Healthcare Reform Thread

[DinoDoc]

The unbe-****ing-lievable amount of red tape we have to go through now for the simplest of visits and prescriptions, quite simply, can not be made any worse by the government. It is simply not possible.

I know that everytime I think of the government, an image of an efficent well oiled machine w/o paperwork comes to mind.

[Ramo]

Incidence differentials are far higher then the differentials between the countries. If Breast cancer is 40 percent more likely, this means that a difference in maybe 10 percent on colorectal will correspond to a difference in 4 percent of breast cancer.

I could run the math on that but I'm being lazy today. Thanks for finding the source on Breast Cancer though.

For the love of all you hold dear, please stop trying to do math.

[asleepathewheel]

Medicare/medicaid are a mess, I really don't want to think about more government involvement in healthcare.

The amount of waste and fraud in the m's is staggering.

[Guynemer]

I know that everytime I think of the government, an image of an efficent well oiled machine w/o paperwork comes to mind.

I'd rather have only one byzantine system to navigate than the 50+ I deal with now on a daily ****ing basis.

[notyoueither]

Yes. That's exactly what I'm going to do. From what I understand, Canadian health care is largely fee-for-service/visit. Beyond using its scale to bargain with providers, it does little to control costs. Compare this to, say, the NHS, which salaries GPs to a much larger extent (and fee-for-service playing a smaller role). It also has one of the leanest health sectors in the developed world (to turn it into a world class system, arguably, all it needs is funding comparable to, say, the OECD mean), as opposed to the comparatively bloated Canadian sector. For a primer on why this distinction is important, see the article that Arrian cited.

Quite to the contrary, the Canadian system controls costs by throttling the ability to deliver care, like testing, beds, OR hours, etc. It is quite effective, so long as you don't mind waiting for your chemo or other needed treatment.

I'm not sure that paying salaries would make a huge difference.

How often does the state actually close a hospital? How does that compare to the size of the health sector? Without numbers, that isn't a particularly meaningful comment.

When budget concerns say they need to. Those 'semi-private' hospitals you brought up that are mentioned on wiki, they are not private at all. They are paid for by government and run by boards that may or may not consist of government appointees. Who appoints doesn"t matter a whole lot. When budgets have to be slashed (80's, 90's) the government closes whatever hospitals they deem are surplus to requirements, no mattewr who sits on the board(s). Governments pay for them. They can do that.

The point is not how many were closed (quite a few). The point is they are not private in any meaningful sense of the word. They live and die at the whim of the government. They are public institutions. < period, and bull**** notwithstanding.

WTF, dude? How many times do I have to tell you that I do not like the Canadian system? Hell, I'm pretty sure I've told you this in previous threads. And yes, that's "threads" as in plural.

I don't recall, and don't see why I should. I recall Che talking about Canadian helathcare before, but I do not recall you piping up. Plural or not.

Now that we're done with that, I think you have an inaccurate view of the benefits of a single payer system and would refer you back to Arrian'a article. The lesson there is that who pays does not matter one single drop of snot.

You seem to be hoping that a single payer will be able to mandate a change of attitudes on the part of prescribing doctors. I have no idea why you think that. OTOH, a single payer can exert control in other ways. Canada is an excellent example of that.

[Ramo]

Quite to the contrary, the Canadian system controls costs by throttling the ability to deliver care, like testing, beds, OR hours, etc. It is quite effective, so long as you don't mind waiting for your chemo or other needed treatment.

I'm not sure that paying salaries would make a huge difference.

Some care may be limited, but not everything is. The Brits are over 20% cheaper than you are. The key appears to be moving away from the fee-for-service/visit model.

They live and die at the whim of the government.

I understand they are being funded by the state. The relevant question here is how they are managed. Look, if you have an alternate source that estimates the degree to which delivery is private, I'd like to see it.

I don't recall, and don't see why I should.

I don't expect you to. I'm making this point because you're mischaracterizing my views over and over again. Like right here:

You seem to be hoping that a single payer will be able to mandate a change of attitudes on the part of prescribing doctors.

I mean, seriously. WTF? Let me make this crystal clear. I support a single payer (with the possibility of private supplementary insurance) primary because it can more effectively control costs by bargaining with medical providers, lowering administrative costs, and incentivizing preventative care. I do not think that single payer alone would be sufficient to contain health care inflation, so I think that a greater public role in delivery would be appropriate.

[asleepathewheel]

What a cluster

http://www.bloomberg.com/apps/news?pid=20601103&sid=aDvu77pZr7k4

Unions’ Health Benefits May Avoid Tax Under Proposal

une 26 (Bloomberg) -- The U.S. Senate proposal to impose taxes for the first time on “gold-plated� health plans may bypass generous employee benefits negotiated by unions.

Senate Finance Committee Chairman Max Baucus, the chief congressional advocate of taxing some employer-provided benefits to help pay for an overhaul of the U.S. health system, says any change should exempt perks secured in existing collective- bargaining agreements, which can be in place for as long as five years.

The exception, which could make the proposal more politically palatable to Democrats from heavily unionized states such as Michigan, is adding controversy to an already contentious debate. It would shield the 12.4 percent of American workers who belong to unions from being taxed while exposing some other middle-income workers to the levy.

“I can’t think of any other aspect of the individual income tax that treats benefits of different people differently because of who they work for,� said Chris Edwards, director of tax policy studies at the Cato Institute, a Washington research group that often criticizes Democrats’ economic proposals. Edwards said the carve-out “smacks of political favoritism.�

Baucus, a Montana Democrat, is proposing to tax Americans whose health insurance is valued at a higher rate than what is offered to federal employees. About 40 percent of insured Americans have costlier benefits, and Baucus has said he is trying to set the level at which taxes would be imposed high enough so fewer people are affected.

‘Gold-Plated’ Plans

The policy is aimed at so-called “gold-plated� plans such as the $40,543 in health benefits paid to Lloyd Blankfein, chief executive of New York-based Goldman Sachs Group Inc., the fifth largest U.S. bank by assets.

It can also affect companies such as Henderson, Nevada- based Zappos.com, where workers’ $11 per hour pay is supplemented by employer-paid health insurance plans worth about $7,500. Federal workers’ health benefits are worth about $4,200 for individuals and $13,000 for families.

Lawmakers are crafting legislation aimed at meeting Obama’s goal of bringing down the cost of health care and expanding coverage to the 46 million Americans who lack insurance. Obama wants Democratic congressional leaders to seek Republican support, and to send him legislation by mid-October.

Baucus said yesterday the cost of health-care options his panel is considering can be cut to $1 trillion over 10 years and won’t add to the deficit, citing the Congressional Budget Office.

Cost Estimates

The non-partisan budget office last week delivered an informal cost estimate of $1.6 trillion for the legislation to overhaul the health-care system, sparking protests from both Republicans and Democrats and prompting Baucus to say his panel may delay consideration of a bill until next month.

“CBO now tells us we have options that would enable us to write a $1 trillion bill, fully paid for,� Baucus, who set that amount as his goal, told reporters at the Capitol.

The panel’s legislation must be joined with competing proposals from other Senate and House committees and forged into a single bill subject to negotiation and approval by both chambers before it can be sent to Obama.

Senate Budget Committee Chairman Kent Conrad, a North Dakota Democrat, said earlier this week that senators are coalescing around the idea of taxing some employer-provided benefits. Baucus said the details are still being negotiated, including how high to set the tax-free exclusion and when any changes would take effect, and whether to exempt union employees until their current contracts expire.

Cutting ‘Subsidy’

“It is hard for me to see how you can have a package that is paid for that does not reduce the subsidy� on employer-paid benefits, Conrad said.

Kentucky Senator Mitch McConnell, the top-ranking Republican in the chamber, said today he has “serious reservations about capping the exclusion, particularly if they have a carve-out for union members,� according to his communications director, Don Stewart. Stewart taped McConnell’s comments and provided excerpts to a reporter.

Stewart said McConnell, discussing the prospect of a tax on some employer-provided benefits, said “table-pounding opposition� would result “if it were to exclude union members.�

Gerald Shea, an AFL-CIO official lobbying for health-care reform, said grandfathering benefits negotiated in a collective bargaining agreement is a “common thing when there is a big change in federal law.�

‘Expectations Are Set’

“Once a collective bargaining agreement is set, employer’s budgets are set, workers expectations are set. It doesn’t make sense to go back in the middle of the contract and change it,� he said.

Union groups and workers said Congress shouldn’t target contractually negotiated benefits.

Anna Burger, secretary-treasurer of the Service Employees International Union, said in an interview that workers have often traded salary increases for better benefits in agreements.

Taxes “shouldn’t be taken from the backs of workers who have bargained away wages and other things for their benefits over the years,� Burger said.

Sandra Carter, a retired Pacific Bell Telephone Co. technician from Stockton, California, said her health benefits, worth about $12,000 per year, were negotiated by the Communications Workers of America. She is unmarried with no children, meaning her individual coverage exceeds benefits paid to federal workers by about $7,800. If that amount were taxed at the 15 percent marginal rate, she would owe $1,170.

“I can’t afford the taxes I pay now,� said Carter, who said she suffers from diabetes. “Why should I get taxed on a benefit that keeps me a functioning person?�

Union Opposition

Other unions say they’re opposed to a tax on some employer- provided benefits, regardless of whether collective bargaining agreements are exempt.

“Either way, we are against a tax on health-care benefits in whatever form it takes,� said Jacob Hay, spokesman for the Laborers’ International Union of North America. The union represents 500,000 workers, largely in the construction industry.

[Drake Tungsten]

I'd rather have only one byzantine system to navigate than the 50+ I deal with now on a daily ****ing basis.

Even if you get paid less to do so?

[Ramo]

The complete Kennedy legislation (which includes a public option) was just scored by the CBO (n.b. the previous score didn't include pivotal parts such as the employer mandate and assumed an excessively weak individual mandate). This legislation (and therefore the score) excludes the Medicaid expansion, Medicare cuts, and changes in the employer tax deduction since HELP has no jurisdiction over these issues. To the surprise of absolutely no one who gives a **** about health care policy in the US, when the provisions that change the deficit are enumerated (and tallied), the public option is not among them - because it would be funded by premiums.

Including the Medicaid expansion, the legislation would insure 97% of legal residents and cost between $1 trillion and $1.3 trillion over ten years. The cost would be offset by spending cuts (principally Medicare cuts) and tax increases (capping the employer tax deduction, possibly other sources) to make the legislation deficit neutral.

[Dinner]

I wonder why they left out lung cancer, coronary heart disease and stroke?

I deal with dozens of insurance companies. Each one has its own rules for referral, its own coverage plan and its own drug formulary. It's a madhouse. Let me assure you, corporate bureaucracy is no better than government bureaucracy. Private insurance companies have taken to outsourcing their call centers, so when I want to find out why Mr. X isn't being permitted to fill a medication I prescribed for him even though the company's website says the drug is covered I call a number, where after pushing a bunch of buttons and some discussion with an operator my call is forwarded to another center, where the same process occurs until I'm finally connected with the insurance company's pharmaceutical management center. The list of annoying nickel and dime stuff with these insurance companies just goes on and on forever. Everyone is fed up with this system and it is time for it to go.

I find the French and Japanese systems to be interesting. They both have private health care providers and even private insurance companies but EVERYTHING is standardized so that coverage standards are identical no matter which provider you go with. It is extremely common for French doctors to do their own paperwork without a secretary to help because the standardized forms are so small and simple that he can do it in 2 minutes; compare that to the US where most hospitals or individual doctors have to hire staff to deal with the massively complicated paper work and problems you spoke about.

[Guynemer]

Even if you get paid less to do so?

Yes, I'd get paid less. But overhead would also be considerably lower. I haven't the faintest idea where the net would end up.

[Drake Tungsten]

The head of the CBO says that claims that the Democratic healthcare reform will control costs are bull****.

CBO Sees No Net Federal Cost Savings in Dem Health Plans

ABC News' Z. Byron Wolf reports:

Here's a blow to President Obama and Democrats pressing health care reform.

One of the main arguments made by the President and others for investing in health reform now is that it will save the federal government money in the long run by containing costs.

Turns out that may not be the case, according to Doug Elmendorf, director of the nonpartisan Congressional Budget Office.

Answering questions from Democrat Kent Conrad of North Dakota at a hearing of the Senate Budget Committee today, Elmendorf said CBO does not see health care cost savings in either of the partisan Democratic bills currently in Congress.

Conrad: Dr. Elmendorf, I am going to really put you on the spot because we are in the middle of this health care debate, but it is critically important that we get this right. Everyone has said, virtually everyone, that bending the cost curve over time is critically important and one of the key goals of this entire effort. From what you have seen from the products of the committees that have reported, do you see a successful effort being mounted to bend the long-term cost curve?

Elmendorf: No, Mr. Chairman. In the legislation that has been reported we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount. And on the contrary, the legislation significantly expands the federal responsibility for health care costs…

As we wrote in our letter to you and Senator Gregg, the creation of a new subsidy for health insurance, which is a critical part of expanding health insurance coverage in our judgement, would by itself increase the federal responsibility for health care that raises federal spending on health care. It raises the amount of activity that is growing at this unsustainable rate and to offset that there has to be very substantial reductions in other parts of the federal commitment to health care, either on the tax revenue side through changes in the tax exclusion or on the spending side through reforms in Medicare and Medicaid. Certainly reforms of that sort are included in some of the packages, and we are still analyzing the reforms in the House package. Legislation was only released as you know two days ago. But changes we have looked at so far do not represent the fundamental change on the order of magnitude that would be necessary to offset the direct increase in federal health costs from the insurance coverage proposals.

http://blogs.abcnews.com/thenote/2009/07/cbo-sees-no-federal-cost-savings-in-dem-health-plans.html

This has been obvious to anyone with a brain for quite a while now, but I imagine some people here need to have the point hammered home.

[Kuciwalker]

My dad sent me that this morning. Depressing and reassuring (that someone is pointing it out) at the same time.

[Ben Kenobi]

I haven't the faintest idea where the net would end up.

Net will be less. I know a few Canadian doctors, and compensation is usually higher in the US.

[Drake Tungsten]

ABC is also publicizing the effects of the Dems' healthcare reform on tax rates.

Study: House Democrats’ Health Care Bill Pushes Top Tax Rates to Over 50% in Most States

A study by the non-partisan Tax Foundation finds that the 5.4% surtax on top wage-earners proposed by House Democrats to help fund health care reform would push top tax rates over 50% in 39 states.

"That means government would be taking more than half of every additional dollar from high-income taxpayers,” said Tax Foundation President Scott Hodge. “The lowest top tax rate would be about 47% --and that's in the nine states that don't tax wages."

The proposal imposes a new surtax of 1 percent on married couples who earn between $350,000 and $500,000 (singles between $280,000 and $400,000). Couples with incomes between $500,000 and $1 million (singles earning between $400,000and $800,000) would have a 1.5 percent surtax imposes. Couples who make more than $1 million, and singles who make more than $800,000, would face a 5.4% surtax.

ABC News’ Dan Arnall reports that the latest data book from the IRS (Tax Year 2006) indicates that 0.3% of all individual income tax returns showed an income of $1 million or higher; 354,093 tax returns out of a universe of 138 million filed that year.

The hardest-hit states in terms of the highest tax bracket would be Oregon (57.5%), Hawaii (57.2%), New Jersey (57.1%), New York (56.9%), California (56.8%), Rhode Island (56.2%), Vermont (55.8%), Maryland (55.6%), Minnesota (54.4%) and Idaho (54.3%).

Washington, DC’s highest tax bracket would be 55.0%. New York City’s would be 58.7%.

http://blogs.abcnews.com/politicalpunch/2009/07/study-house-democrats-health-care-bill-pushes-top-tax-rates-to-over-50-in-most-states.html

Tapper