The House Bill and Health Care Costs
Back when I was in the newspaper business, there used to be a kind of story that we called a "clip and save"--a clear, concise explanation of something that you wanted to keep handy for reference as you wrote your own stories about a complicated subject. If there's an internet equivalent of that for health geeks (and for voters trying to figure out whether they like the legislation that is in front of Congress), it's this blog post by Jonathan Cohn. It looks at the question of whether the House health bill does enough to bring down costs. His answer: yes, no, maybe. Cohn acknowledges that all of this is something of a guess on everyone's part, but he gives us a set of yardsticks by which we can measure this effectiveness of this bill and of all the other versions that are likely to emerge as the legislative machinery grinds forward.
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1
Was that you next to Christi something or other? It was a very short shot, so I may have been mistaken.
Also, why go if you are not gonna be called on? Once you get AP, Reuters, the networks out of the way, all that is left is something like the Plain Dealer placement. This effect is exacerbated by Obama actually answering the questions, with some detail and nuance. Fewer questions result.
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2
Yes, that was me. And I had no clue whether I'd be called on, but this would have been my question:
Mr. President, you say over and over again that if people like the coverage they have, they won't have to give it up. But what if they DON'T like the coverage they have? What if they think their employer plan is too expensive, or doesn't provide what they need? The House bill would, after five years, let them shop for something else through their state insurance exchange--including a public plan. The Senate HELP bill would say that if their employer provides insurance, they are stuck with it. They can't opt out and they can't shop around. Which should it be?
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2.1
Is that in fact what the help bill says? You are stuck with whatever your employer offers? KT can you point me to the lanuage in the bill that says this.
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2.2
Now KT - that's what I call a meaningful question..
As opposed to Mr. President can you absolutely guarantee that no one's health coverage will ever change no matter what if health reform is passed? I say next time around they ought not include that questioner and make room for you.
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2.3
Gunny: No, I cannot point you to that language, and the truth is, I have not read every word of the bill. And legislative language would not say "you are stuck with..." However, I did press the staff that wrote the language on this question, and they confirmed that is the case.
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3
SwampGang: Its..."No feeding Thursday(tm)"!
Karen: I've heard very little about the role that high medical ma;practice premiums play in rising health care costs. Is Tort Reform on the radar as a means to reduce doctor's costs by
1) reducing malpractice premiums and
2) reducing the amount of unnecessary (CYA) medical tests?-
3.1
Obama has made it pretty clear to Republicans that he is open to a deal on that, and this is the idea that I have heard floating around the White House: We'll be doing all this comparative effectiveness research, right, to determine which treatments work best. So one idea is to make "best practices" a defense in malpractice suits. In other words, if a doc says, look, I was following what the research says, so don't blame me. It kills two birds: Alleviates tort issues, and pressures the docs to follow the research.
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3.2
TX did this, capped malpractice awards. Malpractice suits have largely stopped there. No reduction in general medical costs has resulted.
This is, and always has been, a canard.
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3.3
That's because "tort reform" is largely a code word for "insurance companies trying to evade exposure for the malpractice of their insureds". In fact, malpractice premiums have little to nothing to do with rising health care costs.*
People who say that there is a rampant problem with "defensive medicine" know very little about either tort law or how medicine is practiced, in fact.
KT's suggestion that doctors should be held to a "best practices" standard would be brilliant...if that weren't already the legal standard. If you want to win a malpractice case, you already have to prove that a doctor deviated from the accepted standard of care in the medical field. You can't just say that the doctor could have performed a test that had a .000001% chance of discovering a condition. You have to show that a test would have been performed by any competent doctor in the field in the same circumstances.
In REALITY, to the extent that tests like MRIs are over-prescribed, it occurs in order for doctors to recoup the expense of the MRI machine. An orthopedic surgeon who is a partner in an owning a sports-medicine clinic MAY be more free about ordering an MRI because he wants to recover the millions of dollars that his practice spent on building the facility. Not because he is worried about being sued.
In REALITY, malpractice cases are usually extremely time-consuming, complicated, and expensive to bring FOR PLAINTIFFS and the lawyers who specialize in medical malpractice cases tend to be reluctant to shell out tens or hundreds of thousands of dollars of their own money on pipe dreams. Plaintiffs lawyers are usually very selective, choosing cases where there was not merely medical care that meets the legal definition of malpractice, but where the conduct was so egregious that it would make a jury say "Oh, my God!"
* I have no problem with legitimate efforts to reduce doctors' malpractice premiums that occurs because of gouging by an insufficiently competitive insurance market. However, and perhaps unfortunately, that is something that must be accomplished on a state-by-state basis because that is how insurance is regulated.
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3.4
Here's what tort reform did here in Texas.
The limits include a $250,000 cap on noneconomic damages such as pain and suffering
(In cases with multiple defendants, the cap is set at $250,000 for noneconomic damages against all physicians, and $250,000 against one hospital or $500,000 against two or more hospitals for a total of $750,000.
Many nursing homes who are often the target of suits because of their questionable care have either stopped carrying insurance or have switched to $250,000 so-called wasting policies. Under those policies, defense costs are subtracted from the coverage amount, leaving less for payouts to plaintiffs.
Most plaintiffs lawyers here take these type of cases on a contingency fee bases. You do the math after adding up the costs for experts and depositions.
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4
Here's a clip and save from Rhonda Hackett:
Myth: Canada's health care system is a cumbersome bureaucracy.
The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn't when everybody is covered.
Myth: The Canadian system is significantly more expensive than that of the U.S.
Ten percent of Canada's GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada's. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.
~
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5
"The Senate HELP bill would say that if their employer provides insurance, they are stuck with it."
Is that accurate? So if my employer provides insurance I couldn't, for example, switch to my wife's plan which in this scenario is less expensive with lower co-pays?
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5.1
No, you probably could switch to your wife's plan, because you would still be covered by the individual mandate that way. But you couldn't go peruse the offerings on your state insurance exchange.
There's a policy reason for that: If all the young and healthy folks ditch their employer plans for something cheaper, that leaves the company with the old and sick on its hands, which is much more expensive. But I think that most people don't realize as we debate this public plan that a real question is who would be allowed to join it. And it's a huge question.
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5.2
I'm confused, if insurance reform will prohibit insurance companies charging more for folks who are older, have pre-existing conditions, or are sicker etc. then why would younger, healthier employees opting out of their employers insurance plan increase the cost of the remaining employees on the grounds that they are older or sicker?
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5.3
I assume because overall premiums would have to be raised to pay for their medical expenses; in a health care plan with young people the young and healthy essentially subsidize the older and sicker.
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6
Karen, please stop misrepresenting "health care costs" in this manner.
There is a massive difference between the increase in the costs of a federal program that exists because more people get subsidized health care, and increases in the costs of federal programs brought about by health care inflation.
And the problem here is that the only effective means of controlling health care inflation is by creating a massive program (single payer would be most effective) that will reduce society's costs for health care while increasing the cost to the government.
This isn't a difficult concept to communicate, yet the media is so beholden to the health care parasites that it refuses to communicate this basic fact --- that the way that the rest of the world is able to pay half what the US does for health care is because the system is extremely centralized, and that centralization encourages efficiencies (like the kind of systems you are so in love with at Mayo and Kaiser.)
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6.1
But if you put a lot more people into a health care system where there have been no effective cost-containment measures built in, you are accelerating the overall problem, which is that health care costs are threatening to eat the rest of the economy. I am not misrepresenting this at all.
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6.2
Also, would you care to specify exactly what you mean by suggesting that I am beholden to health care parasites?
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6.3
But if you put a lot more people into a health care system where there have been no effective cost-containment measures built in, you are accelerating the overall problem, which is that health care costs are threatening to eat the rest of the economy. I am not misrepresenting this at all.
1) the health care parasite system is extremely inefficient, with anywhere from 20% to 33% of costs going to "overhead" (as opposed to a Medicare which has overhead costs of under 3%). Geting the insurance industry out of "basic" health insurance would result in massive savings in overhead costs.
2) A decentralized system makes it practically impossible to implement cost-savings measures systemwide. You can't compensate doctors for treating a disease based on the Mayo Clinic's "team" approach unless the "team" infrastructure is already in place -- if you try to do so, you'll drive most doctors into bankruptcy, because they (and not their corporate/foundation overlords) are on the hook for all the equipment they've bought for their practice. Once you've centralized the system, you can force the necessary changes.
As for the parasites remark, here is one example.
in the current discussion the Mayo Clinic is functioning like an insurance company/for-profit hospital. Its "opinions" that you constantly site are not based on medical/clinical experimentation, but on what will be best for Mayo's bottom line regardless of how it impacts other systems.
Mayo may (or may not) have the most efficient system -- it all depends on what you measure.
For instance, while overall costs/Medicare patient are higher in Florida than in Minnesota, hospitalization costs are consistently higher in Minnesota across all the most popular procedures. And Florida's Medicare eligible population has a much higher proportion of poor people -- and poor people wait until they are very sick before seeking treatment, driving up the cost of treatment for the "same" disease. Finally, Florida's population is much more transient -- and that lack of continuity of care means that more tests are ordered.
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6.4
It's fine to disagree with me, but you are constantly throwing out implications about my motives and my character. To say I'm "beholden," to call me a "shill" (as you have), suggests that I am somehow on the take or presenting things in ways that I am aware are fundamentally dishonest. I am a reporter who is doing my very best to inform my readers about a large and complicated debate. If I am wrong, and I often am, it is not because I am purposely misleading people or operating on behalf of some special interest. If you think that I am unethical and dishonest, I don't understand why you don't go read someone else.
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6.5
I guess the question is whether its "honest" to report on health care reform in a way that makes it appear that GOP obstructionism, and views promulgated by bought-and-paid-for politicians beholden to the insurance and Pharma lobbies, are actually a legitimate part of the discussion.
I mean, how can you do a piece like your profile on Baucus without mentioning how much cash he's pocketed from the parasites?. How can you sing the praises of a political prostitute like Karen Ignagni without once mentioning the tens of millions of dollars in campaign contributions that she controls that gives her access to people like Baucus (and the White House itself?)
How can you consider it "honest reporting" when it consistently excludes the MONEY that is defining the "debate" over health care?!?! As long as you continue to report on this process as if it isn't wholly corrupted, you are acting as a "shill" for the parasites.
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6.6
I ran across an article on the FactCheck wire that compares donations from the health care industry made to Senators who are for and against the public option. They discovered that some supporters of the public option received as much, or more, from the industry, suggesting it's not quite as simple as just following the money.
http://wire.factcheck.org/2009/07/20/selling-out-the-public-option/
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6.7
McChristian....
The "public option" that is being supported by Dodd etc is an extremely weak version of what had been originally proposed. These so-called "liberal" senators have sold out by endorsing a plan that restricts access to the public option, turning it from a means of transitioning to a single payer system into an insignificant "insurer of last resort" part of the bogus "health insurance exchanges" -
6.8
Nothing is never quite as simple as true believers make it out to be.
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7
Good Q KT. I think they should allow employers to offer the public option as one of the coverage choices. THAT would make for some competition.
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7.1
Which be exact' why THA be not goin' t' be happenin!
YARR!
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8
here's an idea for some real health care reporting...
Here's a letter from the White House detailing how many times representatives of health care parasites have been to the White House...
http://www.politico.com/blogs/joshgerstein/0709/WH_discloses_healthcare_execs_visits.htmlTwo questions need to be answered --
1) how many times were advocates of single payer systems part of these meetings?
2) how many times did each of the individuals listed meet with Max Baucus, Kent Conrad, and other congressional leaders --- and did single payer advocates have the same level of access?
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9
KT,
Though this is hindsight, but do you think Obama would have been better off taking this issue on piecemeal rather than giving Congress marching orders for a complete overhaul?
For example, asking Congress for a bill outlawing insurers from dropping patients without having to prove fraud in court would have pretty broad appeal (one would think) in the country. Likewise, the clinical effectiveness advisory board would probably be a straightforward sell.
Or does your experience around Washington seem to indicate Obama's done the only thing he should i.e. bite the bullet and overhaul the whole thing at once.
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10
Well, my name isn't KT, but I like that question candoc. My opinion is that Congress would reform one or two issues (such as random insurance rescission) and then get claim to have reformed health care. This is incrementalism in the extreme, and I think Obama realizes that this is not an effective approach to HCR at the current time. I would agree, at least in general terms, that Obama had to bite the bullet and go for a complete overhaul while he had the chance to do so.
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11
Karen, did earlier bill to allow Medicare drug savings + direct negotiation w/ drug cos. pass? Is something sim. to this included in public option?
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12
Ignore plukasiak, KT. His once rational and conversation advancing abrasiveness and paranoia have degenerated to the point where he's become what until two threads down I didn't know existed- a liberal birther.
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13
When everyone is finished arguing about whether oranges are better than apples, and the real culprits have left with the swag, let me know...
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13.1
It be worse than apples an' oranges - it be li' we be in Baltimore, tryin' t' get t' Boston, an' we be arguin' vitriolic o'er whether it be best t' go east o'er water or west o'er land...havin' navigated 'round th' globe already an' ended up back in Baltimore...an' absolute ev'ryone refusin' t' even think 'bout per'aps needin' t' go north!
Th' last time we tried this, wi' th' Clintons, we ended up on a round th' world goose chase, an' we be d*mn set on repeatin' ourselves all o'er ag'in, determined tha' doin' so this time will get us whar we need t' be.
East 'r west, see ye all in another 15-20 years back 'ere in Baltimore ag'in!
YARR!
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13.2
Th' Clinton plan, BTW, had us headin' a' least in a northerly direction!
arrgh.
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14
Boehner said yesterday at a press conference
" Issues are coming at us like a machine gun"
Good reason for not being part of health care talks?
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14.1
OrangeMan is actually just admitting he's not up to the job. Here's hoping his constituents get the word on that. He can't lead, he won't follow, and he hasn't the sense to get out of the way.
Then again, I'd be all for his staying in his "leadership" position if he'd just take a few minutes to teach Eric Cantor the finer points of erotic asphyxiation.
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15
I just hope Obama shamed enough of the blue-dog Dems yesterday. He definitely stuck a rhetorical fork in the GOP's eye, and about time.
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16
The only thing good about this one is that we get to watch a feeding frenzy from the gunwales.
This cr@p is nothing but chum...
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16.1
I don't be thinkin' I want t' be watchin' it no more. I've me a iron-strong pirate constitution, bu' I've 'bout had me enough.
Th' problem wi' chummin' be th' sharks be comin' soon after. Tha's th' part I don't want t' be stickin' 'round fer.
yarr.
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17
There is a huge economic cost to forcing people to stay with their employer health care plans: reduced labor mobility. With the rise in home ownership and the decline in the housing market, that's already an obstacle to economic recovery. And failing to address the problem of health insurance-related labor immobility won't help.
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18
Agreed, esblofeld. p_luk has lost the plot.
I have always been a proponent of primary challenges, believing that those who claimed that they were unnecessarily divisive were entrenched insiders trying to discourage competitors. Sadly, the Hillary-Obama primary war may have proved me partially wrong, as a number of previously rational liberals in the blogosphere became unhinged.
What I find most sad is that, by signing on to the birther nonsense, p_luk undermines all the work that he did on the Bush/TANG story, which was methodical and rational.
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19
Yeah I read plukasiak's comment on the birth issue and I'm astonished. Frankly it's so over the top that I doubt it has anything to do with lingering primary divisions; that kind of thinking was certainly never representative of HRC supporters.
Anyway, plukasiak actually supported the "establishment" candidate so if primaries are responsible for damaging internal divisions I guess that suggests Obama shouldn't have run! Seriously, my guess is that people like this have always been around but now the internet makes them more visible.
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19.1
Rose,
Why is it "over the top" to ask for original source documents when they are available.I didn't rely on secondary sources when I looked at Bush's military records, and I don't think I used the wrong standard there.
These are "historic" documents -- the kinds of documents that historians will want to ensure that the record is as complete as possible. So when they are withheld from the public, it simply encourages speculation.
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19.2
If you want the original documents, go to Hawaii and look at them in situ, as Hawaii law requires. People who have done so have testified to their existence.
The copies, which is all that the state of Hawaii will legally release, have already been made available.
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19.3
*Sigh*
I see I have to repeat myself yet again. I was born in Hawai'i. When I needed a copy of my birth certificate, they sent a document that looks identical to the one that Obama has presented numerous times. I do not have my original birth certificate. That is on file with the Hawai'i Bureau of Records. And I will NEVER have the original, as that is against Hawai'ian law. So does that mean I was also born in another country and therefore am not a citizen? My birth announcement is in the Hololulu Citizen as well, was that forged too?
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20
Not one Minnesota representative or senator will vote for one of the existing health care bills.
http://www.minnpost.com/stories/2009/07/23/10437/health_care_debate_in_congress_minnesota_delegation_unites_in_opposing_funding_planThe current proposals simply put more money into a broken system.
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21
As someone who by and large agrees with P-luk's perspective(s) re: H-C reform, the inherent corruption of the congressional process etc. I would simply tell him that if he wants his voice heard on issues that do matter, that talking about Obama's birthplace is not a good way of maintaining relevancy.
I wouldn't say the concerns he's raised put him in the same cat. as the "birthers" but it's unseemly at best. That segment of the pop. is always going to have a problem with an exotically-named biracial president, period. However unwittingly, by pushing his legal angle, he's validating their cretinous nativism. Simply move on and focus on issues about which your voice is a welcome addition to the debate. i.e. Pick your battles.
My two cents.
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