There are irreconcilable differences since the liberals foremost want a government encroachment into a large part of the private economy. Conservative republicans can’t let this happen. But the democrats have the votes, for now.
I notice the shiftng into ‘the liberals’ and the resulting slogans. Instead of this distraction, please point us into the direction of: Is there a problem(s) with the current way of doing things? If not, what are your projections ten years out of trends now for costs that should be considered worth paying?
If there are problems, what are they? and provide quantifiable data as well, and point to thoughtful responses to these problems.
If the Democrats have (solid) majorities in both houses of Congress, I don’t see how any legislation they pass could be considered as not representing the will of the people.
In my limited dealings with the health insurance industry, it is fatally flawed. Arbitrary decisions on what is covered and what is not are rampant. The fact that health insurance is tied so closely to employment in this country makes life tenuous for those making even twice the median income. Depending on one’s job situation, one prolonged health issue could lead to job loss, followed by insurance loss, followed by economic ruin.
While I don’t know much about health insurance in other countries, from what I’ve heard, the Israeli model seems quite interesting. I would love to see a single payor system here (with the opportunity to buy supplemental insurance in the market).
To me, it seems like (for all it’s flaws) health insurance should behave like education – free public schools are available to all children, while private schools provide an “education market”.
That of course does not change the fact there is some sort of divide ill defined by actions or failure to act, and politics and theater are important parts of the whole drama.
Then you should also understand that the Afghanistan and Iraq wars were the “will of the people” since their authorizations and repeated funding have been overwelmingly supported ina bi-partisan way over th eyears (continued to this day)
Ditto for the recently renewed Patriot Act.
Gald you are onboard with the will of the people….
I can’t understand how a visibly failed ideology can trump the real welfare needs of families and the economics of a nation. We should be able to reduce the costs of health care to maybe 10% of GDP and insure all people excellent health care just like other advanced nations do. There is only one way that making it impossible, that is the total corruption of our government, the fact that the corporate elite is the government. The Republicans can’t possibly believe what they are saying, it is just absurd.
Cantab, I for one can’t believe you believe what you are saying. In essence you say the private sector and nothing else counts. If it does not work it can’t and should not be changed. It is like a parent refusing to get medical help for a dying child because the bible says so.
insurance into a death spiral. He also seems to be for increased regulation of banks. Supports using global warming as an excuse to regulate industry. So whenever an issue comes up he seems always to be for expanding the reach of the government or keeping in government hands what they grasped in the past. I would call this a typical attitude of a liberal with socialist tendencies.
I think whatever we get will not be as good as it could be. But looking back and around what other advanced nations have done anything will be an improvement. The future will tell.
Rusty you can use that same logic to say that health care is not in crisis. Because those projected events are in the future. Yet in my own area of interest critics are perfectly confident projecting dollar amounts over the Infinite Future Horizon in order to inform current policy.
That sword cuts two ways.
And if push comes to shove the predictive powers of the ‘Shrill’ liberals like Krugman and Baker have been somewhat superior to those of the Chicago School and the Rubinistas who combined to agree on a Washington Consensus about the Great Moderation.
We can all agree that economists who live in Crystal Palaces should not be shooting off 155 MM Howitzers but a lot of that outgoing fire has been coming from people at little too comfortable with the miracles of Efficient Markets and Rational Economic Markets. A trap that real liberals by and large didn’t fall into.
• Is the goal comprehensive or incremental change?
This basic difference emerged at the very outset of the summit, in an exchange between Mr. Obama and Republican Sen. Lamar Alexander.
Democrats want a comprehensive approach that overhauls insurance practices, expands coverage, changes Medicare and attacks costs all at once.
Republicans don’t simply question that approach, but flatly reject it. “We’ve come to the conclusion that we don’t do comprehensive well,” Mr. Alexander said. Then, uttering the phrase that became the mantra of the day for his side, he said Republicans want to throw out the big bills already passed in favor of a “step-by-step” approach.
That’s more than a tactical difference. It’s a deep strategic disagreement. Democrats argue, as President Obama said in his closing remarks late Thursday, that “baby steps” won’t do the job. You can only change insurance rules to guarantee coverage for people with pre-existing coverage if healthier citizens are in the insurance pool to spread costs, they argue. And you can only get everybody in the insurance pool if the government requires all to have insurance of some kind. And you can only require everybody to have insurance policies if you provide government help to those with lower incomes.
Republicans counter that it’s simply too risky and expensive to make all those changes at once. So they argue for taking smaller steps: allowing insurance policies to be sold across state lines, allowing small businesses to band together into pools to buy insurance with more bargaining power, and so forth.
Democrats want to expand coverage to nearly all Americans, because they think that is a laudable societal goal and because they say the absence of universal coverage actually is driving up costs. The ranks of Americans without insurance are growing, they argue, both creating human tragedies and driving up costs as those Americans delay seeking treatment until maladies have grown far more serious and expensive to treat—at government expense. Expanding access, Democrats argue, actually will drive down costs.
Republicans essentially argue the opposite: Washington’s top goal ought to be to hold down costs first, and then rely on those lower costs to bring about expanded coverage by making it easier for people to obtain and keep coverage. Hence the argument by Republican Sen. Tom Coburn on Thursday that the government’s first steps ought to be to fight fraud and abuse in the Medicare program and stop the spread of malpractice lawsuits, both of which he said would shrink costs right away.
This area of dispute helps explain why the two parties can’t reach a consensus even on points on which they seem to agree: allowing insurance policies to be sold across state lines, and allowing individuals and small businesses to come together to form big pools to buy insurance jointly.
Throughout the long discussion, Democrats advanced their view that the government first needs to set minimum standards for policies that are sold across state lines, or are offered in big, government-organized exchanges. Otherwise, they argued, a company in one state offering cut-rate policies could lure in healthier citizens from another state, leaving behind sicker citizens who find their insurance costs skyrocketing.
Or, they argued, citizens who buy cut-rate policies will discover they aren’t really covered at all for basic procedures, which then will be paid for by others when those citizens go broke.
Republicans argued, as one might expect, that individuals and market forces are better able to sort through such choices.
Those are honest disagreements. The problem is that, in closing, Mr. Obama held out only modest hope that they can be resolved in the month or so he gave lawmakers: “I don’t know frankly whether we can close that gap,” the president said.
I’m a pretty good communicator and when i’m kidding around I think I make it very obvious so as a default position you should assume that I believe what I’m saying and that I have a sound basis for saying it. This basis generally is either one of philosphy and preference or one backed with data and facts.
In the United States we organize economic activity in the private sector. The government is limited to providing infrastructure, enforcing laws, and providing welfare to the needy. The liberals at the end of the day want to turn healthcare into a state run enterprise. This is a non starter as far as i’m conserned and if they ram it through then we need to undo what they’ve done at the earliest possible date.
I am a supporter of universal healthcare coverage. I didn’t start out thinking that way, but reached the conclusion that there is no viable financial alternative. It’s just a matter of time until healthcare costs simply overwhelm the majority of businesses and individual health insurance policyholders. That time will arrive within ten to fifteen years. That’s my basic position.
I watched over three hours of the healthcare summit yesterday.
I give the Republican participants good marks for many of the issues that they raised. Those are vaild concerns.
I think that the Democrats are biting off more than they can chew with their apparent approach to passing a final compromise bill. I have no doubt that such a bill may pass, but it may haunt the Democrats.
Why would I say that?
1. The Democrats have gotten lost along the way with regard to concerns of existing health insurance policyholders. Those concerns focus on policy costs. There is little likelihood in my judgment that passage of a bill similar to the House or Senate bill will sufficiently rein in health insurance costs. It’s just not going to happen with the existing Democrat approach. The voters will not forget this. Not now, not later.
2. The Democrats appear to have focused more concern on expanding coverage than dealing with the runaway health insurance costs. I think that’s a big mistake. To that end, they will be successful but look what happens. Medicaid enrollments will explode. Adding another 18 million or more persons to Medicaid creates a cost problem that will be difficult to manage whether at the State or Federal levels. In the end, the States will be burdened with the Medicaid expansion. Medicaid enrollment will explode once again after the next immigration bill is passed. The States will freak out over the cost obligations going forward, particularly after the Federal assistance is bled off.
3. The Democrats create supposed savings for Medicare but turn right around and obligate such savings to other healthcare programs. That doesn’t answer the mail as there will be no significant net savings.
Healthcare costs are set to spiral out of control. I see nothing that will stop that with the exception of universal healthcare coverage.
Do nothing and holding out for universal healthcare coverage will result in a far greater healthcare cost increase if nothing passes. The House can pass the Senate Manager’s Amendment and they can pass the President’s proposal. It does take an activitist President rather than one who watches from the sidelines. No one is analyzing the cost of doing nothing.
In either proposal there are the means to keep insurance premiums close to what the actual patouts are either by provisional mandate or by ratio. Medicare has the direction of allocating more money towards primary care rather than specialty care. Healthcare will follow Medicare’s lead in cutting prices. The government subsidize Advantage Program will become more expensive for those who choose to have it; but with that cut, healthcare will be able to expand and cover more people. To cover some of the cost, Obama has proposed a 2.9% tax on the god-protected-unearned-income such as capital gains and dividends which were never subject to Medicare taxes. The proposal also attacks Medicare fraud and it limits bankruptcy for those convicted of fraud. It begins to attack the pay to delay aspect of pharma infavor of generics. States have been balancing their budgets by riding on the backs of children, the elderly, schools rather than face the tough tasks of looking for ways to increase revenues. And why not, this group has the weakest voices of any of the constituency as they are no moneyed. There is more to it; but, I believe this is enough for now.
If your stance, as well as others, is Universal Healthcare or nothing; then we will never have healthcare for all people. That stance is similar to what the Repubs have been doing on healthcare and other issues in Congress.
You can buy into all of that and think that everything will be fine. I think that’s hogwash. The proposed bill is a handout to the healthcare insurance companies.
As I explained, there is little likelihood in my judgment that passage of a bill similar to the House or Senate bill will sufficiently rein in health insurance costs. That’s the bottom line. If insurance costs increase 70% instead of 100% or 125% over the next ten years, the issue is still there. Businesses and individual policyholders can’t afford cost increases that exceed say 50% over the next ten years. The problem will still be front and center as long as healthcare cost growth exceeds wage growth.
There is nothing of substance in the bills that will restrain costs from hospitals and doctors. Articles published this week lay out the cost increases being sought by hospitals. Wild numbers.
Similarly, the Medicaid problem appears to be lost on Democrats in the Congress. I think they’re tone deaf on that issue or too dumb to get it.
The Democrats failed to address and restrain all sources of healthcare cost increases in the House and Senate healthcare bills. They don’t have a plan to cover all sources. That’s the problem with their legislation.
It’s not a matter of waiting for legislation that embraces universal healthcare coverage. Rather, it’s a matter of understanding that the patchwork of legislative bills don’t solve the overall cost growth problem. There is no way to get there without universal healthcare coverage.
These legislative exercises that we’re observing are a bit of joke from a cost management perspective. Medicaid expansion will be issue that breaks the backs of State governments down the road.
I think you’re in danger of letting the perfect become the enemy of the good…or in this case the not-as-bad-as-it-would-be-without-a-bill. No one thinks this is a great piece of legislation. And yes, we’re going to spend the next 10 years fixing it and cleaning it up. But at least it’s a start and once the process has begun Republicans are going to find it very difficult to stop. And John Boehner knows it.
I agree that the bill doesn’t go near far enough to rein in costs, but it goes further than the GOP alternative, which is “do nothing” until it crashes and then blame the Democrats. And it’s not like the bill does nothing to rein in costs. It does make some relatively painless cuts in Medicare…painless that is for everyone except the crooks in the medical industry who are running Medicare scams. How many electric wheelchairs do you need? And we are looking at some kind of approach that would be more results driven. And universal coverage would increase premiums for the young and healthy, but would reduce premiums for those who are high risk simply because of bad genes and worse luck. So you should see more level costs rather than today’s practice of charging different costs to different patients for the same service. That’s an expensive way to do business. And hopefully it will encourage earlier detection. So it’s a start.
1. The government is trying to overhaul one-sixth of the economy.
A lie. The healthcare bill only involves about 1 percent of each year’s GDP. Most people will barely notice any change except perhaps slightly lower premiums in a few years.
2. By using reconciliation the Demcrats are invoking the “nuclear option.”
A lie. The “nuclear option” was not about the reconciliation rules; it was about entirely eliminating the filibuster rules for judicial appointments. And it was the Republicans who started to threaten the “nuclear option” when they were in power.
3. The Democrats are trying to overhaul healthcare through the reconciliation process and are completely bypassing the Senate’s 60 vote requirement.
Another lie. I give this one a four Pinocchio pants-on-fire rating. The healthcare bill already passed the Senate with 60 votes. So that’s already on the books. The reconciliation process is about how to find the money in the budget to fund what was already approved.
4. The Democrats aren’t acting in good faith and are steamrolling the minority.
This one also earns a WHOPPER rating. The main problem is that the Democrats wasted too much time trying to woo Republicans who have since PUBLICLY ADMITTED that they were simply stalling for time and never intended to vote for a Democratic bill even if they got everything they asked for. Now that’s bad faith.
“….. so as a default position you should assume that I believe what I’m saying and that I have a sound basis for saying it. Cantab That is an oxymoronic statement. There has been no evidence of its validity in anything you have ever said on this site.
“In the United States we organize economic activity in the private sector.” That is a gross misrepresentation of or Constitution.
” The liberals at the end of the day want to turn healthcare into a state run enterprise.” In fact the entire debate over health care reform has little to do with the actual delivery of care and is only focused on health care finance. Medicare is government’s involvement into the health care finance system. It apparently works as well or better than the private corporate system of health care finance. It costs money? So what? When did the priveate sector provide health care financing for free?
I am a supporter of universal healthcare coverage. I didn’t start out thinking that way, but reached the conclusion that there is no viable financial alternative. Here is a solution. Rather that companies buying insurance for individuals they give individuals a voucher and they go out and get insurance for themselves. This would solve the problem. What do you think?
That would only increase their costs due to lack of a purchasing pool. It sounds like a good idea, but in practice I don’t see the advantage. Besides, what purpose do insurance companies really provide vs. a single payer system?
I believe that single payer is the way to go, and if a person/family/company wants more coverage above and beyond that provided by the single payer system, then buy additional health insurance.
I expect that the U.S. will switch to single payer down the road as costs escalate.
Anything is a start, but that doesn’t mean that it will work or be cost effective on a net basis. I expect that a bill may be passed if enough votes can be pulled together in the House.
Your claim that the GOP alternative is to “do nothing” is simply false. I may not agree with the various GOP proposals, but there were many proposed bills last year. There is a proposed plan identified at the GOP healthcare web site at the present time. I have a list of the bills proposed by Republicans from Jan-Sep 2009, and I have located a source that identifies those proposed since that time.
How are the States supposed to pay for the growth in Medicaid once the Fed funds are pulled? No one appears interested in addressing that issue. The proposed expansion of Medicaid may involve supporting an additional 18-22 million persons. Big bucks. This represents the largest share of additional coverage that will be provided under the proposed healthcare bill. No one is explaining how the States are to handle this financial obligation after the Fed funds are bled off. The failure of Congressional supporters to address this matter should raise concerns. There is no question that Governors and State legislators are concerned about supporting another Federal mandate without funding support. That is what is projected to happen a few years out.
If I lived in Beverly Hills I would drop Anthem and pick up Kaiser and cut my healthcare bill. Shouldn’t everyone be doing this soft of thing across the county. This is the solution in my view of the healthcare issue.
No there wasn’t many proposals by the GOP for healthcare reform other than rape the patient. So what if we finally own up to the 18-22 million people on Medicaid. The alternative is to create jobs with benefits which the Repubs have been dismal doing. How are the states supposed to be bled off?
“Relative to the Senate bill, the President’s Proposal replaces the variable State support in the Senate bill with uniform 100% Federal support for all States for newly eligible individuals from 2014 through 2017, 95% support for 2018 and 2019, and 90% for 2020 and subsequent years.” 90% from 2020 onwards? Unless Boy George Bush the III gets in there. 2020, 10 years from now. Do you believe we will be doing better even though Wall Street bled us with their gambling. 90% from 1020 onwards which is far greter than the help they were getting to date. And the experts say . . . MG, you are being silly.
One problem with that approach is that the two, Kaiser and Anthem, provide different services. Anthem is insurance that covers private medical care. You go to a doctor and the dacotr bills Anthem. Granted that that is a gross simplification. If you’re with Kaiser you pay Kaiser a set amount each year and then yuo use their health care facilities. The two can’t readily be compared. With Anthem, or any other insurance provider as opposed to an HMO, you choose your provider. Again a simplification since insurance providers often direct the insured to stay within a participating network of medical providers. In the case of the HMO or the network of providers there is the problem of comparing the quality of care. With Kaiser if you don’t like the medical provider you’re kind of stuck with him or her. it’s tough to get a second opinion unless you go outside of the HMO and pay for it at a private provider. In the case of the insurance company’s network you have some choice, but not total freedom of choice without increasing your cost of care. it is getting a bit complicated at this point just trying to navigate the combination of health care providers and the variations in health care cost coverage. Can a lay person really read a health insurance contract and fully understand what is being offered?
That is the reason why single payer, otherwise known as universal health care coverage though they are not exactly the same concept, is so necessary. It cuts through the maze of differences from carrier to carrier. It leaves a private practice health care system in place for the insured to choose their medical care. It puts one source of payment with a universal pool to spread the risk of cost of care. That same single source of funding can better survey the prevailing cost of care and negotiate payment. The current system is too much of a hodgepodge conglomeration. Users can’t understand their coverage and that coverage is becoming far too costly.
Rustbelt, Incremental means see-saw in this country as we flip back and forth between two ideologically driven deciders. The more wacko our officials become the less likely that there will be any direction at all. The citizens will just be jerked back and forth and reform will become the dirtiest word known in this nation.
You’re correct that the President’s proposal states that information.
I don’t believe that it will stand the test of time. As the financial burdens increase, two provisions that are likely to take hits will be Federal funding for subsidies and Federal share funding for Medicaid.
Take a good look at the data regarding Medicaid enrollment and funding.
Current projects for Medicaid funding for FY2010-2020 per the President’s budget are stated as $275 271 274 293 313 337 363 390 420 453 488 (billions) which represent the projected Federal share costs absent any consideration for the proposed legislation. Enrollment in Medicaid as of June 2009 was 46.867 million persons according to Kaiser. The projected increased enrollment per the proposed bills is on the order of 18-22 million or more persons without any additional consideration for further impact resulting from passage of a subsequent immigration bill.
Increased Federal costs to support the legislative proposal should result in increased Federal costs well above $100-150 billion per fiscal year, perhaps closer to $200 billion per year or more as proposed Federal share for the increased enrollment (for newly eligible individuals) starts with 100% funding, later dropping to 90% funding for fiscal year 2020 and beyond. That excludes any consideration for additional enrollees resulting from passage of a future immigration bill.
I have no expectation that the future Congresses will retain the President’s proposal on 90-100% Federal share funding for new enrollees in Medicaid.
Prior to my husband’s retirement in August we paid about 5% of our income for our health insurance. Our employers paid more than twice what we paid. After retirement this will go to about 10% of our income and the employer will continue to pay the same until we are eligible for Medicare. When Medicare kicks in the percentage of retirement income will rise a couple of percents (I haven’t computed it). I read that other countries provide insurance in single payer systems that is just about the same percent of income as my retirement insurance cost (WITHOUT my employer’s share). I am with MG’s opinions on the health care (not the politics). I don’t think we can afford anything else except single payer.
run75441 – “No there wasn’t many proposals by the GOP for healthcare reform other than rape the patient.”
You’re going to sit there and say that you read all of the following Republican health bills? And you’re saying further almost all of the bills amounted to nothing more than rape the patient? I think you’re faking it on both accounts. Diehard Democrats and Republicans are good at echoing talking points and popping off with political sound bites.
List of Republican Health Care Solutions Proposed in the U.S. House of Representatives
Status as of September 2009: Speaker Pelosi and the Democrat majority have not considered any of the following Republican Members bills in committee or on the House floor.
H.R. 77 – The Health Care Incentive Act – Introduced: January 6, 2009 H.R. 109 – America’s Affordable Health Care Act of 2009 – Introduced: January 6, 2009 H.R. 198 – Health Care Tax Deduction Act of 2009 – Introduced: January 6, 2009 H.R. 270 – TRICARE Continuity of Coverage for National Guard and Reserve Families Act of 2009 – Introduced: January 7, 2009 H.R. 321 – SCHIP Plus Act of 2009 – Introduced: January 8, 2009 H.R. 464 – More Children, More Choices Act of 2009 – Introduced: January 13, 2009 H.R. 502 – Health Care Freedom of Choice Act – Introduced: January 14, 2009 H.R. 504 – Medicare Hearing Enhancement and Auditory Rehabilitation (HEAR) Act of 2009 – Introduced: January 14, 2009 H.R. 544 – Flexible Health Savings Act of 2009 – Introduced: January 14, 2009 H.R. 643 – Care for Life Act of 2009 – Introduced: January 22, 2009 H.R. 917 – To Increase the Health Benefits of Dependents of Members of the Armed Forces Who Die Because of a Combat-Related Injury – Introduced: February 9, 2009 H.R. 1075 – RECOVER Act (Restoring Essential Care for Our Veterans for Effective Recovery) – Introduced: February 13, 2009 H.R. 1086 – Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 – Introduced: February 13, 2009 H.R. 1118 – Health Care Choices for Seniors Act – Introduced: February 23, 2009 H.R. 1441 – Ryan Dant Health Care Opportunity Act of 2009 – Introduced: March 11, 2009 H.R. 1458 – Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2009 – Introduced: March 12, 2009 H.R. 1468 – Medical Justice Act of 2009 – Introduced: March 12, 2009 H.R. 1658 – Veterans Healthcare Commitment Act of 2009 – Introduced: March 19, 2009 H.R. 1891 – Sunset of Life Protection Act of 2009 – Introduced: April 2, 2009 H.R. 2051 – To Amend Title 10, United States Code, to Authorize Extended Benefits for Certain Autistic Dependents of Certain Retirees – Introduced: April 22, 2009 H.R. 2373 – Home Oxygen Patient Protection Act of 2009 – Introduced: May 12, 2009 H.R. 2520 – Patients’ Choice Act – Introduced: May 20, 2009 H.R. 2607 – The Small Business Health Fairness Act – Introduced: May 21, 2009 H.R. 2692 – CAH Designation Waiver Authority Act of 2009 – Introduced: June 3, 2009 H.R. xxxx – Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act – Introduced: June 6, 2009 H.R. 2784 – Partnership to Improve Seniors Access to Medicare Act – Introduced: June 10, 2009 H.R. 2785 – Health Care Paperwork Reduction and Fraud Prevention Act – Introduced: June 10, 2009 H.R. xxxx – Medical Rights & Reform Act – Introduced: June 16, 2009 H.R. 3141 – Strengthening the Health Care Safety Net Act of 2009 – Introduced: July 9, 2009 H.R. 3217 – Health Care Choice Act – Introduced: July 14, 2009 H.R. 3218 – […]
No one said that the GOP hadn’t offered alternative plans. What I actually said was that the GOP alternative was a “do nothing” approach, which is not quite the same thing as not offering up a bunch of Potemkin bills as alternatives. And “do nothing” was the alternative that the GOP leadership eventually settled on. That was their operational plan. Offering up small ball plans that are mostly sideshows is a “do nothing” policy…especially when prominent GOP leaders have already said that they would oppose the Democratic bill even if they got 100% of what they asked for. I see where you listed Sen. Grassley’s recommendations for healthcare reform. The problem is that Grassley has already said that he would oppose the bill even if it included everything that he wanted. He’s on the record of having said that. He bragged to his teabagger constituents that he was only pretending to cooperate with Democrats in order to kill the Democratic plan in order by stalling for time. He admitted and bragged about the fact that he negotiated in bad faith and now the Democrats are supposed to take his proposals seriously???
Obama said that the Democrats would consider and in some cases have already adopted some of the GOP recommendations. For example, tort reform is something that Obama said he would consider, although the academic studies and CBO’s analysis suggest that this would be a net welfare loss. But it’s not off the table as a piece of follow-on legislation. Another example, Sen. Coburn has introduced a plan that is many ways actually halfway decent. It’s probably something that many Democrats could support…hell, there are parts of it that even Paul Krugman likes! The problem is that Sen. McConnell and the GOP leadership are running away from it because they don’t want the Democratic Congress to have ANY success…even if it’s one that has a lot of GOP ideas; but yet they want to count it as a GOP alternative. And the other night there was a GOP congressman from California who admitted that he had considered introducing some proposals (which actually sounded constructive) but here again the GOP leadership (in this case John Boehner) refused to support it. Boehner put the kabosh on these recommendations. Now why is that? It’s because the GOP’s only real mission here is to set up a political defeat for Obama and the Democrats. A year ago Politico.com was telling us that, based on their insider contacts and GOP internal documents, this was the GOP plan all along. And Sen. DeMint bragged that the whole point of dragging out healthcare reform was to ensure Obama’s “Waterloo.”
You and I are on the same page when it comes to enumerating the many shortcomings in the bill. There are things that will have to be fixed. The main objective right now is to set in place the three primary legs of the healthcare stool. Part of the GOP strategy has been to propose incremental approaches that would only add one leg of the stool at a time. As just about every prominent healthcare economist has pointed out, this incrementalism is a recipe for guaranteed failure. And surely the GOP leadership knows this. Which makes you wonder why the GOP leadership wants to see failure?
I would also prefer a single payer system, but right now that’s not on the table. I also prefer grilled rare tuna steak to leftover tuna casserole, but sometimes I settle for the casserole. It’s hard enough getting Congress to support even the most timid steps towards healthcare reform let alone single payer. If we adopt single payer the next thing might be that we all become more polite and start drinking strong beer. Then what? Suddenly we’re Canada. There’s just no way that single payer goes anywhere.
Cantab, health care is as substantially a part of the infrastructure as is transportation, law and order, education and other public services. The government for the people by the people is just not limited to the protection and benefit of the few, it is responsible to all the people. We need the government to regulate health care, the private sector as is, is privatized socialism with a nice profit margin. Private insurance does use premiums from lucky healthy people to pay for the unlucky sick people with a nice profit for the corporation. Maybe calling it Turbo Capitalism is a better term.
Cantab, what should be the $$$ value of the voucher for people 65 and older with pre-existing conditions? The people the private sector does not want now and will not want in future, they must make a profit for share holders and nothing else.
I don’t agree with you. If you think that Anthem provides better service and that service is worth the extra cost then pay the price for this service. If not, and for me I don’t value service, switch and put the money in your pocket. We don’t need universial coverage. What we need is for people to make the type of decision that I described above. Perhaps rather than a company arranging for healthcare we should tinker with the tax code to say that rather than arranging healthcare for individuals companies provide a voucher to individuals for a fixed amount and they go out and buy their own healthcare. In California for me the ideal amount for this voucher would be something higher than what Kaiser charges and something lower than what Anthem charges. The failure of the democrat appoach in my view is that they don’t put the decisions at the level of the individual consumer. And we can do this regardless of the level we decide to subsidize low income people.
What’s wrong with making profit for shareholders. The muffin and coffee that I have each morning for breakfast is done for profit, the muffin is fresh and the coffee is good and I personally agree to pay the price rather than make my own muffin and coffee. I have a relationship with my muffin/coffee provider and I don’t tend to worry about his profit — since the bagel and lox guy is down the street and I can always buy a yogurt and throw some granola and blueberries in it and call it a meal. Profit it is good since it provides incentives for people to do productive things. Without profit we would be all sipping Vodka and not doing much else.
Cantab, I did not say anything is wrong to make profit for shareholders. If your coffee and muffin is unaffordable you just stop buying it. You can live without it. Health care is different, the need to recieve health care is greater than the need to make profit for shareholders. Universal or singlepayer could eliminate the shareholder issue and make health care more affordable. To rephrase my question, how many $$$ voucher does it take to make it affordable for 65 and older and likely pre-conditions? Is there any way to make it affordable for the people on the one hand and profitable for the industry on the other hand? As it is the private sector does not want to insure these people that is why we have MEDICARE in the first place. With nothing but high risk customers you just can’t make a profit. When people can’t buy what it is you are selling you can’t have a profit either.
There are irreconcilable differences since the liberals foremost want a government encroachment into a large part of the private economy. Conservative republicans can’t let this happen. But the democrats have the votes, for now.
I notice the shiftng into ‘the liberals’ and the resulting slogans. Instead of this distraction, please point us into the direction of: Is there a problem(s) with the current way of doing things? If not, what are your projections ten years out of trends now for costs that should be considered worth paying?
If there are problems, what are they? and provide quantifiable data as well, and point to thoughtful responses to these problems.
If the Democrats have (solid) majorities in both houses of Congress, I don’t see how any legislation they pass could be considered as not representing the will of the people.
In my limited dealings with the health insurance industry, it is fatally flawed. Arbitrary decisions on what is covered and what is not are rampant. The fact that health insurance is tied so closely to employment in this country makes life tenuous for those making even twice the median income. Depending on one’s job situation, one prolonged health issue could lead to job loss, followed by insurance loss, followed by economic ruin.
While I don’t know much about health insurance in other countries, from what I’ve heard, the Israeli model seems quite interesting. I would love to see a single payor system here (with the opportunity to buy supplemental insurance in the market).
To me, it seems like (for all it’s flaws) health insurance should behave like education – free public schools are available to all children, while private schools provide an “education market”.
That of course does not change the fact there is some sort of divide ill defined by actions or failure to act, and politics and theater are important parts of the whole drama.
Domer96
Then you should also understand that the Afghanistan and Iraq wars were the “will of the people” since their authorizations and repeated funding have been overwelmingly supported ina bi-partisan way over th eyears (continued to this day)
Ditto for the recently renewed Patriot Act.
Gald you are onboard with the will of the people….
Islam will change
I can’t understand how a visibly failed ideology can trump the real welfare needs of families and the economics of a nation. We should be able to reduce the costs of health care to maybe 10% of GDP and insure all people excellent health care just like other advanced nations do.
There is only one way that making it impossible, that is the total corruption of our government, the fact that the corporate elite is the government. The Republicans can’t possibly believe what they are saying, it is just absurd.
Cantab, I for one can’t believe you believe what you are saying. In essence you say the private sector and nothing else counts. If it does not work it can’t and should not be changed. It is like a parent refusing to get medical help for a dying child because the bible says so.
insurance into a death spiral. He also seems to be for increased regulation of banks. Supports using global warming as an excuse to regulate industry. So whenever an issue comes up he seems always to be for expanding the reach of the government or keeping in government hands what they grasped in the past. I would call this a typical attitude of a liberal with socialist tendencies.
I’m a little nervous that liberals (say Krugman) can so accurately predict the results of health care reform.
Given the recent failures of economists and politicians to predict events, this makes me more than a little gun shy.
Save_The_Rustbelt:
Yogi said it best: It’s tough to make predictions, especially about the future.
To me, the current state seems so wrong, anything different almost has to be an improvement by definition
I think whatever we get will not be as good as it could be. But looking back and around what other advanced nations have done anything will be an improvement. The future will tell.
And the weakly regulated financial markets recent performance seem to have validated the neo-con’s view that “the market is always right” quite well.
Rusty you can use that same logic to say that health care is not in crisis. Because those projected events are in the future. Yet in my own area of interest critics are perfectly confident projecting dollar amounts over the Infinite Future Horizon in order to inform current policy.
That sword cuts two ways.
And if push comes to shove the predictive powers of the ‘Shrill’ liberals like Krugman and Baker have been somewhat superior to those of the Chicago School and the Rubinistas who combined to agree on a Washington Consensus about the Great Moderation.
We can all agree that economists who live in Crystal Palaces should not be shooting off 155 MM Howitzers but a lot of that outgoing fire has been coming from people at little too comfortable with the miracles of Efficient Markets and Rational Economic Markets. A trap that real liberals by and large didn’t fall into.
This one got chopped up.
Recap of the health care summit
Parties’ Differences Are Clear — and That’s a Start
26 Feb 2010
http://online.wsj.com/article/SB20001424052748703795004575087833459496708.html
• Is the goal comprehensive or incremental change?
• Is access or cost the top priority?
• Should government or markets set the standards?
EXCERPT:
• Is the goal comprehensive or incremental change?
This basic difference emerged at the very outset of the summit, in an exchange between Mr. Obama and Republican Sen. Lamar Alexander.
Democrats want a comprehensive approach that overhauls insurance practices, expands coverage, changes Medicare and attacks costs all at once.
Republicans don’t simply question that approach, but flatly reject it. “We’ve come to the conclusion that we don’t do comprehensive well,” Mr. Alexander said. Then, uttering the phrase that became the mantra of the day for his side, he said Republicans want to throw out the big bills already passed in favor of a “step-by-step” approach.
That’s more than a tactical difference. It’s a deep strategic disagreement. Democrats argue, as President Obama said in his closing remarks late Thursday, that “baby steps” won’t do the job. You can only change insurance rules to guarantee coverage for people with pre-existing coverage if healthier citizens are in the insurance pool to spread costs, they argue. And you can only get everybody in the insurance pool if the government requires all to have insurance of some kind. And you can only require everybody to have insurance policies if you provide government help to those with lower incomes.
Republicans counter that it’s simply too risky and expensive to make all those changes at once. So they argue for taking smaller steps: allowing insurance policies to be sold across state lines, allowing small businesses to band together into pools to buy insurance with more bargaining power, and so forth.
EXCERPT:
• Is access or cost the top priority?
Democrats want to expand coverage to nearly all Americans, because they think that is a laudable societal goal and because they say the absence of universal coverage actually is driving up costs. The ranks of Americans without insurance are growing, they argue, both creating human tragedies and driving up costs as those Americans delay seeking treatment until maladies have grown far more serious and expensive to treat—at government expense. Expanding access, Democrats argue, actually will drive down costs.
Republicans essentially argue the opposite: Washington’s top goal ought to be to hold down costs first, and then rely on those lower costs to bring about expanded coverage by making it easier for people to obtain and keep coverage. Hence the argument by Republican Sen. Tom Coburn on Thursday that the government’s first steps ought to be to fight fraud and abuse in the Medicare program and stop the spread of malpractice lawsuits, both of which he said would shrink costs right away.
EXCERPT:
• Should government or markets set the standards?
This area of dispute helps explain why the two parties can’t reach a consensus even on points on which they seem to agree: allowing insurance policies to be sold across state lines, and allowing individuals and small businesses to come together to form big pools to buy insurance jointly.
Throughout the long discussion, Democrats advanced their view that the government first needs to set minimum standards for policies that are sold across state lines, or are offered in big, government-organized exchanges. Otherwise, they argued, a company in one state offering cut-rate policies could lure in healthier citizens from another state, leaving behind sicker citizens who find their insurance costs skyrocketing.
Or, they argued, citizens who buy cut-rate policies will discover they aren’t really covered at all for basic procedures, which then will be paid for by others when those citizens go broke.
Republicans argued, as one might expect, that individuals and market forces are better able to sort through such choices.
Those are honest disagreements. The problem is that, in closing, Mr. Obama held out only modest hope that they can be resolved in the month or so he gave lawmakers: “I don’t know frankly whether we can close that gap,” the president said.
Lysistrata,
I’m a pretty good communicator and when i’m kidding around I think I make it very obvious so as a default position you should assume that I believe what I’m saying and that I have a sound basis for saying it. This basis generally is either one of philosphy and preference or one backed with data and facts.
In the United States we organize economic activity in the private sector. The government is limited to providing infrastructure, enforcing laws, and providing welfare to the needy. The liberals at the end of the day want to turn healthcare into a state run enterprise. This is a non starter as far as i’m conserned and if they ram it through then we need to undo what they’ve done at the earliest possible date.
Now Bruce, I have never spoken against reform or in favor of the status quo.
I am more of an incrementalist that the Krugman crowd, to be sure.
And I am not in lockstep with either Chicago or the Rubinista.
I am a supporter of universal healthcare coverage. I didn’t start out thinking that way, but reached the conclusion that there is no viable financial alternative. It’s just a matter of time until healthcare costs simply overwhelm the majority of businesses and individual health insurance policyholders. That time will arrive within ten to fifteen years. That’s my basic position.
I watched over three hours of the healthcare summit yesterday.
I give the Republican participants good marks for many of the issues that they raised. Those are vaild concerns.
I think that the Democrats are biting off more than they can chew with their apparent approach to passing a final compromise bill. I have no doubt that such a bill may pass, but it may haunt the Democrats.
Why would I say that?
1. The Democrats have gotten lost along the way with regard to concerns of existing health insurance policyholders. Those concerns focus on policy costs. There is little likelihood in my judgment that passage of a bill similar to the House or Senate bill will sufficiently rein in health insurance costs. It’s just not going to happen with the existing Democrat approach. The voters will not forget this. Not now, not later.
2. The Democrats appear to have focused more concern on expanding coverage than dealing with the runaway health insurance costs. I think that’s a big mistake. To that end, they will be successful but look what happens. Medicaid enrollments will explode. Adding another 18 million or more persons to Medicaid creates a cost problem that will be difficult to manage whether at the State or Federal levels. In the end, the States will be burdened with the Medicaid expansion. Medicaid enrollment will explode once again after the next immigration bill is passed. The States will freak out over the cost obligations going forward, particularly after the Federal assistance is bled off.
3. The Democrats create supposed savings for Medicare but turn right around and obligate such savings to other healthcare programs. That doesn’t answer the mail as there will be no significant net savings.
Healthcare costs are set to spiral out of control. I see nothing that will stop that with the exception of universal healthcare coverage.
Hi MG:
Do nothing and holding out for universal healthcare coverage will result in a far greater healthcare cost increase if nothing passes. The House can pass the Senate Manager’s Amendment and they can pass the President’s proposal. It does take an activitist President rather than one who watches from the sidelines. No one is analyzing the cost of doing nothing.
In either proposal there are the means to keep insurance premiums close to what the actual patouts are either by provisional mandate or by ratio. Medicare has the direction of allocating more money towards primary care rather than specialty care. Healthcare will follow Medicare’s lead in cutting prices. The government subsidize Advantage Program will become more expensive for those who choose to have it; but with that cut, healthcare will be able to expand and cover more people. To cover some of the cost, Obama has proposed a 2.9% tax on the god-protected-unearned-income such as capital gains and dividends which were never subject to Medicare taxes. The proposal also attacks Medicare fraud and it limits bankruptcy for those convicted of fraud. It begins to attack the pay to delay aspect of pharma infavor of generics. States have been balancing their budgets by riding on the backs of children, the elderly, schools rather than face the tough tasks of looking for ways to increase revenues. And why not, this group has the weakest voices of any of the constituency as they are no moneyed. There is more to it; but, I believe this is enough for now.
If your stance, as well as others, is Universal Healthcare or nothing; then we will never have healthcare for all people. That stance is similar to what the Repubs have been doing on healthcare and other issues in Congress.
run75441,
You can buy into all of that and think that everything will be fine. I think that’s hogwash. The proposed bill is a handout to the healthcare insurance companies.
As I explained, there is little likelihood in my judgment that passage of a bill similar to the House or Senate bill will sufficiently rein in health insurance costs. That’s the bottom line. If insurance costs increase 70% instead of 100% or 125% over the next ten years, the issue is still there. Businesses and individual policyholders can’t afford cost increases that exceed say 50% over the next ten years. The problem will still be front and center as long as healthcare cost growth exceeds wage growth.
There is nothing of substance in the bills that will restrain costs from hospitals and doctors. Articles published this week lay out the cost increases being sought by hospitals. Wild numbers.
Similarly, the Medicaid problem appears to be lost on Democrats in the Congress. I think they’re tone deaf on that issue or too dumb to get it.
The Democrats failed to address and restrain all sources of healthcare cost increases in the House and Senate healthcare bills. They don’t have a plan to cover all sources. That’s the problem with their legislation.
It’s not a matter of waiting for legislation that embraces universal healthcare coverage. Rather, it’s a matter of understanding that the patchwork of legislative bills don’t solve the overall cost growth problem. There is no way to get there without universal healthcare coverage.
These legislative exercises that we’re observing are a bit of joke from a cost management perspective. Medicaid expansion will be issue that breaks the backs of State governments down the road.
“The Experts Say . . . .”
MG,
I think you’re in danger of letting the perfect become the enemy of the good…or in this case the not-as-bad-as-it-would-be-without-a-bill. No one thinks this is a great piece of legislation. And yes, we’re going to spend the next 10 years fixing it and cleaning it up. But at least it’s a start and once the process has begun Republicans are going to find it very difficult to stop. And John Boehner knows it.
I agree that the bill doesn’t go near far enough to rein in costs, but it goes further than the GOP alternative, which is “do nothing” until it crashes and then blame the Democrats. And it’s not like the bill does nothing to rein in costs. It does make some relatively painless cuts in Medicare…painless that is for everyone except the crooks in the medical industry who are running Medicare scams. How many electric wheelchairs do you need? And we are looking at some kind of approach that would be more results driven. And universal coverage would increase premiums for the young and healthy, but would reduce premiums for those who are high risk simply because of bad genes and worse luck. So you should see more level costs rather than today’s practice of charging different costs to different patients for the same service. That’s an expensive way to do business. And hopefully it will encourage earlier detection. So it’s a start.
Let’s count the GOP lies.
1. The government is trying to overhaul one-sixth of the economy.
A lie. The healthcare bill only involves about 1 percent of each year’s GDP. Most people will barely notice any change except perhaps slightly lower premiums in a few years.
2. By using reconciliation the Demcrats are invoking the “nuclear option.”
A lie. The “nuclear option” was not about the reconciliation rules; it was about entirely eliminating the filibuster rules for judicial appointments. And it was the Republicans who started to threaten the “nuclear option” when they were in power.
3. The Democrats are trying to overhaul healthcare through the reconciliation process and are completely bypassing the Senate’s 60 vote requirement.
Another lie. I give this one a four Pinocchio pants-on-fire rating. The healthcare bill already passed the Senate with 60 votes. So that’s already on the books. The reconciliation process is about how to find the money in the budget to fund what was already approved.
4. The Democrats aren’t acting in good faith and are steamrolling the minority.
This one also earns a WHOPPER rating. The main problem is that the Democrats wasted too much time trying to woo Republicans who have since PUBLICLY ADMITTED that they were simply stalling for time and never intended to vote for a Democratic bill even if they got everything they asked for. Now that’s bad faith.
“….. so as a default position you should assume that I believe what I’m saying and that I have a sound basis for saying it. Cantab
That is an oxymoronic statement. There has been no evidence of its validity in anything you have ever said on this site.
“In the United States we organize economic activity in the private sector.”
That is a gross misrepresentation of or Constitution.
” The liberals at the end of the day want to turn healthcare into a state run enterprise.”
In fact the entire debate over health care reform has little to do with the actual delivery of care and is only focused on health care finance. Medicare is government’s involvement into the health care finance system. It apparently works as well or better than the private corporate system of health care finance. It costs money? So what? When did the priveate sector provide health care financing for free?
CONtab,
Stop the psywar blither.
Explain the concept of “insurance death spiral”. Why should I be concerned if Blue Cross or Chase are in “death spirals”?
Do you know why insurance rates are high or low?
Do you know why an US consumer buys insurance?
Do you know about actuarial pools?
How do all those ideas equal an “insurance death spiral”?
Cut the psywar catch phrases.
There are no PLA divisions getting ready to attack you for controlling banks’ propensity to ruin the US.
Militarism was the will of both the German and Japanese people in the 1930’s.
See what it got them.
Plunder the US and its liberty kill Islam to change it.
So Vietnam! Burn their villages to save them.
ilsm will not change.
Yogi said: “When you come to a fork in the road take it”.
If you know Long Island NY you understand.
Any decision will almost always get you somewhere better than here.
MG,
I am a supporter of universal healthcare coverage. I didn’t start out thinking that way, but reached the conclusion that there is no viable financial alternative.
Here is a solution. Rather that companies buying insurance for individuals they give individuals a voucher and they go out and get insurance for themselves. This would solve the problem. What do you think?
Slubs
1. The government is trying to overhaul one-sixth of the economy.
This is true. The democrats took control and on cue they try to socialized medicine.
2. By using reconciliation the Demcrats are invoking the “nuclear option.”
They are doing an end round by the will of the American people. Payback is a bitch.
3. The Democrats are trying to overhaul healthcare through the reconciliation process and are completely bypassing the Senate’s 60 vote requirement.
Yes, that’s their point in going this route.
4. The Democrats aren’t acting in good faith and are steamrolling the minority.
Of course, as they are steamrolling the majority of Americans. Don’t blame me, I never voted for the demo-socialists.
Slugs
1. The government is trying to overhaul one-sixth of the economy.
This is true. The democrats took control and on cue they try to socialized medicine.
2. By using reconciliation the Demcrats are invoking the “nuclear option.”
They are doing an end round by the will of the American people. Payback is a bitch.
3. The Democrats are trying to overhaul healthcare through the reconciliation process and are completely bypassing the Senate’s 60 vote requirement.
Yes, that’s their point in going this route.
4. The Democrats aren’t acting in good faith and are steamrolling the minority.
Of course, as they are steamrolling the majority of Americans. Don’t blame me, I never voted for the demo-socialists.
Cantab,
That would only increase their costs due to lack of a purchasing pool. It sounds like a good idea, but in practice I don’t see the advantage. Besides, what purpose do insurance companies really provide vs. a single payer system?
I believe that single payer is the way to go, and if a person/family/company wants more coverage above and beyond that provided by the single payer system, then buy additional health insurance.
I expect that the U.S. will switch to single payer down the road as costs escalate.
2slugbaits,
Anything is a start, but that doesn’t mean that it will work or be cost effective on a net basis. I expect that a bill may be passed if enough votes can be pulled together in the House.
Your claim that the GOP alternative is to “do nothing” is simply false. I may not agree with the various GOP proposals, but there were many proposed bills last year. There is a proposed plan identified at the GOP healthcare web site at the present time. I have a list of the bills proposed by Republicans from Jan-Sep 2009, and I have located a source that identifies those proposed since that time.
How are the States supposed to pay for the growth in Medicaid once the Fed funds are pulled? No one appears interested in addressing that issue. The proposed expansion of Medicaid may involve supporting an additional 18-22 million persons. Big bucks. This represents the largest share of additional coverage that will be provided under the proposed healthcare bill. No one is explaining how the States are to handle this financial obligation after the Fed funds are bled off. The failure of Congressional supporters to address this matter should raise concerns. There is no question that Governors and State legislators are concerned about supporting another Federal mandate without funding support. That is what is projected to happen a few years out.
MG,
If I lived in Beverly Hills I would drop Anthem and pick up Kaiser and cut my healthcare bill. Shouldn’t everyone be doing this soft of thing across the county. This is the solution in my view of the healthcare issue.
Please delete the second post.
MG:
No there wasn’t many proposals by the GOP for healthcare reform other than rape the patient. So what if we finally own up to the 18-22 million people on Medicaid. The alternative is to create jobs with benefits which the Repubs have been dismal doing. How are the states supposed to be bled off?
“Relative to the Senate bill, the President’s Proposal replaces the variable State support in the Senate bill with uniform 100% Federal support for all States for newly eligible individuals from 2014 through 2017, 95% support for 2018 and 2019, and 90% for 2020 and subsequent years.” 90% from 2020 onwards? Unless Boy George Bush the III gets in there. 2020, 10 years from now. Do you believe we will be doing better even though Wall Street bled us with their gambling. 90% from 1020 onwards which is far greter than the help they were getting to date.
And the experts say . . . MG, you are being silly.
One problem with that approach is that the two, Kaiser and Anthem, provide different services. Anthem is insurance that covers private medical care. You go to a doctor and the dacotr bills Anthem. Granted that that is a gross simplification. If you’re with Kaiser you pay Kaiser a set amount each year and then yuo use their health care facilities. The two can’t readily be compared. With Anthem, or any other insurance provider as opposed to an HMO, you choose your provider. Again a simplification since insurance providers often direct the insured to stay within a participating network of medical providers. In the case of the HMO or the network of providers there is the problem of comparing the quality of care. With Kaiser if you don’t like the medical provider you’re kind of stuck with him or her. it’s tough to get a second opinion unless you go outside of the HMO and pay for it at a private provider. In the case of the insurance company’s network you have some choice, but not total freedom of choice without increasing your cost of care. it is getting a bit complicated at this point just trying to navigate the combination of health care providers and the variations in health care cost coverage. Can a lay person really read a health insurance contract and fully understand what is being offered?
That is the reason why single payer, otherwise known as universal health care coverage though they are not exactly the same concept, is so necessary. It cuts through the maze of differences from carrier to carrier. It leaves a private practice health care system in place for the insured to choose their medical care. It puts one source of payment with a universal pool to spread the risk of cost of care. That same single source of funding can better survey the prevailing cost of care and negotiate payment. The current system is too much of a hodgepodge conglomeration. Users can’t understand their coverage and that coverage is becoming far too costly.
Rustbelt,
Incremental means see-saw in this country as we flip back and forth between two ideologically driven deciders. The more wacko our officials become the less likely that there will be any direction at all. The citizens will just be jerked back and forth and reform will become the dirtiest word known in this nation.
run75441,
You’re correct that the President’s proposal states that information.
I don’t believe that it will stand the test of time. As the financial burdens increase, two provisions that are likely to take hits will be Federal funding for subsidies and Federal share funding for Medicaid.
Take a good look at the data regarding Medicaid enrollment and funding.
Current projects for Medicaid funding for FY2010-2020 per the President’s budget are stated as $275 271 274 293 313 337 363 390 420 453 488 (billions) which represent the projected Federal share costs absent any consideration for the proposed legislation. Enrollment in Medicaid as of June 2009 was 46.867 million persons according to Kaiser. The projected increased enrollment per the proposed bills is on the order of 18-22 million or more persons without any additional consideration for further impact resulting from passage of a subsequent immigration bill.
Increased Federal costs to support the legislative proposal should result in increased Federal costs well above $100-150 billion per fiscal year, perhaps closer to $200 billion per year or more as proposed Federal share for the increased enrollment (for newly eligible individuals) starts with 100% funding, later dropping to 90% funding for fiscal year 2020 and beyond. That excludes any consideration for additional enrollees resulting from passage of a future immigration bill.
I have no expectation that the future Congresses will retain the President’s proposal on 90-100% Federal share funding for new enrollees in Medicaid.
http://www.whitehouse.gov/omb/budget/fy2011/assets/tables.pdf
http://www.statehealthfacts.org/comparemaptable.jsp?ind=774&cat=4
http://www.statehealthfacts.org/comparecat.jsp?cat=4
.
Prior to my husband’s retirement in August we paid about 5% of our income for our health insurance. Our employers paid more than twice what we paid. After retirement this will go to about 10% of our income and the employer will continue to pay the same until we are eligible for Medicare. When Medicare kicks in the percentage of retirement income will rise a couple of percents (I haven’t computed it). I read that other countries provide insurance in single payer systems that is just about the same percent of income as my retirement insurance cost (WITHOUT my employer’s share). I am with MG’s opinions on the health care (not the politics). I don’t think we can afford anything else except single payer.
run75441 – “No there wasn’t many proposals by the GOP for healthcare reform other than rape the patient.”
You’re going to sit there and say that you read all of the following Republican health bills? And you’re saying further almost all of the bills amounted to nothing more than rape the patient? I think you’re faking it on both accounts. Diehard Democrats and Republicans are good at echoing talking points and popping off with political sound bites.
List of Republican Health Care Solutions
Proposed in the U.S. House of Representatives
Status as of September 2009: Speaker Pelosi and the Democrat majority have not considered any of the following Republican Members bills in committee or on the House floor.
H.R. 77 – The Health Care Incentive Act – Introduced: January 6, 2009
H.R. 109 – America’s Affordable Health Care Act of 2009 – Introduced: January 6, 2009
H.R. 198 – Health Care Tax Deduction Act of 2009 – Introduced: January 6, 2009
H.R. 270 – TRICARE Continuity of Coverage for National Guard and Reserve Families Act of 2009 – Introduced: January 7, 2009
H.R. 321 – SCHIP Plus Act of 2009 – Introduced: January 8, 2009
H.R. 464 – More Children, More Choices Act of 2009 – Introduced: January 13, 2009
H.R. 502 – Health Care Freedom of Choice Act – Introduced: January 14, 2009
H.R. 504 – Medicare Hearing Enhancement and Auditory Rehabilitation (HEAR) Act of 2009 – Introduced: January 14, 2009
H.R. 544 – Flexible Health Savings Act of 2009 – Introduced: January 14, 2009
H.R. 643 – Care for Life Act of 2009 – Introduced: January 22, 2009
H.R. 917 – To Increase the Health Benefits of Dependents of Members of the Armed Forces Who Die Because of a Combat-Related Injury – Introduced: February 9, 2009
H.R. 1075 – RECOVER Act (Restoring Essential Care for Our Veterans for Effective Recovery) – Introduced: February 13, 2009
H.R. 1086 – Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2009 – Introduced: February 13, 2009
H.R. 1118 – Health Care Choices for Seniors Act – Introduced: February 23, 2009
H.R. 1441 – Ryan Dant Health Care Opportunity Act of 2009 – Introduced: March 11, 2009
H.R. 1458 – Comprehensive Immunosuppressive Drug Coverage for Kidney Transplant Patients Act of 2009 – Introduced: March 12, 2009
H.R. 1468 – Medical Justice Act of 2009 – Introduced: March 12, 2009
H.R. 1658 – Veterans Healthcare Commitment Act of 2009 – Introduced: March 19, 2009
H.R. 1891 – Sunset of Life Protection Act of 2009 – Introduced: April 2, 2009
H.R. 2051 – To Amend Title 10, United States Code, to Authorize Extended Benefits for Certain Autistic Dependents of Certain Retirees – Introduced: April 22, 2009
H.R. 2373 – Home Oxygen Patient Protection Act of 2009 – Introduced: May 12, 2009
H.R. 2520 – Patients’ Choice Act – Introduced: May 20, 2009
H.R. 2607 – The Small Business Health Fairness Act – Introduced: May 21, 2009
H.R. 2692 – CAH Designation Waiver Authority Act of 2009 – Introduced: June 3, 2009
H.R. xxxx – Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act – Introduced: June 6, 2009
H.R. 2784 – Partnership to Improve Seniors Access to Medicare Act – Introduced: June 10, 2009
H.R. 2785 – Health Care Paperwork Reduction and Fraud Prevention Act – Introduced: June 10, 2009
H.R. xxxx – Medical Rights & Reform Act – Introduced: June 16, 2009
H.R. 3141 – Strengthening the Health Care Safety Net Act of 2009 – Introduced: July 9, 2009
H.R. 3217 – Health Care Choice Act – Introduced: July 14, 2009
H.R. 3218 – […]
MG,
No one said that the GOP hadn’t offered alternative plans. What I actually said was that the GOP alternative was a “do nothing” approach, which is not quite the same thing as not offering up a bunch of Potemkin bills as alternatives. And “do nothing” was the alternative that the GOP leadership eventually settled on. That was their operational plan. Offering up small ball plans that are mostly sideshows is a “do nothing” policy…especially when prominent GOP leaders have already said that they would oppose the Democratic bill even if they got 100% of what they asked for. I see where you listed Sen. Grassley’s recommendations for healthcare reform. The problem is that Grassley has already said that he would oppose the bill even if it included everything that he wanted. He’s on the record of having said that. He bragged to his teabagger constituents that he was only pretending to cooperate with Democrats in order to kill the Democratic plan in order by stalling for time. He admitted and bragged about the fact that he negotiated in bad faith and now the Democrats are supposed to take his proposals seriously???
Obama said that the Democrats would consider and in some cases have already adopted some of the GOP recommendations. For example, tort reform is something that Obama said he would consider, although the academic studies and CBO’s analysis suggest that this would be a net welfare loss. But it’s not off the table as a piece of follow-on legislation. Another example, Sen. Coburn has introduced a plan that is many ways actually halfway decent. It’s probably something that many Democrats could support…hell, there are parts of it that even Paul Krugman likes! The problem is that Sen. McConnell and the GOP leadership are running away from it because they don’t want the Democratic Congress to have ANY success…even if it’s one that has a lot of GOP ideas; but yet they want to count it as a GOP alternative. And the other night there was a GOP congressman from California who admitted that he had considered introducing some proposals (which actually sounded constructive) but here again the GOP leadership (in this case John Boehner) refused to support it. Boehner put the kabosh on these recommendations. Now why is that? It’s because the GOP’s only real mission here is to set up a political defeat for Obama and the Democrats. A year ago Politico.com was telling us that, based on their insider contacts and GOP internal documents, this was the GOP plan all along. And Sen. DeMint bragged that the whole point of dragging out healthcare reform was to ensure Obama’s “Waterloo.”
You and I are on the same page when it comes to enumerating the many shortcomings in the bill. There are things that will have to be fixed. The main objective right now is to set in place the three primary legs of the healthcare stool. Part of the GOP strategy has been to propose incremental approaches that would only add one leg of the stool at a time. As just about every prominent healthcare economist has pointed out, this incrementalism is a recipe for guaranteed failure. And surely the GOP leadership knows this. Which makes you wonder why the GOP leadership wants to see failure?
Anna Lee,
I would also prefer a single payer system, but right now that’s not on the table. I also prefer grilled rare tuna steak to leftover tuna casserole, but sometimes I settle for the casserole. It’s hard enough getting Congress to support even the most timid steps towards healthcare reform let alone single payer. If we adopt single payer the next thing might be that we all become more polite and start drinking strong beer. Then what? Suddenly we’re Canada. There’s just no way that single payer goes anywhere.
Cantab, health care is as substantially a part of the infrastructure as is transportation, law and order, education and other public services. The government for the people by the people is just not limited to the protection and benefit of the few, it is responsible to all the people. We need the government to regulate health care, the private sector as is, is privatized socialism with a nice profit margin. Private insurance does use premiums from lucky healthy people to pay for the unlucky sick people with a nice profit for the corporation. Maybe calling it Turbo Capitalism is a better term.
Cantab, what should be the $$$ value of the voucher for people 65 and older with pre-existing conditions? The people the private sector does not want now and will not want in future, they must make a profit for share holders and nothing else.
Jack,
I don’t agree with you. If you think that Anthem provides better service and that service is worth the extra cost then pay the price for this service. If not, and for me I don’t value service, switch and put the money in your pocket. We don’t need universial coverage. What we need is for people to make the type of decision that I described above. Perhaps rather than a company arranging for healthcare we should tinker with the tax code to say that rather than arranging healthcare for individuals companies provide a voucher to individuals for a fixed amount and they go out and buy their own healthcare. In California for me the ideal amount for this voucher would be something higher than what Kaiser charges and something lower than what Anthem charges. The failure of the democrat appoach in my view is that they don’t put the decisions at the level of the individual consumer. And we can do this regardless of the level we decide to subsidize low income people.
Lysistrata,
What’s wrong with making profit for shareholders. The muffin and coffee that I have each morning for breakfast is done for profit, the muffin is fresh and the coffee is good and I personally agree to pay the price rather than make my own muffin and coffee. I have a relationship with my muffin/coffee provider and I don’t tend to worry about his profit — since the bagel and lox guy is down the street and I can always buy a yogurt and throw some granola and blueberries in it and call it a meal. Profit it is good since it provides incentives for people to do productive things. Without profit we would be all sipping Vodka and not doing much else.
Cantab, I did not say anything is wrong to make profit for shareholders. If your coffee and muffin is unaffordable you just stop buying it. You can live without it. Health care is different, the need to recieve health care is greater than the need to make profit for shareholders. Universal or singlepayer could eliminate the shareholder issue and make health care more affordable. To rephrase my question, how many $$$ voucher does it take to make it affordable for 65 and older and likely pre-conditions? Is there any way to make it affordable for the people on the one hand and profitable for the industry on the other hand? As it is the private sector does not want to insure these people that is why we have MEDICARE in the first place. With nothing but high risk customers you just can’t make a profit. When people can’t buy what it is you are selling you can’t have a profit either.
they make enough and will get far more insurance contributions then health care will cost them if they vote down their own insurance.
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