 billion in 2019, and that cost is growing at about 8 percent per year toward the end of the 10-year budget window. As a rough approximation, CBO assumes continued growth at about that rate during the following decade.”
MG:
I believe Maggie to have made several points, which why I asked if we could cross post her words here.
I find it difficult to assess the true cost of anything until the bill is fleshed out which is not going to happen with the passage of the initial bill. With the skelton of a bill in place, we can begin to see the costs to “families and individuals” begin to emerge replete with a cap on out of pocket . . . something which disappeared in the eighties.
As Maggie points out now and later, I find Elmendorf to be disingenuous in his words about “any” healthcare reform and the public option. This is not a Democrat or even an Orzag who offer an independent analysis as a CBO Director. This is the first time in a decade I have seen a partisan CBO Director. The CBO today is no better than the GAO. You can quote Elmendorf’s numbers all you prefer; but, I believe them to be tainted.
Is it your position to do nothing?
Don’t know where to start. But after reading this I am more opposed to this bill than ever. Why? Let’s use Ms. Maher’s own words and data (makes it easier and we don’t argue about the ‘facts’)
1: And average family plan costs $13,500. But under the new system it now just costs $1360 or $2,013. A savings of over 85% for your family. Great. Who picks up the tab for the difference (and arguing that will come from corporate profits or savings in Fraud, Waste, and abuse is nuts.)?? Where does this money come from?
2: You cap the maximum out-of-pocket expenses to $10,000/year. So your $200,000 car accident shouldn’t force a bankruptcy. So who pays the $190,000? Is that covered by the group premiums above? Ms. Maher suggests you get to pay in installments. Ok, at what interest rate and term? $190K loan is a HOUSE payment in most of the US, except in this case it would be the equivalent of a personal loan – no collateral.
“In that situation, doctors and hospitals will let you pay off your bills over time, because they know you can. You won’t be forced into bankruptcy court. This represents an enormous step forward.” Why would not adding a $190K in debt NOT force you into bankruptcy? And how would the doctors and hospital know you can? What would change? BTW, Could you discharge the debt in a BK or is it like Government Education loans that you can’t get out from?
Oh wait, you mean this will be like the current insurance which pays 100% after the copay. Right? So what is the difference from now? You just made an outstanding argument for catastrophic health insurance and HSAs. Both are outlawed in many states and will go away under these bills.
3: “In addition, under reform, private insurers will not be able to put a cap on how much they will pay out to you and your family, over the course of a year, or over a lifetime.”
So who is covering the extra premium? Going from a risk of $1-3 million to infinity will cost something.
cont:
4: “Finally, and perhaps most importantly, Medicare needs time to begin eliminating waste in the system—saving billions of health care dollars while simultaneously lifting the quality of care.”
No one has been able to do that before, why on Earth do you think they will now? Why did this not start at least in 2006 when the Dems retook the congress? Are you really telling me Bush wouldn’t sign legislation to reduce this waste? Where was the legislation to gather up this waste before? Who covers the bill when these ‘savings’ don’t materialize as they have never been found before.
5: “As President Obama has promised, Medicare cuts can make healthcare safer and more affordable for everyone—including the upper-middle class.” He also promised to close GITMO – I wouldn’t bank anything on Obama’s word. But skip that the rest of the sentence makes even less sense. You plan to cover more people, increase that coverage, and lower the cost. So once again – who’s is paying for this? Or our magic fairies bringing gold pixie dust to everyone?
6: From MG’s post. “16-18 million individuals will not seek (or be able to afford) healthcare insurance and will be burdened with penalty taxes.”
So both bills make 16-18 million people criminals, subject to fines and jail time. Why again should I support this? Your right on the mark here: “would change the lives of millions of Americans.” By making them criminals. No thanks.
I like your emotional appeal and I could go on. But the details will hopefully kill this.
Islam will change
rdan
What did I do wrong? I just cut and pasted this comment in from Word…it looked good in preview
Don’t know where to start. But after reading this I am more opposed to this bill than ever. Why? Let’s use Ms. Maher’s own words and data (makes it easier and we don’t argue about the ‘facts’)
1: And average family plan costs $13,500. But under the new system it now just costs $1360 or $2,013. A savings of over 85% for your family. Great. Who picks up the tab for the difference (and arguing that will come from corporate profits or savings in Fraud, Waste, and abuse is nuts.)?? Where does this money come from?
2: You cap the maximum out-of-pocket expenses to $10,000/year. So your $200,000 car accident shouldn’t force a bankruptcy. So who pays the $190,000? Is that covered by the group premiums above? Ms. Maher suggests you get to pay in installments. Ok, at what interest rate and term? $190K loan is a HOUSE payment in most of the US, except in this case it would be the equivalent of a personal loan – no collateral.
“In that situation, doctors and hospitals will let you pay off your bills over time, because they know you can. You won’t be forced into bankruptcy court. This represents an enormous step forward.” Why would not adding a $190K in debt NOT force you into bankruptcy? And how would the doctors and hospital know you can? What would change? BTW, Could you discharge the debt in a BK or is it like Government Education loans that you can’t get out from?
Oh wait, you mean this will be like the current insurance which pays 100% after the copay. Right? So what is the difference from now? You just made an outstanding argument for catastrophic health insurance and HSAs. Both are outlawed in many states and will go away under these bills.
3: “In addition, under reform, private insurers will not be able to put a cap on how much they will pay out to you and your family, over the course of a year, or over a lifetime.”
So who is covering the extra premium? Going from a risk of $1-3 million to infinity will cost something.
4: “Finally, and perhaps most importantly, Medicare needs time to begin eliminating waste in the system—saving billions of health care dollars while simultaneously lifting the quality of care.”
No one has been able to do that before, why on Earth do you think they will now? Why did this not start at least in 2006 when the Dems retook the congress? Are you really telling me Bush wouldn’t sign legislation to reduce this waste? Where was the legislation to gather up this waste before? Who covers the bill when these ‘savings’ don’t materialize as they have never been found before.
5: “As President Obama has promised, Medicare cuts can make healthcare safer and more affordable for everyone—including the upper-middle class.” He also promised to close GITMO – I wouldn’t bank anything on Obama’s word. But skip that the rest of the sentence makes even less sense. You plan to cover more people, increase that coverage, and lower the cost. So once again – who’s is paying for this? Or our magic fairies bringing gold pixie dust to everyone?
6: From MG’s post. “16-18 million individuals will not seek (or be able to afford) healthcare insurance and will be burdened with penalty taxes.”
So both bills make 16-18 million people criminals, subject to fines and jail time. Why again should I support this? Your right on the mark here: “would change the lives of millions of Americans.” By making them criminals. No thanks.
I like your emotional appeal. But the details will hopefully kill this.
Islam will change
Buff:
Maggie is on vacation for a few days longer; but, I am sure she will field your questions once she returns. For the time being, you are stuck with me.
The one thing I liked about Maggie’s posts was the citing of today’s insurance costs as compared to tomorrow’s insurance costs under either the Senate or the House Healthcare plans. I have not seen this before and I believe it to answer quite a few questions which remained unanswered before about either plan. I believe Maggie has also offered a middle ground for progressives on both plans and this may be scary for those who are of a more conservative ilk (If you didn’t hear the latest news, Ben Nelson of Nebraska signed on to one of the Senate plans). She asks three basic questions, answers them, and then goes on with a dialogue on the both the Senate and House plans.
“Why can’t everyone sign on for the public plan in 2013? Why do we have to wait until 2013? Why can’t they roll out universal coverage next year?”
During the Clinton administration, there was an attempt to pass Healthcare Reform which was successfully blocked by the filibustering Repubs. I do not believe this will happen this time and there will be Universal Healthcare plus a Public Option detailed by 2013. One could very well ask the question of both you and MG for the comparison of costs then and now for private healthcare and whether the nation and the taxpayers have faired any better under private healthcare and its > than inflation increasing costs. The answer of course would be “No!” Elmendorf even then played a role in determining whether Universal Healthcare would pass. Elmendorf helped to quash the Clinton Healthcare Reform bill and he is pretty much doing the same today with his “probablys” and “typicallys” phrases littering the letter to Charles Rangel and in his public statements. Typically, the CBO Director has played a neutral role in analyzing congressional bills and budgeting and the CBO previous analysis has been taken in high regard because of their neutrality. Elmendorf hides behind the CBO’s neutrality and goes on to make a political inference not seen before.
I will ask you the same question I asked MG. Is it your stance we do nothing at this point? If so and given the past history of healthcare and healthcare insurance costs increasing at a faster rate than inflation and as exhibited since Clinton’s healthcare reform 15-16 years ago, what would you propose we do?
continued:
Buff:
The Urban Institute has taken it upon themselves to project a best case and worst case scenario for healthcare which I believe addresses the issue of doing nothing. I will C&P the key findings here:
1. In the worst-case scenario, the number of uninsured Americans would increase to 57.7 million in 2014 and to 65.7 million in 2019. In the best case the number of uninsured grows to 53.1 million in 2014 and 57.0 million in 2019. All of these estimates assume that states would continue to maintain current eligibility levels for public coverage. Without this, the number of uninsured would be even higher.
2. In all three scenarios, we see a decline in ESI coverage rates. The ESI rate would fall from 56.1 percent in 2009 to 49.2 percent in 2019 in the worst scenario and to 53.9 percent in the best case.
3. Under all three scenarios, there would be substantial increases in employer premiums
for businesses of all sizes. We estimate that employer spending on premiums would increase from $429.8 billion in 2009 to $885.1 billion in 2019 in the worst-case scenario and $740.6 billion in the best case.
4. Individual and family spending would increase significantly—from $326.4 billion in 2009 to $548.4 billion in 2019 in the worst-case scenario and to $476.2 billion in the best case.
5. Medicaid and CHIP coverage would increase substantially with enrollment increasing from 16.5 percent of the population in 2009 to 20.3 percent in 2019 in the worst-case scenario, an increase of 13.3 million more Americans covered under public programs. Even in the best case, enrollment would increase to 18.3 percent of the population.
6. Medicaid and CHIP expenditures would grow substantially both because of increased enrollment and because of higher health care costs. In the worst-case scenario, Medicaid and CHIP spending for the non-elderly would increase from $251.2 billion in 2009 to $519.7 billion in 2019. In the best case, spending would increase by 60.7 percent to $403.8 billion.
7. The cost of uncompensated care would also increase as much as 128 percent in the worst-case scenario and by 72 percent in the best case. Together with the increased spending for Medicaid and CHIP, this would inevitably mean higher taxes even without reform.
as taken from here: http://www.urban.org/uploadedpdf/411965_failure_to_enact.pdf “The Cost of Failure to Implement Healthcare Reform”
MG, Buff.
That covering 31 million more Americans is not cost free is not a surprise, the demand that this bill be deficit neutral being more political than reality based.
Many of those 16-18 million criminals are already criminals by your lights being undocumented workers who don’t file legitimate tax returns anyway and so are not exposed to those penalties to start with.
More precision please.
run75441,
It is my opinion that three separate healthcare bills should have been proposed and passed in the following order – (1) Medicare, (2) Medicaid/CHIP, and (3) other healthcare issues.
Medicare reform should have been addressed separately as the program as we know it today is not sustainable. The cost projections provided by the trustees have indicated that Medicare has to be reined in. Handle that first and let the public deal with the reality of the cost issues.
Medicaid/CHIP deserved the second level of consideration. Obviously, expanding enrollment for these two programs costs bucks. Identify the sources of such funding. Let the public deal with the reality of that issue.
Other healthcare issues are similarly important, but not as important as protecting the viability of (1) Medicare, and (2) Medicaid/CHIP. So, tackle the remaining issues in a separate bill following passage of the first two healthcare bills. If the public deems it necessary to provide financial subsidies for healthcare insurance and expand coverage to the public by other means (public option, co-ops, and whatever else), then let the debate be focused on those issues alone without dragging in consideration any changes to Medicare and Medicaid/CHIP.
Threat the issues separately and stop pretending that changes in existing public healthcare programs will help fund the new initiatives. Neither Medicare nor Medicaid/CHIP are on solid ground going forward. In my judgment, three separate bills would have forced more serious decisions by members of the Congress.
That’s what I would have done.
Bruce,
I am not sure what your complaint is regarding my first comment post. Can you be more specific?
Bruce – Glad you agree with me that we will thi sbill will cuase an increase in criminals in the 16-18 MILLION range. Great bill!
No one addressed any of my questions. Hopw about a simple one. Will I pay more for my insurance to insure illegal alliens? If so will some of that money be used to DEPORT them?
How the hell to you get costs lowered by 85%????
If this is so obviously NOT going to be anywhere near revenue neutral why are the Dems lieing about it???
And I agree with MG – why the rush? If its a great bill there should be no need to rush. Oh wait….
Islam will change