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How big is the bill, really?

billsvstrills.jpgWe should start by putting the health-care bill into proper perspective. Opponents and supports of the bill have both profited immensely from exploiting the average person's inability to put billions and trillions into context. So let's begin by breaking down the numbers. The $900 billion price tag is repeated with the regularity of a rooster's crow. That's a shame, as the number is, somewhat impressively, misleading in both directions.

On the one hand, that $900 billion -- or, more precisely, $940 billion in the final legislation -- is stretched over 10 years. But people don't think in 10-year increments. They don't pay taxes once a decade. Put more simply, the bill will cost an average of $94 billion a year over the first 10 years.

But that's not quite right either: The bill wouldn't really kick in until 2014. To get a more accurate annual figure, look at a year in which the bill is fully operational. In, say, 2016, the bill's spending will be about $160 billion (you can find these numbers on page 22 of the CBO report). According to the Center for Medicare and Medicaid Services, total health-care spending that year will be about $3.7 trillion. In other words, the bill's spending is equivalent to about 4 percent of what we'll spend in health care in a year, and it will be covering 30 million people.

So that's really what we're talking about here -- a large health-care expansion that's a slight fraction of overall spending. The graph on the right tells the tale (though the $175 billion refers to the Senate bill; the reconciliation fixes increase the 2018 spending to about $200 billion, which is no different for the purposes of the image).

Let's go even further: It's an expansion that most people won't notice in 10 years. According to the Congressional Budget Office, the Senate bill will change the insurance of about 40 million people by 2019, about 30 million of whom would have been otherwise uninsured. The other 10 million will come from the employer or individual markets in search of more affordable options. About 23 million people will still be uninsured, many of them illegal immigrants. About 90 percent of Americans will be exactly where they'd be if this reform had never passed.

That accounts for the spending side of the bill. What about the cost control?

It's the same story, but more so. Although the bill solves most of the coverage problem, it accounts for a mere fraction of the cost problem. A report by the centrist policy group Third Way estimated that the Senate legislation would save more than $800 billion over the next 15 years. That's consistent with the CBO's expectation that the Senate legislation and the reconciliation fixes would save more than a trillion dollars over the next 20 years.

That's a big number. Quite a bit more than my car cost, and I thought my car cost a lot of money. But the savings amounts to no more than a rounding error given the tens of trillions of dollars we're going to spend over that period. It's half of 1 percent of expected GDP.

Importantly, though, it's a rounding error in the right direction. The bill is thick with efforts to move toward cost control, if not efforts to actually impose cost controls. The excise tax, the Medicare Commission, the pilot programs to change how hospitals are paid and most of the other proposals are designed to bear fruit in the future. The excise tax -- which slaps a fee on high-cost plans in order to give a competitive advantage to those that hold costs down more effectively -- initially applies to very few plans but would hit more as premium costs rise. The payment reforms have to pay off as pilot programs before being considered for Medicare-wide -- much less systemwide -- use. I'll talk about all these in greater detail later today.

But the key when thinking about them is to recognize that the name of the game isn't impressive-sounding cuts. As we've already seen, such cuts are actually not that impressive when put into context. Instead, the key is changes to the growth rate in health-care spending -- even small ones.

The problem with health-care spending is not that we spent $2.3 trillion in 2008. It's that that number has been growing by 7 percent annually. It's the rate of increase, and not the level of spending, that we need to change.

Consider again the $2.3 trillion we spent in 2008. Given the current rate of growth, in 2028, we'll spend $8.9 trillion on health care. Imagine, however, that we got really serious about cost control and cut $200 billion next year. If costs were to grow at the same rate, we'd still be spending $8.1 trillion in 20 years. Imagine, then, that we didn't cut a dollar -- but got cost growth down to 5 percent (which is still faster than wage or GDP growth). In that case, that $2.3 trillion would only be $6.1 trillion in 2028 -- and we'd have saved money every year leading up to that. That's actually manageable.

But changing the growth of the health-care system is a lot harder than just cutting a few dollars here or there. It requires us to change how doctors practice medicine, or how much medicine people buy or how much they need -- or maybe all three. We're doing a lot on health-care reform this year, but we're not doing that much. And we shouldn't fool ourselves into thinking otherwise. We'll be back at this again, and soon.

This post has been adapted and updated from an earlier column.

By Ezra Klein  |  March 22, 2010; 10:00 AM ET
Categories:  Explaining health-care reform , Health Reform  
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Next: What does the health-care bill do in its first year?

Comments

This comparison (the first paragraph and the charts) is an important one, one I've tried to emphasized to people when the discussion turns to this bill and its impacts and significance. I think Ezra and others should repeat it at the start of every piece about HCR and the bill, even if everyone shouts," Enough already, we know that now!!!"

Posted by: bdballard | March 22, 2010 10:10 AM | Report abuse

So, at what point should we be able to see if HCR has really worked to cut the growth of healthcare spending? 2012? 2014?

Posted by: Kevin_Willis | March 22, 2010 10:11 AM | Report abuse

Hmm, the bill spends 4% of total expenditures and covers 10% of the population. Who says government is inefficient?
Ok, that's not quite fair because Medicare is much more expensive because the pool covered requires much more health care than the 30M covered by this bill, but still makes a good sound bite.

Posted by: _SP_ | March 22, 2010 10:16 AM | Report abuse

Ezra, one aspect of the bill on which I'd appreciate further details today would be the employer mandate; the individual mandates are of course much stronger in this legislation, and therefore receive all the attention, but I'm still not entirely clear on how the limited employer mandates / fines are structured, and how they will affect businesses of different sizes.

Posted by: JPhils | March 22, 2010 10:18 AM | Report abuse

1) No government healthcare program, here or in any other country, has even remotely stayed in the neighborhood of what it was originally projected/guessed to cost. Many overshoot by factors of 5 or 10. So talking about what this "will" cost in 2028 or even 2016 based on its proponents is dubious at best. Everyone knows those figures are stage managed just to get the law passed, because afterwards we're stuck with it even as it skyrockets.

2) This bill is just the thin edge of the wedge, not the end of the story. President Obama has been candid when before sympathetic audiences that this is just the first step towards single-payer and government control over the entire healthcare system. We've left base camp, but we're nowhere near the summit -- yet. Costs to get there will fall somewhere between hilarious and ludicrious. Nobody seems to know what comes after 'trillion' but we'll find out soon.

3) It should be 'supporters' not 'supports' in the first paragraph. Sorry to be a tool, but this is a print medium.

Posted by: zippyspeed | March 22, 2010 10:19 AM | Report abuse

from the new york times:

a. $437 billion dollar federal income tax increases. What few realize, it is actually the single largest tax increase in U.S. history… *ever* I am surprised this hasn’t been discussed more, because their are 7 tax increase provisions in the bill that will damn near bankrupt the middle class.

b. forces businesses to provide full coverage insurance to all employee’s whether full time or part time (about $8,000 a year each). Not many will be able to survive that.

c. tax credits for small business… tax credit and rebate are two different things… tax credit means they will never see that money back… ever… It just means paying less business tax on the difference. Results, must terminate a large % of staff to maintain current level of business or go bankrupt…. See More

d. Severe expansion of medicaid no state can afford. On average, every state must double income taxes to to stay solvent. Texas alone has scored it at $27 billion… Iowa, will be roughly $400 million more annually. California… Already not solvent, but the state will go into default within just a few months.

e. must have full coverage health insurance for the right to exist… just to be alive…. This is called servitude, eg slavery… Including, criminal prosecution for non compliance… A criminal, just to be alive…

f. catastrophic health insurance which most small business owners have, because it costs less will now be illegal. full coverage government mandated insurance will be the law of the land… Full coverage, meaning ALL the bells and whistles… *expensive as hell*

g. real cost: $941 billion + $50 billion + $250-$300 billion * the average fed bill bloating of 30% comes close to $1.6 trillion… Not the scaled down $941 billion the CBO scored it at.

h. using public money for abortion… it is correct… presidential executive order does NOT trump federal law… only way presidential executive order is valid is when it is used with existing federal law, or no law exists already… Result: Yes, it is loopholed into law that tax dollars will be used for free abortions to anyone who wants one or DHS says someone has to have one.

i: expansion of the IRS… It is provisioned in the bill to hire 16,000 more IRS employee’s to enforce the financial aspects and enfore compliance under threat of criminal prosecution.

j: expansion of DHS… DHS will now have access to all medical and financial records for every single person in america, including access to their bank accounts…. So if they know you got any money and refuse to pay up, they can just go ahead and steal it from you without your permission.

k: no doctor fix… cutting $500 billion from medicare, no doctor fix, expanding the user base of medicare and medicaid without ANY funding (actually cutting spending) all leads to one thing… Heavy rationing, reduced services, and death rates go through the roof… Not going to be theory here soon…

Posted by: charlietuna666 | March 22, 2010 10:19 AM | Report abuse


It gets harder and harder to curb healthcare costs the moment those 32 million newly insured folks start utilizing health care.

When the Medicare tax on investment income goes into effect, dividends will effectively be taxed at 43.4%. As we all know the dividend tax is a double tax (private enterprise pay taxes).

Posted by: RandomWalk1 | March 22, 2010 10:20 AM | Report abuse

Ezra, does the excise tax hit all plans over $24,000/yr (or whatever number they settled on), or does it only apply to employer-provided health insurance? Thanks!

Posted by: MosBen | March 22, 2010 10:20 AM | Report abuse

Zippy: Incorrect (I have Ezra's entire archive- in my brain!)
http://www.commonwealthfund.org/Content/News/In-The-Media/2009/Aug/Congressional-Budget-Office-Has-Underestimated-Savings-and-Overestimated-Costs.aspx

Posted by: _SP_ | March 22, 2010 10:22 AM | Report abuse

"About 90 percent of Americans will be exactly where they'd be if this reform had never passed."

Assuming that for once the government accurately estimated the future costs of a program. (Medicare is roughly 10 times more expensive today that it was estimated it would be at this point.) The only way to pay for this will be with large tax increases or major cuts in other govt services both of which will adversely impact many of those 90% of Americans.

Posted by: TKH2 | March 22, 2010 10:25 AM | Report abuse

Kevin Willis,

2019. I'll be looking to see how close we came to that $940 billion figure and also its effect on the private market because as we know CBO doesn't score private expenditures. Any word on the CMS report?

Posted by: visionbrkr | March 22, 2010 10:25 AM | Report abuse

So many problems with this it's hard to know where to start.

I guess with the deficit effect. So, CBO predicts it will cause $160b in spending in '16 and Klein tells me I shouldn't worry because that is such a small amount compared to total health care spending?? How is that relevant? It's over 1% of GDP! Another significant increase in mandatory spending. Plus, given previous history, the odds of that $160b being correct are virtually zero. The heavy odds favorite is that it will be significantly more than that. Anyone who even remotely pays attention to the state of our other existing mandatory spending programs knows that they are on the verge of crisis. So, we just significantly increased that problem.

I guess my second biggest problem is that you ignored the effect this will have on insurers. For all the vicious rhetoric heaped on them recently, they actually only earn about 6% in profits. Now, thanks to community rating, guaranteed issue and a weak individual mandate, they have lost almost all ability to control their bottom line. This approach has been tried in a number of states and every time, insurers first lost massive of amounts of money, then pulled out of those states. Well, they can't pull out of the US market if they're a US company so after losing massive amounts of money, what will their option be? Same as GM and AIG, federal intervention. Hello single payer and the well-proven failures of Canada/UK and the rest of Western Europe. Higher unemployment, lower standard of living and worse quality of care.

This bill is a disaster. You focus on certain ratios and amounts that skirt the damage that this bill will bring on our health sector specifically and our fiscal situation generally.

Posted by: Avar | March 22, 2010 10:35 AM | Report abuse

I don't understand all your fancy charts and numbers. I'm just a caveman. But I know this - every American man, woman, and child deserves to get quality affordable care and we can't continue spending money we don't have.

Posted by: benintn | March 22, 2010 10:52 AM | Report abuse

I don't understand all your fancy charts and numbers. I'm just a caveman. But I know this - every American man, woman, and child deserves to get quality affordable care and we can't continue spending money we don't have.

Posted by: benintn | March 22, 2010 10:52 AM | Report abuse

Here's a different summary:
http://www.john-goodman-blog.com/obamacare-by-the-numbers/

Posted by: staticvars | March 22, 2010 10:53 AM | Report abuse

So, according to Klein's chart, the cost of health care will double over the next eight years. Look at that curve bend!

Posted by: msoja | March 22, 2010 10:59 AM | Report abuse

"But changing the growth of the health-care system is a lot harder than just cutting a few dollars here or there. It requires us to change how doctors practice medicine, or how much medicine people buy or how much they need -- or maybe all three"

I agree with this but notice a curious omission- the insurance companies. The President and the Democrats have painted the insurance companies as the source of all evil but it is the medical delivery system that has to be reformed so that coverage can be extended to all, not the "rapacious" insurance companies. The bill is almost entirely medical insurance company "reform" when what we needed was medical delivery reform.

Posted by: PCK2 | March 22, 2010 10:59 AM | Report abuse

So when will Rush Limbaugh be moving to Costa Rica?

Posted by: nisleib | March 22, 2010 10:59 AM | Report abuse

Well Ezra- I'm looking forward to your answers here- you are my go to guy on this bill. I am really tired of the debate but things like "bankrupting the middle class" really kind of crack me up. I mean what middle class? There's the wallstreet guys who get those 6-figure bonuses and the big CEo's (ins. co's. too) who get the 6-figure bonuses and then all the other people who live paycheck to paycheck (if they're lucky). They can't afford to get sick even if they have insurance and they're paying insurance premiums like mortgage payments neither of which are affordable. So -middle class? It's fat cats and working poor. Let's be real. The middle class went bankrupt a long time ago.But let me say thanks for all your analysis.

Posted by: espell | March 22, 2010 11:01 AM | Report abuse

"In, say, 2016, the bill's spending will be about $160 billion"

To further put that number in perspective, under the CBO's baseline forecast, it would equal less than 4% of total federal spending -- about 1/5th the size of the defense budget, and roughly as much as the government will spend on military and civilian employee pensions.

That seems like a pretty good deal to insure 30 million Americans.

Posted by: PeterPrinciple | March 22, 2010 11:03 AM | Report abuse

Numbers are numbers. Just that. Depends who uses it you can twist it and turn it and multiply it, add to it. The USA is one of the wealthiest and most influential countries of the world. MOst of the people who already have healthcare are spitting mad since they have to pay for those who do not have healthcare. THose who do not have healthcare are the poorest, and the least influentials. Their approval will never show up in a fancy surveys, and unfortunately they are not the ones who will go to the polls next time neither, still they should have the same right for health and for survival. THis should not be conservatives against democrats but humanitarianism against greed. If you are against this bill, think more about it the next time when you pick up your tall slim, long latte at Starbucks.

Posted by: someanyone | March 22, 2010 11:04 AM | Report abuse

A projected reduction in the federal deficit over 10 years does not remotely equate to a "savings" or a reduction in the cost of health care. The mechanisms needed to pay for this reform -- Medicare tax on unearned income, higher capital gains tax rate, excise tax on high-option health plans, etc. -- means that there is no guarantee that the average American will see any savings or benefit at all. Is there anything in either of the bills that helps control costs of health care for people already covered under employer-sponsored health plans?

The reason public opinion was so heavily against the legislation was because the Democrats did a lousy job of explaining how the average worker would be better off - or at least no worse off - under the reform plan. Sure, it will cover a few more million currently uninsured Americans, but how is the rest of the population protected?

Posted by: mnm9897 | March 22, 2010 11:10 AM | Report abuse

An otherwise nice article, and cost and dynamics aside it's a great thing that more folks will have insurance, but I don't know why the CBO "$900 billion price tag" ever appears in print if it includes in its calculation $250B in fake doc reductions, $114B in unincluded expenses to be legislated later, $70B in long term health care insurance premiums included as deficit reduction because the benefit it pays for deemed not to happen until after 2020, $53B in extra SS taxes even though those extra funds cause a higher SS payout and are spoken for (albeit after 2020), etc. NYT's Krugman did the same thing this morning. I've never seen any attempt to refute the above. How narrow is economist reporters' reading and knowledge?

Posted by: michaelv1 | March 22, 2010 11:16 AM | Report abuse

People seem to act as if extending coverage to 32 million uninsured is like letting everyone into their private country club. As if they don't crash it anyway.

In other words, I think it's important to note what health care those newly 32 million Americans would normally consume if left uninsured. Do they just disappear when they get sick? do they simply get better on OTC medications? Or are they somehow immune to all diseases and illnesses? No- they get the cadillac plans right there- the most expensive care, or when in advanced disease states or near end of life. And so that's a tax on the system too. Does that constitute a kind of tax increase? If I thought 20c of my tax dollar was going to education and environmental protection, but actually 19c is going to them b/c of an unanticipated increase in health care, I don't know- I suppose it's a not an actual tax increase per se, but it probably is a distortion of our democratic process.

Posted by: Lonepine | March 22, 2010 11:23 AM | Report abuse

On Medicare costs- a great explanation on how Medicare gave birth to the the fee for service system we have today that's breaking the bank:

http://www.npr.org/templates/transcript/transcript.php?storyId=124090475

Posted by: Lonepine | March 22, 2010 11:26 AM | Report abuse

Given that we spend 2-3 times per capita on health care than they do in Europe and Japan, for results that are the same or not as good, I'd say that it IS a problem that we spend a few trillion on health care, with no end in sight to the increases. We could have had an honest debate about how to get to the cheaper and more satisfying outcomes that these other countries enjoy, but guys like Ezra chose not to have it and to promise that we would deal with the question of making health care more affordable some day. Good luck with that.

Posted by: redscott | March 22, 2010 11:27 AM | Report abuse

Ezra is nothing but a lapdog of the Obama agenda...you can spin and spin all you want, but the bottomline health care costs will not be contained from this HC bill period and anyone knows the quality of healthcare will only get worse.

Posted by: johnrick | March 22, 2010 11:30 AM | Report abuse

Avar, your post is full of lies. Canada/UK and the rest of Europe have much better outcomes and care for their populations as a whole than here. OH, those poor insurers! Their 6% profit is what's left AFTER all those thousands of claims-denying employees, middle managers and multi-millionaire CEOs get paid. Your post is a crock!

Posted by: rjewett | March 22, 2010 11:33 AM | Report abuse

To all of the whiners about HCR.

Expanding coverage is the first step. Cost control once we have near universal coverage is going to be a continuing effort in the years to come. It depends a lot on which of the pilot projects yields the most bang for the buck.

For what it's worth, cost control is 10x harder than coverage expansion, mostly because the republicans ruthlessly pillory anyone who starts talking about where to rein in costs (except for Paul Ryan's plan to voucherize medicare, which would dramatically cut senior's access to health care).

If any of you whiners were actually interested in cost cutting, you would have supported single payer or a VA style system (really the best for cost control) as a 1st step. The next thing you would support would be an overall cap on health care spending as a % of gdp, mostly in the form of a premium cap. This would get insurers to bargain harder with doctors, drug and device makers, and hospitals instead of simply raising premiums to cover their increased costs (and boosting their profits, the same % of a larger number). This is one way that other countries keep their health care expenditures low. In a private insurance system, this is one of the only ways to bend the cost curve.

The exchanges when they are finally set up will also allow heath consumers to choose between health plans on a level playing field, where the benefits have to be above a certain baseline of care.

Posted by: srw3 | March 22, 2010 12:09 PM | Report abuse

Interesting Obama world we live in where $200 billion a year is considered chump change in the grand scheme of things. For all the talk of the massive cost of Obamacare, Massachusetts'Democratic Sec of the Tresury with his experiences under Romneycare says the U.S. will be bankrupt in 4 years, I guess my biggest gripe with this wonderful new law is how it takes away another chunk of our freedoms and gives it away to the U.S. government. Where in the constitution does it say that the federal government has the right to mandate that it's citizens buy a private service? Where does it give the federal government the right to tax it's citizens and use the power of the IRS to enforce that tax if they don't buy a product or service? And not only do you have to buy that product or service but you have to buy the federal government mandated levels of service? Do we really want this country to turn into a Eurapean style cradle to grave welfare state? Do we want the European malaise of high taxation declining population, declining tax revenue and increasing government cost? Wasn't this country founded by people who wanted to get away from the governmental tryanny of European kings and despots to practice their religion and polotics in peace? Didn't we have a revolution in this country for the right to be finally free of Europe? Do we want over a 150 new U.S. government bureacacies and thousands of new bureacrats per bureacacy created under Obamacare? All that to cover the small percentage of the population who don't have health insurance. Not healthcare since you can get healthcare in one fashion or another all the way to the extreme of showing up at the emergency room when your sick. We're giving up our freedoms for what?

Posted by: RobT1 | March 22, 2010 12:19 PM | Report abuse

This bill is the naked exercise of raw political power. It is an attempt by the Democrats to tilt the balance of power by giving one more free lunch to the most unproductive elements of our society at the expense of the people who work and contribute. What makes it particularly galling is enduring the endless pretentious lectures from Pelosi et al about how they are protecting us from ourselves. This will further polarize the county.
Today almost every state in the country is facing extraordinary budget crisis and in every state the two largest expenditures are unfunded Medicare mandates, and exorbitant expenditures on public employment, i.e. unionized public employment, particularly K-12. The stimulus plan passed last year directed almost no money to private stimulus but was used across the country to avoid public cutbacks to public unions. Now that the Federal expenditure level is at 25% of the economy, they add this latest bit of madness. But it can not go on without draconian tax increases, and those will be stopped. What is unsustainable is not health care, it is Obama and Pelosi's wreak-less class warfare!

Posted by: pondering | March 22, 2010 12:24 PM | Report abuse

To someanyone, maybe if poor people put their lives in order before having children there wouldn't be so much hardship. You get an education, start a career, meet someone get married and then decide if you want to have children. So many people who have made a shamble of their lives with poor life choices and now people who did things right have to support them for their entire life. I have to work 2 jobs to pay for my insurance and yours. fair????

Posted by: think11 | March 22, 2010 12:26 PM | Report abuse

Third Way is not a "centrist" group. From their own website, they clearly identify with the "progressive movement".

Posted by: mez_ | March 22, 2010 12:28 PM | Report abuse

What this bill does not address in any way is:

1) it does not fix the unfairness that people who want to or have to buy insurance on their won as opposed to through their employer must do so with After Tax dollars - and I believed democrats were all about fairness. How do you explain that to this people who are mos tlikely not all millionaires
2) It certainly does not adddress the main issue with cost whihc we all know is the 'Agency problem' - the fact that somebody else pays once you pay your premiums (your employer, your insurer, the government depending on your case) - co-pays and deductibles help a bit but not enough. When most americans buy anything expensive they research it, talk to friends, look at alternatives, etc. (think of cars, appliances, TVs, even clotes) - but we have no information as to how much a medical procedure will cost, we have to go in blind (that is not the case on plastic surgery, lasix and dentistry which by at large are not covered by insurance - in these there is efficient price disclosure and competition). That is the problem that needs to be fixed to reduce total spend (Americans are very quick to act on price signals, just look at what happened when gas was $4/Gallon - less driving, people were buying smaller cars, more train/bus ridership. I am sure we will make similar choices with medical care).

Finally, I would that I am disgusted at the tricks Ms. Pelosi and her friends pulled to pass this. A truly popular bill would not need them. They act as if they have an 80% popular majority when the vote tally says they are at about 50% (and certainly less without the tricks).

Posted by: CTTaxpayer | March 22, 2010 12:41 PM | Report abuse

The results of this health care decision will be horrible.

http://www.communislam.com/health-care-266

Posted by: servant119b | March 22, 2010 12:51 PM | Report abuse

Ezra, I just want to thank you for your excellent coverage of the health care debate over the last six or more months. You are one of the few who added light, rather than heat, to the national debate.

Posted by: esch | March 22, 2010 12:57 PM | Report abuse

Caterpillar says this bill will cost them $100 Million the first year. That' equal to 1,333 jobs paying $75,000/year.

If you multiply that by other companies in USA the size of Caterpiller that would be a job loss of another 500,000 $75,000/year paying jobs.

This is only at the big companies.

For smaller companies the S-Corp, they will lose about 5 million jobs due to having to pay almost 50% in federal tax rates.

The administration said it was going to double exports - yes they are. Jobs will be the number 1 export.

Posted by: debmries | March 22, 2010 1:00 PM | Report abuse

This bill is GOVERNMENT EXPANSION, nothing more. How many Americans are going to stand for government telling us WE CAN'T BUY CATASTROPHIC INSURANCE? Government is forcing some small businesses to "go under." And a 30% tax cut will do nothing when you have to start paying insurance for part-time workers!
Bottom Line: if you want a job, you'd better vote Republican.
Democrats ARE KILLING JOBS, left and right.
Caterpillar,who employs 150,000 people, said this bill will cost them $500 million the first year! Do you thik they
will be hiring? HahAHAHAH.

Posted by: ohioan | March 22, 2010 1:00 PM | Report abuse

For those who keep saying we spend more on healthcare than other countries for services that is not as good here's the facts:

We spend more because of medicare underpaying. The federal gov't blew thru our savings and now they have to underpay for services because medicare is broke. So you & I pick up the tab - even tho we've paid for medicare throughout our working year.
Do you realize that if you made $50,000 and you saved the money you put in medicare and social security - you would have $3.5 Million upon retirement. Our gov't blew that money.

We pay more for healthcare because we have the highest lawsuit awards - up to 100 times that of England.

We pay more because we have more choices and higher end treatment options.

We are ranked 37th by WHO not because are results are poorer as a matter of fact we rank #1 in almost every category.
They universal healthcare as the #1 factor when ranking countries and since we don't have that - we go down to 37. This is a fact - go look it up.

So USA currently has the best healthcare available in the world.

Posted by: debmries | March 22, 2010 1:07 PM | Report abuse

charlietuna666 wrote:

from the new york times:

c. tax credits for small business… tax credit and rebate are two different things…

-----------

As far as I know, if your taxes are more than the credits, then a rebate and credit are identical. It's a deduction that is significantly different as you only get a percentage of that back.
Please correct me if I'm wrong

Posted by: mytwocents | March 22, 2010 1:08 PM | Report abuse

Please tell me ONE fairly large gov't program that has EVER come in at or under budget??? Medicare, Medicaid, Social Security?? Hell..event he Massachusetts Health Care program that some of this was modeled after is EXTREMELY over budget. Give me a break Ezra.

Posted by: rigoman33 | March 22, 2010 1:22 PM | Report abuse

The bill is a fact, you may like it or not. With the recovery of the world economy, which is already taking place, the tax effort to finance a quasi-universal health system, taken for granted in all other advanced nations, will seem more and more reasonable. Besides, as the two wars started by the previous administration come to an end, the U.S. will be able to finally control its budget and reduce its debt.

Posted by: gpcarvalho | March 22, 2010 1:22 PM | Report abuse

One thing that is largely ignored is how is this bill going to influence insurance premiums? Also, how is the cost of forcing people to buy insurance factored in?

Posted by: wolfcastle | March 22, 2010 1:25 PM | Report abuse

Srw3,

For the record, I am one of the cost control whiners in favor of a UK/VA style system, albeit one that functions more as a safety net than one designed to be the whole healthcare system. It would be run by CEOs selected by states, funded at the UK's per capita level (which is ~6.0% of GDP here, funding capped at 6% of GDP), open to anyone who wanted to use it.

Posted by: justin84 | March 22, 2010 1:29 PM | Report abuse

New York Times:

In reality, if you strip out all the gimmicks and budgetary games and rework the calculus, a wholly different picture emerges: The health care reform legislation would raise, not lower, federal deficits, by $562 billion.

//end cite

http://www.nytimes.com/2010/03/21/opinion/21holtz-eakin.html

Posted by: msoja | March 22, 2010 1:33 PM | Report abuse

Ezra,
The fatal flaw in your analysis is this: when is the last time the CBO and/or Congress came anywhere close to their original estimates for a programs expense.

Let's take, for example, the new Capital Hill Visitor's Center. The CBO said it would cost $70 million. It ended up costing over $600 million.

So the $160 billion you cite for 2016 will probably be more like $500 billion - or more - by the time more individuals that estimated get dumped into the new publicly financed system, and the costs run much higher than anticipated.

So when your $160 billion becomes $500 billion, yet the revenues don't change, what becomes of the 'deficit reduction' projection then?

Math: the ultimate foil for progressives.

Posted by: dbw1 | March 22, 2010 1:33 PM | Report abuse

This analysis is so shallow as to intrude on the non-sensical. At the end of the day, this thing is going to cost someone a trillion dollars directly through taxes, fees and reduced care options. Indirectly, employer mandates are going to translate through to lower wage increases which will, in turn simply shift discretionary income from one pocket to the other.

Cover more people? Well, if that's the choice, then so be it. It took a lot of integrity out of the legislative process and marginalized the opinions of at least half the population who will ultimately bear the cost.

So -- why hasn't Ezra or Obama or Pelosi (or even most of the MSM) taken the time to explain to everyone what the ramifications to this bill are likely to be? What price have we, are we, going to pay?

I figure my total health care cost under this bill is going to go up 80%, taxes and likely premium increases included. That's not small change and not change I could use. If you don't think that a $200K trigger for medicare taxation of passive income, think about the rebound of 2009 when tens of millions would have been affected simply through the turnover in their 401K's and other portfolios.

And, for the 2-3% of the population who will be paying through the nose for this, Obama didn't have the common courtesy of saying, "thanks for your large sacrifice." Instead, they got villified.

Not even a "thanks for letting us bleed you again." Guess in the greater scheme of shared sacrifice, some people just don't matter that much.

Posted by: DOps | March 22, 2010 1:37 PM | Report abuse

If I was a gambler, I'd bet the bill will fail once it gets started for a variety of reasons but mostly because a) it was a partisan piece of legislation that does not have American support; and b) government can't manage anything well and the money will be blown and in the pockets of politicians and lawyers and not taking care of the citizens.

Posted by: 45upnorth | March 22, 2010 1:37 PM | Report abuse

If you think that a major consideration is containing prices for the working stiff and not about giving free loaders in this country another freebie, I have a bridge I'll sell you.

Posted by: redskins2k1 | March 22, 2010 1:39 PM | Report abuse

A NEW CNN poll:

"As you may know, the U.S. House of Representatives and the U.S. Senate are trying to pass final
legislation that would make major changes in the country’s health care system. Based on what you
have read or heard about that legislation, do you generally favor it or generally oppose it?
Mar 19-21
2010

Favor 39%

Oppose 59%

No opinion 2%

Attention Democrat Party and the Installed One........you will be hearing from all of us Americans on the night of November 2nd, 2010...

A night that will live in infamy......

Posted by: allenridge | March 22, 2010 1:46 PM | Report abuse

every American man, woman, and child deserves to get quality affordable care and we can't continue spending money we don't have.

Posted by: benintn
----------------
There is no such thing as "quality affordable," unless one of the two words, "quality" and "affordable" is taken with a large grain of salt, indeed probably both will be taken with a grain of salt.

For years, Americans have been trying to buy a Cadillac and pay for a VW, and borrowing money from their children's future to do that. Sooner or later there will be reckoning.

Posted by: rohitcuny | March 22, 2010 1:48 PM | Report abuse

What is the political cost to this all? Is bipartisanship dead? Is honest and open debate a thing of the past? Will any party with a simple majority now just say there cause is important and the american people need it, so reconciliation turns into the norm?

Posted by: dave09 | March 22, 2010 1:48 PM | Report abuse

To think11: You do not pay for my health coverage, trust me on that. But just to set the record straight. Even though that I am an immigrant I have never used welfare. I am a professional with 2 kids. Both me and my husband are working, and make very good living. We paid off our first house's mortgage in 5 years, and we are in our second house with little mortgage to go. We travel a lot. We donate regularly to various causes. I guess we are just a rare bread at the place where you come from. WE do not ask, how someone lost their job and so on, we just recognize that not everyone is as fortunate as we are. You are judging people who have no health coverage without even knowing them, just as you judged me. (I am not religious by the way.) I am happy that I am nothing like you, and I never be!

Posted by: someanyone | March 22, 2010 1:52 PM | Report abuse

If Medicare and SSA are entitlements and they're already in trouble what changes that makes this entitlement somehow different? And adding the people with pre-existing conditions and children up to age 26; exactly what is going to keep insurance companies from jacking everybodys rates to pay for this?

Posted by: ronjaboy | March 22, 2010 2:00 PM | Report abuse

"What is the political cost to this all? Is bipartisanship dead? Is honest and open debate a thing of the past? Will any party with a simple majority now just say there cause is important and the american people need it, so reconciliation turns into the norm?"

dave09,

It is asounding how you people never give up on the lying, and just rearrange history to suit your whining.

The HCR bill that the House and Senate have now both passed, passed in the Senate with SIXTY VOTES after months of open debate and compromises.

Reconciliation is only being used for a narrow group of amendments.

Are you a supporter of the Cornhusker Kickback? Is that why you are unhappy about the reconciliation process to improve the bill?

Posted by: Patrick_M | March 22, 2010 2:01 PM | Report abuse

I've never liked mandatory auto insurance, which is the law of the land here in my state of Washington. It seems like an extortion racket run by the insurance industry with the government serving as enforcer. It allows companies to charge higher premiums and impose higher deductibles than might otherwise be the case if simply having no insurance was a legitimate option for consumers. So now the whole country will have mandatory HEALTH insurance. I wonder if the effects on consumers will be the same?

Posted by: cocktails42 | March 22, 2010 2:08 PM | Report abuse

Klein says,
"The excise tax -- which slaps a fee on high-cost plans in order to give a competitive advantage to those that hold costs down more effectively -- initially applies to very few plans but would hit more as premium costs rise."

Intersting, I've rarely seen "reform" proponents admit this. All health plans will be "Cadillac" plans under this Bill within a short period of time, effectively raising taxes considerably on the middle class. This is why the unions were against it.

Posted by: jiann | March 22, 2010 2:12 PM | Report abuse

The fact that health care cost projections are for 10 years makes me wonder what would happen if we looked at all matters this way. I know it knocked my socks off when I looked at how much my house payments amounted to over the 30 years of the mortgage. Then too, if we applied the same logic to defense spending we would see that we will spend $7 trillion over the next 10 years-yikes! Makes the health care expenditures look kind of small.

Posted by: cdierd1944 | March 22, 2010 2:16 PM | Report abuse

$900 billion is only the initial down payment. It will be $900 trillion within 10 years since the government is now obligated to cover everything and has given a blank check to the insurance and drug companies. Whenever the government forcasts a cost over 10 years you can multiply it by 10 to 100 times the projection. Taking inflation into regard (which is soly based upon government spending) you can expect everything to cost between 10 to 100 times more in the next 10 years. Absolutely nothing will go down in cost because of profit greed.

Posted by: maphound | March 22, 2010 2:23 PM | Report abuse

"I've never liked mandatory auto insurance, which is the law of the land here in my state of Washington. It seems like an extortion racket run by the insurance industry with the government serving as enforcer."

Maybe you could rent a brain, cocktails42.

If an uninsured driver hits you and sends you to the hospital, is it an "extortion racket" that the driver who is at fault carries liability insurance to pay for your medical bills (so your own UM insurance won't have to)?

Do you think auto insurance would be cheaper if there were MORE uninsured drivers on the road, thereby increasing the risk of every insured driver?

Posted by: Patrick_M | March 22, 2010 2:26 PM | Report abuse

Thanks Ezra, I think I get it. So, from a fiscal perspective, this healthcare reform bill is really "incremental", just what the Republicans asked for? But from a human perspective, it's also a great big helping hand, maybe life saving for many of the 30 million who will soon be able to afford insurance? I'm no genius but this sounds like a bargain to me. I trust your reasoning and your numbers more than that of, hmm, the other side.

Posted by: DavidH3 | March 22, 2010 2:28 PM | Report abuse

Great column because it puts in perspective the actual costs that drive the system. I am glad the Health-care bill passed because, I believe access to Health-care is s right not s privilege but this bill still leaves in place and does not restructure the fundamental system. We still have a third party payer system where costs are subsidized from below and not controlled from above and the individual players are financially separated from their medical decisions. The Doctors get paid for more procedures and the patient does not have to pay directly for the services. The government does not impose price controls. Third party payer system, no market controls and no price controls; so what you have is a perfect formula for runaway inflation.

Posted by: mlang461 | March 22, 2010 2:28 PM | Report abuse

the only reason this country is in any sort of trouble supporting medicare and social security is the insane military spending we encountered as a result of the war in iraq brought on (you remember "bring it on") by the brush cutting born again idiot from texas and his running mate the war criminal cheney.

Posted by: surlydoc | March 22, 2010 2:29 PM | Report abuse

This entire process of health care came down to one choice for the GOP and their followers, GET OBAMA.
Tell me I'm not right when every member of the GOP voted no in the house. This had nothing to do with the citizens of our country, more like keeping the insurance companies extremely rich.

Posted by: shipfreakbo214 | March 22, 2010 2:32 PM | Report abuse

Very well put. Here's another comparison:

Annual DOD appropriation: In the neighborhood of $500 Billion. With a B.
$500,000,000,000.

Each YEAR.

Combined untouchables (i.e. entitlements, including DOD, Social Security, Medicare/Medicaid, etc)) per annum: Neighborhood of $1.2 to 1.4 TRILLION. With a T. Or
1,200,000,000,000. That's a whole mess of zeroes.

PER YEAR.

Any questions?

Posted by: wxdancer | March 22, 2010 2:37 PM | Report abuse

Let's not forget that the CBO gives out an ESTIMATE, that changes due to that which is input based on the innocuous data supplied...or quite simply, as with the 2700 plus pages, will eventually turn out to cost more than we can afford.
But hey, Congress got what they wanted so be prepared to pay up when the time comes, guys! What's the cost of bankruptcy to be shared by all!

Posted by: SeniorVet | March 22, 2010 2:44 PM | Report abuse

When about thirty percent of the American public thinks that Barny the Dinosaur and the Flintstones is gospel truth. And over fifty percent can't do basic math with decimals. It's not very surprising that so many wingnuts and "tea baggers" can't comprehend large numbers. Thanks to Ezra Klein for putting the HCR numbers into a sensible perspective for the rest of us.

Posted by: Doowadiddy | March 22, 2010 3:10 PM | Report abuse

Your article assumes that $940 billion is what the government will limit it's spending to.

In 1964, it was estimated that Medicare would cost $12 billion in 1990, but when 1990 rolled around the actual cost was $107 billion.

Do you really think Congress will reach $940 billion and say, "Okay, time to spot spending...". No way this will do anything but rack up an already out of control deficit.

Posted by: HokieDoke | March 22, 2010 3:12 PM | Report abuse

"A billion here, a billion there, pretty soon, you're talking real money"

Senator Everett Dirksen

Posted by: JAH3 | March 22, 2010 3:17 PM | Report abuse

Klein's analysis presupposes the CBO reports are reliable, with realistic numbers.

Doesn't he realize CBO writes limited-use reports written for exceedingly narrow purposes useful only within a very insular political environment?

CBO doesn't have any ethical criteria guiding balance, fairness, etc., within its reporting content. Just check its website.

Until CBO embraces rules for report balance, it will continue to report anything the political class wants to hear.

Posted by: hungrypirana | March 22, 2010 3:20 PM | Report abuse

Ezra,

I'm just a guy from the coal fields of eastern Pennsylvania, so please pardon my ignorance --- but what's the point of your ramblings? Your narrow analysis focuses on how much additional spend will occur in the health care sector -- and I think everyone agrees that its already too much. Where's the reduction in total health care spend so that we can begin allocating more of our GDP to private investment, education, the space program, infrastructure, etc.? I know you like to think you're smarter than everyone, even the grandson of a coal miner who came from Lithuania not because of free health care, or social security --- but because of the opportunity to work, prosper, and enjoy the fruits of his own labor.

And your thoughts on cost control are quite amusing. Increase taxes, extort lower prices from health care providers for government run programs, and decide which procedures and protocols (rationing) are to be paid for. Most of the above has already been done by insurance companies --- except of course instead of raising taxes they raise premiums. They've been villified by Obama and his kool aid drinking cronies --- now the federal government will have absolute power over this stuff, and you know what will happen to you if you try to opt out --- say hello to the IRS.

Posted by: jeffreyshovlin | March 22, 2010 3:22 PM | Report abuse

Just finished reading Ghris Cizzilla/The Fix -- he's all about winners and losers, like so much of the rest of the mainstream media. Then I turn to Ezra who is mostly all about the substance. I'm very glad we have you.

Posted by: DigiMark | March 22, 2010 3:35 PM | Report abuse

Avar:
"Hello single payer and the well-proven failures of Canada/UK and the rest of Western Europe."

Well-proven successes maybe. Ask anyone in the UK if they'd want to trade the NHS for our current system. Go ahead.

Posted by: presto668 | March 22, 2010 3:42 PM | Report abuse

Why are you comparing the spending under this bill to the total spending on health care? Isn't most of the spending in this bill in the form of subsidies to buy insurance? If so, the relevant comparison is total spending on health INSURANCE, not total spending on healthcare.

Posted by: cjknew | March 22, 2010 3:48 PM | Report abuse

CTTaxpayer:
"Finally, I would that I am disgusted at the tricks Ms. Pelosi and her friends pulled to pass this. A truly popular bill would not need them."

What tricks, exactly?

Posted by: presto668 | March 22, 2010 3:52 PM | Report abuse

Somehow, I don't think many people would like the GOP plan to bend the cost curve, since it would limit tax benefits to catastrophic insurance costs + Health Savings Account contributions. If you add in a Flexible Spending component and decrease an HSA payout (forcing employees to kick in), you will not save any tax funds but you will tick off medical providers, who must wait until HSA balances get to deductible levels before they get paid.

The GOP plan could well be the one no one likes. Indeed, the McCain plan and the Obama plan were compared. Guess who won the war of public opinion in the only poll that mattered in November 2008?

Posted by: michaelbindner | March 22, 2010 3:56 PM | Report abuse

No big surprise, but insurance companies and Big Pharma should be winners now that the the health bill has passed.

http://www.minyanville.com/businessmarkets/articles/stocks-health-care-reform-biotech-bill/3/22/2010/id/27401

Posted by: Fletch_F_Fletch | March 22, 2010 3:58 PM | Report abuse

we shouldnt be raising health care spending by the government or families and this bill will do both. and if the trillion that is going to this bill in the first 6 years was going to be raised and spent it should have been spent on balance the budget.

this just increases the scope and severity of tax hikes and spending cuts that are going to be needed in the near future to bring our budget back into some semblance of balance.

and dont given me this "it reduces the deficit" garbage. its called opportunity cost and that cost here is mnay times larger than any deficit reduction this bill promises (i'll even leave alone the "doc fix" scam, because every democrat knows how disgraceful that is).

Posted by: dummypants | March 22, 2010 4:00 PM | Report abuse

So the lying and spin has begun by the worthless media like the WaPo. It won't matter what is said to prop up Obama and the Democrats. They have committed political suicide. This will be apparent in November and 2012.

Posted by: MikeJ9116 | March 22, 2010 4:03 PM | Report abuse

i am just dumbfounded that obama went out there with a straight face and told people that health insurance company profits (0.5% of all health care spending, an industry with one of the smallest profit margins around) were the problem with health care costs and that people have a right to health care when he is simultaneously denying some $500 billion in medical care from medicare patients, or that a lack of health insurance among 10-15% of the population is the reason america is so unhealthy as a nation.

he wasted a golden opportunity to drive a real deep and productive discussion on health care in this country that actually went after and invited us to tackle the real issues. instead he reverted back to tried and true liberal democratic tax and spending.

does it astound anyone else the opportunity that this guy threw away for himself as a president and america as a whole?

Posted by: dummypants | March 22, 2010 4:07 PM | Report abuse

Avar:
"Hello single payer and the well-proven failures of Canada/UK and the rest of Western Europe."

Well-proven successes maybe. Ask anyone in the UK if they'd want to trade the NHS for our current system. Go ahead.

Posted by: presto668 | March 22, 2010 3:42 PM

~~~~~~~~~~~~~~

Maybe you should go ask. They are desperately trying to figure out how to fix BOTH health care systems. Canada's top doctor says their system is "imploding" and Britain's system is HORRIBLE and the costs of it have skyrocketed to unsustainable levels. They are cutting care, raising taxes and still drowning.

Posted by: anna_78750 | March 22, 2010 4:14 PM | Report abuse

The true cost of this legislation is unknown, but we already know that $940 billion is a lie.

The cost is $2.4 TRILLION for the first 10 years the plan is fully functioning, and that doesn't include the money for the IRS and HHS to administer it. Those costs still haven't been calculated. It also doesn't include the costs to the states for 15 million new Medicaid patients that they will have to start paying for in 4 years.

Posted by: anna_78750 | March 22, 2010 4:18 PM | Report abuse

Those two comments at 1:00 pm are priceless.

I've heard Caterpillar's costs will be not $100 million the first year, not $500 million, but $600 million!

Posted by: fallschurch1 | March 22, 2010 4:20 PM | Report abuse

Crooks are at it again saying that tax increase provisions in the bill will bankrupt the middle class. This is ridiculous. If you are single making >$200,000/yr or family making >$250,000/yr, you are not middle class. You can live in a million dollar house. Increasing taxes on rich, who are paying less of their share in taxes, is not bad.

Posted by: Realist17 | March 22, 2010 4:22 PM | Report abuse

This craptrap about Canadians system imploding and Great Britians system being horrible is just that. Utter falsified crap made up by the One of Dick Army's 6 newly founded health care "non-profits" that are fully funded by 3 of the nations largest insurance companies, and then spread dutifully to the ignorant masses by the likes of Limbaugh, Hannity and that high school dropout, drug addict adulterer Beck.

They live longer, spend half as a nation on health care than we do and cover everyone. This whole tea party crap from the last year would have been cancled if any of them can actually "read" any of the legislation and count to more than 10 without getting confused.

Alas...thats a lot to ask of a lot of Americans.

Posted by: Nosh1 | March 22, 2010 4:27 PM | Report abuse

So $900B over 10 years is only a small fraction of total spending?! Well, Christ, I feel better already! Thanks, Ezra. Spoken like a true statist.

Posted by: TheEmpiricist | March 22, 2010 4:30 PM | Report abuse

BULL, STEAL-O-CRAT


Social Security has grown 900% MORE than CBO said it would.

Obama is an INEXPERIENCED BUMBLER-politician with NO REAL-WORLD ACCOMPLISHMENTS.

STEAL-O-CRATS have a PROVEN track record of INCOMPETENCE and FRAUD.

As in: VAN JONES, Timmy Geithner, BLAG-O, the STEAL-O-CRAT Illinois governor-FELONS.

Kid, blather all you want.

NO ONE WITH A BRAIN believes a word you say.

Posted by: russpoter | March 22, 2010 4:35 PM | Report abuse

Hmmm.... so let me see if I get this right: When a Republican is in office, Deficits don't matter. But, when a Democrat is in office, Deficits DO matter.

Gee Republicans, HYPOCRISY much??

Posted by: austininc4 | March 22, 2010 4:56 PM | Report abuse

I do not know if the article is accurate (and I do not have time to read all the posts) but it is the first reasonable thing I have read about the bill. I was opposed for many reasons. Now I am opposed for less reasons. Tx

Posted by: mmherndon | March 22, 2010 5:12 PM | Report abuse

There are more basic commonalities between the Canadian & US health care systems than one would think. In both cases, the costs are high & escalating fast. If the cost in Canada was as high as in the US, our system would truly be unsustainable! Ultimately, health costs are paid for by the wealth our societies create. In Canada the purse strings are largely controlled by the provincial governments; they collect the money & pay out to doctors/hospitals without middle men. In the US the payouts for most people are controlled by insurance companies rather than by government. It strikes me that the path the money follows is a bit more convoluted. The money that funds insurance company health programs comes from employers. That employer's cost is tacked onto the price that consumers pay for that company's goods & services. The insurance company adds its costs and profits into the equation. For-profit hospitals take an extra cut. Don't forget all the malpractice insurance built into the system. Overall, it is not the most effective use of health care dollars. If Canada spent the kind of money that Americans pay (@ $4800 per person versus $7300 per person) we would have a real gold-plated Cadillac service. As it is, it has worked well for our family in practice. My wife was a bank executive and came down with a nasty neurological disease resulting in long term disability for 12 years now with many months of hospitalizations, surgery, radiation etc. Even with that good job, a US-style insurance system would have run its course for her and we would be wiped out. It ain't perfect, but no major complaints from up here!

Posted by: johndron | March 22, 2010 5:14 PM | Report abuse

Ezra:

Good job on helping this make sense. Now, how about lots of columns on how to save healthcare costs. I go to a chiropractor--he charges me a $25 co-pay, but apparently he charges the insurance company several hundred dollars for this 20 minute adjustment--what a rip off to my insurance company!

Posted by: audiemurphy | March 22, 2010 5:16 PM | Report abuse

Here comes Afro-Chavez

Posted by: metadata | March 22, 2010 5:17 PM | Report abuse

Here comes Afro-Chavez writes metadata.

Republicans are a hate-filled party of racists. Their "leaders" "denounce" the "isolated" tea baggers who yelled the n-word. But whether they say it or not, you know they think it. Witness the comments on these boards. You have nothing but hysterical, fanatical, hate-filled rants that have nothing to do with the issues at hand.

They are truly repulsive people.

Posted by: monk4hall | March 22, 2010 5:36 PM | Report abuse

If Pelosi, Reid and Dear Leader had put as much effort in to fixing the tanked economy as they have polarizing America and trying to destroy the middle class, the unemployment rate would be a 2%.

Posted by: JAH3 | March 22, 2010 5:46 PM | Report abuse

So, at what point should we be able to see if HCR has really worked to cut the growth of healthcare spending? 2012? 2014?

Posted by: Kevin_Willis | March 22, 2010 10:11 AM | Report abuse

===================
DON'T get sick
or
DIE suddenly
and
you will not have to worry..

Posted by: Fei_Hu | March 22, 2010 5:53 PM | Report abuse

This article states: "About 90 percent of Americans will be exactly where they'd be if this reform had never passed."

- But, I thought that this was a major issue that affected everyone?

Posted by: gjconely | March 22, 2010 5:56 PM | Report abuse

I don't know about the rest of you, but $9,000,000,000 is still a lot of money to me.

Posted by: OneWhoSpeaksTruth | March 22, 2010 6:12 PM | Report abuse

I don't know about the rest of you, but $900,000,000,000 is still a lot of money to me.

Posted by: OneWhoSpeaksTruth | March 22, 2010 6:13 PM | Report abuse

Does this mean it is not the “End of the world” as Congressman Boehner (R-Oh) said on Sunday?

I wonder how many little old ladies couldn’t sleep after the house minority leader told them the end of the world was near? How can anyone trust what he says now?

Posted by: NewThoughts | March 22, 2010 6:16 PM | Report abuse

An even better idea is to freeze ALL government spending for 2 years! We will save an enormous amount over a twenty year period! It's something we need to do NOW to save ourselves! Suck it up for 2 years government!

Posted by: writedave | March 22, 2010 6:19 PM | Report abuse

avar: The OECD (note, no biased UN rankings)rates those places always listed in the top tier with the best outcomes for healthcare, standard of living and education as: Canada, Australia, Sweden, Japan, Norway, Holland, Finland and New Zealand.... all considerably above the US in rankings. Those "socialists" BTW are all Monarchies within a Parliamentary Democracy.

Posted by: sjag1 | March 22, 2010 6:41 PM | Report abuse

Surely there are trillions being spent on health care now. Otherwise, how could corporations such as Cigna give an executive a $110 million bonus in one year? And of course, that bonus had to come out of premiums. How else do they make their money?

Posted by: tinyjab40 | March 22, 2010 6:42 PM | Report abuse

First of all $900 Billion is an imaginary figure. The cost will be multiples higher.

Second, the Gov't has the force of law. No one is calculating the effect of new taxes. No one is calculating what will happen simply due to "rules" that will force certain behaviors on insurance companies. Obama's plan is to bankrupt them.

This bill is a royal-screwing of the American middle class.

Posted by: pgr88 | March 22, 2010 6:44 PM | Report abuse

If you want to experience a nice Staph infection or try out the new super-bug "C-Diff" go to a British Hospital!

Posted by: pgr88 | March 22, 2010 6:48 PM | Report abuse

Democrats Care!
Republicans Don't!

Posted by: lunetrick | March 22, 2010 6:50 PM | Report abuse

Just curious: how does $900 billion ($94 billion a year) over ten years compare to what has been spent to "disarm" Iraq of WMD's since 2003?


Posted by: Timelordnot | March 22, 2010 7:22 PM | Report abuse

Advocating that spending is only a small fraction of our spending is a spacious argument. We are running a hug deficit, yet we have excuse after excuse for not balancing the budget. Can we really afford this program?

If not, what has to be cut so we can afford this program. Please, Mr. Klein tell the readers.

Posted by: SteveR1 | March 22, 2010 7:33 PM | Report abuse

Your article assumes that $940 billion is what the government will limit it's spending to.

In 1964, it was estimated that Medicare would cost $12 billion in 1990, but when 1990 rolled around the actual cost was $107 billion.

Do you really think Congress will reach $940 billion and say, "Okay, time to spot spending...". No way this will do anything but rack up an already out of control deficit.

================================================================
They took the 5 billion paid in the 60's estimated pop. growth and multiplied to hit the 1990 figure. Even so 1990 had 8 times the cost of the sixties after 25 years. The last 20 years has not seen the pop. more than double up about 50% with medicare/medicaid costing 1 trillion a year. 1998 had 8 million CT scans, today 72 million. We are overtesting bigtime and not cheap mammograms but expensive tests costing more than $1000. Better medicine has increased life expectancy from 67 in the early sixties to 82 today (higher if increased gun deaths in inner cities are factored in). If we want these costs paid for we must double the medicare tax something politicians won't do after old man Bush lost being fiscally responsible.

Posted by: jameschirico | March 22, 2010 7:41 PM | Report abuse

In Australia we view the US flagelation over health care with a large amount of incredulity. How your nation could have advanced so far without universal health care is unbelievable and listening to House members in the debate talk of the coming of communism is bizarre in the extreme. The old US system which seems to be only slightly tinkered with by this legislation is a mish mash of medicare for the elderly, medicaid for the extremely poor and employer provided insurance for those lucky enough to have employment. There was a huge underclass, who would be caught by a safety net in any other advanced society who missed out altogether in this system. The new regime still has a fair % who will miss out albeit that most of them appear to be visa miscreants.

Univeral health care as practised in leading Western Social Democratic countries in Western Europe and the English speaking world, value their systems because they are very popular, lead to social cohesion, good societal outcomes and save money long term. Why? Because a healthy nation is more productive and leads to increased national wealth. A wealth surplus that more that adequately covers the extra Govt costs of universal, full safety net coverage.

Posted by: jstewart1 | March 22, 2010 7:41 PM | Report abuse

If you believe that this healthcare legislation will cost what is claimed, or that it will reduce the deficit, then you are dumb as dirt.

Posted by: concerned1231 | March 22, 2010 7:50 PM | Report abuse

CITIZENS OF AMERICA, PREPARE YOURSELVES FOR CIVIL WAR.

THE DECLARATION OF INDEPENDENCE
“When in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. –That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, –That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it. . .”

Posted by: charlietuna666 | March 22, 2010 7:57 PM | Report abuse

Of course, another analysis could be that if you are spending $3.7 trillion on 300 million people ($12,000 per person?), how do you figure you'll only spend $160 billion on the 30 million you are adding ($5,000 per person)? Especially when you say you are adding high cost people the current insurance carriers won't touch and adding all those people who currently die because they don't have insurance? Maybe that's why some people question the math.

Posted by: termiteavenger | March 22, 2010 7:58 PM | Report abuse

Ezra

Are you including the spending which the States are now required to do ?

Are you including the spending which individuals are not required to do ??

AND how much do the taxes go up ????

Your numbers are a bit of a joke, right??

This article is being sarcastic, right ???


.

Posted by: 37thand0street | March 22, 2010 8:30 PM | Report abuse

Hilarious column...

As noted by others, the Third Way is not a centrist organization. Check their web site. So if you can't get this right, why should we take the rest of your column seriously?

"It's half of 1 percent of expected GDP." Cool...then you pay for it. Half percent of gdp here, half a percent of gdp there,....pretty soon you're talking some real money.

"The excise tax -- which slaps a fee on high-cost plans in order to give a competitive advantage to those that hold costs down more effectively -- initially applies to very few plans but would hit more as premium costs rise. "

Do ya think employers will adjust health care policies such that they're just below the threshhold. So the amount of tax collected might not be as much as anticipated???

"The problem with health-care spending is not that we spent $2.3 trillion in 2008. It's that that number has been growing by 7 percent annually. It's the rate of increase, and not the level of spending, that we need to change."

And we'll solve it by forming government led pilot groups! In the words of John Cleese, "This calls for immediate analysis!"

Posted by: eeterrific | March 22, 2010 8:35 PM | Report abuse

Maybe just maybe our healthcare bill would not be so expensive if our great leader would educate his large following about birth control and condom usage.Maybe then we wouldn't have so many unwanted children in the world.Maybe we wouldn't have so many peolpe on wellfare asking for an abortion every time they feel like getting themselves knocked up.But Mr President has that all covered,go get yourselves knocked up and he will have we tax payers pay for your abortion.Oh yes I had forgotten, and have you bleed the little bit of wealth out of us so you can sit back and consider your next romantic encounter.This whole Obama crap makes me want to up-chuck.I should work all my life to have the chosen one tell me I must have less of what I work for.He and you know who he is should be crucified in a public place for what he is doing to this country.

Posted by: dollar_bil2 | March 22, 2010 8:48 PM | Report abuse

How many doctors and nurse practitioners could we have educated for $940 billion, thereby increasing the availability AND lowering the costs of health care?
(The answer is several millions).

Single payer and free education for anyone smart enough to go to medical school. It would have been the best possible solution, ensuring high quality, availability, and guaranteed coverage. And a two paged bill a toddler would understand. Understand we got this, something. It's something, and hopefully we can pare it down to something simple and sensible in the years ahead.

Stop voting for lawyers. In case you hadn't noticed, they're idiots! And if Ezra Klein wants to join our ranks as a real numbers person, he needs to stop sticking up for them.

Posted by: Wallenstein | March 22, 2010 8:49 PM | Report abuse

@37thand0street,

Good points. I know the Excutive Branch has to worry about Unfunded Mandates. Does Congress have to abide by its own Unfunded Mandates Reform Act?

Regulations

Posted by: Wallenstein | March 22, 2010 8:51 PM | Report abuse

Hey Ezra...a trillion here, a trillion there and pretty soon you're talking about real money...except it isn't real money...because we don't have it really...we're just printing it...like Weimar Germany did in the 20's and like Argentina did in the 80's.

Posted by: PanhandleWilly | March 22, 2010 8:52 PM | Report abuse

Here's something on the UMRA and health care:
http://blogs.investors.com/capitalhill/index.php/home/35-politics/460-does-house-health-bill-violate-federal-law

Congress always has an out by raising the threshold (this one is automatically inflation adjusted anyway). But it's currently at something like $120-$140 million. I'd think the unfunded mandates in this bill are way, way higher. So it will be sued and lose.

Posted by: Wallenstein | March 22, 2010 8:57 PM | Report abuse

Ezra, you seem to be saying that the cost of the bill is insignificant compared to the total spent on health care nationally. Well, the "cost" of the bill is in question, because it does not include costs included in seperate bills, like the "doctor fix". Also, 10 year and 15 year projections assume that you can predict the future; not a wise assumption. Who knows what our nation will face in ten years that affects the budget? But, more importantly, how will this bill reduce the costs of health care? We know it will subsidize insurance coverage for many, but who pays for the subsidy? That cost doesn't go away; it just gets shifted to other people. For the other people, cost is increased. And that's just insurance premiums. But what about uncompensated care? Some people won't buy insurance and will go to emergency rooms, no matter what. Uncompensated care gets charged to those who do pay. Others won't buy insurance until they already have a medical problem since the bill allows this. That will require higher insurance premiums. For anyone who has insurance now, this can only increase your premiums.

Posted by: allamer1 | March 22, 2010 9:24 PM | Report abuse

Still scratching my head over this one... save 800 billion/20 years to equal 40 billion per year. Then, spend 940 billion/10 years to equal 47 billion per year. Assuming that those numbers hold true (the way the Medicare and Medicaid numbers did), I'm still looking for the "savings". The only conclusions about the savings are:

1. The government is going to be more efficient than private industry (not impossible, but unlikely)
2. We are not accounting for savings in expenditures to private hospitals to cover indigents at the ERs. This means that payments to hospitals have to be cut; okay, since they are the enemy.
3. With the new power that it has (and don't fool yourself- if you want the government to have more power- hooray!- it will) the government will begin to leverage cost controls onto hospitals and doctors, resulting in a lower standard of health care via lower paid (and less desirable) jobs, or simply less care.

Why are we worried about the big corporations, when we have a government with all this power? Relax America, we don't have to worry any more.

Posted by: Labrador1 | March 22, 2010 9:34 PM | Report abuse

This should have been the discussion all along. Too bad the GOP it was more important to focus on calling the Dems communist, socialist, baby killer, etc. Of course any logical discussion on the numbers would have been WAY above the average Tea Party member.

If we do save money great, thanks Dems. If this bankrupts us we can thank the GOP for acting like brown shirts than representatives of the American people.

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Posted by: rritkonlyyou | March 22, 2010 9:57 PM | Report abuse

The Pee Party, Racist Right Extremists and the Born Again Idiot Bigots urinating Hate, Ignorance, Intolerance and Stupidity everywhere they go. You know the Flea Baggers are Idiots when they want America to go back to the 17th Century with their stupid triangular hats, open carry guns, old flags and ancient prehistoric ideas. No, Flea Baggers, women don't only belong in the home, but they can compete in the workplace. This is not an Idiotic Islamic retarded country. Women and every person in this country have rights. So, carry your Guns in your Mouth, Pee Brain Idiot Creepy Cowards.

Only Cowards and Criminals need to cling and worship their Guns, Pro Life Killers.

Is it amazing how violent, disgusting and disgraceful these Born Again Idiot Bigots can become. They must learn it every Sunday at their Churches of Hypocrisy.

Fart Stupid and the Moron Cons should have been aborted along with the Guns Owned Party of Born Again Bigots, Fairy Tale Based Hypocrite Frauds, Pro Life Mass Murdering Serial Killing War Criminals and the National Right to Annihilate Gun Clinging Cowards. The RetardiCon Party of NOOOOOOOOOOOO are full of Hypocrite Idiot Bigot Cowards.

Posted by: mawt | March 22, 2010 10:15 PM | Report abuse

1. The President's health care bill would destroy the practice here in the United States of America. If you look at the spending trends, all doctors will close their doors to medicine. It would not make sense to practice medicine in America with the proposed spending.
2. This bill will destroy medicine as we know it. Foreign governments will dictate the degree of medicine through money market control measures. Mr. President and Congress (The Underground) stop the madness.

Antonio Ivan Easterling
Chief Editor
The Proletarian Review

Posted by: sterlinggo1 | March 22, 2010 10:21 PM | Report abuse

1. The health care bill is straight public corruption. This bill will not stand because terrorist nations such as North Korea and Iran now have a say in our health care standards.
2. This is another breach of national security by the Bush-Obama Administration.

Posted by: sterlinggo1 | March 22, 2010 10:28 PM | Report abuse

Through this bill we will see more aim about prevention, a decrease in trans fats, cigarettes fading, salt reduction, high fructose shriveling, cancer rates dropping, heart attacks dropping, alzheimers, a history lesson...Consumerism has been poisoning the minds and bodies of the Western World for far too long...however, if they begin persuading us to put nano chips in our bodies then we have a major problem. Health care needs to focus primarily on Surgical procedures and quit pumping people full of prescriptions.

Posted by: mahovictor | March 22, 2010 11:09 PM | Report abuse

Your numbers do not add up. You said that we spent $2.3 trillion in 2008. However GDP is only 14.5 Trillion. That is 16% of GDP. We keep on hearing that HC is only 6% of GDP = $870 Billion. Which is it?

Posted by: ngpilsung | March 23, 2010 10:09 AM | Report abuse

Ezra makes some very interesting points. And if his research is sound, and the numbers emanating from same are sound, then his article is eye-opening. But not for the obvious reasons.

This bill introduces a system of checks (with no genuine balances) so draconian as to have made Trotsky gasp in delight at the knowing of it.

That we have to be enslaved (again) is one thing, but to have to pay for the 'privilege' is another. That this enslavement comes at the hands of a black-white guy would be hilarious if it were not tragic.

Ezra, keep an eye on the OTHER hand . . that's where all the (evil, empirical) magic is coming from.

Posted by: jobewan100 | March 23, 2010 11:57 AM | Report abuse

You're letting facts get in the way of Ideology!! I want to be angry!! I want to hate government, especially when it's being run by (a popularly elected) radical socialist Muslim black man from the Chicago school of politics and that hot bed of liberalism, Harvard Law School!!! I want an excuse to take up arms to fight my fantastical enemies!!! I want to divide America into us and them! For Us or Against Us!! I hear the voice of God telling me I'm right!!!!

I'M A REPUBLICAN!!!

Posted by: thebobbob | March 23, 2010 1:25 PM | Report abuse

I like the effort to look at how we reimburse doctors and providers. This could produce savings. However, I am still furious that tort reform was not part of the bill. How much tort reform can save over the long run can be debated. However, it is ridiculous that we are not doing everything possible to bend healthcare cost curve down.

Posted by: hardworking2 | March 24, 2010 9:01 AM | Report abuse

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