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By Ezra Klein  |  August 13, 2010; 9:32 AM ET
 
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Comments

Fish. In. A barrel.

Posted by: vvf2 | August 13, 2010 10:50 AM | Report abuse

brillant.

Posted by: SnowleopardNZ | August 13, 2010 1:46 PM | Report abuse

even as a conservative I love Jon Stewart (in a completely non Prop 8 necessary way)


Its funny too because the same rhetoric applies to people that think you can legitimately cover an extra 32 million people AND save money.

Here's a hint. They're both politicians. They're both liars.

Posted by: visionbrkr | August 13, 2010 1:52 PM | Report abuse

"Its funny too because the same rhetoric applies to people that think you can legitimately cover an extra 32 million people AND save money."

The problem is that it's not rhetoric. As we know, our peer nations manage to cover everyone and spend 1/3 less to half as much as we do, and they get comparable (and sometimes better) results.

Maybe what was passed isn't the way to do it, or maybe it will take more time, but it's not lying to say it's possible--since it's actually been done.

Posted by: dasimon | August 13, 2010 4:26 PM | Report abuse

dasimon,

WOW. That's almost, not quite but close enough to the first admission from a liberal that I've seen that what we did had almost nothing to do with deficit reduction and everything to do with expanding coverage. Which is fine, IF you admit to that.

So in other countries you're right its not rhetoric. In ours, it is.

Thanks for making my point for me.

Posted by: visionbrkr | August 14, 2010 7:50 AM | Report abuse

visionbrkr, I was just responding to your claim that it wasn't possible to expand coverage and save money (you said those who made such claims were "liars"). Other countries have shown that it is possible. Whether our version of it will or will not, I don't know, and I didn't say--probably because no one knows how it will turn out, though it's certainly the hope. I don't know why you imply that I "admitted" anything or made any point for you.

And even if I were making whatever point you think I was, I've read plenty of "liberal" commentary that says universal coverage has to come before cost reduction. See T.R. Reid's book "The Healing Of America," for example.

But it's certainly possible that it will save money. The CBO says so, at least. You can contest the CBO analysis, but there are others who think the CBO is being too conservative on the savings front.

I don't want to get combative, but since you seem to concede that other nations have been successful at doing what you imply can't be done, do you "admit" that "you can legitimately cover an extra 32 million people AND save money"?

Posted by: dasimon | August 14, 2010 11:21 PM | Report abuse

dasimon,

I don't want to be combative either. And yes I do believe we can do it as you say there is irrefutable proof in countless other countries. But then again (as you also say) we're not doing what those other countries are. We're still subsidizing the doctors (with no price controls), pharma (with a 12 year window to generics for biologics) and insurers (with timid MLR's that will likely be overly bloated). The only ones not "making out" in this deal of PPACA is probably hospitals who will continue to have razor thin margins.

So again other countries can and are doing it but we didn't have the intestinal fortitude to do it.

If we didn't have Republicans politicizing death panels maybe we could have had a serious cost control discussion.

Then again Dems are already forgoing a discussion on SS reform referring to it as "the catfood commission".

Posted by: visionbrkr | August 15, 2010 8:44 AM | Report abuse

"So again other countries can and are doing it but we didn't have the intestinal fortitude to do it."

Except that the CBO says the legislation does do it: that the legislation does have a moderate reduction of the deficit, even without the cost-cutting measures.

I suppose one has to define what "it" is, and I think we've both conflated the two. There's a difference between saving money (your claim in the first post) and deficit reduction (the claim in your second post). Other countries save money compared to us, so they've done the former. But we've done the latter: Obama always insisted that reform not contribute to the deficit, so it was always the case that legislation would be paid for and perhaps be a deficit reducer. Part of that equation is cutting costs, which the legislation starts doing and my understanding is that most observers believe we'll have to wait and see how various methods play out and are most effective. But again, there are lots of people who think savings (overall, public + private) will be higher than what they say are conservative CBO estimates. (The Gawande article in the New Yorker seems to show there are plenty of opportunities to cut costs without affecting quality of care.)

I think most liberals freely admit that the legislation here was just a start in terms of how we deliver health care; indeed, they're disappointed it didn't do more.

"If we didn't have Republicans politicizing death panels maybe we could have had a serious cost control discussion."

As a friend of a friend of mine says, I will not argue with you: you are right!

"Then again Dems are already forgoing a discussion on SS reform referring to it as 'the catfood commission'."

I'm not a big fan of any of these commissions. There elected officials; make a friggin hard choice already, and challenge your constituents to come up with better solutions if they have them. I've read that when people are forced to sit down and deal with real options, they actually come to fairly reasonable accommodations. But as long as politicians demagogue on the issue, we're not going to get anywhere. (I don't like how Dems just jumped all over Boehner's suggestion on gradually raising the SS retirement age; what's their alternative?)

I suppose that's too much to ask going into an election, though...

Posted by: dasimon | August 15, 2010 10:47 AM | Report abuse

Argh, typo, "They're elected officials..." I hate not being able to fix those things!

Also in first graph, I'm referring to the cost-cutting measures you cite in your post; there are attempts at cost-cutting in the legislation too (it does reduce or eliminate Medicare Advantage, doesn't it?)

Posted by: dasimon | August 15, 2010 10:52 AM | Report abuse

dasimon,

part of the problem I've always had with the analysis of CBO is that it confirms deficit reduction based upon a worst case scenario(which is the status quo).


Its like when you look at GDP from this year compared to last and say its "X" percentage better than last year. Well sure it looks good but still not near where it needs to be to sustain this economy. Its because the trough was so low that anything is going to look good in comparison.

The biggest problem I've ever had with HCR is that this was our last time to give "them" something of value for cost controls and it failed in that regard (IMO) Sure its better than if we did nothing and sure its better that there are some nice little pilot programs in there that I hope stick and actually help but everyone knows we needed to do a whole lot more in the realm of cost controls and much was sacrified from the MLR being reduced to the SGR of medicare not being permanently corrected to the fact that we still have FFS. Add in the biologics issue (that Obama wanted at 5-7 years and Congress got to 12) and it'll cost us a ton in the future and people don't look at that.

I think we also know that CBO is a projection and also only a projection on the governmental side at that. Many of those projections have been wrong in the past including Medicare's projection of its costs.

I expect we'll be in the mess that MA is in right now in a couple years (2015-2016?)


I likewise don't get why one side can politicize both sides of a similar issue. Republicans are screaming "Don't mess with my Medicare" but are rightfully looking at ways to sustain SS. Conversely Democrats are saying they're "Strengthening medicare" and correctly point to the expected length in sustainability of Medicare while some on the far left complain about the weakening of the social safety net with an extension of eligibility of SS to make it more sustainable. Sorry but if people are living longer then we need to find a way to either:

1-extend the solvency of social security through moving the eligibility age back, or

2-make sure the federal government stops taking monies from the SS trust fund.

Posted by: visionbrkr | August 15, 2010 11:10 AM | Report abuse

"The biggest problem I've ever had with HCR is that this was our last time to give "them" something of value for cost controls and it failed in that regard (IMO)"

Perhaps I'm not knowledgeable enough to be as pessimistic, but I don't see why this was the last opportunity. The issue will be revisited repeatedly. And as Atul Gawande pointed out in his New Yorker piece subsequent to his initial one on health care costs, our vast increase in agricultural efficiency started out with pilot programs. When farmers saw how well other farmers did with them, they spread quickly. Moreover, something will have to be done eventually since unsustainable trends by definition can't be sustained; the question is whether we'll do it gradually with foresight or wait for a crisis with its far more painful adjustments.

We know CBO's projections are only projections and are bound to be off, but haven't they've been off on both over and underestimates?

As for the rest, too many TLAs (Three Letter Acronyms) for me!

Posted by: dasimon | August 15, 2010 6:57 PM | Report abuse

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