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Thread: The five most promising cost controls in the health-care bill

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    The five most promising cost controls in the health-care bill

    Ezra Klein - The five most promising cost controls in the health-care bill

    Interesting read. To sum up, the ways that this bill helps medical costs:

    1. Creates a competitive insurance market

    2. Reforms Medicare

    3. Taxes "Cadillac Plans"

    4. Bundles Costs

    5. Adds incentive for lowering costs.
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    Re: The five most promising cost controls in the health-care bill

    1. Creates a competitive insurance market: Government takes over...again

    2. Reforms Medicare: Assures it's destruction in 1/2 the time..

    3. Taxes "Cadillac Plans": Damn the Constitution.. we make our own rules!

    4. Bundles Costs: this ain't cable TV folks

    5. Adds incentive for lowering costs.Or just runs private insurance companies off American soil providing complete socialized heathcare for all Americans

    YEP ...does ALL those things!
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    Re: The five most promising cost controls in the health-care bill

    Quote Originally Posted by ConservaBill View Post
    1. Creates a competitive insurance market: Government takes over...again

    2. Reforms Medicare: Assures it's destruction in 1/2 the time..

    3. Taxes "Cadillac Plans": Damn the Constitution.. we make our own rules!

    4. Bundles Costs: this ain't cable TV folks

    5. Adds incentive for lowering costs.Or just runs private insurance companies off American soil providing complete socialized heathcare for all Americans

    YEP ...does ALL those things!
    Did you even read the article?
    The Makeout Hobo is real, and does indeed travel around the country in his van and make out with ladies... If you meet the Makeout Hobo, it is customary to greet him with a shot of whiskey and a high five (if you are a dude) or passionate makeouts (if you are a lady).

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    Re: The five most promising cost controls in the health-care bill

    Quote Originally Posted by the makeout hobo View Post
    Ezra Klein - The five most promising cost controls in the health-care bill

    Interesting read. To sum up, the ways that this bill helps medical costs:

    1. Creates a competitive insurance market

    2. Reforms Medicare

    3. Taxes "Cadillac Plans"

    4. Bundles Costs

    5. Adds incentive for lowering costs.
    1. A couple of problems with this one. First, most people get their insurance from their employers so this will have no effect. Next we were told during the debate that in many states there are virtual monopolies. How are you going to both add competitors while reducing profits as this would suggest.

    2. Time will tell on this one. We have talked about the fraud and abuse in Medicare for decades with no fixes.

    3. As the article states this does not into effect until 2018. If it is that great an idea why wait so long? Also 27.5 thousand is 2X to 3X the cost of the average family plan so hard to see how this will get a lot of savings.

    4. See #1

    5. It will have experiments, but no real answers in this bill which is the tragedy. The article says congress will have to act or their constituents will get bad, guess what, they are mad already and congress clearly does not care.

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    Re: The five most promising cost controls in the health-care bill

    Quote Originally Posted by the makeout hobo View Post
    Ezra Klein - The five most promising cost controls in the health-care bill

    Interesting read. To sum up, the ways that this bill helps medical costs:

    1. Creates a competitive insurance market

    2. Reforms Medicare

    3. Taxes "Cadillac Plans"

    4. Bundles Costs

    5. Adds incentive for lowering costs.
    I still don't get this "cadillac" plan tax.

    If people are paying $27,000 premiums then they are probably paying WAY more than they will ever spend. For normal medical care w/o insurance.

    It sounds like a bunch of voodoo economics, political labeling (E.g., "cadillac"), and poor reasoning for taxing plans that don't really provide anything unfair but higher premiums for less hassle at the doc's office.

    It would be like taxing car insurance more for plans that cover expensive cars. It makes no sense except as a way to tax the wealthy in some strange way.
    Last edited by scourge99; 03-22-10 at 04:02 PM.
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    Re: The five most promising cost controls in the health-care bill

    Quote Originally Posted by the makeout hobo View Post
    Did you even read the article?
    NOPE... try to avoid liberal spew as much as practical..
    CROUCH DOWN AND LICK THE HAND THAT FEEDS YOU; MAY YOUR CHAINS WEIGH LIGHTLY UPON YOU; AND MAY PROSPERITY FORGET THAT YE WERE MY COUNTRYMEN. -SAMUEL ADAMS

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    Re: The five most promising cost controls in the health-care bill

    Quote Originally Posted by ConservaBill View Post
    NOPE... try to avoid liberal spew as much as practical..
    Thank you for identifying yourself as a partisan hack whose comments should be ignored. Saves me and others a lot of time.
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    Re: The five most promising cost controls in the health-care bill

    Quote Originally Posted by the makeout hobo View Post
    Ezra Klein - The five most promising cost controls in the health-care bill

    Interesting read. To sum up, the ways that this bill helps medical costs:

    1. Creates a competitive insurance market
    His explanation for how this will create a more competitive insurance market is incredibly tenuous at best. First, the only people who will be affected by this are the 6-7% of the country that will be on the exchange. Second, the bulk of the "competitive" effect that he refers to will come from making it easier for consumers to pick between providers, like they do with those online auto insurance calculators. This is certainly a useful thing, but the impact will likely be minimal and there's no reason that it couldn't be done privately.

    2. Reforms Medicare

    The Senate bill would establish an Independent Medicare Advisory Board, which would be required to recommend changes to the Medicare program to limit its spending growth. Its recommendations would go into effect automatically unless Congress votes to block them.
    That sounds strikingly similar to the Doc Fix, the AMT patch, and the PAYGO rules. They're great ways to tell the public that you'll be fiscally responsible in the future without actually having to follow through. Do you honestly believe that the same Congress (on either side) that passes the Doc Fix every year to avoid cutting reimbursement rates is now going to have the political courage to allow these cuts to come into play.

    3. Taxes "Cadillac Plans"
    There is absolutely no chance on earth that the excise tax will ever come into effect. None. It's already been pushed back to 2018, and I'd be astonished if it isn't pushed back or repealed before we even get that far.

    4. Bundles Costs
    This is a proposal that sounds like it might have a positive effect. Of course, it might also save no money or produce worse outcomes. Either way, this is hardly a monumental proposal.

    5. Adds incentive for lowering costs.
    His rationale on this point makes absolutely no sense. He first says that by adding more people to the system, there will be more people complaining about costs, which he concludes will make Congress more attentive. He then says that because Congress will be on the hook for the extra spending, it will have its own incentives to keep costs down.

    This is absurd in two ways: First, people already complain constantly to Congress about health care. Does he actually think complaints about health care will increase now that more people are covered? Common sense would say that complaints would be larger when those people didn't have insurance at all.

    Second, he really thinks that the threat of increased deficits will cause Congress to take bold action to cut medical costs? The same Congress that won't touch Medicare's unfunded liability with a 10 foot pole and that passes an annual doc fix every year that adds to the deficit and increases medical costs?

    Ezra Klein is a smart guy, but there's no way that he can actually believe the things he writes.
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    Re: The five most promising cost controls in the health-care bill

    klein posits:
    The bill says congressmen and their staff members need to buy their insurance from these exchanges, too.
    if that is the case then why is this measure in the present bill:
    These multistate
    plans will be offered separately from the
    Federal Employees Health Benefit Program and
    will have a separate risk pool.
    page 13 of this http://www.kff.org/healthreform/uplo...bill_final.pdf
    there would seem to be no further reason to offer the Federal Employees Health Benefit Program if federal employees were going to be expected to buy insurance from the state/multi-state offerings

    the Independent Medicare Advisory Board is touted to be the mechanism to adjust pricing of medicare in a way congress is not. but the key will be the 15 person panel ... how long until they too, are bought by the insurance industry. they should face strong, constant scrutiny, in order to actually be effective. if that is done, this is one promising aspect of the bill

    taxing the cadillac plans is a bogus approach to increasing revenue. klein acknowledged that. but he makes this comment while articulating that taxing the cadillac plans is a legitimate effort:
    ... that means individuals don't know how much their insurance really costs and don't have as much incentive to keep those costs down. Imagine the pressure for cost control if the 70 percent that employers pay were coming out of our own pockets, instead of quietly coming out of our wages.
    the cadillac plan will not tax the first dollar of these plans but only that portion which exceeds the ceiling. those high value employees who realize such plans pay little of them - seldom the 30% portion most pay for their employer provided plans. i see no real ability for this provision to actually do anything. it will not be a source of significant revenue and it will not hold down the size of the plans of the heavy hitters who enjoy them
    ... 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. If this leads to lower costs and doesn't harm patients, it will be expanded. That would be the beginning of the end of paying for quantity of treatment, and the beginning of paying for quality of treatment.
    excuse me. how is bundling going to actually save money? the physician cannot project how much care patients will require. so, are they going to price lean, recognizing that a bundle will deal with medical unknowns or price high in order to cover any unanticipated costs required to aid the patient. this is the democrats' version of voodoo economics
    and it is unfortunate the republicans refused to participate in this debate. in the end, anti-trust protection is still available to the insurers and cross state competition is not. we lost the opportunity to introduce the competitiveness of buying from any plan available in any state; there is nothing about insurance which could not be provided across state lines. so why can't we purchase it that way?
    hopefully, that will be rectified in round two
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    Re: The five most promising cost controls in the health-care bill

    From FDL, responding to the same article:

    Yes, The Health Bill Really Lacks Serious Cost Controls | FDL Action

    The idea of lousily regulated health insurance exchanges is not new. The Federal Employee Health Benefit plan (FEHB) has been a health insurance exchange for several decades now. With roughly 8 million users, it is bigger than any state exchange will be. Yet, the evidence is that health care costs on the FEHB grow at at effectively the same rate as the rest of the employer market. Even Klein himself has admitted this. Exchanges will probably smooth out the fluctuations and imbalances in the individual market and should reduce some amount of administrative overhead in a small part of the health insurance market, but the evidence they will systematically bring down cost is sorely lacking.
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