Ezra Klein - The five most promising cost controls in the health-care bill
hmm, alrighty, let's see:
t's hard to overstate how important the Congressional Budget Office (CBO) -- which makes the official judgments on how much bills cost and save -- is in Washington
hmmm. this would be the CBO that stated that insurance premiums would go
up under this new health care legislation?
1. Creates a competitive insurance market
actually no it doesn't. had we gotten rid of state barriers to purchasing health insurance,
then we would have a "competitive insurance market". instead all that happened was that the current list of State mandates placed on insurance (which is what helps to make the market uncompetitive) got added to with a list of Federal mandates. in those states where multiple options are available, now fewer are, and for those Americans with HSA's, they aren't allowed on the exchange.
the health insurance market just got
less competitive. but as a market advocate, it's nice to see that the opposition is at least now paying us the compliment of attempting to hijack our arguments to defend their policies.
from the article:
Enter the Independent Medicare Advisory Board. Modeled off of the highly respected (but totally toothless) Medicare Payment and Advisory Commission, IMAC is a 15-person board of independent experts chosen by the president, confirmed by the Senate and empowered to cut through congressional gridlock. IMAC will write reforms that bring Medicare into like with certain spending targets. Congress can't modify these proposals, it can't filibuster these proposals, and if it wants to reject them, it needs to find another way to save the same amount of money. Making the process of passing tough reforms easier is the single most important thing you can do to make sure tough reforms actually happen.
this is what republicans were talking about when we warned of the death panel. this is a board that is slated to find ways to begin to reduce available health care, and is designed in such a way as to make it nigh impossible for congress (you know, representative government - that thing that is
supposed to be making our political decisions?) to counteract. this will indeed lower health care costs paid by the government; similar to how
NICE operates in Britain:
Tens of thousands with chronic back pain will be forced to live in agony after a decision to slash the number of painkilling injections issued on the NHS, doctors have warned. Instead the National Institute of Health and Clinical Excellence (NICE) is ordering doctors to offer patients remedies like acupuncture and osteopathy.
Specialists fear tens of thousands of people, mainly the elderly and frail, will be left to suffer excruciating levels of pain or pay as much as £500 each for private treatment.
The NHS currently issues more than 60,000 treatments of steroid injections every year. NICE said in its guidance it wants to cut this to just 3,000 treatments a year, a move which would save the NHS £33 million.
so yes, this will actually cut government costs. :thumbsup: good job on that one, if there is something we can all agree on, it's hurting the elderly.
incidentally, on that 'medicare cost cut'?
the "Doc Fix" is currently working it's way through congress. so
that "bending of the cost curve" will last, oh, about two weeks.
3. Taxes "Cadillac Plans"
yeah. i thought this was hilarious. if the government deems that your health care plan is too sparse, they will tax you! but if the government deems that your health care plan is too generous.... then they'll tax you for that, too! why anyone would think that the bozos in congress are going to be able to fine-tune what your health insurance plan should include better than, say, the job they've done on the federal budget is beyond me, but oh well.
then they slapped the same disaster growth rate on it as they did with the Alternative Minimum Tax.
from the article on this:
if your plan costs $27,600, the final $100 bucks would be taxed (technically, the insurer pays the tax, but it'll pass that onto your employer). That's a very expensive plan, but over time, that $27,500 threshold grows by inflation, usually around 3 percent) rather than health-care inflation (closer to 7 percent). So if we don't get health-care inflation down, this will hit many more plans.
this reminds me of the
underpands gnomes business plan from South Park. We tax expensive plans + over time we tax more people + something magical happens = costs go down!
from the article:
The health-care bill seeds Medicare with many experiments to change this status quo, the most immediately promising of which are the "bundling" programs. Instead of getting paid for everything they do to help a diabetic, hospitals will get paid once for treating that person's diabetes and all related conditions over a certain period of time.
IE: we're going to make it extremely difficult for providers to make a profit, and then we're going to offer them a powerful incentive to give people the minimum defensible amount of care. but we're going to keep tort law the way it is, so that if they actually
do provide the minimum defensible amount of care, they get their butts sued off.
this is the "the way to lower health care costs is to get rid of all the doctors" argument. it puts providers in a no-win situation and then blames them for being there. of course they're not going to stay.
5. Adds incentive for lowering costs.
actually the article lists "Changing the politics of reform" and it contains a number of laughable provisions. for example:
"
the individual mandate in the bill brings everyone into the insurance market"
actually the individual mandate combined with the provision that forces insurance companies to cover those with preexisting conditions at the same rate as healthy people provides a powerful incentive for anyone who is healthy to flee the insurance market. It makes
everyone de facto insured because if something traumatic happens, you go to your local office, and not only do they
have to take you, they can't charge you extra. so if i am Healthy Young Joe, and i have the option of paying a $750 fine or a $13,000 premium
and no matter what i pick an insurance company will still be paying for me if i get really sick.... then i have a $12,250 incentive to get rid of my health insurance. heck, that's more than 50% higher than the incentive we're giving to try to get people to purchase
houses.
"
Congress will have to get serious about holding costs down in the system".
yes. just like they are having to get serious about deficit spending and our looming unfunded entitlement nightmare?
"
Republicans and Democrats both agree that we need more cost control in the health-care system. But politicians don't like to actually cut costs, because those votes reduce benefits and make people angry."
easy solution. it's typical of a left-winger to think of everything as flowing through government; but by simply getting rid of the state barrier and enacting loser-pays tort reform we can lower costs
without lowering anyone's government benefits or costing Washington a dime.