United States Healthcare Reform

[bago]

Originally Posted by Brettmcd

Nah, they are doing a favor to all the senators who never bothered to read the entire bill.

Because nobody has a staff or has bothered to read proposals for the last 10 months. Look, I know we're still recovering from the Bush era where a 3 page bill to spend nigh upon a trillion dollars with no oversight was considered normal, but lets give the staffers some credit.

[Brettmcd]

Originally Posted by Skipper

They are doing anything to prevent any positive effects from this Bill to take place before Obama leaves office. It's the game politicians play.

They are trying to prevent something from passing that larger and larger numbers of americans oppose as time goes on. This poll that was posted in another thread shows support down to 40%. Also interesting is that 58% of the independents in the poll oppose it also.

http://publicpolicypolling.blogspot..../11/acorn.html

You have to click on full results to see the question and the response to it.

[Brettmcd]

Originally Posted by bago

Because nobody has a staff or has bothered to read proposals for the last 10 months. Look, I know we're still recovering from the Bush era where a 3 page bill to spend nigh upon a trillion dollars with no oversight was considered normal, but lets give the staffers some credit.

We dont elect staffers to tell a senator what the staffer thinks a bill says. We elect our representatives to read these things and be informed on the issues themselves. Not to inform themselves by what someone else thinks about it.

[Skipper]

Originally Posted by Brettmcd

They are trying to prevent something from passing that larger and larger numbers of americans oppose as time goes on. This poll that was posted in another thread shows support down to 40%. Also interesting is that 58% of the independents in the poll oppose it also.

http://publicpolicypolling.blogspot..../11/acorn.html

You have to click on full results to see the question and the response to it.

No. The Replublicans do want healthcare reform. They just want this passed with either more of their specific needs applied to it, or with the net effect taking place after 2014. I wonder why they would want it to happen after that time period? Oh I know, that would be after the next election. How smart of them.

Dems are pushing early so that those items which can take place early, are indeed doing so before this term ends. Both sides are playing the game here Brett.

[LesJarvis]

The whole "read the bill" schtick is one of the dumber memes to emerge in the healthcare debate, which is pretty impressive. Bruce Bartlett recently explained why reading the bill is a colossal waste of time:

http://www.capitalgainsandgames.com/...ill-waste-time

[wahoo]

Originally Posted by Skipper

No. The Replublicans do want healthcare reform. They just want this passed with either more of their specific needs applied to it, or with the net effect taking place after 2014. I wonder why they would want it to happen after that time period? Oh I know, that would be after the next election. How smart of them.

Dems are pushing early so that those items which can take place early, are indeed doing so before this term ends. Both sides are playing the game here Brett.

That is completely and utterly wrong. The effect doens't take effect until 2014 so that the bill will be scored at CBO under $900 billion. If the bill starts to take effect before then, then the bill expands the budget deficit and breaks President Obama's pledge. Remember the health bill has to be deficit neutral and under $900 billion. If you start taxes at day 1 and benefits much later, the bill can fit those criteria much easier!

Senator Reid delayed the implementation of the bill by an extra year so he could have a more generous bill at the same cost as the other bills. If you want more a generous bill, then delay the start so CBO will score it cheaper over a ten year period.


Big Edit: For all those who thing that Medicare panels etc will really work, look at the big mammogram controversy this week. Evidence based medicine came out and said women should delay getting them till later. The HHS Secretary quickly beat that down as quick as possible. Given the doc fix that also passed this week, why do people believe that these are effective cost control mechanisms? We had a test case this week and HHS said don't pay any attention to those academic wonks. In this case, you have a panel of experts that issues an opinion that isn't popular. And politicians couldn't run for cover fast enough. People are naive if they think that all these cuts are going to happen and some how experts will how magic sway and shelter politicians from an angry populace.

From the Post:

Health and Human Services Secretary Kathleen Sebelius, in a written statement, said the new guidelines had "caused a great deal of confusion and worry among women and their families across this country," and she stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government."

Sebelius's statement challenged the recommendations of that influential panel, the U.S. Preventive Services Task Force, made up of independent experts assembled by her department to address one of the most explosive issues in women's health.

[Brettmcd]

Originally Posted by bago

Because nobody has a staff or has bothered to read proposals for the last 10 months. Look, I know we're still recovering from the Bush era where a 3 page bill to spend nigh upon a trillion dollars with no oversight was considered normal, but lets give the staffers some credit.

I wonder if blaming the bush administration will ever go out of style. I guess it makes it easier then taking responsibility for ones own actions.

It was stupid when the republicans tried to tie everything to Clinton and its stupid now watching the dems do the same thing.

'Oh no, its raining and I forgot my umbrella, must be that damn Bush that made me forget.'

[Kraaze]

Originally Posted by wahoo

That is completely and utterly wrong. The effect doens't take effect until 2014 so that the bill will be scored at CBO under $900 billion. If the bill starts to take effect before then, then the bill expands the budget deficit and breaks President Obama's pledge. Remember the health bill has to be deficit neutral and under $900 billion. If you start taxes at day 1 and benefits much later, the bill can fit those criteria much easier!

Senator Reid delayed the implementation of the bill by an extra year so he could have a more generous bill at the same cost as the other bills. If you want more a generous bill, then delay the start so CBO will score it cheaper over a ten year period.


Big Edit: For all those who thing that Medicare panels etc will really work, look at the big mammogram controversy this week. Evidence based medicine came out and said women should delay getting them till later. The HHS Secretary quickly beat that down as quick as possible. Given the doc fix that also passed this week, why do people believe that these are effective cost control mechanisms? We had a test case this week and HHS said don't pay any attention to those academic wonks. In this case, you have a panel of experts that issues an opinion that isn't popular. And politicians couldn't run for cover fast enough. People are naive if they think that all these cuts are going to happen and some how experts will how magic sway and shelter politicians from an angry populace.

From the Post:

Health and Human Services Secretary Kathleen Sebelius, in a written statement, said the new guidelines had "caused a great deal of confusion and worry among women and their families across this country," and she stressed that they were issued by "an outside independent panel of doctors and scientists who . . . do not set federal policy and . . . don't determine what services are covered by the federal government."

Sebelius's statement challenged the recommendations of that influential panel, the U.S. Preventive Services Task Force, made up of independent experts assembled by her department to address one of the most explosive issues in women's health.

Note that the big insurance companies, the ones with the theoretical (but never actually observed) financial interest in using evidence based medicine to reduce costs jumped in just as publicly and loudly against the new mammogram recommendations.

http://www.usatoday.com/news/health/...ram19_ST_N.htm

So this is actually the opposite of what you suggested. This isn't evidence that government panels can't set healthcare standards as well as the insurance industry, it's evidence they can do it equally well and without the overhead.

[malchior]

Originally Posted by Brettmcd

I wonder if blaming the bush administration will ever go out of style. I guess it makes it easier then taking responsibility for ones own actions.

Dude, just a few posts ago you posted a link showing Republican polling showing that they blame acorn for the NY-23 electoral loss. Are you fucking kidding me with this shit?

[wahoo]

Originally Posted by Kraaze

So this is actually the opposite of what you suggested. This isn't evidence that government panels can't set healthcare standards as well as the insurance industry, it's evidence they can do it equally well and without the overhead.

We agree. Insurance/government caters to the will of the people. The idea that private companies/the government will buck what people want is ludicrous.

Let's recap: People cite this govt panel which will tell people what best practices are. Then the government will only pay for those best practices. Our test cases is that early mammogram screening is not cost effective and should be discontinued according to our panel of government experts. Did insurers or the govt back this finding which would help lower the cost of health care?

Hell no. Insurers and the Secretary of Treasury threw the expert panel under a tank and ran them over repeatedly. So why do we think that things are going to be different in these new government established panels of health care?

Do people really think that politicians will say, you're right. We shouldn't have as many breast, prostate exams b/c the experts say it's not cost effective. We won't cover those procedures.

All the evidence points the complete opposite direction where politicians will rush to overcome the panel recommendations. Because politicians don't want people upset when procedures are taken away from them.

So Ezra Klein can believe in this new super powerful government panel will restrain health care costs. Reality says politicians won't let these cuts take place at the request of bureaucrats

[Kraaze]

Originally Posted by wahoo

We agree. Insurance/government caters to the will of the people. The idea that private companies/the government will buck what people want is ludicrous.

The government won't ask for a profit and is more likely to take the occasional unpopular stand (see Roe V Wade).

[Brettmcd]

Originally Posted by malchior

Dude, just a few posts ago you posted a link showing Republican polling showing that they blame acorn for the NY-23 electoral loss. Are you fucking kidding me with this shit?

That part of the poll shows the republicans are idiots to think that, I was looking at the health care results of the poll. So no I am not kidding you, I think its stupid for both parties to do nothing but blame the other guy so they dont have to take responsibility for their own actions.

[wahoo]

Originally Posted by Kraaze

The government won't ask for a profit and is more likely to take the occasional unpopular stand (see Roe V Wade).

I don't understand that. What does a profit have to do with it in this scenario?

Also, Roe V. Wade was a court decision done by people who don't have to face voters.

[bago]

Originally Posted by Brettmcd

I wonder if blaming the bush administration will ever go out of style. I guess it makes it easier then taking responsibility for ones own actions.

It was stupid when the republicans tried to tie everything to Clinton and its stupid now watching the dems do the same thing.

'Oh no, its raining and I forgot my umbrella, must be that damn Bush that made me forget.'

There's a difference between blame and facts.

[jeffd]

Originally Posted by wahoo

We agree. Insurance/government caters to the will of the people. The idea that private companies/the government will buck what people want is ludicrous.

Let's recap: People cite this govt panel which will tell people what best practices are. Then the government will only pay for those best practices. Our test cases is that early mammogram screening is not cost effective and should be discontinued according to our panel of government experts. Did insurers or the govt back this finding which would help lower the cost of health care?

Hell no. Insurers and the Secretary of Treasury threw the expert panel under a tank and ran them over repeatedly. So why do we think that things are going to be different in these new government established panels of health care?

Do people really think that politicians will say, you're right. We shouldn't have as many breast, prostate exams b/c the experts say it's not cost effective. We won't cover those procedures.

All the evidence points the complete opposite direction where politicians will rush to overcome the panel recommendations. Because politicians don't want people upset when procedures are taken away from them.

So Ezra Klein can believe in this new super powerful government panel will restrain health care costs. Reality says politicians won't let these cuts take place at the request of bureaucrats

How do you account for the French, German, Japanese, Canadian, and British systems doing exactly what it is you're saying they can't do?

[Jason McCullough]

Originally Posted by wahoo

So Ezra Klein can believe in this new super powerful government panel will restrain health care costs. Reality says politicians won't let these cuts take place at the request of bureaucrats

If government is incapable of cost cutting, why are we pretending to be concerned about costs? We should just repeal Medicare then, apparently.

[wahoo]

Originally Posted by jeffd

How do you account for the French, German, Japanese, Canadian, and British systems doing exactly what it is you're saying they can't do?

A version of path dependency. They don't know what they don't have b/c it's not covered. In the US, the genie is out the bottle so you have to take things away. In other countries, they restrict entry from the start.

There's also a lot less utilization of new health care technologies and techniques. Some of these b/c they won't pay for them and some they don't prove to be worthwhile. Also, lot less doctor compensation in Europe.

And I also think there are cultural differences. I look to NICE that says the UK won't cover something. There's grumbling but acceptance. In the US, the AARP would send their members on the warpath if something was excluded from Medicare.

[DragonPup]

Originally Posted by wahoo

I don't understand that. What does a profit have to do with it in this scenario?

Also, Roe V. Wade was a court decision done by people who don't have to face voters.

So was Gideon v. Wainwright. Also, Brown v. Board of Education.

This is why Supreme Court judges are not get elected.

[StGabe]

Originally Posted by jeffd

How do you account for the French, German, Japanese, Canadian, and British systems doing exactly what it is you're saying they can't do?

He'll just tell you that Americans are "different" and "special".

Anyway, the whole thing is a smoke screen anyway. For those proposing healthcare changes, the burden of proof requires perfection. Any individual case of failure means the whole system is doomed. For those proposing alternatives, apparently, there is very little burden of proof.

Of course what most of us want is a system where the independent panel has the power, not Kathleen Sebelius. Were that case, we'd actually be considering a change at this point.

[TheTrunkDr]

Originally Posted by wahoo

A version of path dependency. They don't know what they don't have b/c it's not covered. In the US, the genie is out the bottle so you have to take things away. In other countries, they restrict entry from the start.

You know these systems didn't exist from the beginning of time, at some point they were instituted.

[Skipper]

Originally Posted by wahoo

That is completely and utterly wrong. The effect doens't take effect until 2014 so that the bill will be scored at CBO under $900 billion. If the bill starts to take effect before then, then the bill expands the budget deficit and breaks President Obama's pledge. Remember the health bill has to be deficit neutral and under $900 billion. If you start taxes at day 1 and benefits much later, the bill can fit those criteria much easier!

Senator Reid delayed the implementation of the bill by an extra year so he could have a more generous bill at the same cost as the other bills. If you want more a generous bill, then delay the start so CBO will score it cheaper over a ten year period.

This was my understanding after hearing it discussed on NPR this week. Yes, Reid introduced with the 2014 timeframe however there were a number of effects which would kick in much before that. Some of the finagling of the bill and timeline was thought to be a push by the Republicans (or nervous Dems) to get the effects outside of the voting window and outside of this administrations "job done" timeframe.

Blame me for misconstruing what the political guy was saying on NPR but I could have sworn that was the summary.

[Kraaze]

Originally Posted by wahoo

Also, Roe V. Wade was a court decision done by people who don't have to face voters.

Perhaps citing a court case muddied the waters there. I should have instead pointed out that entities like the EPA, FCC, etc can all make unpopular decisions stick when they really want to. That's probably a better comparison to a hypothetical care guideline setting panel inside some government agency.

[Spam]

I'm still not getting the usefulness of Reid's proposal. Do I have this right? ~6 years of coverage @$850B, which is $25k+ per person for a $3k policy?

Sum dood seems to think Reid's bill compares unfavorably to what's happening in massachusetts, where, I am told, the wait to see a primary care physician is now up over 50 days and costs have nearly doubled.

So run it by me again how the massachusetts plan scales to 300 million people and an area as geographically large as the US?


Edit: Oh and, expert panels with no oversight! That's something we can all get behind.

[Kraaze]

Originally Posted by wahoo

A version of path dependency. They don't know what they don't have b/c it's not covered. In the US, the genie is out the bottle so you have to take things away. In other countries, they restrict entry from the start.

That rings quite false.

First off, Why do we have to take things away to reduce consumption of expensive services? Just putting a cap on expansion of new services and holding the status quo is quite likely a very acceptable solution that will make the problem solve itself in 10 or 15 years.

Second, I'm not convinced that we are over consuming services because educated citizens demand the. All the medically expensive stuff in my life has been done because my physician said I should. If the physicians stops making expensive recommendations, I bet a lot of the problem

Third, I'm not convinced overconsumption of services is a serious problem or serious cost driver.

[wahoo]

Originally Posted by Kraaze

First off, Why do we have to take things away to reduce consumption of expensive services? Just putting a cap on expansion of new services and holding the status quo is quite likely a very acceptable solution that will make the problem solve itself in 10 or 15 years.

Second, I'm not convinced that we are over consuming services because educated citizens demand the. All the medically expensive stuff in my life has been done because my physician said I should. If the physicians stops making expensive recommendations, I bet a lot of the problem

Third, I'm not convinced overconsumption of services is a serious problem or serious cost driver.

I agree with you. If we held the line and capped expansion, it wouldn't be a problem in ten years.

But take a step back to what you're proposing...A) The US delays any new medical breakthroughs or services or b) That the govt tells doctors what they can or can't to treat patients.

This looks good on paper, I think people will vigorously resist being denied access to new medicine or procedures their doctors want to do. I'm sympathetic to some of your statements, but I do believe the overconsumption of health care is a problem.

I think our difference is that I don't think that caps or trying to hold the status quo will be an effective cost control measure.

[Blackadar]

Waiting for brettmcd to come and accuse me of supporting the federal public option simply because I'm a liberal in 3...2...1

[jeffd]

Originally Posted by Kraaze

Third, I'm not convinced overconsumption of services is a serious problem or serious cost driver.

It is, but it's not the serious cost driver.

I posted some graphs several pages back, go check them out. The bottom line, and the root cause of the problem, is that the United States pays significantly more per unit of healthcare than any other developed nation. It's not that we get more MRIs, more mammograms, more surgeries, etc. It's that when we get an MRI, a mammogram, some surgery, or whatever it costs as much as ten times as much as it costs elsewhere.

[TheTrunkDr]

Originally Posted by Spam

I'm still not getting the usefulness of Reid's proposal. Do I have this right? ~6 years of coverage @$850B, which is $25k+ per person for a $3k policy?

Sum dood seems to think Reid's bill compares unfavorably to what's happening in massachusetts, where, I am told, the wait to see a primary care physician is now up over 50 days and costs have nearly doubled.

So run it by me again how the massachusetts plan scales to 300 million people and an area as geographically large as the US?


Edit: Oh and, expert panels with no oversight! That's something we can all get behind.

The Massachusetts plan is and always was stupid. It's a mandate and little else, some state run insurance for the few that qualify. Insurance companies don't simply give back money just because the state forces everyone to be paying customers. They just have bigger numbers on their balance sheets.

[Brettmcd]

Originally Posted by Blackadar

Waiting for brettmcd to come and accuse me of supporting the federal public option simply because I'm a liberal in 3...2...1

Nah you support it because you are an idiot, being liberal is just part of your whole idiocy.

[Blackadar]

Originally Posted by Brettmcd

Nah you support it because you are an idiot, being liberal is just part of your whole idiocy.

Gosh, you can't even get that right since I don't support it. Try again.