Healthcare Reform Thread

[Guynemer]

Adam Smith sighting!

[KrazyHorse]

CBO:
Adam Smith:

[Kuciwalker]

Adam Smith:
Skunks

[Ramo]

The most significant cost control measures that would be part of health reform would be a broad public option, changing the way Medicare disbursement happens, and attacking in some way employer-based health care.

The public option (even the House version, which is the strongest possibility) is going to be very limited in the number of people covered (i.e. would likely exclude people currently covered by large employers) and its legislative mandate to bargain with providers. The CBO scored a relatively broad proposal as cutting $150 billion/ten years, but that version is probably not going to happen.

Medicare disbursement rates are set by an institution called "MedPac," but its recommendations are frequently overturned by Congress. So you have a ton of waste on lots of parochial bull****. For example, Ted Stevens, just before he left, secured a 35% increase in disbursements for Alaskans, specifically. Orszag and Sen. Rockefeller are pushing to change this structure, setting the institutional bias towards reform. The idea is to impose a set of rules on how MedPac makes changes (i.e. aggregate spending doesn't increase, changes either improve quality or efficiency). Then the set of recommendations are presented to Congress for an up or down vote. The military base closing committee (BRAC) operates on similar principles. This was not in the House bill, and HELP does not have jurisdiction over these rules. The question is whether it makes it out of Finance, where Rockefeller has been pushing it. I think if it gets out of Finance, it happens.

The other reform Elmendorf is pushing is moving away from employer-based health care. Removing the employer tax deduction would eliminate a regressive subsidy for health care - gold plated plans without demonstrable utility in furthering public health. This is not on the table, but certain members of the Finance Cmte are pushing for using a capped deduction as a revenue source. The House went with a surtax on the rich (something a lot more politically popular), and Obama has been pushing for capping the charitable deduction (which is better than the House, but not as good as taking a stab at employer system). This is one issue where the conservative Dems (minus Conrad) are probably more helpful than Obama. Sen. Wyden is pushing legislation, the "Healthy Choices Act," to allow a much broader health insurance exchange, where anyone can buy in if they choose (coupled with the employer mandate and subsides up to some multiple of the federal poverty level). Without utilizing this hidden subsidy, the idea is, people are not going to spend more on health care than is needed (but a lower bound conducive to public health is imposed by the regulatory structure). This legislation, incidentally, also allows the public plan to be broader (since it lives within the exchange). I have no idea what its legislative prospects are.

So cost control, within the limits of political reality, comes down to these areas. Hopefully, Elmendorf makes substantive reform (as opposed to boosting the safety net) significantly more likely.

[Ramo]

The CBO Director's job is to be the skunk at the Congressional garden party.
Each new director receives a stuffed animal skunk courtesy of the staff.

Adam Smith
Proud member of the skunk works since 2007

[Kuciwalker]

Ramo, did you just not read Drake's post, or are you deliberately pretending you didn't?

[Ramo]

Do you have a point, or are you deliberately pretending you do?

Because Orszag/Rockefeller's "IMAC" and Wyden's legislation have not been scored. Indeed, it would be very difficult to score something like the IMAC - since we don't even have a set of consensus recommendations. A variant of Wyden's legislation (comprehensive reform, as opposed to an amendment to the consensus legislation) has been scored, and is deficit neutral almost immediately.

[Ramo]

And a clarification to my post: Wyden's legislation to amend the consensus is the "Free Choice Act." The "Healthy Americans Act" is his comprehensive reform legislation. The "Healthy Choices Act" doesn't exist.

[Drake Tungsten]

Good article on healthcare reform on Slate today. Sounds a little like the previous Brooks' column...

It is on the sociological level, though, that we're missing the boat most completely by sticking doggedly with a workplace-based system that no longer makes sense. America has always been a mobile society with a labor market that grows more fluid over time. Once, the norm was to work for a single employer for one's entire career. Today, people change jobs an average of 11 times before they reach 40. Fear of losing health coverage keeps people in jobs they would otherwise leave, creating a drag on economic efficiency. As the Senate's smartest health care wonk, Ron Wyden of Oregon, says: "A big part of the reform challenge is to look at how the culture of the American workforce has changed since the basic structure of American health care was put in place. Today's culture is all about flexibility."

The premise of Wyden's bipartisan bill is that we should move away from job-based insurance. It would do this by converting the tax deduction for employer-provided health insurance into a tax credit and requiring that individuals use it to buy insurance. Wyden's bill would achieve universal coverage, apply meaningful cost controls, and, according to the Congressional Budget Office, pay for itself within a few years. It's going nowhere. Instead, Democrats are poised to pass legislation that spends an additional $1 trillion, fails to restrain spending, and shores up an anachronistic employer-based system. I guess you could call it a uniquely American solution.

http://www.slate.com/id/2223037/

[Guynemer]

Urge to kill: rising.

[Dinner]

The reform so far, according to the GAO, is revenue neutral so that's not good or bad. Really they need to take on the drug companies because that's where the big savings are to be found.

[Ramo]

When a Republican (with the possible exceptions of Snowe and Collins) actually votes for something like Wyden-Bennett, I'll believe it. Look at the some of the supposed "cosponsors" opinion on the employer mandate (a feature of both Wyden and the consensus).

The last time the Dems pushed reform with the potential of disrupting doctor-patient relationships, it was demagogued into oblivion. Not a huge surprise they're avoiding that route this time.

But if these Republicans are genuinely on board, there is the Wyden amendment (Free Choice Act) that will be coming to a Senate floor near you.

[Drake Tungsten]

The GOP needs to make sure that it kills the public option for good before it starts devoting serious effort toward passing a more responsible healthcare reform bill.

[Ramo]

Yes. Once we privatize Medicare, the Republicans will give us our fantastic, cost-effective universal health care system.

[DinoDoc]

The GOP needs to make sure that it kills the public option for good before it starts devoting serious effort toward passing a more responsible healthcare reform bill.

The tide of public opinion seems to be swinging in that direction. The final deathknell will probably come when it fails to pass before the recess.