Althouse: "What happened to Obamacare? Rhetoric met reality."

July 24, 2009

"What happened to Obamacare? Rhetoric met reality."

"[Y]ou can't fake it in legislation. Once you commit your fantasies to words and numbers, the Congressional Budget Office comes along and declares that the emperor has no clothes. President Obama premised the need for reform on the claim that medical costs are destroying the economy. True. But now we learn -- surprise! -- that universal coverage increases costs. The congressional Democrats' health-care plans, says the CBO, increase costs on the order of $1 trillion plus."

69 comments:

Balfegor said...: It's not even universal coverage. That said, it was pretty clever how they drafted the bill to hide most of the costs by shifting them onto the insurance companies and their clients (viz. us). I'm kind of shocked that they still got stuck with $1 trillion, even after that whole rigmarole.; 7/24/09, 1:04 PM
The Dude said...: Skippy is what happened to it - thank you Gates, you have just spared working Americans trillions of dollars.

Keep losing your temper, you little bitch - every time you have a hissy fit the budget gets closer to being balanced.; 7/24/09, 1:06 PM
chickelit said...: Krauthammer's money quote:

This is not about politics? Then why is it, to take but the most egregious example, that in this grand health-care debate we hear not a word about one of the worst sources of waste in American medicine: the insane cost and arbitrary rewards of our malpractice system?...
...The Democrats are parasitically dependent on huge donations from trial lawyers.; 7/24/09, 1:06 PM
MadisonMan said...: This whole thing seems predictable. Democrats just don't have the ram-it-through-Congress smarts of Republicans. Why, they didn't even give it a catchy nickname!; 7/24/09, 1:12 PM
traditionalguy said...: The Obama mission does not include health care reform...Only health care dreams and visions at the next election cycle. No surprises here.; 7/24/09, 1:13 PM
lucid said...: It is very hard to escape the conclusion that Obama rally doesn't have a clue about how to manage a government--that his speeches contained casually acquired ideas, picked up at cocktail parties and other informal settings, but never subjected to the rigors of the real world.

In other words, Hillary was right about him--it's easy to give a good speech, but it's hard to solve real problems when you don't have any experience or in-depth knowledge.

Obama is clearly out of his depths.; 7/24/09, 1:16 PM
Chennaul said...: Krauthammer has an excellent point-

And I'd like to add-

Does anyone think that the rush to pass this Health Care Bill is hinged on the possible failure of the Stimulus Package?

Why else would you demand a deadline of-

two weeks!?

Why can't we wait on this Health Care Bill until there is something, anything that proves that maybe the largest Stimulus Package in history actually worked?

Like -how about a significant reduction in the unemployment rate-

instead of-

the significant increase in the number of unemployed.

I hate to sound like George Herbert Walker Bush but wouldn't it be prudent to have some kind of proof-that The Wonderkind know what they are doing?; 7/24/09, 1:18 PM
Bissage said...: I promise I read all of Mr. Krauthammer’s column but I have to admit I didn’t understand what he was saying.

What’s all this about health-care reform, anyway?

Shouldn’t we be talking about insurance reform?

Who could be opposed to that?!

Oooooh, look, over there, it’s a butterfly!!!

Labels: economics, Krauthammer, Obama economics, Obama's health, bullshit; 7/24/09, 1:21 PM
Lem Vibe Bandit said...: Obama care is like Skip scare...

Both alarmist.; 7/24/09, 1:24 PM
Balfegor said...: Like -how about a significant reduction in the unemployment rate-

instead of-

the significant increase in the number of unemployed.

Be fair to the man -- (1) the stimulus doesn't really kick in until 2010 (election year!) so it's not really reasonable to expect it to have an effect now; and (2) even if the stimulus works, employment is a lagging indicator; it's not going to recover until we are well into our recovery. That's what sunk George Herbert Walker Bush.; 7/24/09, 1:26 PM
garage mahal said...: I'm kind of shocked that they still got stuck with $1 trillion, even after that whole rigmarole..

Kraphammer or Althouse would never point this out, [the full CBO analysis that came out a day later] because they don't give a shit about health care anyway. They have, what's the big deal? But here read for yourself from the same CBO. Why link to the actual report when you can just talk loosely about it!

"The new draft also includes provisions
regarding a “public plan,” but those provisions did not have a substantial
effect on the cost or enrollment projections, largely because the public plan
would pay providers of health care at rates comparable to privately
negotiated rates—and thus was not projected to have premiums lower than
those charged by private insurance plans in the exchanges"; 7/24/09, 1:27 PM
Anonymous said...: Very soon we'll be hearing that people oppose Obama's spending and healthcare programs because people are racists.; 7/24/09, 1:29 PM
I'm Full of Soup said...: Trusting Obama's admin to fix healthcare is not wise after the stimulus failure.

It would be like hiring the same contractor to re-build your house after he blew it up when he was re-modeling your kitchen.

Fool me once, shame on you, President Obama. Fool me twice, shame on me.

How can he regain his severely damaged credibility?; 7/24/09, 1:29 PM
Roger J. said...: This comment has been removed by the author.; 7/24/09, 1:34 PM
Chennaul said...: Damn you Balfegor! Damn you!

Touche!

But!-I've always questioned the timing!

[Also the troops coming home-that'll be for election results probably too.]

Let's see how about this-

We've been without this Wonder Health Care for some 200 years can we wait for lagging indicators?; 7/24/09, 1:35 PM
Roger J. said...: While I have bemoaned the kerfluffle over the Gates incident, as noted here the Gates thing did manage to vitiate any message Obama was trying to make at his presser a couple of days ago.

Moreover, according to Rasmussen, Obama has slipped to under 50% and trending down. I think there is a reason the administration is desparate to get this thing passed now. They dont want the honorable members going home to their districts over recess and get hammered by their constituents. Even Harry Reid knows this which is why the senate isnt going to act on it until the Fall.

The longer the health care bill languishes in committee, the less likely it is to get passed--and those first and second term honorable members arent going to lose their relection chances hitched to an unpopular bill (more than 55% disapprove according to recent polling IIRC) and a president whose approval numbers are trending down.
Wow--we apparently didnt even need Harry and Louise. All I can say is: Rove, you magnificent bastard--how did you manage that gates thing.; 7/24/09, 1:36 PM
Lem Vibe Bandit said...: Very soon we'll be hearing that people oppose Obama's spending and healthcare programs because people are racists.

Racism?... when they say "universal coverage" they don’t mean that kind of universe.; 7/24/09, 1:39 PM
The Drill SGT said...: madawaskan said...
Does anyone think that the rush to pass this Health Care Bill is hinged on the possible failure of the Stimulus Package?

Like AJ implied above, the country was dazzled by Obama on Jan 20. If he had tried health care first, he could have rammed this disaster down the country's throat and gotten away with it.

The democratic pork greed screwed them, but saved the country from an even worse health care disaster. the trillion on the budget and porkulus was a small price to pay for saving our generally good health care system from nationalization.; 7/24/09, 1:40 PM
The Dude said...: I don't think it is dead. It is just resting.; 7/24/09, 1:46 PM
Anonymous said...: If he had tried health care first, he could have rammed this disaster down the country's throat and gotten away with it.

But the temptation (and, frankly, the need under the Chicago political method) to have a huge slush fund to buy acquiessence and favors, was just too great.

But they have their $500B slush fund, and are now, more than ever, going to save it for specific targets in 2010 and 2012.; 7/24/09, 1:48 PM
Chennaul said...: AJ-

I love this analogy-

It would be like hiring the same contractor to re-build your house after he blew it up when he was re-modeling your kitchen.

LOL!

Drill Sgt.-

Man I hope you are right-but who is going to stop them....

Maybe the Blue Dogs, or maybe, hopefully because Democrats have previously put so much importance on public opinion polls-if the American public does something-but it almost could be out of their hands...; 7/24/09, 1:51 PM
Widmerpool said...: Garage,

You have linked to a CBO report on a different version of the bill which was done after the initial CBO assessment (CBO letter of June 15). That letter does indeed mention the $1 trillion price tag. Your Dem pals simply downsized the program a bit after the initial, disastrous (from your perspective) CBO report. You are not being honest.; 7/24/09, 1:56 PM
I'm Full of Soup said...: Obama will get a 2nd chance to do something right. If he's smart, he will do some big $100 Billion infrastructure project which will put construction workers back to work.

If he's really smart, he will take a hatchet to the federal budget and eliminate $100 Billion or so in old recurring year-after-year wasteful spending.

That will be very tough for Obama because he really believes more government is the answer. That is curious when you consider the three Top Dogs in the Obama admin got rich via free market capitalism (Obama, Rahm Emanuel & Axelrod). I suspect Axelrod is still raking it in via some businesses he still owns.

Don't get me wrong - I am in favor of raking it in thru hard work and taking a risk.; 7/24/09, 2:03 PM
Anonymous said...: This is a public service message, reminding you that Dems don't need one single solitary Republican vote to pass this debacle if it's such a great idea.

This message will be repeated until the whining stops.

Thank you.; 7/24/09, 2:08 PM
Anonymous said...: "That is curious when you consider the three Top Dogs in the Obama admin got rich via free market capitalism (Obama, Rahm Emanuel & Axelrod)."

Ah. I see. Careers in rent-seeking and working in backscratching, do-nothing jobs represent the new "free market capitalism."; 7/24/09, 2:14 PM
I'm Full of Soup said...: Rocketeer:

What I mean is they got rich in the "private sector". You can't argue with that. It is true.

However, I was not blessing nor judging their work nor true value in the private sector. For instance, I do understand Rahm Emanuel jumped to an investment bank for 1-2 years and made $20 Million. Then he returned to govt sector.

I do find it ironic they take the money in the private sector then crucify businessmen and corp execs whenever possible.; 7/24/09, 2:20 PM
Anonymous said...: "Moreover, according to Rasmussen, Obama has slipped to under 50% and trending down. .."

Skip, you magnificent bastard!; 7/24/09, 2:33 PM
BJM said...: Balfegor @ 1:26
Be fair to the man -- (1) the stimulus doesn't really kick in until 2010 (election year!) so it's not really reasonable to expect it to have an effect now;

Au Contraire, mes amis, Obama ticked off a list of successes from the Stimulus bill during his presser Wednesday.

Obama doesn't know when to stop digging. He's blathering about Gates & Crowly again

"Because this has been ratcheting up and I obviously helped to contribute ratcheting it up, I wanted to make clear in my choice of words I think I unfortunately gave an impression that I was maligning the Cambridge Police Department or Sgt. Crowley specifically," Obama said. "And I could have calibrated those words differently."

Ya think?; 7/24/09, 2:36 PM
knox said...: I don't think it is dead. It is just resting.

Yup. Even if we manage to avert this disaster, it'll keep coming back. Unless the republicans eventually get in power and manage to make some real changes. hahahaha hoo hoo! That was a good one.; 7/24/09, 2:38 PM
garage mahal said...: Your Dem pals simply downsized the program a bit after the initial, disastrous (from your perspective) CBO report. You are not being honest..

Hah. So it's okay to send the talking point du jour into the stratosphere based on a preliminary CBO report, but not the updated CBO report that came out a day later? Hacktakular.; 7/24/09, 2:38 PM
knox said...: Skip, you magnificent bastard!

LOL; 7/24/09, 2:40 PM
knox said...: garage, neither you nor Obama even know what's in the bill...

... so what is it that you are advocating, exactly?

The rest of us can at least honestly object to another extremely costly (and don't give me any of that it pays for itself!!!! malarkey) plan when it is ambiguous and ever-changing at best.

But how can you really defend this much spending so vigorously not even knowing what's in the bill?; 7/24/09, 2:43 PM
knox said...: ....cue garage:

I never said I was for it! It merely amuses me that you all are so against it... blah blah blah...; 7/24/09, 2:44 PM
Roger J. said...: "But how can you really defend this much spending so vigorously not even knowing what's in the bill?" ummmmmm--because Obama wants it and his presidency depends on it?; 7/24/09, 2:45 PM
Widmerpool said...: Garage,

I just knew that would be your response. Here is the reality, whether you like it or not: O, Teddy, Harry and Nancy crafted a proposal that the CBO scored as costing $1 trillion. This is the proposal they wanted, this is the proposal they wanted the vote on. You are stuck with it. The fact that they have retreated (and in coming days will retreat further if not give up entirely) is of no consequence.; 7/24/09, 2:52 PM
garage mahal said...: garage, neither you nor Obama even know what's in the bill....

Well I'm only one that actually linked to the CBO report.

Just a comment up you said "Even if we manage to avert this disaster....".

So why don't you tell us what's "disastrous" in this bill!?; 7/24/09, 2:53 PM
I'm Full of Soup said...: Garage:

If Obama said he could arange it so every American could vacation for two weeks every year at a beach resort like Martha's Vineyard and there'd be no extra govt spending involved and no ginormous traffic jams, would you believe him?; 7/24/09, 3:05 PM
Elliott A said...: Here's what is disasterous in the bill:

1: The very popular Medicare Advantage program will disappear. This will significantly raise out of pocket costs for our seniors.

2. It will not be legal to sell an individual a health insurance policy after Jan. 1, 2013. It's either the Gov't plan or nothing.

3. HSA plans will disappear. My out of pocket expenditures on my HSA plan (I am the employer and employee) dropped 3K per year with this plan for the identical insurance I had before.

4. Attempts to lower already rediculously low reimbursements for providers will result in many picking up their stethoscope and going home. Insurance doesn't do you any good if there is no hospital or doctor to go to.

5. Some abortions would be mandated to be funded. If this occurs, ALL Catholic hospitals in the US will up and close. They currently represent about 20% of all hospital beds and outpatient services in teh country. In many communities, they are the only provider.

This doesn't even discuss the cost, it is just a disasterous plan which benefits no one! Scrap this and go back to the drawing board.; 7/24/09, 3:07 PM
garage mahal said...: As I've demonstrated, you can't trust conservatives for the time of fucking day.; 7/24/09, 3:08 PM
Roger J. said...: This comment has been removed by the author.; 7/24/09, 3:08 PM
Scott M said...: @garage

When a sector of private businesses are compelled to compete with the government subsidies, you see private businesses either fail, move to other sectors, or downsize their expenditures (including jobs) considerably. This is axiomatic.

Along with this, if you don't participate, both private citizens and employers get taxed as a penalty. Well, citizens get fined heavily.

Tax-deductable Medical Savings Accounts are the way to go with the government providing catastrophic backup in the case of overwhelming or, um, catastrophic medical costs.

Tort reform is an absolute must. We have GOT to get doctors to stop practicing defensive medicine. Make the penalties for outright fraud or incompetence severe, but cap the damned lawsuits and make the looser pay court costs.

EXPAND liberty. Do not oppress it. Especially when the resulting oppression of liberty will not accomplish what you set out to do in the first place...; 7/24/09, 3:13 PM
Roger J. said...: I was going to suggest these things were disastrous, but Elliot A beat me to it: Whats disastrous? (1) the price tag and the inevitable growth in bureaucracy that comes from all initiatives such as this; 7/24/09, 3:13 PM
Scott M said...: @garage

Please answer Elliot's five points. In particular, address the HSA's. I'm very interested on what you have to say about that particular contraction, or, more accurately obliteration, of personal freedom.; 7/24/09, 3:15 PM
Roger J. said...: And I think Scott's prescriptions are right on target and can be done with minimal cost compared to the approximately trillion dollars for the current proposal.; 7/24/09, 3:17 PM
Balfegor said...: Re: Garage:

Here's the updated CBO report. I actually linked this with some discussion of specific provisions in a previous thread which attracted basically no comments, so it's not surprising that you think I haven't read it. But I have. And I've skimmed the July draft from the House (and skimmed, with less detail, a June draft from the Senate).

The $1 trillion price tag is still there. Breakdown is on page 6. Majority of that trillion ($770 billion) comes from massive subsidies to purchase coverage through the insurance exchanges. If you look at the last page, you can see that those only kick in after 2013, which is when you see that gigantic hump in all those graphs that are floating around.

The $1 trillion reflects only direct federal deficits -- it doesn't take into account costs that have been deflected onto insurance companies and their customers.; 7/24/09, 3:31 PM
Anonymous said...: Unless the republicans eventually get in power and manage to make some real changes. hahahaha hoo hoo! That was a good one.

I thought that was a knee-slapper, Knox! ;-); 7/24/09, 3:40 PM
BJM said...: Garage:
So why don't you tell us what's "disastrous" in this bill!?

Cuts to Medicare Part A will be a disaster to any family with an elderly parent or disabled adult.; 7/24/09, 3:42 PM
knox said...: So why don't you tell us what's "disastrous" in this bill!?

I already told you, I think it's enough that
Obama doesn't even know what's in it... yet insists that it's absolutely crucial that it pass.

He lists off all these problems... yet offers no concrete examples of what is in the bill to solve them. That entire press conference the other night was a bunch of nonsensical accusations hurled at doctors, apocyphal anecdotes and vague things like "eliminating waste." Well, how exactly?

If he can't even tell me, then, yeah, I think it's fair to say it's a disaster in the making.

You never answered my question, but that's okay.; 7/24/09, 3:43 PM
Balfegor said...: Re: Eliot --

I think the bill is a bad bill, but my list of bad points is different from yours. A few comments on your points:

2. It will not be legal to sell an individual a health insurance policy after Jan. 1, 2013. It's either the Gov't plan or nothing.

I don't think this is exactly correct (although, again, I have not pored over every word, just skimmed.) Here, for reference, is the bill. When I look at it, my guess would be that you are understanding the requirement that everyone purchasing new insurance get a "qualified health benefits plan" (or get taxed - See Sec. 401) as a requirement for government plan. Two points.

(1) As I read it, insurers aren't prevented from offering other insurance plans; they're just not all going to be "qualified health benefits plans," so you'll be slammed with a tax as a result. Sec. 122(b) outlines what needs to be covered, in very broad outline. Sec. 123 outlines an advisory council to establish recommended benefit standards, and Sec. 124 provides for their adoption.

(2) The qualified health plans, while they are heavily constrained by the statute (see Sec. 101(b), flagging the "affordable coverage," "essential benefits" and "consumer protection" requirements) are nevertheless supposed to be offered by insurance companies through government run health insurance exchanges.

5. Some abortions would be mandated to be funded. If this occurs, ALL Catholic hospitals in the US will up and close. They currently represent about 20% of all hospital beds and outpatient services in teh country. In many communities, they are the only provider.

The bill as written does not directly do that, as far as I can see. Now, we all know that's what the political forces in the administration are going to push for, if the bill is implemented in this form, but I think the bill leaves open the possibility that those services will not be covered.

I also do not see where the bill mandates that hospitals must all provide all covered procedures -- I suspect (unless the President is a complete idiot) that Catholic hospitals will not be required to provide abortion services, even if abortion services are covered.; 7/24/09, 3:46 PM
chickelit said...: 3. HSA plans will disappear. My out of pocket expenditures on my HSA plan (I am the employer and employee) dropped 3K per year with this plan for the identical insurance I had before.

Well that about does it for me. If this bill becomes law with that provision intact, I'm going to look into using my HSA balance to pay for my son's orthodontia--better that than pay for someone else's abortion.; 7/24/09, 4:05 PM
Balfegor said...: As far as what's "disastrous" here, I think the overspecification of the "essential benefits package" to be included in any "qualified health benefits plan" provided for in Sections 122-124 basically robs the Health Exchanges of their real benefit. I do kind of like the idea of the health insurance exchanges. I think we'll run into massive implementation problems, but the basic idea is one I would support, despite the potential for it to blow up spectacularly. I just don't support it in this way.

There's little point in comparison shopping if all you can buy is a narrow range of cosmetic variations on a standardised product (the essential benefits package, in its basic, enhanced, and premium forms - see Sec. 203(c)). There's some possibility for variation in coverage above and beyond the "essential" package, I suppose, but a better approach that doesn't constrain consumer choice to quite that extent would be to open the markets to a much broader variation of packages.

For example, people have talked about "catastrophic-only" coverage making sense as a bottom-of-the-line health package, but such a package would not qualify as a "qualified health benefits plan" so anyone who bought such a plan as their only insurance would be slammed with a tax under Section 401 -- this doesn't directly outlaw that kind of variation in health care plans, but it will tend to be a pretty big disincentive against creative healthcare insurance plans -- the market at the moment is not exactly good on this score, but that's not an excuse to make things worse. This legislative top-down approach to controlling the health insurance market is fundamentally misguided.

The employer taxes (8% of payroll, with some relief for small companies) for employes who do not provide qualified health benefits plans to their employees are also absurd, especially at a time like this. See Sec. 412.

Lastly, I don't particularly care for that $1 trillion of deficit spending projected by the CBO. The subsidies, etc. etc. Wait a little on that, and see how the structural reforms work out, before larding that stuff on too.; 7/24/09, 4:06 PM
Jim said...: Balfegor -

"The bill as written does not directly do that, as far as I can see. "

Except that it does. It's a bone of contention with pro-life Democrats who are threatening to vote against the bill unless funding for abortions is stripped out of it.

"I suspect (unless the President is a complete idiot) that Catholic hospitals will not be required to provide abortion services, even if abortion services are covered."

Never underestimate the stupidity of the Obama administration. Planned Parenthood and feminist organizations are demanding that all healthcare providers be required to perform all services. Given how little regard Obama has shown for his political opponents and how much sway he's given special interest groups over his administration and legislation to date, what would make you believe that he would hold the line on requiring those who don't want to perform abortions to do them anyway?; 7/24/09, 4:07 PM
Balfegor said...: Also I went back and checked, and it turns out I did not link the CBO report. Just the bill itself and some other stuff. So mea culpa there. I did read it, though.; 7/24/09, 4:07 PM
knox said...: I forgot to add that fundamentally I oppose the plan because there have been efforts (bills) to remove various (gov't) constraints on our free-market system in the past. And democrats have rejected them every time.

The last resort should always be government programs, takeovers, and massive spending.

Until the democrats are willing to try these other solutions first and give them a fair shake, I can only conclude that healthcare reform is not really their end goal.; 7/24/09, 4:11 PM
Balfegor said...: Except that it does. It's a bone of contention with pro-life Democrats who are threatening to vote against the bill unless funding for abortions is stripped out of it.

My understanding is that they want a provision written in specifically excluding abortions. They know that when the administration apparatchiks pick the advisory council from section 123, they'll come back with a recommendation that abortion is included. The Section 123 council is basically an American analogue of the Shingikai in Japan, and this is a trick the bureaucrats there pull all the time -- people is policy, after all. But again, abortion is not specifically covered in the bill as written. I did a word search.; 7/24/09, 4:11 PM
Balfegor said...: Planned Parenthood and feminist organizations are demanding that all healthcare providers be required to perform all services.

I suspect that they don't know what they're demanding, then. I'm pretty sure not every hospital even has MRI and CAT scan machines, but I would guess those procedures will be included under "preventive" care. If every facility were required to provide every procedure, that would be either a gigantic boon to Siemens, or trigger closure of a whole lot of smaller hospitals and clinics.; 7/24/09, 4:14 PM
Jim said...: Balfegor -

"But again, abortion is not specifically covered in the bill as written."

But as you said, if it's not specifically excluded, it will be included. So it's not inaccurate to say that the bill includes funding for abortions.; 7/24/09, 4:15 PM
Jim said...: Balfegor -

"I'm pretty sure not every hospital even has MRI and CAT scan machines, but I would guess those procedures will be included under "preventive" care."

But every hospital has an OB/GYN working there, so they won't be able to say "we're not equipped to do abortions here." So that's an equivalent comparison.; 7/24/09, 4:17 PM
Jim said...: sorry...NOT an equivalent comparison; 7/24/09, 4:17 PM
Balfegor said...: But as you said, if it's not specifically excluded, it will be included. So it's not inaccurate to say that the bill includes funding for abortions.

I think that's a semantic matter. I'm pretty certain abortion funding would be the result, but it's ultimately just a lay projection. I wouldn't be comfortable summarising the bill as including funding for abortions, at least not without caveating that such is merely the likely effect of implementing the bill at this time.; 7/24/09, 4:19 PM
garage mahal said...: Balfegor
My understanding is that the leaked preliminary CBO report on July 1 with the cost of 1 trillion dollars that's being touted everywhere never included any language of a public option in their equation. The HELP committee since has figured out a plan that would cost 600 billion over 10 yrs that includes a public option that would cover 97% of the uninsured. The downside, it doesn't include cost of Medicaid expansion estimated at 400-600 billion, so that would put the tag back to 1 trillion. [I'm not positive this is in the bill or under HELP jurisdiction]. But, the CBO score also doesn't take into account any of the Administration's proposals for cost-savings in Medicare or new revenue. Meaning the whole thing, at least on paper, could be entirely paid for. You can discount the proposals, but they are there.

My exception was always to that leaked CBO report [that was incomplete] touted by people just trying to create a shitstorm, who know it's incomplete, and perpetuated by people too lazy to look it up themselves, or crying that they don't know what's in the bill.; 7/24/09, 4:30 PM
chickelit said...: For example, people have talked about "catastrophic-only" coverage making sense as a bottom-of-the-line health package, but such a package would not qualify as a "qualified health benefits plan" so anyone who bought such a plan as their only insurance would be slammed with a tax under Section 401 -- this doesn't directly outlaw that kind of variation in health care plans, but it will tend to be a pretty big disincentive against creative healthcare insurance plans -- the market at the moment is not exactly good on this score, but that's not an excuse to make things worse. This legislative top-down approach to controlling the health insurance market is fundamentally misguided.

Reason number two why I strongly oppose this tinkering with healthcare. Congress is basically telling me: you were wrong to move to high deductable insurance, we're going to punish you for it.

F*ck the author of this bill and the horse he rode in on.; 7/24/09, 4:37 PM
Balfegor said...: My understanding is that the leaked preliminary CBO report on July 1 with the cost of 1 trillion dollars that's being touted everywhere never included any language of a public option in their equation.

The one from early July (I thought it was July 2, but you may be right) has a $1 trillion price tag. But so does the July 14 CBO report, which I believe is the most recent and most complete.

I think when people link the "public plan" and the $1 trillion figure, they are conflating two different issues. The July 14 CBO report does not actually link the $1 trillion figure to the public plan -- it links it $438 billion for Medicaid increases and $773 billion in subsidies to purchase coverage through the exchanges (not necessarily the public plan). These are offset slightly by some tax increases.

Two things are probably interfering with casual public perceptions here -- the first is that the $773 billion subsidy for health insurance purchases looks kind of like it would be going to the public plan (i.e. be a subsidy of the public plan), but I don't see that clearly in the statutory text.

The second is that our experience of public plans leads us naturally to assume it's going to run a deficit (especially if it tries to price itself below the private plans -- unlike Medicare or Medicaid, its funding base is limited to plan participants and a couple billion in startup capital from the Treasury), and will eventually require a government bailout. The CBO isn't projecting that bailout, or factoring it into the $1 trillion figure.

Appropos of that last point, as you note, the CBO isn't factoring in projected Medicare savings and so on. But it isn't factoring in the horrible things that could go wrong, e.g. those Medicare savings failing to materialise because of a "managed care" debacle like TennCare, or the funding shortfalls Commonwealth Care in Massachussetts (similar to the public option under the current bill) necessitating a federal bailout/subsidy.; 7/24/09, 4:49 PM
Roger J. said...: This is a very well done thread with intelligent and articulate posts--thanks for adding to the public knowledge!

One small point about adding Scanning technology to hospitals--scanners require radiologists to read them and the more recent generation of scanners means that radiologists require even more time--as scanning technology increases in specificity so does radiologist time to read--for example going from a sixteen "slice" image to a 64 slice image quadruples the radiologist's time.; 7/24/09, 5:09 PM
Jim said...: balfegor -

" I wouldn't be comfortable summarising the bill as including funding for abortions, at least not without caveating that such is merely the likely effect of implementing the bill at this time."

If you changed "likely" to "almost certain" I might be willing to go along with you on that. But is a 99% chance really all that much different than 100%?; 7/24/09, 6:03 PM
Bruce Hayden said...: Be fair to the man -- (1) the stimulus doesn't really kick in until 2010 (election year!) so it's not really reasonable to expect it to have an effect now; and (2) even if the stimulus works, employment is a lagging indicator; it's not going to recover until we are well into our recovery. That's what sunk George Herbert Walker Bush.

The problem with that is that it was sold as being absolutely so urgent that Congress couldn't take the time to read the bill.

Of course, there was always that disconnect with the "stimulus" bill. Any more, shovel ready infrastructure projects are almost impossible. And so, there is invariably a long time lag before they get designed, bid, let, and then started. We all know how government procurement works, and it isn't fast. But projects coming online in (now later) 2010, 2011, all the way up to apparently 2019, are likely to be countercyclical. But these are supposedly the best type of projects for Keynesian economic stimulus.

The reality is that the "stimulus" bill was never really about stimulus, but rather primarily about paying of political constituents and implementing a number of long term liberal wish list items. The problem though is that the Obama Administration put its reputation on ramming this through because our economy so desperately needed the stimulus, likely knowing that it wouldn't really stimulate the economy or save jobs. So, now they want another "stimulus" package to do what the first one was sold to us to do, but was never designed to accomplish.; 7/24/09, 10:13 PM
knox said...: or crying that they don't know what's in the bill.

How passive-aggressive of you.; 7/25/09, 10:03 AM
chickelit said...: @garage:

Which part of the horse this bill rode in on are you?; 7/25/09, 10:07 AM
Bruce Hayden said...: Probably a bit too late to get any comments here, but this is the last thread on ObamaCare I have found here.

I was thinking in the shower this morning about the Health Insurance Exchanges. The statewide one makes a bit of sense, maybe. But there is also supposed to be a national one, and that is what has me worried.

The problem is that there are reasons that health insurance premiums differently in different parts of this country, and that difference is primarily due to costs. There are two big cost items of interest.

First, there is the cost of living. Living in New York City or San Francisco is far more expensive than living in much of flyover country. We just opened a San Jose office, and our billing rates for CA work are $100 or so an hour higher than in adjoining states (NV and AZ). And, even then, our rates are notably lower than those with comparable skills living in that area, and are just imposed to pay the high rent for that area.

Everything is expensive in those high cost areas, including rent, salaries, and invariably taxes (higher rate on a higher base). And, yes, so is heath care and health care insurance.

Secondly, one of the stark differences between NV and CA is that the former has fairly draconian medical malpractice limitations. Not only are non-economic damages capped fairly low, but there are procedural safeguards against anything approaching a frivolous case.

Not surprisingly, health care costs are significantly higher for states that don't have medical malpractice limits in place, even controlling for everything else. Malpractice insurance is significantly lower, and there may be a bit less totally defensive testing, etc. going on.

So, any insurance company brave enough to compete in a national insurance exchange is going to have to rate according to the worst possible scenario - high cost state with no effective medical malpractice limitations in place.

So, why is this feature so attractive to the Obama base and why is it in the bill? My guess is that it is there because this is a mechanism for those in flyover country to subsidize the health care of those in the bi-coastal areas where Obama has the most support (and where medical costs are highest for the reasons above). Oh, and it provides a way to mitigate the damage done to the health care consumers in those states by runaway medical malpractice verdicts (which benefits one of his biggest contributing constituencies).

Just a thought.; 7/25/09, 1:01 PM