CBO deals new blow to health plan

celticlord · Jul 25, 2009

CBO deals new blow to health plan - Chris Frates - POLITICO.com

For the second time this month, congressional budget analysts have dealt a blow to the Democrat's health reform efforts, this time by saying a plan touted by the White House as crucial to paying for the bill would actually save almost no money over 10 years.

A key House chairman and moderate House Democrats on Tuesday agreed to a White House-backed proposal that would give an outside panel the power to make cuts to government-financed health care programs. White House budget director Peter Orszag declared the plan "probably the most important piece that can be added" to the House's health care reform legislation.

But on Saturday, the Congressional Budget Office said the proposal to give an independent panel the power to keep Medicare spending in check would only save about $2 billion over 10 years- a drop in the bucket compared to the bill's $1 trillion price tag.

Proving once again, sports fans, that HR3200 is a $1 Trillion spending spree with no cost controls and no efforts to plausibly address the real economic issues within health care.

Dear Leader lied when he said this plan would be deficit neutral.

The Anti-Republicans lied when they said this would control costs.

HR3200 is NOT health care reform
HR3200 is $1 Trillion spent on less care

RightinNYC · Jul 25, 2009

White House budget director Peter Orszag declared the plan "probably the most important piece that can be added" to the House's health care reform legislation.

But on Saturday, the CBO said that the proposal . . . would only save about $2 billion over 10 years

That's pretty bad messaging for the White House.

DarkWizard12 · Jul 25, 2009

This thread is relevant to my interests.

/subscribe.

jackalope · Jul 25, 2009

RightinNYC said:
That's pretty bad messaging for the White House.

Yup, it is. I was just reading about this on Politico.

When you get into the details, it might be good news for the American people, down the road (past the 10 yr scoring), but in terms of helping to pay for the health care legislation, and passing it, no, it's not good news for the WH.

There was a separate, new Medicare deal reached last night w/ regard to eliminating disparities b/w high-cost states like NY, and low cost states like MN/IA/WI. It was only arrived at last night, and hasn't been scored yet by the CBO, so I don't know if it will do what they say it will. But it does sound like it has a big cost savings potential.

( I posted the article in a different thread, but here's a link to last night's Med deal )

jackalope · Jul 25, 2009

celticlord said:
CBO deals new blow to health plan - Chris Frates - POLITICO.com

Proving once again, sports fans, that HR3200 is a $1 Trillion spending spree with no cost controls and no efforts to plausibly address the real economic issues within health care.

Dear Leader lied when he said this plan would be deficit neutral.

The Anti-Republicans lied when they said this would control costs.

HR3200 is NOT health care reform
HR3200 is $1 Trillion spent on less care

Um, no. This CBO news is not good news in terms of helping pay for legislation, no question, but neither is it what you say up above. In fact, what you say above is not rooted in any fact at all, but is in line with Republican messaging. Typically fact-free.

celticlord · Jul 25, 2009

jackalope said:
Um, no. The CBO is not good news, no question, but neither is it what you say up above. In fact, what you say above is not rooted in any fact at all, but is in line with Republican messaging. Typically fact-free.

But on Saturday, the Congressional Budget Office said the proposal to give an independent panel the power to keep Medicare spending in check would only save about $2 billion over 10 years- a drop in the bucket compared to the bill's $1 trillion price tag.

The CBO did not say HR3200 would cost $1 Trillion?

"In CBO's judgment, the probability is high that no savings would be realized ... but there is also a chance that substantial savings might be realized. Looking beyond the 10-year budget window, CBO expects that this proposal would generate larger but still modest savings on the same probabilistic basis,"

CBO Director Douglas Elmendorf did not say the independent Medicare commission would not save any money?

RightinNYC · Jul 25, 2009

jackalope said:
There was a separate, new Medicare deal reached last night w/ regard to eliminating disparities b/w high-cost states like NY, and low cost states like MN/IA/WI. It was only arrived at last night, and hasn't been scored yet by the CBO, so I don't know if it will do what they say it will. But it does sound like it has a big cost savings potential.

( I posted the article in a different thread, but here's a link to last night's Med deal )

So the idea is to save money by eliminating a pay disparity that exists with good reason? That seems absolutely idiotic.

Medicare costs more in NYC and LA than it does in MN or IA because everything costs more in NYC and LA than it does in MN or IA. The government acknowledges this, and even pays extra in every other aspect of administration, so why on earth would someone propose eliminating the COL adjustment, unless they were simply trying to come up with a way to reduce costs on paper regardless of whether it makes sense?

jackalope · Jul 25, 2009

celticlord said:
The CBO did not say HR3200 would cost $1 Trillion?

No, it did not. Just as profit does not equal sales; neither does the cost of this program equal only expenses. Thought you said you put in two decades with P&Ls? This is accounting 101, you don't even need a fancy report to get that.

celticlord said:
CBO Director Douglas Elmendorf did not say the independent Medicare commission would not save any money?

No, he didn't. However he did say the savings were likely to be small. However, this one provision is not the bill. It is not even part of the report you got so very wrong last night. It's a scoring on a single provision, released just today.

jackalope · Jul 25, 2009

RightinNYC said:
So the idea is to save money by eliminating a pay disparity that exists with good reason? That seems absolutely idiotic.

Medicare costs more in NYC and LA than it does in MN or IA because everything costs more in NYC and LA than it does in MN or IA. The government acknowledges this, and even pays extra in every other aspect of administration, so why on earth would someone propose eliminating the COL adjustment, unless they were simply trying to come up with a way to reduce costs on paper regardless of whether it makes sense?

Yup. It will force inefficient states to compete with efficient states, or pay for the excesses themselves. Currently bloated inefficient states are paid more, because they are inefficient. Lower cost, efficient states get paid less, because they worked to control costs. Makes NO sense at all.

And, if everything costs more in NYC and LA, well that's a problem they'll have to work out themselves, because they didn't PAY any more into the system than low-cost states did. NYC doesn't pay Medicare at a higher percentage, no reason to collect it.

RightinNYC · Jul 25, 2009

jackalope said:
Yup. It will force inefficient states to compete with efficient states, or pay for the excesses themselves. Currently bloated inefficient states are paid more, because they are inefficient. Lower cost, efficient states get paid less, because they worked to control costs. Makes NO sense at all.

Are you seriously arguing that the reason things cost more in NYC or LA is because NYC and LA are "less efficient" than MN or IA?

And, if everything costs more in NYC and LA, well that's a problem they'll have to work out themselves, because they didn't PAY any more into the system than low-cost states did. NYC doesn't pay Medicare at a higher percentage, no reason to collect it.

Do you really think we should shift to a system where federal money is distributed based on what areas pay in more? I can guarantee you that if we do, it won't be NYC or LA that loses out.

The rich (and high COL) areas in this country subsidize the **** out of the poor (and low COL) areas of this country.

Harry Guerrilla · Jul 25, 2009

jackalope said:
Yup. It will force inefficient states to compete with efficient states, or pay for the excesses themselves. Currently bloated inefficient states are paid more, because they are inefficient. Lower cost, efficient states get paid less, because they worked to control costs. Makes NO sense at all.

And, if everything costs more in NYC and LA, well that's a problem they'll have to work out themselves, because they didn't PAY any more into the system than low-cost states did. NYC doesn't pay Medicare at a higher percentage, no reason to collect it.

No one on Medicare now has payed enough in to collect what they are getting now, by that line of reasoning we should cut all Medicare payments everywhere.

jackalope · Jul 25, 2009

RightinNYC said:
Are you seriously arguing that the reason things cost more in NYC or LA is because NYC and LA are "less efficient" than MN or IA?

Do you really think we should shift to a system where federal money is distributed based on what areas pay in more? I can guarantee you that if we do, it won't be NYC or LA that loses out.

The rich (and high COL) areas in this country subsidize the **** out of the poor (and low COL) areas of this country.

I think unless efficiencies are forced into the system, they will not happen.
Also, I find it interesting that you side with the liberal Democrats on this issue. They are opposed to this, and were not in favor of the deal.

celticlord · Jul 25, 2009

jackalope said:
No, it did not. Just as profit does not equal sales; neither does the cost of this program equal only expenses. Thought you said you put in two decades with P&Ls? This is accounting 101, you don't even need a fancy report to get that.

Profit, grasshopper, is Revenues less Expenses (which are also known as costs).

Per the CBO, HR3200 will cost $1042 Billion, of which $583 Billion is offset by new government revenue streams (which are also known as taxes), and another $219 Billion is offset by Medicare/Medicaid "savings" of $219 Billion (also known as not paying the bill), for a net cost of $239 Billion (also known as IOUs shipped off to China).

http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf

RightinNYC · Jul 25, 2009

jackalope said:
I think unless efficiencies are forced into the system, they will not happen.

And I think that this is an absolutely moronic place to try to find an "efficiency." If we proposed to cut all payments to doctors whose last names started with "M," that would be an efficiency as well. Why don't we just do that?

Also, I find it interesting that you side with the liberal Democrats on this issue. They are opposed to this, and were not in favor of the deal.

If you find that interesting, you haven't read many of the things that I've argued for.

jackalope · Jul 25, 2009

Harry Guerrilla said:
No one on Medicare now has payed enough in to collect what they are getting now, by that line of reasoning we should cut all Medicare payments everywhere.

That's true, but nonetheless, Medicare paots are per recipient. NYC and LA are not paying into the system at a higher rate than citizens in other states, no reason for them to collect at a higher rate.

If they cannot contain the costs, and compete with more efficient states, then they'll have to charge an add'l tax to cover it.

celticlord · Jul 25, 2009

jackalope said:
Yup. It will force inefficient states to compete with efficient states, or pay for the excesses themselves. Currently bloated inefficient states are paid more, because they are inefficient. Lower cost, efficient states get paid less, because they worked to control costs. Makes NO sense at all.

Medicare payments are styled as "reimbursements"--meaning they are presumed to be covering actual costs. Why should Maine get paid more than they spend on Medicare? (Assuming of, course, Maine is one of the efficient states, which begs the question of why Maine needs other states to pay for its health care)

jackalope · Jul 25, 2009

RightinNYC said:
And I think that this is an absolutely moronic place to try to find an "efficiency." If we proposed to cut all payments to doctors whose last names started with "M," that would be an efficiency as well. Why don't we just do that?

If you find that interesting, you haven't read many of the things that I've argued for.

That's true! I don't claim to know you at all, that's why I said it was interesting! I didn't mean it as a dig, but as a statement of expression. I always find it interesting when people have complex positions, and not party-line positions. Sorry if you read it as a dig, I didn't intend it that way. :2wave:

However, back to your first statement, I don't find it moronic at all. Things must change. Efficiencies must be forced into the system. What exists now is unsustainable. But, cutting pmts to people with initials obviously is ridiculous.

If your contention is that NYC just costs more, than NYC should charge more.

RightinNYC · Jul 25, 2009

jackalope said:
That's true, but nonetheless, Medicare paots are per recipient. NYC and LA are not paying into the system at a higher rate than citizens in other states, no reason for them to collect at a higher rate.

If they cannot contain the costs, and compete with more efficient states, then they'll have to charge an add'l tax to cover it.

TaxProf Blog: Red States Feed at Federal Trough, Blue States Supply the Feed

States Receiving Most in Federal Spending Per Dollar of Federal Taxes Paid:

1. D.C. ($6.17)
2. North Dakota ($2.03)
3. New Mexico ($1.89)
4. Mississippi ($1.84)
5. Alaska ($1.82)
6. West Virginia ($1.74)
7. Montana ($1.64)
8. Alabama ($1.61)
9. South Dakota ($1.59)
10. Arkansas ($1.53)

States Receiving Least in Federal Spending Per Dollar of Federal Taxes Paid:

1. New Jersey ($0.62)
2. Connecticut ($0.64)
3. New Hampshire ($0.68)
4. Nevada ($0.73)
5. Illinois ($0.77)
6. Minnesota ($0.77)
7. Colorado ($0.79)
8. Massachusetts ($0.79)
9. California ($0.81)
10. New York ($0.81)

By your logic, we should level this out to $1 per state across the board. I'm 100% in favor of that.

That's true! I don't claim to know you at all, that's why I said it was interesting! I didn't mean it as a dig, but as a statement of expression. I always find it interesting when people have complex positions, and not party-line positions. Sorry if you read it as a dig, I didn't intend it that way.

No worries. :2wave:

However, back to your first statement, I don't find it moronic at all. Things must change. Efficiencies must be forced into the system. What exists now is unsustainable. But, cutting pmts to people with initials obviously is ridiculous.

I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.

WI Crippler · Jul 25, 2009

RightinNYC said:
I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.

I'm sure there will likely emerge a condition that doctors will not be able to refuse service, and they will just have to take the reimbursement rate and like it, even if its at a level lower than the cost of medical care provided. But its ok, if the government lowballs a doctor, because thats part of "efficiency". When an insurance company does it, its "greed".

celticlord · Jul 25, 2009

RightinNYC said:
I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.

Which makes one wonder why folks think that a public plan that locks in those cut back Medicare reimbursement rates to doctors is a good idea--and that is exactly what HR3200 does.

http://www.cbo.gov/ftpdocs/104xx/doc10430/House_Tri-Committee-Rangel.pdf

The proposal would also establish a “public plan” available only through the insurance exchanges. That plan would be set up and run by the Secretary of Health and Human Services (HHS). On average, it would pay Medicare rates plus 5 percent to physicians and other practitioners (and those rates would not be determined by the sustainable growth rate formula that is used to set rates for physicians in Medicare but instead would be increased over time using an index of physicians’ input costs). On average, the public plan would pay Medicare rates for hospital and other services and supplies on fee schedules, and negotiated rates for drugs or other items or services not on a fee schedule. Providers would not be required to participate in the public plan in order to participate in Medicare. (A more detailed summary of the proposal’s key provisions is attached.)

jackalope · Jul 25, 2009

RightinNYC said:
TaxProf Blog: Red States Feed at Federal Trough, Blue States Supply the Feed

By your logic, we should level this out to $1 per state across the board. I'm 100% in favor of that.

No worries. :2wave:

I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.

You are correct, there are contributor states, and taking states, no question. However, those payments reflect all kinds of federal expenditures in states, including federal employees, projects, programs, military bases, etc. That is as much need, as it is politics.

Medicare is simply one kind of payment. It's not a matter of one state having a military base and another not. Every state has Medicare payments, but some states get paid less per recipient than others. It just reinforces the bloat.

Again, if NYC costs so much more, NYC should charge so much more.

celticlord · Jul 25, 2009

jackalope said:
You are correct, there are contributor states, and taking states, no question.

And New York should pay for Maine's Medicare bills because....????

jackalope · Jul 25, 2009

WI Crippler said:
I'm sure there will likely emerge a condition that doctors will not be able to refuse service, and they will just have to take the reimbursement rate and like it, even if its at a level lower than the cost of medical care provided. But its ok, if the government lowballs a doctor, because thats part of "efficiency". When an insurance company does it, its "greed".

Always a reason to worry about the negative, that's why it hasn't been fixed yet.

"This is about a health care system that is breaking America's families. ... We can't afford the politics of delay and defeat when it comes to health care -- not this time, not now." - Pres Obama

celticlord · Jul 25, 2009

WI Crippler said:
I'm sure there will likely emerge a condition that doctors will not be able to refuse service, and they will just have to take the reimbursement rate and like it, even if its at a level lower than the cost of medical care provided. But its ok, if the government lowballs a doctor, because thats part of "efficiency". When an insurance company does it, its "greed".

jackalope said:
Always a reason to worry about the negative, that's why it hasn't been fixed yet.

Only you're not addressing what WI Crippler said. Why is it ok for government to refuse to pay doctors and hospitals but it is not ok for insurance companies to do the same thing?

Why is one "cost control" while the other is "greed"?

RightinNYC · Jul 25, 2009

jackalope said:
You are correct, there are contributor states, and taking states, no question. However, those payments reflect all kinds of federal expenditures in states, including federal employees, projects, programs, military bases, etc. That is as much need, as it is politics.

Medicare is simply one kind of payment. It's not a matter of one state having a military base and another not. Every state has Medicare payments, but some states get paid less per recipient than others. It just reinforces the bloat.

I'm sorry, but I don't see a difference. These numbers encompass all federal dollars taken in and given out. My state pays far more than its fair share.

Again, if NYC costs so much more, NYC should charge so much more.

We don't charge a higher rate, but we certainly pay more into the system due to the fact that we have many more people maxing out on their medicare payments.

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