Healthcare Reform Thread II

[Ramo]

I guess Ramo needs to find a new variety of pixie wings to put his faith in.

When did I say that I expected lots of cost savings in the ten year window? We are talking about the long term here. Elmendorf specifically sees a several percent reduction in Medicare (time period not specified) if the proposal is appropriately drafted.

[Jon Miller]

Why is several % being argued about, isn't that just a drop in the bucket?

JM

[Ramo]

It depends on the relevant time period (frustratingly, it's missing in his statement). He was referring to "tens of billions per year." Depending on how many tens we're talking about, that's equivalent to, say, the Medicaid expansion.

[KrazyHorse]

Well, cutting doctors fees by definition has a much larger effect than cutting a specific kind of treatment since it presumably would effect much more people. So I don't know what you mean about "hard decisions."

It doesn't affect anybody other than doctors so long as the doctors continue to accept medicare.

Think before you post, son.

The day will come when medicare pays so much less than private insurance that docs will swallow their objections and just refuse to treat medicare patients. When that comes it will affect patients. Until then, medicare cuts across the board look like free money to politicians

[KrazyHorse]

I guess Ramo needs to find a new variety of pixie wings to put his faith in.

When did I say that I expected lots of cost savings in the ten year window? We are talking about the long term here. Elmendorf specifically sees a several percent reduction in Medicare (time period not specified) if the proposal is appropriately drafted.

Several percent doesn't do ****. It certainly will not make it even revenue neutral to cover the uninsured.

[asleepathewheel]

Tort reform would yield tens of billions in savings.

Bald assertion, conveniently unquantified. Texas, for example, has instituted pretty harsh tort reform (an absolute cap of IIRC $100k), yet costs are much higher than the mean. See, i.e. the Dartmouth study measuring Medicare reimbursements per enrollee, where Texas is among the most expensive states both in absolute terms and growth rate.

Texas absolute cap of 100k? No, not even close. the 2003 reform capped non-economic damages at 250k for the drs and 250k for 1 hospital, 500k for 2+hospitals, for a cap of 750k in non-economic damages. Economic damages are not capped, which means there are still multi-million dollar lawsuits out there, but only for those whose employment future is affected or they need full-time care. My major gripe with the Texas law is that it isn't tied to inflation or interest rates, which doesn't make a whole lot of sense to me, but whatever. 250k (I believe that is not taxed) is quite a lot of money for something non-quantifiable and due to mere negligence.

Using the medicare reimbursement map as evidence of anything other than medicare reimbursements is quite a stretch, not the least of which is gauging the effects of tort reform. For example, the dark green states, by virtue of being the most populous, are being robbed blind in Medicare/Medicaid. I've heard estimates of 1b/year in Houston alone. That certainly jacks up the average per person expenditures.

edit: I swear I've corrected you on your texas tort reform dollar amounts before, maybe that was someone else.

[Ramo]

Well, cutting doctors fees by definition has a much larger effect than cutting a specific kind of treatment since it presumably would effect much more people. So I don't know what you mean about "hard decisions."

It doesn't affect anybody other than doctors so long as the doctors continue to accept medicare.

Think before you post, son.

The day will come when medicare pays so much less than private insurance that docs will swallow their objections and just refuse to treat medicare patients. When that comes it will affect patients. Until then, medicare cuts across the board look like free money to politicians

That's absurd. The number of doctors is much larger than the constituency for just about any marginal treatment.

Several percent doesn't do ****. It certainly will not make it even revenue neutral to cover the uninsured.

As my other posts made clear, I'm not sure what time frame that refers to. What Elmendorf did say is that it accounts for tens of billions of dollars annually. Which IS the same order of magnitude as the Medicaid expansion. Again, the caveat here is that Elmendorf is probably pulling numbers out of his ass.

asleep:

Texas absolute cap of 100k?

I did say IIRC for a reason, namely that I didn't find that detail particularly meaningful. Since that number lacks context. It is clear, however, that tort reform drastically reduced medical malpractice lawsuits (for good or ill). In hindsight, this is the parenthetical comment I should've made.

The numbers in Texas tell the tale. According to the Texas Alliance for Patient Access (TAPA), a healthcare industry group that lobbied for the caps, the number of med-mal suits filed in the San Antonio, Fort Worth, Dallas and Houston areas has declined by nearly 50 percent, from 1,517 in 2002 to 715 in 2005. In the first half of this year, a total of 359 med-mal suits were filed in the four counties.

http://www.allbusiness.com/services/legal-services/4086280-1.html

Using the medicare reimbursement map as evidence of anything other than medicare reimbursements is quite a stretch, not the least of which is gauging the effects of tort reform.

I'm obviously not gauging the effectiveness of tort reform. I'm saying that the effect it has is small compared to all other factors, so it makes no sense to focus on it exclusively.

For example, the dark green states, by virtue of being the most populous, are being robbed blind in Medicare/Medicaid. I've heard estimates of 1b/year in Houston alone. That certainly jacks up the average per person expenditures.

I have no idea what you're trying to say here.

I swear I've corrected you on your texas tort reform dollar amounts before

No.

[KrazyHorse]

That's absurd. The number of doctors is much larger than the constituency for just about any marginal treatment.

The pushback is NOT by those who would be denied a given treatment. It is against the entire idea of limiting treatments based on cost-effectiveness, by anybody who fears that any of the treatments they might need someday might be denied.

Holy ****ing ****, you're going on ignore.

I refuse to believe that you're actually this obtuse. The only other option is that you're being disingenuous.

[DirtyMartini]

[q]The day will come when medicare pays so much less than private insurance that docs will swallow their objections and just refuse to treat medicare patients.

That day has already come.

[DinoDoc]

Does Pelosi even have the votes to get this out of the House without the votes of the Blue Dogs?

US Waxman will let panel be bypassed on health care

WASHINGTON, July 24 (Reuters) - The chairman of the U.S. House Energy and Commerce Committee, Representative Henry Waxman, said on Friday he would let the full House by pass his committee on healthcare reform if the panel could not reach agreement on its version of the legislation.
Fiscally conservative Democrats on that committee have refused to go along with the proposal over its high cost of $1 trillion over 10 years and that has stalled the process of getting a bill to a vote in the full House before it begins a monthlong recess on July 31.

Waxman told reporters that he was going to meet the conservative Democrats on the panel shortly to discuss another proposal to try to meet their concerns. But if they do not agree, "we going to have to look at perhaps bypassing the committee," he told reporters. This would allow a health care reform bill go to the House floor without a vote of his panel. (Reporting by Susan Cornwell, editing by Jackie Frank)

[Dinner]

As it stands right now probably not but a few changes could make a world of difference and then of course there is the option to just bipass the committee and take it to the general floor. Right now Republicans are against any change as they believe this is a great issue to demagogue over while Democrats seem to be completely limp dicked and unwilling to stand up to any moneyed lobbying group. If Democrats actually became serious about reform and cost savings (which would no doubt piss off big pharma and the insurance lobby) then they could make an excellent case to the American people for pushing this through. So far though they've been to cowardly and have tried to call a bill reform without actually reforming much of anything.

What I wouldn't give for an LBJ right now instead of Obama's mushy centrist stance on everything. LBJ knew how to get stuff done by strong arming, really punishing pols who leave the reservation, and providing incentives to tempt pols back. In short he knew how to get stuff down in down and dirty Washington while Obama has been more or less letting the limp dicks piss about and call the shots (which is to say not really shooting anything).

[DinoDoc]

Mathematically, I don't see how such a measure (shoving it onto the floor in the face of Dem opposition) would meet with anything but defeat.

[Dinner]

The difference is that the make up of certain committees tends to be 50-50 between the parties so even 1 or 2 obstructionists in your own party can block something but in a vote on the whole floor the obstructionists/people of a certain view point no longer run the show the way they do on committees. It would actually be a vote for all reps instead of just a few from each party. Depending on exactly who is on the committee in question it can make a world of difference. Individual reps become one of several hundred instead of one in a dozen so if you have one or two hold outs in a committee then their control amounts to 1/420th (or something) votes on the total floor instead of 1/12th (or what not) in their special committee.

It introduces a whole lot more players into the equation so die hard hold outs can be bypassed instead of holding up the entire show as they could in a 12 or 16 member committee.

[Dinner]

The key would be Dems would have to do what they have so far been completely unwilling to do and that is take on big money special interests to get real cost savings. If they did that while insuring everyone in the country (which is possible but which moneyed interests, for their own parochial reasons, oppose) then I think they could tap into the strong 60% public approval for real reform. This of course means Dems would have be get serious and offer real reform which they so far have not but if they did I fully expect the 60% poll numbers to force the hands of the weak willed mushy center. Those guys blow with the wind after all.

The question is will Dems actually grab their balls and sound off with real reform which the general public will back or will they keep tinkering at the edges without challenging any real special interests? If they do then the public will probably back them but if they continue to be weak panderbears for special interests then the public won't go for it.

[Kuciwalker]

As it stands right now probably not but a few changes could make a world of difference and then of course there is the option to just bipass the committee and take it to the general floor.

Dude, what the ****. Did you even read the goddamn post you were responding to? "there is the option to bypass the committee and take it to the general floor" THAT'S WHAT DD JUST SAID

Right now Republicans are against any change as they believe this is a great issue to demagogue over while Democrats seem to be completely limp dicked and unwilling to stand up to any moneyed lobbying group.

Dude, again, wtf. Republicans don't have anything to do with the question, since the Democrats have a majority. If the Democrats can't convince the moderate wing of their own party to vote for this, why would you expect Republicans to?