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Charts and Graphs That Will Finally Make It Clear

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As Ross Perot's success showed, presidential candidates have successfully used graphs to amplify the message of their campaigns. Congressmen routinely use graphs to illustrate points in their floor speeches or arguments around legislation. But presidents don't much use graphs. They still rely on people listening to them speak for an hour, or going to reread a transcript, or getting an accurate summation from the media. It's not a terribly efficient way to communicate. Not, at least, compared with graphs. For instance, what's more useful in understanding the basic shape of health-care reform? Every word you've heard or read up until this point, or Nick Beaudrot's flowchart?

(For more on Nick's flowchart, see this post.)

By Ezra Klein  |  September 10, 2009; 3:49 PM ET
Categories:  Charts and Graphs  
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Next: A Conversation With John Dingell Jr.

Comments

Pretty chart, now let's separate the wheat from the chaff.

1. “Incentive changes to improve quality and reduce waste” sounds great. Can you provide an example (since Medicare’s inception) where this has actually happened?

2. Won’t those bans and requirements in employer based insurance increase the costs of the policies? Wasn’t this supposed to save us money? This sounds like a free lunch.

3. Won’t all those subsidies and Medicaid expansions cost a bunch of money? Who gets to pay the bill for that?

Posted by: kingstu01 | September 10, 2009 4:38 PM | Report abuse

kingstu01, I can answer your questions.

1. They would have made these changes even absent a more general health reform, but they were waiting for the right moment. Don't worry about it.

2. Insurance companies wouldn't dare. Don't worry about it.

3. Rich people. Don't worry about it.

Posted by: ostap666 | September 10, 2009 5:32 PM | Report abuse

Or, alternative answers to your questions:

1. Comparative Effectiveness Research, de-politicizing what has historically been an incredibly political MedPac process, and Health IT

2. The bans referred to are strictly enforced in the individual market and are a great source of problem and frustration ion the individual market. To a large extent, these provisions already do not apply in the employer market...very few annual caps, ifetime caps that are raised as soon as people hit them, pre-ex was essentially legislated away by HIPPA, most do not rate based on gender, already cover preventive, etc. Ideally Nick's chart should have parsed employer and individual policies.

3.The cost is paid for as Obama suggested last night: a tax on the insurers underwriting the richest (cadillac plans), savings from all the items mentioned in #1 which should not be discounted as they are huge, and if everyone is now insured, hospitals do not need supplementary payments because they have so many uninsured, so that payment can be reduced as insurance payments fills the gaps.

Posted by: scott1959 | September 10, 2009 6:05 PM | Report abuse

Now go to the bottom of the chart and write in, "Total cost to you: Seven Dollars."

No less accurate than everything else, but even more appealing for folks who believe the chart tells the whole story.

Posted by: whoisjohngaltcom | September 10, 2009 7:09 PM | Report abuse

The IRS will everyone's new BFF, thanks to Obamacare's requirement for means testing for just about everyone----------- e.g., for middle class subsidies for premiums, for Medicaid coverage of the young and working poor, for Part D, for Medigap, etc.

And we all know what a good friend the IRS can be.

Posted by: johnowl | September 11, 2009 9:18 AM | Report abuse

I think that this is a better link to Nick's chart: http://www.donkeylicious.com/2009/08/flowchart.html

Posted by: eRobin1 | September 11, 2009 9:23 AM | Report abuse

He's improved it! http://www.donkeylicious.com/2009/09/improved-health-insurance-reform.html

I'm going to hold out for the box set release.

Posted by: eRobin1 | September 11, 2009 11:38 AM | Report abuse

to Kingstu01:

1. Example (just one) 1980's change from procedure-oriented reimbursement to flat fees for diagnosis for Medicare patients - saving 20 billion a year, or 30% of total Medicare spending, twice the savings estimated by Congressional Budget office (which has chronically underestimated healthcare savings initiatives).

2. I share your concern.

3. Large savings will come from current unreimbursed, costly emergency room care for those who lack good basic care. Good basic care will save us on "heroic," federally mandated rescue care. Wish I had the numbers, can't take the time to get them now, sorry.

4. (Mine) I still don't understand how any of this this all makes insurance affordable for my 62 year old stepmother, who works at least 12 hours a day at her own bakery business starting around 4AM. All she will get is a new $3,800 Baucus fine if she doesn't buy insurance which will cost her around $12,000 a year, or around say 25% of her income. Yes, she would get a fine, but no insurance. Anyone: please, please correct me if I am wrong.

I have not heard that age will be eliminated as a criterion for setting rates. (I hope I'm wrong!)

Is there any definition of "affordable" besides: "if you make more than $32,000, you can afford it?" A 60 year old making 36,000 a year would likely be paying 33% of their income for health insurance. Is that "affordable"? Not in any other country!

Posted by: tom0063 | September 11, 2009 7:38 PM | Report abuse

tom0063......I have not seen any suggestion that age be eliminated as a criteria for setting rates, but the ratios are now being mandated (ie, the ratio from the oldest to the youngest can not exceed 5:1)

As for the fine, I do not believe it would apply if there are not "affordable insurance choices" available. So your stepmother will not have to pay 25% of income for a plan.....she gets a subsidy based on her income (assuming she is at/below either 300% or 400% of the FPL), and if that does not bring the net cost down to "affordable" (which is I think a maximum of 13% of income), then the penalty does not apply.

Posted by: scott1959 | September 11, 2009 9:47 PM | Report abuse

Scott 1959

thanks for the info.

I think my stepmother makes 40-50K, which is more than 300/400% of poverty level.

Good to know no fine, and that 13% is "affordable."

However, since I have not seen anything about rates decreasing, it is bad to know that for her, and for many millions more, there will likely be no "affordable" insurance option.

"Universality" means only for those who receive employer coverage or who are subsidized by the government.

The middle class thins yet further.

Posted by: tom0063 | September 11, 2009 10:42 PM | Report abuse

Scott 1959

Although if the 1 to 5 ratio holds true.....

If the young pay $100/month, $500/m might be acceptable. $200/month and we are back in unaffordable land....

Posted by: tom0063 | September 11, 2009 10:44 PM | Report abuse

tom0063....devil is in the details...will the 5:1 hold? what dollar amount equates to the "1"? at what level will the subsidies be?

You are right about the affordability issues...if we agree that 13% or so is affordable and the middle class has to pay that on top of the other bills they are struggling to pay, then we have an issue for some. Although I think Ezra has quoted CBO figures on how many will fall into the "unaffordability zone" and it is not a huge number.

We are probably making an argument for a public option here, you know? Not having the cost shifting from the uninsured should help insurance premiums in theory, but it would be even better to have the pressure from a public option, trigger or no.

Posted by: scott1959 | September 11, 2009 11:50 PM | Report abuse

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