The Preliminary CBO score for HC reform is out

[nick1985]

Compared to what?

Compared to what it is right now against other major currencies.

 

[heyheybooboo]

...
That said, I don't think the Medicare reimbursement rate is different between people on normal medicare and those using Medicare advantage.
....

The government spends about $1.30 on Medicare Advantage patients for each dollar it spends on patients in traditional Medicare.

The reimbursement rates vary --- but as I understand it, that is more a function of location across the country.


--

 

[Patranus]

The cliffs:
$940 billion over 10 years in costs.
1.3 trillion over 20 years in deficit reductions.
32 million more people insured (95% of uninsured American citizens)

Um.....
The CBO only project 10 years out not 20 years..........

And let me remind everyone that there are 10 years of taxes to pay for 6 years of services.......

Doesn't take a rocket scientist to figure out what will happen.

 

[cubby1223]

Isn't the CBO numbers "rosey" because the costs of adding new people to medicare & medicaid, comes out of state funding? Where the states will be forced to spend more?

What happens if we add all the additional expenses at the state level into the scoring of this federal bill?

 

[werepossum]

I can tell you from personal experience that the biggest problem with Medicaid is that the provider reimbursement rate is too low. That said, I don't think the Medicare reimbursement rate is different between people on normal medicare and those using Medicare advantage.

As I said, the whole thing is bullshit. Medicare Advantage is still a government health insurance solution. It's not a private plan if the government is paying for it, it's just an illusion that it is.

It's just how Medicaid works in NYS. You sign up for Medicaid and pick an HMO, for example, Blue Cross. Then Blue Cross manages all your health insurance. They can still deny you for claims, based on whatever policy they have in place. When they fill a claim, they are paid by the state.

It's pretty much the exact same problem we have with student loans.

Anyway, I'm off to work.

I agree that if private health insurance companies are not delivering equivalent services for equal or less money, the program should be discontinued.

 

[woolfe9999]

Isn't the CBO numbers "rosey" because the costs of adding new people to medicare & medicaid, comes out of state funding? Where the states will be forced to spend more?

What happens if we add all the additional expenses at the state level into the scoring of this federal bill?

There is no expansion of Medicare, so far as I know. Medicaid, yes. The bill has the fed picking up 100% of the cost of the expansion until 2016, and 91% after that. So your point is kind of valid. There is an additional, hidden cost to states. It just doesn't stand to be very much, especially not with the reconciliation bill which increases the federal contribution from about 81% in the Senate bill to about 91%.

- wolf

 

[Darwin333]

Without the power of law behind it, my guess is not nearly as much.

fraud and waste are currently legal?

Well, we know waste is but fraud? Really? I would imagine it would be easy to pass a bill that, at no cost to services, saved us hundreds of billions of dollars so why is it dependent on the passage of HC? If HC doesn't pass do we just keep the fraud?

 

[blackangst1]

So the deficit will be like 19.8 trillion when Obama leaves office instead of 20 trillion? And then like 39 trillion in 2025 or so instead of 40? GREAT NEWS!!!!!

Dont forget its Bush's fault though. You have to take that into account.

 

[Carmen813]

Um.....
The CBO only project 10 years out not 20 years..........

And let me remind everyone that there are 10 years of taxes to pay for 6 years of services.......

Doesn't take a rocket scientist to figure out what will happen.

The CBO was asked by Congress to provide 20 year numbers. So let me remind you to actually read links the I provide

 

[shira]

It isnt a leap of faith to expect a govt run program to deliver less and be overbudget.

You must have tried really hard to misunderstand my last comment. I wrote that it's a giant leap of faith to claim that "your" figures are better than the CBO's. The CBO hasn't been asked to determine if a particular set of figures is correct. They've been asked to make a best guess as to what will actually happen, given the legislation.

You, of course, can see into the future better than the CBO. People must pay you millions and millions of dollars for your amazingly accurate predictions.

 

[Genx87]

You must have tried really hard to misunderstand my last comment. I wrote that it's a giant leap of faith to claim that "your" figures are better than the CBO's. The CBO hasn't been asked to determine if a particular set of figures is correct. They've been asked to make a best guess as to what will actually happen, given the legislation.

Did I present figures? If so what do my mythical figures tell us to the penny on how much this will cost us? You must have tried ultra hard to decide my figures are wrong lol

You, of course, can see into the future better than the CBO. People must pay you millions and millions of dollars for your amazingly accurate predictions

Again it doesnt take a giant leap of faith to think a govt program will underserve and be overbudget.

 

[Hayabusa Rider]

Heh, this is funny. $500 billion in waste/fraud? Right.

I'll say this Carmen. Look at what Medicare D was supposed to cost. Not even near what it came out to be.

In fact the CBO really has no idea (and we discussed estimating health care costs before) what it's going to be.

No one knows anything in government about such a massive project as I've said before.

BTW, I did learn one good thing from Wolf. Apparently the increased cost to NY taxpayers for Medicaid was in a previous version, and the Feds will have to pony up for a couple years. Then who knows. It says 9%, but you know that if it comes up as expensive as I suspect they'll be looking to pass it on to the states ASAP.

I expect people are going to get their political parachute bill through in time for 2010.

Oh well, I can't wait to see the Healtcons spin this when it fails like Iraq.

 

[Carmen813]

Heh, this is funny. $500 billion in waste/fraud? Right.

I'll say this Carmen. Look at what Medicare D was supposed to cost. Not even near what it came out to be.

In fact the CBO really has no idea (and we discussed estimating health care costs before) what it's going to be.

No one knows anything in government about such a massive project as I've said before.

BTW, I did learn one good thing from Wolf. Apparently the increased cost to NY taxpayers for Medicaid was in a previous version, and the Feds will have to pony up for a couple years. Then who knows. It says 9%, but you know that if it comes up as expensive as I suspect they'll be looking to pass it on to the states ASAP.

I expect people are going to get their political parachute bill through in time for 2010.

Oh well, I can't wait to see the Healtcons spin this when it fails like Iraq.

As I said, it $500 billion total, and a huge portion of that is from medicare advantage.

The difference between this bill and Medicare D is that Conservatives didn't even try to find a way to pay for Part D. It was just pure deficit spending. In addition, a lot of the people who were trying to say how the deficit projection was wrong were strong armed into remaining silent.

I can see parallels, but it's not the same situation.

The CBO is doing the best job it can. It is the organization Congress has used for a very long time, and they are working their asses off to produce these estimates. That said, I think the projected deficit savings may end up not being accurate just because of how hard it would be to compute this...however I do believe worst case scenario is deficit neutral.

 

[shira]

Heh, this is funny. $500 billion in waste/fraud? Right.

I'll say this Carmen. Look at what Medicare D was supposed to cost. Not even near what it came out to be.

In fact the CBO really has no idea (and we discussed estimating health care costs before) what it's going to be.

No one knows anything in government about such a massive project as I've said before.

BTW, I did learn one good thing from Wolf. Apparently the increased cost to NY taxpayers for Medicaid was in a previous version, and the Feds will have to pony up for a couple years. Then who knows. It says 9%, but you know that if it comes up as expensive as I suspect they'll be looking to pass it on to the states ASAP.

I expect people are going to get their political parachute bill through in time for 2010.

Oh well, I can't wait to see the Healtcons spin this when it fails like Iraq.

Please define what "fails" means in this context.

If 30 million more Americans get coverage, the bill is doing what it intends to do. If health insurance companies can no longer reject an applicant for pre-existing conditions, then the bill is doing what it intends to do.

About the only thing you can question is what this thing will cost, and we now have an estimate, which sounds pretty good. What we absolutely DO know is the right now - with no legislation in place - costs are spiraling rapidly out of control.

It's awfully easy to sit back and criticize legislation that that may cost many hundreds of billions of dollars more OR LESS than current estimates. But why don't you compare that with the status quo? Is what exists now BETTER than what has been proposed? Well, that's the right-wing solution.

 

[Chaotic42]

Please define what "fails" means in this context.

If 30 million more Americans get coverage, the bill is doing what it intends to do. If health insurance companies can no longer reject an applicant for pre-existing

Is it 30 million more Americans? I haven't done a whole lot of research, but I keep seeing "people", which makes me think that the huge illegal population may be getting care under this and thus increasing the numbers.

 

[Craig234]

Hoyer called it the biggest deficit reduction bill since the 1990s, when President Bill Clinton put the federal budget on a path to surplus.

Funny I thought it was Newt Gingrich and the Republican congress that promised to balance the budget back then.

That's apparently because you get your news from poor sources. The first two years of Clinton Democrats had all 3 branches - and the defecit reductions were about the same.

 

[Hayabusa Rider]

If 30 million more Americans get coverage, the bill is doing what it intends to do. If health insurance companies can no longer reject an applicant for pre-existing conditions, then the bill is doing what it intends to do.

Like I've posted, NY has a great many that "have" insurance. They just can't use it. What will happen when the cost is far greater than currently projected? What happens then? Are resources being used properly? Will the answer be to cut another $500 billion in "waste"?

How will this affect medicine. The relationship between provider and patient? Are the consequences of control without expertise even being considered?

Like I've said, health care needs reform and it needs to be done properly from the outset. Take Medicaid (please). It's crap to deal with, and people get kicked for just being a few dollars over the limit, and it expensive. Real expensive.

So we're going to expand it by half without reforming it? It's like fixing Pinto gas tanks by installing more of the bad ones.

The point is and shall ever be to get this right first, because once it starts, there's no going back and little chance of fixing something which is institutionalized, like Medicaid.

 

[woolfe9999]

BTW, I did learn one good thing from Wolf. Apparently the increased cost to NY taxpayers for Medicaid was in a previous version, and the Feds will have to pony up for a couple years. Then who knows. It says 9%, but you know that if it comes up as expensive as I suspect they'll be looking to pass it on to the states ASAP.

I expect people are going to get their political parachute bill through in time for 2010.

Oh well, I can't wait to see the Healtcons spin this when it fails like Iraq.

This bill has death panels!

No, it doesn't have death panels.

Oh, ok. Well, you know what, I feel certain that they will add death panels some time in the future.

That is pretty much parallel to the logic you just employed about Medicaid funding in this bill.

I tend to think if we are going to critique a bill, that the text of the bill is what's relevant, not some hypothetical bad piece of legislation that can occur in the future. If that line of reasoning is valid, I can just as easily say I favor the bill not because of what's in it, but because of some future good thing that will be enacted later.

- wolf

 

[woolfe9999]

As I said, it $500 billion total, and a huge portion of that is from medicare advantage.

The difference between this bill and Medicare D is that Conservatives didn't even try to find a way to pay for Part D. It was just pure deficit spending. In addition, a lot of the people who were trying to say how the deficit projection was wrong were strong armed into remaining silent.

I can see parallels, but it's not the same situation.

The CBO is doing the best job it can. It is the organization Congress has used for a very long time, and they are working their asses off to produce these estimates. That said, I think the projected deficit savings may end up not being accurate just because of how hard it would be to compute this...however I do believe worst case scenario is deficit neutral.

I am trying to parse through the CBO reports to determine how much exactly they are putting down to savings from elimination of waste, fraud and abuse and it isn't entirely clear. It's definitely nowhere near $500 billion.

Here is an interesting piece from last year in the NY Times about how the CBO has historically underestimated cost-savings from changes to Medicare, including increased fraud oversight, and OVERestimated added cost provisions like Part D. Yup, they over-estimated the cost of that, not underestimated.

http://www.nytimes.com/2009/08/26/opinion/26gabel.html?pagewanted=1&_r=1

In sum, if appears that with respect to any kind of Medicare reform, the CBO's estimates have historically erred, to a very significant degree, on the pessimistic side, not the other way around.

This thread is so thick in BS I could hardly make it through the first page.

- wolf

 

[Ozoned]

The Senate Health Care Bill Violates Statutory PAYGO
Legislation Raids Social Security and CLASS Act Funds


Linky

Even though Democrats claim that their health care legislation is fiscally responsible, a new Congressional Budget Office (CBO) analysis of the Senate-passed bill reveals that it relies on revenues from trust funds that existing law and the bill itself declare off-limits:
• The updated CBO score reduced the projected deficit savings in the bill’s first 10 years by more than 10 percent—from $132 billion down to $118 billion.i
However, the score also notes that the bill generates $52 billion in additional Social Security revenues, reflecting higher payroll tax receipts. Because these receipts will eventually need to be paid out as higher Social Security benefits in future years, this revenue is considered “off-budget” for CBO scoring purposes.
• Likewise, the bill includes $70.2 billion in revenues generated by a new long-term care entitlement program—the CLASS Act.ii Because the program would work like an insurance program, with premiums collected now to pay needed benefits later, these revenues will be needed to pay out benefits in future decades. Preserving this insurance link is essential, as the non-partisan actuaries at the Centers for Medicare and Medicaid Services have cited a “very serious risk” that the program could become fiscally “unsustainable.”iii CLASS Act funds were protected in the Senate bill with Sense of the Senate language stating that Social Security and CLASS Act revenue “should be reserved” for their intended use, “and not spent in this Act for other purposes.”iv
• Excluding the $122.2 billion in new revenues that must eventually be paid out in benefits ($52 billion from Social Security, and $70.2 billion from the CLASS Act), the bill’s $118 billion in savings turns into a net deficit of $4.2 billion. Thus either the Senate bill raises the deficit, or it raids the Social Security and CLASS Act trust funds to pay for new health care entitlements.
• Because the PAYGO law specifically exempts the CLASS Act from the spending scorecard used to measure compliance with the deficit requirements of the Act, and because Social Security is declared off-budget,v
the $122.2 billion in revenues for these two programs cannot be used to comply with PAYGO provisions, meaning the Senate bill violates statutory PAYGO by $4.2 billion, triggering automatic sequestration cuts at the end of this fiscal year.
• The House’s impending consideration of the Senate health bill comes mere days after Blue Dog Democrats objected to the passage of “jobs” legislation because of their concerns about whether the bill complied with PAYGO.vi
Will the same Blue Dog Democrats who blocked a $15 billion measure for not complying with statutory PAYGO now roll over and pass a $1 trillion measure that similarly violates the PAYGO law passed with such fanfare just last month? And how can a bill that does not comply with statutory PAYGO be justified by Blue Dog Members—or anyone else—as fiscally responsible in the first place?
• The Democratic “raid” on Social Security and CLASS Act revenue comes at a time when Social Security itself faces growing financial pressure. For the first time in decades, the Social Security trust fund is expected to pay out more in benefits than it generates in new revenue, forcing the
government to cash-in Treasury bonds to fund the shortfall.vii
An additional raid on trust fund obligations to fund new health care entitlements would only compound the debt woes facing Social Security—and the Treasury.
America’s rapidly rising debt levels have resulted in international alarm; the ratings service Moody’s recently released a report indicating the United States could soon lose its AAA rating absent action to control government spending.viii
i Congressional Budget Office, Letter to Honorable Harry Reid, March 11, 2010, With federal deficits and debt skyrocketing out of control, many may question this latest budget gimmick to raid existing programs in order to fund trillions in spending on new health care entitlements—and how any Democrat who votes for a bill that violates both these trust fund obligations and the principles of statutory PAYGO can claim the mantra of fiscal responsibility.

 

[shira]

Like I've posted, NY has a great many that "have" insurance. They just can't use it. What will happen when the cost is far greater than currently projected? What happens then? Are resources being used properly? Will the answer be to cut another $500 billion in "waste"?

How will this affect medicine. The relationship between provider and patient? Are the consequences of control without expertise even being considered?

Like I've said, health care needs reform and it needs to be done properly from the outset. Take Medicaid (please). It's crap to deal with, and people get kicked for just being a few dollars over the limit, and it expensive. Real expensive.

So we're going to expand it by half without reforming it? It's like fixing Pinto gas tanks by installing more of the bad ones.

The point is and shall ever be to get this right first, because once it starts, there's no going back and little chance of fixing something which is institutionalized, like Medicaid.

I think that major components of the current bill would be in any comprehensive solution: The mandate, no pre-existing-condition exclusions, a defined baseline plan, a framework for performing "best practices" analysis, subsidies for premiums based on income.

I don't see any of that as being inconsistent with needed cost-control measures. For example, there's absolutely nothing about the current plan that precludes future legislation on medical-malpractice reform. Pretending that malpractice reform "must be in there NOW" or it will never happen is a ridiculous argument. The right already criticizes the current legislation for being "too big" at 2700 pages and counting. So explain to me how a 5000 page "comprehensive" plan would be more acceptable?

There's plenty wrong with the current plan, but once the plan is in place, the right will actually have an incentive to play a game other than "just say no." The crafting of a BETTER plan starts the day this current plan is passed.

 

[werepossum]

As I said, it $500 billion total, and a huge portion of that is from medicare advantage.

The difference between this bill and Medicare D is that Conservatives didn't even try to find a way to pay for Part D. It was just pure deficit spending. In addition, a lot of the people who were trying to say how the deficit projection was wrong were strong armed into remaining silent.

I can see parallels, but it's not the same situation.

The CBO is doing the best job it can. It is the organization Congress has used for a very long time, and they are working their asses off to produce these estimates. That said, I think the projected deficit savings may end up not being accurate just because of how hard it would be to compute this...however I do believe worst case scenario is deficit neutral.

If someone is not currently covered by health insurance, they are either not writable (due to pre-existing conditions or lifestyle), can't afford it, or find it not a desirable investment considering their risk factors.

If insurance companies are not currently willing to write policies, it is because those individuals are collectively a loss; they cost more in payouts than the company will take in in premiums. Therefore everyone else's premiums must go up to cover the extra costs, so health care costs will rise. (Look for Congress to follow up with legislation preventing premium increases.)

Those individuals who cannot afford it will not be magically enriched by this bill, meaning that states or the federal government will have to pay for them. Either taxes must go up, or all premiums must go up. (Taxing health care insurance or actual health care devices to pay for health care is a moron's perpetual motion machine.) Either way, health care costs still rise.

Those who choose not to have health insurance will likely choose to pay the fine. Their health care will still be provided at need by local health care providers, with the fines going to the federal government. But even if they choose to purchase insurance, health care costs still rise.

The CBO scores a bill statically, by the assumptions given. If the bill says $500 billion in Medicare/Medicaid fraud and waste will be saved, that's the assumption that is used. If the bill says that on day thirteen magic flying unicorns will appear and shit Krugerrands and piss Bubble-Up, that's the assumption that is used. This behavior - which is almost inescapable because any dynamic scoring requires using someone's assumptions - coupled with the well-known but always ignored fact that people use more of something desirable if it's free or subsidized and less if its cost is increased, is why no major Washington program is every accurately predicted. This program will be the same - I think intentionally.

This bill is aimed strictly at bankrupting private and non-profit health insurance companies. It's almost a stroke of evil genius in that implementing a single payer system today would result in millions of workers being laid off at once by insurance companies which would retain billions in capital. By seizing control of health care and gradually squeezing the insurance companies - whom progressives hate more than anyone except Karl Rove and Sarah Palin - D.C. gets to siphon that money out, into government, systematically destroying private health insurance while growing the federal government's share and control and building the case that single payer must be embraced. It's no coincidence that those who foam most about insurance companies are all supporting this bill, from Obama down to Kucinich.

 

[cubby1223]

There's plenty wrong with the current plan, but once the plan is in place, the right will actually have an incentive to play a game other than "just say no." The crafting of a BETTER plan starts the day this current plan is passed.

But there are still very basic logistical problems to all of this.

It is not possible to provide full health care services to all the population. There is not enough cash in our economic model, nor are there enough doctors to handle that workload, and with costs controls is only going to get worse.

It is impossible for the private industry to achieve the goal of full health care coverage for all. But, it is also impossible for the government to achieve the same but dang it if they hope enough and believe enough and want to fundamentally change enough of the role of government in the pursuit of a "progressive" utopia...

 

[shira]

This bill is aimed strictly at bankrupting private and non-profit health insurance companies. It's almost a stroke of evil genius in that implementing a single payer system today would result in millions of workers being laid off at once by insurance companies which would retain billions in capital. By seizing control of health care and gradually squeezing the insurance companies - whom progressives hate more than anyone except Karl Rove and Sarah Palin - D.C. gets to siphon that money out, into government, systematically destroying private health insurance while growing the federal government's share and control and building the case that single payer must be embraced. It's no coincidence that those who foam most about insurance companies are all supporting this bill, from Obama down to Kucinich.

You righties are a laugh riot. How many posts have we seen that claim that the current legislation is a huge windfall for the insurance companies? And now we see that - on the contrary - the plan will bankrupt insurance companies.

I guess if you can claim that this bill will simultaneously enrich and bankrupt the insurance companies, you can customize the argument to suit the characteristics of the particular audience you're attempting to defraud.

More low-IQ hijinx by the right.

 

[Carmen813]

Is it 30 million more Americans? I haven't done a whole lot of research, but I keep seeing "people", which makes me think that the huge illegal population may be getting care under this and thus increasing the numbers.

30 million more Americans. If you included illegals, that number would be more like 47 million.