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Health Care Reform in Danger

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Health reform is, I think it fair to say, in danger right now. The news out of the Senate Health, Education, Labor, and Pensions Committee was bad. The Congressional Budget Office had scored a partial bill and the result was a total fiasco. But the news out of the Finance Committee is much, much worse.

Put simply, the Finance Committee wanted its bill to cost $1 trillion over 10 years. The CBO returned an early estimate to the panel on Tuesday night: $1.6 trillion over 10 years. The specifics of the estimate have not been made public. But the final number changed everything. Max Baucus, the chairman of the committee, pushed markup back behind the July 4th recess. He has promised to get the bill below $1 trillion over 10 years.

That's very dangerous.

It is, for one thing, an arbitrary target. Why $1 trillion? Why not $1.3 trillion or, for that matter, $700 billion? And it's an arbitrary financing target. It's not $1 trillion with coverage expanded to 40 million people. Just $1 trillion.

There are two ways to make a $1.6 trillion bill a $1 trillion bill. The first is to do less reform. The second is to do more reform. That sounds confusing. But it shouldn't be: In health care, the less you change, the more it costs.

Right now, I'm told Finance is going down the road of less reform. They're cutting the subsidies, cutting the generosity of the basic benefit package and cutting the number of people who will ultimately be insured by their proposal. This reflects a simple reality: If you're going to try to leave the central features of the health-care system untouched, you can't get to universal coverage, or even anywhere near it, on $100 billion a year.

But there's another path. This CBO estimate could be the first step towards making health reform better rather than worse. Rather than capping the employer tax exclusion, the Finance Committee could end it entirely and convert it, as Ron Wyden does, to a progressive standard deduction. Wyden's plan, incidentally, was scored by CBO as being revenue neutral in two years and revenue positive in four. Rather than protecting the private insurance system, the Finance Committee could include a public plan with the ability to bargain to Medicare rates, thus saving, according to the Commonwealth Fund, 20 percent to 30 percent against traditional private insurance. Ezekiel Emmanuel, brother to Rahm and health-care adviser to Peter Orszag, has a proposal for a universal voucher system funded by a value-added tax. All these ideas would make health reform better, cheaper, and more sustainable. None of them, so far as I know, are under serious consideration.

But health reform has just gotten harder. The hope that we could expand the current system while holding costs down appears to have been just that: a hope. And CBO doesn't score hopes. It only scores plans. The question now becomes whether we want health-care reform that achieves less of what we say the system needs, or more. Doing less would be cruel to those who have laid their hopes upon health reform. But doing more will be very, very hard.

For more on this: See Jon Cohn.

Photo credit: Melina Mara -- The Washington Post

By Ezra Klein  |  June 18, 2009; 10:49 AM ET
Categories:  Health Reform  
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Comments

i remember when we planted an american flag on the moon.
it seemed that the united states could accomplish anything.

reading this, and lamenting over what is happening in california.
all of the money spent in iraq, and our hopes being dimmed with health reform. many of our industries like massive shipwrecks....
i dont understand.
i just am not a student of economics, but i just dont understand.
american people are working hard. everyone is trying their hardest.
i keep hoping that after a long and difficult cycle, even a broken clock is right twice a day, and things will somehow come out right again.

Posted by: jkaren | June 18, 2009 11:14 AM | Report abuse

President Obama's main goal is to ride shotgun and protect the employer-based health insurance system. It's basically a behemoth Blue Cross bailout.

Employer-based health insurance costs $16,000 per year per family. Yet in the free and open market portable individual HSA health insurance only costs $198 a month for a 35-year-old couple and 2 children in Lansing, MI.

ezra, a wonk's wonk, says purchasing individual health insurance is too scary. The truth is a caveman could do it. Is purchasing auto insurance too scary too?

We need better wonks at the Washington Post.

Posted by: RonGreiner | June 18, 2009 11:24 AM | Report abuse

The problem with healthcare reform is that Republicans are reeling that the last bastion of wealth, that is, the for-profit healthcare system, will finally have some competition from an unlikely source, the federal government. When healthcare companies are making record profits, that means that people are being denied coverage, claims are being denied and medical care is being denied. If the private, for-profit healthcare system were working, people would not be asking for a public option. Keep the public option on the table. The continuous for-profit, system of denial of medical care needs to be challenged. For-profit healthcare does not work.

Posted by: cricket35 | June 18, 2009 11:27 AM | Report abuse

AMERICA’S NATIONAL HEALTHCARE EMERGENCY!

It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.

STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.

We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.

And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.

Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).

Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.

In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!

Contact congress and your representatives NOW! AND SPREAD THE WORD!

God Bless You

Jacksmith – WORKING CLASS

Posted by: JackSmith1 | June 18, 2009 11:28 AM | Report abuse

our tax money pays for all the politican's in Washington 's health care i paid taxes for 42 years for there health care.now i don't have health care coverage because i lost my job like millions of Americans did.They should think of all the people not covered and dont worry about the cost of it.life is is more important than the cost for health insuranceStop all the greediness and selfenees.PASS A BILL FOR THE PEOPLE

Posted by: jampk59 | June 18, 2009 11:33 AM | Report abuse

For RonGreiner, sorry to say that your numbers seem incredibly low. How about $800/mo for a family 3 of in an employer based plan? That's the cost of a small business based plan. Healthcare reform is definitely needed. I'll take the same plan as my congressman has.

Posted by: cricket35 | June 18, 2009 11:36 AM | Report abuse

I've always wondered why they couldn't just tack on a public option to the Wyden plan.

Posted by: SteveCA1 | June 18, 2009 11:36 AM | Report abuse

If you plan to live and work in DC on political issues for the rest of your life and you react to every little twist and turn in the political process by becoming excited you're going to die young.

Posted by: ostap666 | June 18, 2009 11:40 AM | Report abuse

How incredibly disappointing and totally predictable. You just can't change anything with this Congress and its weak leadership. As the first poster noted, we put a man on the moon 40 years ago...40 years!...and we still can't provide affordable health care for all Americans. It is truly, truly sad.

Posted by: mslavick | June 18, 2009 11:43 AM | Report abuse

If more people were pushed into the private individual healthcare market then the competition for their business would bring down costs. That's how markets work.

Employer-based insurance is more expensive because it covers everyone that is employed regardless of their individual risk factors for the same flat premium.

Posted by: fallsmeadjc | June 18, 2009 12:02 PM | Report abuse

What's going to happen with government funding of healthcare, no matter how you slice the delivery mechanism, public plan, everybody on Medicare, HSA, etc. ad infinitum is a limitation and rationing of care. Everybody gets aspirin, nobody gets Lipitor after 65; everybody gets emergency room catastrophic but no hip relacements or heart transplants after 50.

Posted by: ronjaboy | June 18, 2009 12:04 PM | Report abuse

May be it is not a bad idea for President Obama to show some leadership now that the crunch time is arriving. It does not need to be Sen. McCain who needs to remind our President for the ‘leadership time’. There got to be more to Presidency than eloquent speeches and leaving details to be worked out by the Congress cooks.

What has happened is while being fixated on how Clinton Reform failed, Obama Administration has ignored today’s concerns; the single most being the fiscal reality and extremely limited ability of American Government to increase taxes. Trillion dollars to increase coverage for little over half the uninsured folks (or even less)? Forget it, that is not going to happen.

Similarly, taxing to full tilt employer health benefits? Do Dems want to lose both houses of Congress by 2010 with only one term Obama Presidency? So that is not going to happen too. Limiting that benefit and taxing it after that limit is only acceptable. Still that is a tax, the one candidate Obama opposed. The reason why we have to go to this source is that is the only reliable and robust stream compared to all that baloney White House is floating.

Finally, the realistic way is for Dems to acknowledge the fiscal reality and give up the hope of universal coverage because simply there is no Political gumption with Dems to accept the harder, but sustainable route, indicated by Ezra – dramatic reforms. Dems themselves have too much political baggage and vested interests in continuing the current system. Before blaming GOP, Dems got to see what sacrifice are they ready for. Come on, when our President cannot even contemplate the possibility of capping malpractice lawsuit compensation, how on earth there can be any sensible reforms?

President is mixing increase in coverage with cost reduction. Controlling Medicare cost is the fiscal reform imperative for Fed and that should be done independently of coverage increase. Go there, save some solid bundles for Government, earn the ‘chips and credibility for fiscal management’ and then commit those saved resources for coverage increase. At that time public can accept some taxes to complete the funding of increased coverage. True, these two parts (controlling costs and increasing the coverage) can be tied together and the omnibus bill can be passed for legislative efficiency purposes as well as political expediency. But what is happening is President is waving the candy first before earning necessary political capital by way of controlling the daemon of Health Care Costs.

O yes; we are in deep s**t with the way current Health Care Reform is driven.

Posted by: umesh409 | June 18, 2009 12:15 PM | Report abuse

I wish HSA's were the answer, but they are not. Even their proponents admit that they must be heavily regulated in order to work as advertised, and it does not solve the primary problem.

We have an entire layer of people who get paid for figuring out who pays for what and how to get out of as much of it as possible. This is the purpose of the health insurance industry.

"Health insurance" is NOT "health care". It is a parasitical function that our country can no longer afford and must be eliminated.

We need single payer health care. Turn our premiums into taxes to fund it, and in a few years it will start paying for itself.

Yes, I know a lot of people work in the health insurance industry, but when they get laid off like so many other Americans have lately, at least they will have health care.

Right now, about half the people I know, hard working, responsible people either do not have or are in danger of loosing health insurance.

Posted by: abright1 | June 18, 2009 12:15 PM | Report abuse

This news is so disappointing that I do not know where to really begin. It strikes me that one of the problems with being a Democrat is Democratic Senators. This is quite possibly the worse managed bill I have ever seen. The question I have is does waiting until Al Franken becomes a potential 60th vote and waiting for reconciliation change the dynamic in any way?

Posted by: paulrichardson82 | June 18, 2009 12:40 PM | Report abuse

A lot of cost of the current health care system could be reduced by returning health insurers and corporate providers to the status that they were 35 years ago, as not-for-profit corporations. Congress would need to buy-out stockholder equity, and then reorganize insurers like Blue Cross and providers like Kaiser Permanente as not-for-profits. Congress should also require all states to provide certain minimums of funding to help subsidize these entities, so that regional disparities are minimized. The whole system could be funded by a VAT or national sales tax. This is the solution that will actually reduce costs without rationing care or doing other politically unpopular things like requiring that people see nurses for their illnesses first before geting to see a doctor. That might be needed eventually, but it's too much to try to do it right now. Go after the corporate profits, and you can reduce costs right away. Most people have little love for corporations these days anyway.

Posted by: ripvanwinkleincollege | June 18, 2009 12:51 PM | Report abuse

It will be inexcusable if health care reform does not occur...soon.

I see health care reform divided into two separate issues: 1/ Cost of insurance to consumers; and 2/Quality of care.

I have not heard one argument that has convinced me that quality will be affected. To say so, seems to me to be a slam against physicians.

As far as cost is concerned I don't understand why every hospital in my area has to have the same expensive diagnostic equipment. Why can't hospitals in large metropolitan areas adopt the division of labor techniques of most other industries? Can't one hospital specialize in oncology treatment, another in pediatrics, another in cardio-vascular, etc.? In my community, EVERY hospital has to have the lastest and most up-to-date machinery available.

Another aspect of consumer costs is monthly premiums which is diluting my disposable income. As a fairly healthy adult, my doctor visits are minimal, but my monthly premium is nearly $300.00 (single subscriber) a month. As a part-time teacher that is taking a big chunk of my salary that could be spent on other things. In my school division, some people are paying over $700.00 per month just for their premium. I have been told that some employees write a check to the school division on December 31 because their salary is lower than their health care premiums. They are working for health care only. And these, unfortunately, are the folks who are at the bottom of the pay scale.

From a consumer's perspective, I see health care as the biggest obstacle to my spending on other goods and services.

Posted by: ilcn | June 18, 2009 1:04 PM | Report abuse

ronjaboy - Yes, you're correct that reform will result in 'rationing' of health care. This shouldn't be surprising, since our current system (using the term loosely) rations health care. It just does so on the basis of the patient's ability to pay, or, through insurance, to get someone else to pay. I congratulate you for being wealthy enough to afford whatever treatments you may want. The rest of us already have our health care 'rationed' by the bean-counters at the insurance companies.

Posted by: lp2004 | June 18, 2009 1:26 PM | Report abuse

The fundamental truth is that we face a decision between profit and basic health care. Lowering hc cost means lowering profit for the few big money players which comprise the health care insurance oligopoly. And the oligopoly is winning. As a nation, greed has consumed us and it appears we cannot escape.

Posted by: NoodleUp | June 18, 2009 1:31 PM | Report abuse

"Reform" that consists of big up-front expenditures (mostly in the form of a gravy train for the insurers), while exhibiting no realistic ability to deliver the promised cost savings down the road, needs to be more than "in trouble". It needs to be stone cold dead.

This is one of those cases where "doing something"- something worse than useless- really is much worse than doing nothing. As I've been saying for years, real reform will not happen until the current hyper-expensive mess simply cannot be sustained any longer. We're getting closer to that day, but it isn't here yet. I care about health care, not about a fig leaf to allow Obama to pretend he accomplished something.

Posted by: labonnes | June 18, 2009 1:37 PM | Report abuse

It's really pretty understandable that Congress does not understand health care reform. Judgung by the comments here, a lot of their constituents - even those that read this incredibly informative blog - don't understand the issues very well either.

E.g; RonGreiner: "In the free and open market portable individual HSA health insurance only costs $198 a month for a 35-year-old couple and 2 children"

Even if this figure were correct, it means nothing if they can't buy coverage due to a pre-existing condition.

Fallsmeadjc: "If more people were pushed into the private individual healthcare market then the competition for their business would bring down costs. That's how markets work."

We already have competition - for the healthy people. So our expensive, moderately effective health care system is focused by the market primarily towards those that need it least. Thanks a lot free market!

And the point above that "compromise" "moderate" (half-assed) reform is far more expensive and less effective than full blown reform seems to be completely missed by Congress. The current proposals only make sense if Congress is either stupid or entirely in the tank of the industries making profits off the current mess.

Posted by: jeirvine | June 18, 2009 1:50 PM | Report abuse

If you would like to help pressure Congress to pass single payer health care please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php

Posted by: letsgobuffalo | June 18, 2009 2:07 PM | Report abuse

jeirvine: // E.g; RonGreiner: "In the free and open market portable individual HSA health insurance only costs $198 a month for a 35-year-old couple and 2 children"

"Even if this figure were correct, it means nothing if they can't buy coverage due to a pre-existing condition." //

A small percentage of people are uninsurable at 35 years of age. Sure if people smoke the $198 premium will go up a bit. If the wife is 5'7" and tops the scales at 250lb the $198 goes up a small amount but she can get insurance.

Obama wants to take away medical underwriting so healthy people's premiums will soar. Obama should due away with medical underwriting in life insurance too. Then the cost of life insurance could soar too.

I suppose you think that a person dying of cancer should be able to buy a million dollar life insurance policy. Those darn life insurance companies are cherry picking again.

You liberals are a hoot.

Posted by: RonGreiner | June 18, 2009 2:25 PM | Report abuse

We must return to Democracy. The Democratic Party is out of step and highly threatening to at least half the country. Read the attached article and sign in to vote it up.
http://www.digitaljournal.com/article/274378

Posted by: lclifton | June 18, 2009 2:46 PM | Report abuse

Why doesn't our gov't ask for the tens of millions of dollars overpaid to the skilled nursing facilities such as SUN HEALTHCARE GROUP INC? Is it becasue SUN sold their pharmacy subsidiary, Sunscript, in 2003 for $90 M cash and that money is simply "gone"? see this article

Potentially inappropriate nursing home payments spur increased Medicare Part A, Part D oversight
June 08, 2009
Tens of millions of dollars were likely inappropriately paid to skilled nursing facilities through the Medicare Part D prescription drug program in 2006, according to a recently released report from the Department of Health and Human Services Office of the Inspector General.

According to the OIG report, Part D spent roughly $41 million that year to pay for drugs for nursing home residents who should have been covered under the Medicare Part A benefit. While admitting that a small number of facilities constituted the vast majority of inappropriate payments-30 long-term care pharmacies were responsible for 18% of the payments-investigators say that nearly every SNF and half of all pharmacies have at least one Part A patient inappropriately receiving Part D subsidized prescriptions.

In response to the oversight, the OIG made a series of recommendations to the Centers for Medicare & Medicaid Services, which include more oversight and guidance for skilled nursing facilities. Specifically, OIG told CMS to implement retrospective reviews to prevent future inappropriate payments, and to further educate facilities, pharmacies and drug plans about which Medicare plan is responsible for which medication repayment.

Hey the whistleblower for that could collect a whole lot of money.

Posted by: DeborahCalvert | June 18, 2009 2:50 PM | Report abuse

Ron Greiner's back to shill his HSA business, and yet again with the slick sales talk about his imaginary Lansing, MI family? (Google him if you like: there are 216 invocations out there.)

Welcome back, Ron -- we missed you! What is it, three or four years?

Posted by: pseudonymousinnc | June 18, 2009 2:52 PM | Report abuse

For the life of me I don't understand how the Obama and the left can promise (as they have) to cover more people, improve the quality of care, AND do both for less money. Not too long ago such claims would be tagged with the labels of "voodoo economics" and "fuzzy math."

Frankly, government is a big part of the problem. Case in point: when my daughter was born, we didn't have much choice at all as consumers on the kind or amount of health insurance to get for her. Every policy was more or less identical because government mandated what the benefits had to be for this newborn, including (no kidding!) breast implants, treatments for alcoholism, hair transplants, accupuncture, etc. etc. etc. Gimme a freaking break! The onyl choice we had a consumers was to pick the deductible amount.

Real (and meaningful) health reform would let me as a consumer shop for the kind and amount of health insurance I want and need - just as I shop for food, clothing, housing, transportation, and pretty much everything else in life. If I want mental health coverage, along with 100 other people, put me in that pool and charge me accordingly. But don't force me to buy what I don't want or need beyond coverage for catastrophic events (which is really what insurance is really suppose to be all about).

Sadly, though, I don't think the politicians on the left, who right now run the whole show, get that. So we're probably destined for complete government-run health care somewhere down the road.

God have mercy on us all.

Posted by: bbahler | June 18, 2009 2:56 PM | Report abuse

Klein's column is distressingly partisan, and he has only good things to say about the Obama administration's proposals. Here's a link to another view. Hopefully, it will stay up for long enough for some people to see before it's taken down:

http://www.americanissuesproject.org/blogs/columns/archive/2009/06/18/three-dirty-little-secrets-in-the-public-health-care-plan.aspx

Posted by: WashingtonDame | June 18, 2009 2:57 PM | Report abuse

It should be obvious that health care reform is intrinsically hard. Otherwise, we would not have so much problems doing it. It should also be obvious that grand plans are always suspect. Those plans rarely survive much contact with the stubborn realities of human behavior. On the other hand, the trends in health care cost can't be ignored forever. So, the propects for some significant reform may not be that bad. But it is likely just to be a first step and only to take form as the legislative process unfolds.

Posted by: dnjake | June 18, 2009 2:57 PM | Report abuse

Beware the old axiom of having government "do something": the quicker the government acts to solve a problem, the less likely the problem will be solved and the more likely that the problem will be aggravated.

Obama is doing too much (indeed, he is doing a LOT of things that government has no business doing). I can guarantee that none of this will end well.

Posted by: cmb551 | June 18, 2009 3:06 PM | Report abuse

That Greiner doofus sure is one busy troll. No one here wants to buy your scam contracts. Get back over to Redstate where the real suckers are.

Posted by: fishermansblues | June 18, 2009 3:14 PM | Report abuse

bbahler,

yes there are mandates on the kind of insurance you must have, but those mandates also exist when it comes to auto insurance. Why do we have those mandates? Well what happens when you choose the lowest amount of coverage your child is born with a serious birth defect? Who is going to pay for it? This is the problem we have right now. The government should require that everyone have at least some BASIC level of health insurance. HSA don't work because you need the money upfront to pay for them. The majority of folks who could afford an HSA can afford health insurance. Remove the stipulation that employers cover health insurance (make it an option) and have everyone pay for their own plan. In the end employers will pay for it anyone because anyone looking for a job will simply price themselves accordingly. Those who CAN NOT afford private insurance can choose the public plan which should provide them the basic preventative care.

Posted by: negee99 | June 18, 2009 3:52 PM | Report abuse

fishermansblues, in Mass. there are only 5 insurance companies in their magical exchange. You must buy insurance from this monopoly or face state fines. If you make under $33,000 a year the taxpayers will pay the bloated price. If you make more than $33,000 you are on your own paying 550% more for Blue Cross of MA.

ezra needs a MA Connector to sell him Blue Cross because shopping on his own is too scary.

Get your HSA from where the palm trees sway.

Posted by: RonGreiner | June 18, 2009 3:58 PM | Report abuse

These are strange times, I have thought, but then I remember what's her name, from Tampa, who was on life support and the way that Congress manipulated that. Schavo. That's right. So, nothing is too inappropriate for Congress. They have proved this over the years.

With respect to the reform of our health system, it starts with us. People have to be willing to pay higher taxes in exchange for national health care (curiously, Baucus and the gang of Democrats seem ridiculously willing to vote for any war funding bill, throwing the bill to our nieces, children, grandchildren, etc., but for health care, it's got to be neutral). It's unfortunate, but that is how it goes.

An alternative is to run true progressives who are willing to stand up and truly battle the insurers. It would be difficult to do, but it's becoming necessary. I hope you Pennsylvania Democrats are taking notice, as Arlen needs a challenger.

Posted by: teoandchive | June 18, 2009 4:11 PM | Report abuse

I do not understand where these cost calculations come from. What about the 30% of spending that is going into for-profit insurance company coffers? Why doesn't someone accept the fact that the only cost effective reform is to cut them out of the picture?

And why are my elected representatives cowering before the likes of Mitch McConnell and Eric Cantor? I was voting to neutralize people like that. Why are they so worried about what they might or might not do?

Posted by: Athena_news | June 18, 2009 4:42 PM | Report abuse

When Democrats unveil their plan that taxes health care benefits of everyone EXCEPT union members, how do you think the 85% of non-union Americans are going to react? It is giving the election to the republicans. Baucus's compromise was to not tax the cadillac plans of the unions.

How is that fair? Do you really think the country is going to accept that?

Posted by: Cornell1984 | June 18, 2009 4:52 PM | Report abuse

Eliminate the mortgage interest deduction and the capital gains exclusion for selling your house. Eliminate tax deductions for companies buying health insurance for their employees.

These changes alone would generate more than $1.5 trillion over 10 years.

Then add in greater efficiency, electronic health records, etc. and there is no reason why universal health insurance couldn't turn out to be net positive over 10 years.

If Congress sticks it to us again, then we need to vote out all incumbents who sided with industry and their lobbyists in future elections. Enough is enough. I am tired of lame excuses.

Posted by: JackJo | June 18, 2009 4:54 PM | Report abuse

Bbahler: "I don't think the politicians on the left, who right now run the whole show, get that. So we're probably destined for complete government-run health care somewhere down the road."

I sure hope you're right. All the other industrialized countries have that, and get the same outcomes at half the cost. Sign me up.

Posted by: jeirvine | June 18, 2009 5:14 PM | Report abuse

You know, I'm okay with whatever half-assed "reform" they come up with - as long as they have to get their health care the same way we do.

Posted by: uberblonde1 | June 18, 2009 5:35 PM | Report abuse

f more people were pushed into the private individual healthcare market then the competition for their business would bring down costs. That's how markets work.

Employer-based insurance is more expensive because it covers everyone that is employed regardless of their individual risk factors for the same flat premium.

Posted by: fallsmeadjc | June 18, 2009 12:02 PM

==========================================

Markets work by what's profitable. If it's profitable to take in more people then that's what they'll do--some healthcare systems actually structure it to force companies to compete for as many people as possible and get them well. If on the other hand it's profitable to exclude all but the healthiest--as is the case here in the U.S.--that's what the markets will do. Forcing everyone into the private market as it stand right now will make cause more people to be uninsured and cause cost to rise due to costs of providing care for people who can't afford it.

The idea of insurance is combining people into large groups and spreading risks so your logic about employer-based coverage doesn't make sense. Employer-based coverage is more cost-effective in the long run to group people together, because the risk is spread. Individual insurance is less cost effective for the inverse reason--fewer people. Individual insurance also carries the pitfalls of "pre-existing."

Posted by: UnPatriotic | June 18, 2009 5:36 PM | Report abuse

Real (and meaningful) health reform would let me as a consumer shop for the kind and amount of health insurance I want and need - just as I shop for food, clothing, housing, transportation, and pretty much everything else in life. If I want mental health coverage, along with 100 other people, put me in that pool and charge me accordingly. But don't force me to buy what I don't want or need beyond coverage for catastrophic events (which is really what insurance is really suppose to be all about).


Posted by: bbahler | June 18, 2009 2:56 PM

--------------------------------------

So when you have a medical emergency you'll shop around for the best hospital deal and then go?

Insurance is most effective when you combine people into large groups spreading risk--coverage for a pool of 100 people is bound to be expensive for that reason.

Posted by: UnPatriotic | June 18, 2009 5:41 PM | Report abuse

"The idea of insurance is combining people into large groups and spreading risks so your logic about employer-based coverage doesn't make sense. Employer-based coverage is more cost-effective in the long run to group people together, because the risk is spread. Individual insurance is less cost effective for the inverse reason--fewer people. Individual insurance also carries the pitfalls of "pre-existing.""

Actually, as far as keeping premiums down and avoiding adverse selection, it is better to group individuals than to sell individually to people. However, this need not be mandated by the government. Indeed, the reason that grouping is mandated is not because it keeps costs down, but because it allows governments to meet their "maximum coverage" philsophy: you cannot prevent one person from joining the group based on certain criteria. No, insurance companies can group on a variety of factors: geographic area, gender, etc.

By the by, a really interesting article:
http://www.windsorstar.com/goes+Buffalo+life+saving+treatment/1702800/story.html

Another axiom: be careful what you wish for. You may just get it.

Posted by: cmb551 | June 18, 2009 6:30 PM | Report abuse

And one thing to remember is that you should always add between one-third and one-half to any projection by the CBO to get what the legislation will actually cost. The sad thing for supporters of this legislation is that the money is there, it's just being spent in other, less important areas, like farming subsidies (that almost always go to huge corporations anyway), education transfers (which the states could pay for themselves), NASA, the Nat'l Endowment for the Arts, etc. But finding money in other programs is not how Washington works. This legislation will eventually pass without regard for our current fiscal situation, and it will be one more brick we've allowed to be placed in the debtors' prison being built by our government.

Posted by: Bretzky | June 19, 2009 8:48 AM | Report abuse

In 2008 members of Congress received $46 million from the insurance industry and $400 million from the complete health care complex. You might ask: Why would this money be given if it didn't buy or block policy? Aren't these patient dollars to begin with?

The last thing in the world the insurers want is a good public system competing with a good private system. The politicians don't want it either. The private system cannot come close on price because of excessive costs not seen in the public plan, such as broker commissions, high CEO salaries, high shareholder profits, marketing and actuarial costs, and even lobbying and campaign contributions that must be passed on to the patient.

The privates want to do away with the public option and so do the politicians. Not just because of the $46 million in bribes that they've already received from the industry, but because going forward, private entities can continue loading up their campaign coffers, and public entities like Medicare cannot give political cash.

Jack Lohman
http://SinglePayer.info

Posted by: jlohman | June 19, 2009 11:48 AM | Report abuse

If it's true that the private system cannot come "close on price because of excessive costs not seen in the public plan", Jack, then why are the politicians seeking to exempt themselves from having to participate in the "public option"?

"The president is barnstorming the nation, urging swift approval of legislation that is taking shape in Congress. This legislation -- the Affordable Health Choices Act that's being drafted by Sen. Edward Kennedy's staff and the Health, Education, Labor and Pensions Committee -- will push Americans into stingy insurance plans with tight, HMO-style controls. It specifically exempts members of Congress (along with federal employees; the exemptions are in section 3116)."
http://online.wsj.com/article/SB124536864955329439.html

"Choice for me, but not for thee." Americans need to wake up before they end up with a nightmare system from which we cannot return.

Posted by: cmb551 | June 19, 2009 12:32 PM | Report abuse

cmb551, politicians are distancing themselves from getting between the insurance interests that fund their campaigns and the voters that can oust them. Cowardly, yes, but can you understand why? $46 million is a lot of "speech."

And I disagree that we'll not be able to fix mistakes later. But more importantly, why are we allowing our politicians to take money from an industry that wants to stay in the taxpayer's pockets?

Posted by: jlohman | June 19, 2009 1:39 PM | Report abuse

"Obama wants to take away medical underwriting so healthy people's premiums will soar. Obama should due away with medical underwriting in life insurance too. Then the cost of life insurance could soar too."

You seem to have no concept of risk pooling or of problems with the current system. It's an outrage that close to 50,000,000 Americans have no health insurance.

Posted by: Dismayed1 | June 20, 2009 10:29 PM | Report abuse

I find it interesting that there is a lot of reports/discussion about obesity and health care reform at the same time without any linkage between the two. Everyone is pointing fingers at insurer and providers for the rising cost of health care when, in fact, it is most likely due to the US population eating too much of the wrong thing and not exercising.

The Surgeon General’s "Call to Action to Prevent and Decrease Overweight and Obesity," updated January 2007 states, "in 1995 the total (direct and indirect) costs attributable to obesity amounted to an estimated $99 billion. In 2000, the total cost was estimated to be $117 billion ($61 billion direct and $56 billion indirect). Most of the costs associated with obesity are due to Type II diabetes, CHD, and hypertension."

Obesity is not a condition it is a choice and it is not fair for the healthy to pay for those who choose to be unhealthy.

Personally, I believe that health insurance coverage should continue to be underwritten, but instead of assessing risk based on the conditions one has, it should be based on how healthy a person lives their life. There should be consequence for choosing to be unhealthy and I believe the cost of their health insurance should be one of those consequences. If someone becomes sick even after they have taken good care of themselves then I am all for my premiums going to help cover their costs (since I would want them to do the same for me).

Health care coverage should be a privilege and you need to earn it by taking care of yourself.

FYI... I am also all for the sin tax to help pay for the costs. It is ridiculous that it costs more for fresh fruit than fast food.

Posted by: rodehorst | June 22, 2009 10:46 AM | Report abuse

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