Population size and geography are certainly issues. Scalability and service allocation wrinkles alone.
I don’t think they are issues, not at this level of debate. At best, they are implementation details to be worked out later on once we’ve sorted out the real issues.
Well these are very real issues and without even considering them you can never reform health care in any meaningful way, and any try to do so will be a disaster.
Wait…what?
Dude, seriously. You’re correct when you suggest that the debate at this point ultimately won’t have much to do with these issues, but that’s mostly because the debate now has transformed into How to Give Insurance to the Minority of People Who Don’t Have It instead of reducing costs in the system. For cost reduction, you have to understand why care happens the way it does, why certain health problems are more prevalent in certain areas, and how the standard of care takes shape and can be maintained while cutting costs. If the goal is to reduce costs, those facts have to be considered. If the goal is providing insurance, well, knock yourself out, but that’s only going to make the problem worse.
No, you really don’t have to do any of that. Doing stuff like that is a distraction. You are no different than the people who say “You can’t do serious cost containment without tort reform.” It’s not meant as a good faith contribution to the debate, it’s meant as a distraction and an attempt to stall.
For cost reduction, all you have to do is look at the graphs I posted earlier. That is your starting point. Regional variances are probably something worth looking into - eventually - but in terms of lowering healthcare cost growth in the United States they don’t make the top five issues list, and probably don’t even crack the top 10.
No amount of regional variance, or any of the other nonsense you posted about, is going to account for the fact that in the United States a CT scan costs ten times as much as it does in most other first world other nations.
Bah. Just read CBO director on the Heatlh Care bills. Calling these bills deficit neutral is crap. The reason the bills are deficit neutral is because payments to doctors and hospitals are held below inflation. Elmendorff all but calls the House Bill ridiculous. Does anyone really thing that the House will really let doctor’s bills be cut by 21 percent and then maintained below inflation for the future?
Games have to be played b/c no one these bills pass if people understand the true cost. Instead we have typical DC gimmicks of provisions not starting till several years into the 10 year scoring cycle to hold down costs…or assuming things that will never happen.
If you can prove those are material contributing factors to cost, and not (as I strongly suspect) responsible for only trivial differences then I’ll be happy to retract my statement.
Link?
No one cares about cost reduction. The Dems just bought the AMA today who embraced the the house health care bill…which is partially paid for health care by freezing doctor pay (H.R. 3962). HR 3962 is budget neutral b/c it cuts doctor’s pay and that’s worth $230 Billion http://cbo.gov/ftpdocs/106xx/doc10688/hr3962Rangel.pdf on page 7…
Why might you think the AMA would endorse the health care bill if its cutting doctor pay by $230 billion? Well, let’s look at H.R. 3961. It makes sure the doctor’s pay cut never happens!
I love the sheer dishonesty. The House bill is budget neutral b/c we cut doctor’s fees! but of course there’s a concurrent house bill that doesn’t cut doctor’s fees and and in fact raises them!
So why would anyone think costs are going to be remotely cut? The house bill is a massive deficit explosion. the Senate bill has the excise tax which is good policy and will control costs!
Links for evidence:
AMA press release touting both bills: http://www.ama-assn.org/ama/pub/health-system-reform/ama-supports-house-bills.shtml
Elemendorr on why House bill scoring is a joke: http://cboblog.cbo.gov/?p=403 Read the last paragraph. It’s the only scoring where the CBO director basically says this bill is totally unrealistic in the payfors…it also has the below inflation line.
HR. 3961, which hey, pays doctors more and makes 3962 moot.
http://cbo.gov/ftpdocs/107xx/doc10704/hr3961.pdf
I find it interesting that you are getting this worked up over the dishonest little games in health care bills but not anywhere else. My understanding is that this sort of silly game playing is par for the course for any contentious bill and this is what one finds if one dares to peek inside the sausage factory. Do you feel this is an exceptional case full of more dishonesty or deception than normal for congress?
Wahoo I think you’re a bit confused over what you’re talking about. Or maybe not - I’m going from memory here.
3961 is a bill that simply reflects reality. A while back some law was passed that capped the rate at which payments via Medicare could increase. Every years since then Congress has been deferring that cap - e.g. “we’ll go ahead and cut payments later, but this year we’re letting them grow past the cap.”
HR3961 is a bill that simply acknowledges reality. We’re never going to make those cuts. The reason it’s being passed is to allow the CBO, when it crunches numbers, to stop pretending as if those cuts are going to be made. CBO has pretty strict rules by which it operates, so it has to pretend as if ANY DAY NOW Congress is going to MASSIVELY slash Medicare compensation rates. It is actually (GASP) a fiscally responsible bill, in the sense that it will force our government to face reality.
At any rate - 3961 doesn’t actually increase the deficit a cent (the money is already spent), it just closes a loophole that’s been getting wider and wider every year, and lets CBO more accurately reflect reality.
3962 attempts to (amongst other things) cap Medicare compensation rates going forward. Who knows if that will actually work out.
The starting thing midyear is pretty par for the course (see Bush tax cuts and prescription drugs). But I don’t think Bush ever pretended the drugs would be deficint neutral. He just lied about the cost element, (although so far it’s under budget which is surprising to me).
What is incredible is that people are pretending these bills are deficit neutral while at the same time passing bills that make up for the tough elements that make the bills deficit neutral. Running HR 3961/3962 concurrently is awful. I believe it’s lying to the people.
Do you read your own links?
Oh, I’m probably definitely confused. and you may be right. This is what is confusing me. Elmendorrf says the "bill would leave in place the 21% rate cut for 2010. I believe “the bill” is referring to 3962 but he’s an economist so descriptive English is beyond him. Read this paragraph or the whole thing and tell me if you think the doc pay cut is in 3962 or not. Or maybe jsut part of the cut?
different emphasis:
The bill would put into effect (or leave in effect) a number of procedures that might be difficult to maintain over a long period of time. It would leave in place the 21 percent reduction in the payment rates for physicians currently scheduled for 2010.
Edit: Read this in conjunction with the AMA press release which makes clear that HR 3961 does away with the 21% cut. We both agree on that, believe. I read the CBO director’s sentence as the “The bill” as 3962.
Last edit: Jeff, I agree Medicare spending is gonna be way down. But as Elemendorr notes holding payments below inflation? Really? And does that short payment to Medicare include w/ or w/o 3962. That’s my question
Reading some more: Jeff, we’re both right. HR 62 doesn’t rely on the cuts to doctors but assumes they’re there. Hr 61 raises the cost of Medicare to above the 62 levels.
Kraaze: This is more old school Washington bribery and ridiculous assumptions that no one believes is gonna happen (See the CBO’s director’s skepticism that costs will be below inflation much less medical inflation). I don’t have much problem with this b/c it’s not assume -262 in one bill and add in another bill.
It looks like the House is going to pass HR 3962 today. This will be the first time either house of Congress has passed comprehensive helathcare reform.
Of course it’s not a pretty process, as Ezra Klein documents.
No vote yet, but you can watch the final debate here:
It is actually pretty entertaining. Congressmen are going all out in these last minutes of debate.
Well we can only hope now the Senate does the right thing and never passes this pile of crap so we can start over and deal with things that will actually lower the cost of health care.
That site shows that democrats tweet twice as often as republicans.
I’m really rooting for single-payer too, but I don’t think it will happen any time soon.