Impeding changes to our Health Care system

[TheMercenary]

July 19, 2010
An Ugly Preview of ObamaCare

By Robert Samuelson
WASHINGTON -- If you want a preview of President Obama's health care "reform," take a look at Massachusetts. In 2006, it enacted a "reform" that became a model for Obama. What's happened since isn't encouraging. The state did the easy part: expanding state-subsidized insurance coverage. It evaded the hard part: controlling costs and ensuring that spending improves people's health. Unfortunately, Obama has done the same.

Like Obama, Massachusetts requires most individuals to have health insurance (the "individual mandate"). To aid middle-class families too well-off to qualify for Medicaid -- government insurance for the poor -- the state subsidizes insurance for people up to three times the federal poverty line (about $66,000 in 2008 for a family of four). Together, the mandate and subsidies have raised insurance coverage from 87.5 percent of the non-elderly population in 2006 to 95.2 percent in the fall of 2009, report Sharon Long and Karen Stockley of the Urban Institute.

People have more access to treatment, though changes are small. In 2006, 87 percent of the non-elderly had a "usual source of care," presumably a doctor or clinic, note Long and Stockley in the journal Health Affairs. By 2009, that was 89.9 percent. In 2006, 70.9 percent received "preventive care"; in 2009, that was 77.7 percent. Out-of-pocket costs were less burdensome.

But much didn't change. Emergency rooms remain as crowded as ever; about a third of the non-elderly go at least once a year, and half their visits involve "non-emergency conditions." As for improvements in health, most probably lie in the future. "Many of the uninsured were young and healthy," writes Long. Their "expected gains in health status" would be mostly long-term. Finally -- and most important -- health costs continue to soar.

Aside from squeezing take-home pay (employers provide almost 70 percent of insurance), higher costs have automatically shifted government priorities toward health care and away from everything else -- schools, police, roads, prisons, lower taxes. In 1990, health spending represented about 16 percent of the state budget, says the Massachusetts Taxpayers Foundation. By 2000, health's share was 22 percent. In 2010, it's 35 percent. About 90 percent of the health spending is Medicaid.

State leaders have proven powerless to control these costs. Facing a tough re-election campaign, Gov. Deval Patrick effectively ordered his insurance commissioner to reject premium increases for small employers (50 workers or less) and individuals -- an unprecedented step. Commissioner Joseph Murphy then disallowed premium increases ranging from 7 percent to 34 percent. The insurers appealed; hearing examiners ruled Murphy's action illegal. Murphy has now settled with one insurer allowing premium increases, he says, of 7 percent to 11 percent. More settlements are expected.

Attacking unpopular insurance companies is easy -- and ultimately ineffectual. The trouble is that they're mostly middlemen. They collect premiums and pay providers: doctors, hospitals, clinics. Limiting premiums without controlling the costs of providers will ultimately cause insurer bankruptcies, which would then threaten providers because they won't be fully reimbursed. The state might regulate hospitals' and doctors' fees directly; but in the past, providers have often offset lower rates by performing more tests and procedures.

A year ago, a state commission urged another approach: Scrap the present "fee-for-service" system. The commission argued that fee-for-service -- which ties reimbursement to individual services -- rewards quantity over quality and discourages coordinated care among doctors and hospitals. The commission recommended a "global payments" system to force hospitals, doctors and clinics to create networks ("accountable care organizations"). These would receive flat per-patient payments to promote effective -- not just expensive -- care. Payments would be "risk adjusted"; sicker patients would justify higher payments.

But the commission offered no blueprint, and efforts to craft consensus among providers, consumer groups and insurers have failed. State Senate President Therese Murray, an advocate of payment change, has given up for this year. "Nobody is in agreement on anything," she told The Boston Globe.

All this anticipates Obamacare. Even if its modest measures to restrain costs succeed -- which seems unlikely -- the effect on overall spending would be slight. The system's fundamental incentives won't change. The lesson from Massachusetts is that genuine cost control is avoided because it's so politically difficult. It means curbing the incomes of doctors, hospitals and other providers. They object. To encourage "accountable care organizations" would limit consumer choice of doctors and hospitals. That's unpopular. Spending restrictions, whether imposed by regulation or "global payments," raise the specter of essential care denied. Also unpopular.

Obama dodged the tough issues in favor of grandstanding. Imitating Patrick, he's already denouncing insurers' rates, as if that would solve the spending problem. What's occurring in Massachusetts is the plausible future: Unchecked health spending determines government priorities and inflates budget deficits and taxes, with small health gains. And they call this "reform"?

from: http://www.realclearpolitics.com/art...ld_106358.html at July 22, 2010 - 05:04:04 PM CDT

[Happy Monkey]

Originally Posted by TheMercenary

So instead we have traded a good plan for "getting any plan passed" at great cost to the taxpayer that will be ineffective in controlling costs and add to the deficit?

It eliminates "preexisting conditions". That's worth the rest of it. Plus there are plenty of other good parts, which make it worth it all the more.

[TheMercenary]

Originally Posted by Happy Monkey

It eliminates "preexisting conditions". That's worth the rest of it. Plus there are plenty of other good parts, which make it worth it all the more.

I would agree that the elimination of the pre-existing condition is good. But you can't put one good thing in a 3000 page bill and call it good, not at the estimated long term costs to the taxpayer.

"Hey great button on the dash, to bad the car is a piece of shit."

[Happy Monkey]

Eliminating preexisting conditions requires the mandate. The mandate requires subsidies. My guess is that takes up quite a few of those 3000 pages. All whinging I've heard about the plan is either
a) About the mandate or the cost of subsidies, which are required.
b) Far outweighed by the elimination of preexisting conditions.
or c) that the plan doesn't go far enough, with which I and most Democrats agree. If there had been any non-tool Republicans to offset the tools among the Democrats, maybe we could have done something about that. Hopefully some time in the future, we will. But that's an argument for doing more, not an argument against doing what was done.

[TheMercenary]

Originally Posted by Happy Monkey

Eliminating preexisting conditions requires the mandate. The mandate requires subsidies. My guess is that takes up quite a few pages. All whinging I've heard about the plan is either
a) About the mandate or the cost of subsidies, which are required.
b) Far outweighed by the elimination of preexisting conditions.
or c) that the plan doesn't go far enough, with which I and most Democrats agree. If there had been any non-tool Republicans to offset the tools among the Democrats, maybe we could have done something about that. Hopefully some time in the future, we will. But that's arn argument for doing more, not an argument against doing what was done.

And none of that controls costs which is why it will fail in the end. And none of that requires that everyone contributes, only that those who have insurance and money pay for those who don't. And none of that will fix the problems in healthcare, Mass tried this approach, see above link, and it failed. You have deluded yourself. So far the government programs of Medicaid are expensive, bloated, and inefficient, and this is the same government that is going to control this bill. There is so much wrong with this Bill it does not outweigh the good. There was so much potential for the Dems to do the right thing, they failed.

[TheMercenary]

Obama: Mr. Incredible
By David Keene - 07/19/10 05:34 PM ET
During the healthcare debate, President Obama and his operatives assured congressional Democrats and the media that once Obama-Care passed, all would be well. The president himself said the GOP focus on process would be forgotten quickly by a public far more interested in “policy than process.”

However, the public has made it clear it likes neither the product (about which more is being learned by the day) nor the process that led to passage. Many of the deals needed to piece together majorities in the House and Senate received enough publicity at the time to outrage many, but as time goes on revelations about additional concessions made to woo votes are justifying what were dismissed as simple partisan attacks during the debate.

Moreover, the possible consequences of the bill are making many wake up and take note.

When critics of the legislation alleged during the debate that the enforcement of its many provisions would vastly increase the power of the IRS and empower tax collectors to go where they had never gone before, administration spokesmen reacted in outrage. The president’s critics, they charged, were not just wrong, but lying to scare people.

It turns out that the critics were dead right and that if there was any lying going on, they weren’t the guilty ones. In the days since passage, we have learned that the IRS will have to hire literally thousands of new agents, auditors and analysts to make sure everyone required to buy into the program does so and to catch those who violate its many provisions as well as to collect the data that will be required of small businesses to help the government collect new taxes to pay for the scheme.

The result is that small-business owners who were promised they would benefit from the new law are up in arms as they discover that they will in fact be targets of an IRS planning to impose even more regulations on the way they operate. The absolute ludicrousness of the new requirements is that business owners will apparently now be required to file forms reporting on aggregate annual payments of as little as $600 to “vendors” like Staples or the office coffee supplier.

Meanwhile, it turns out that while some members of Congress were being promised one thing in return for their votes, others were being assured that such promises would never be kept. Thus, while members concerned about whether benefits would be extended to illegal immigrants were assured that this would not be the case, members of the Congressional Hispanic Caucus in the House were being told that they shouldn’t worry about any restrictions in the healthcare bill because they would be removed later … in the administration’s promised immigration reform bill.

Recent news reports that Democratic leaders promised Hispanic Caucus members that provisions inserted in the healthcare to win the votes of others would be removed later suggest that South Carolina Rep. Joe Wilson’s (R) charge that President Obama’s denial that the healthcare bill would cover illegal aliens was a lie was dead on.

The healthcare bill as passed and signed into law prohibits illegals from buying into the so-called healthcare exchanges that will be established under the law and denies even temporary legal immigrants access to Medicaid unless they’ve been here for five years. Hispanic Caucus leaders are now charging that the administration specifically promised to eliminate these and other restrictions and are vowing to hold the president and congressional Democratic leaders to that promise.

Under the Obama plan, of course, Medicaid has been expanded and something like half of all illegals in the country would qualify if the restrictions written into the law are removed, increasing the costs of a program that is already expected to exceed the estimates publicized by the administration before its passage by tens of billions of dollars.

The monetary cost of delivering on this promise would be enormous, but the political cost could be even higher. President Obama gives pretty good speeches, but fewer and fewer Americans are paying much attention to what he says. Some are beginning to ignore him for lack of follow-through or because he’s overexposed, but increasing numbers of those who were initially shocked by Wilson’s outburst are becoming convinced that he was right.

A president’s credibility is key to his success. When those he deals with in Washington or those on whose votes he relies for reelection conclude that his word isn’t worth much, his ability to lead vanishes.

http://thehill.com/opinion/columnist...bama-mr-incred

[Happy Monkey]

Originally Posted by TheMercenary

And none of that controls costs which is why it will fail in the end.

We'll see what happens on the exchanges. But if they don't work, then "the end" could be the impetus to go public option or single payer. It would be nice if we didn't have to take the long way round, but we are giving them the rope to hang themselves. Hopefully we're willing to be hangmen when the time comes.

And none of that requires that everyone contributes, only that those who have insurance and money pay for those who don't.

The only alternative to that is to let poor people die in the streets. Our current method is emergency rooms. At least under the new system, the poor will be able to get preventive care that way, rather than just catastrophic care.

And none of that will fix the problems in healthcare,

That's... unspecific. There will probably be plenty of problems it doesn't fix. It's only 3000 pages, after all. but it does fix the biggest problem - preexisting conditions. And that fix has the further effect of curbing the second biggest problem - recisions. If you can't cut someone for a preexisting condition, you can't cut them for not reporting it.

So far the government programs of Medicaid are expensive, bloated, and inefficient,

But less so than private insurance, so I agree that a public option would have been great.

But, as I said, things the bill doesn't do are things to do in the future. They aren't arguments against what the bill does.

[TheMercenary]

The cost alone is an argument agains the bill.

(deleted)

[TheMercenary]

Originally Posted by Happy Monkey

The only alternative to that is to let poor people die in the streets. Our current method is emergency rooms. At least under the new system, the poor will be able to get preventive care that way, rather than just catastrophic care.

That is not happening now and never has, so what makes you think that this Bill will fix something that is not broken? What makes you think that if given the opportunity that the poor will seek preventative care. They often don't take care of themselves now so how would this change? Not to say that some would not take advantage of some preventative care in the future, nor would this be a bad thing. Take for example smoking. Do you think there will suddenly be a rush on people taking smoking cessation classes? How about alcoholism among the poor? Do you think the poor who drink excessively or have other abuse problems will suddenly seek out a healthier lifestyle?

[Happy Monkey]

Originally Posted by TheMercenary

That is not happening now and never has,

I am assuming that "that" refers to "let poor people die in the streets".

Yes, we don't do that now. Like I said, it is the only alternative to having people with money subsidize the healthcare of people without. Our current method is emergency rooms, which is the most ineficient way to do it.

What makes you think that if given the opportunity that the poor will seek preventative care. They often don't take care of themselves now so how would this change? Not to say that some would not take advantage of some preventative care in the future, nor would this be a bad thing.

You refute yourself immediately. Saves me the trouble.

Take for example smoking. Do you think there will suddenly be a rush on people taking smoking cessation classes? How about alcoholism among the poor? Do you think the poor who drink excessively or have other abuse problems will suddenly seek out a healthier lifestyle?

Where are you going with this? Poor people won't use preventive healthcare even if they can afford it? Some will, some won't. My guess is that lots of parents will, for their children if not for themselves.

[TheMercenary]

Originally Posted by Happy Monkey

I am assuming that "that" refers to "let poor people die in the streets".

Yes, we don't do that now. Like I said, it is the only alternative to having people with money subsidize the healthcare of people without.

That happens now and does not change under the new plan. Certain incomes don't contribute to the Federal Income tax system now. This bill does not change that.

Our current method is emergency rooms, which is the most ineficient way to do it.

Agreed.

You refute yourself immediately. Saves me the trouble.Where are you going with this? Poor people won't use preventive healthcare even if they can afford it? Some will, some won't. My guess is that lots of parents will, for their children if not for themselves.

Children are covered under other plans. This bill mostly addresses adult care.

[Lamplighter]

All children will be covered under the parent's new plan starting 9/19/10. This includes "adult children" up to some age (25 ?)

[Happy Monkey]

Originally Posted by TheMercenary

That happens now and does not change under the new plan.

It will NEVER change, nor should it. Like I said, the only alternative is letting the poor die in the streets.

An if, as I hope, we aren't willing to do that, what we can do is increase the efficiency of subsidizing the poor. Subsidizing their movement into the normal healthcare system instead of just the emergency rooms is a good start.

[TheMercenary]

Originally Posted by Happy Monkey

It will NEVER change, nor should it. Like I said, the only alternative is letting the poor die in the streets.

An if, as I hope, we aren't willing to do that, what we can do is increase the efficiency of subsidizing the poor. Subsidizing their movement into the normal healthcare system instead of just the emergency rooms is a good start.

Again. The poor are not dying in the streets. That is a bleeding heart straw man argument.

My only point was, as you championed the healthcare of the "poor", is that they do not now seek preventive care, and would still not do so even if it was "free".

These are but small portions of the bill.

How about the role of the IRS in this new process. Latest estimates are that the IRS is going to have to hire thousands of people just to monitor this process, so now we have created more bigger and bloated government at great cost and for what return?

[TheMercenary]

Originally Posted by Lamplighter

All children will be covered under the parent's new plan starting 9/19/10. This includes "adult children" up to some age (25 ?)

Sort of a misnomer don't you think. You can go to Iraq and die at 18 so you are an adult at 18 or in many cases at 17. But they are not really children. They are adults who can be covered under parents plans to the age of 26. In some cases this is a good thing.