The Preliminary CBO score for HC reform is out

[Carmen813]

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.

What kills me is that I provided a link from The Lewin Group, which is OWNED by United Healthcare, and it shows that private insurers will survive under this reform effort. In fact survive is hardly the right word, as they will do quite well with around 15 million new customers.

If you followed their analysis of each proposal dating back to last summer you would see this wasn't always the case, the Lewin Group quite clearly stated when they felt the reforms would cause over 80 million people to leave private insurance pools. The reason they are no longer saying that is because it simply isn't going to happen anymore.

 

[woolfe9999]

I'm going to post the text of that article I just linked so it doesn't get ignored.

FOR competence and integrity, few organizations command more respect in Washington than the nonpartisan Congressional Budget Office. As health care reform makes its way through Congress, the budget office’s assessment of how much various elements might cost may determine the details of legislation, and whether it ultimately passes. But when it comes to forecasting the costs of reform, the budget office’s record is suspect. In each of the past three decades, when assessing major changes in Medicare, it has substantially underestimated the savings the changes would bring.

In the early 1980s, Congress changed the way Medicare paid hospitals so that payments would no longer be based on costs incurred. Instead, hospitals would receive a predetermined amount per admission, based on the patient’s primary medical problem. This encouraged shorter stays, led to fewer diagnostic services and reduced administrative costs. The Congressional Budget Office predicted that, from 1983 to 1986, this change would slow Medicare hospital spending (which had been rising much faster than the rate of inflation) by $10 billion, and that by 1986 total spending would be $60 billion. Actual spending in 1986 was $49 billion. The savings in 1986 alone were as much as three years of estimated savings.

Why was the budget office so far off? It had projected that the new payment strategy would increase hospital admissions, because hospitals would maximize their payments by admitting patients who were less severely ill and discharging them quickly. In short, they would make up money with faster turnover. But in the first year of the new payment system, admissions, which had been increasing, actually declined by 3.5 percent. By the third year, they had declined by 15.9 percent. It may be that the declining admissions resulted from a new and stronger program for reviewing admissions.

But the Congressional Budget Office was correct in assuming that hospital stays would grow shorter. In the first three years of the payment system, the length of Medicare patients’ hospital stays, which had been decreasing by 1 percent to 2 percent a year, fell by 17 percent. The new system also led hospitals, for the first time in decades, to cut their work forces — by 2.3 percent in the first year alone.

In the 1990s, the biggest change in Medicare came with the Balanced Budget Act of 1997, a compromise between a Republican-controlled Congress and a Democratic administration. At the time, the Congressional Budget Office forecast that, from 1998 to 2002, the act would reduce Medicare spending by $112 billion — a 9.1 percent reduction. Part of that — $36 billion worth — would come from paying skilled nursing facilities and home health care services a set fee per patient. But only a tiny fraction of the savings, about $100 million, would come from better monitoring of fraud and abuse on the part of health care providers, according to budget office projections.

The actual savings turned out to be 50 percent greater in 1998 and 113 percent greater in 1999 than the budget office forecast. Overall spending increased just 1.2 percent from 1998 to 2000, rather than 5.6 percent, as was projected. With increased monitoring for fraud and abuse, hospitals billed less aggressively. Spending for skilled nursing facilities, which had increased by 38 percent per year from 1988 to 1997, did not increase at all in 1998 and 1999. At the same time, spending for home health care services, which had been rising at the rate of 25 percent a year, fell by 52 percent. In fact, Medicare spending fell so much that Congress increased payment levels to hospitals and other providers in 1999 and 2000.

In the current decade, the major legislative change to the system was the Medicare Modernization Act of 2003, which added a prescription drug benefit. In assessing how much this new program would cost, the Congressional Budget Office assumed that prices would rise as patients demanded more drugs, and estimated that spending on the drug benefit would be $206 billion.

Actual spending was nearly 40 percent less than that. Spending on drugs declined from fiscal year 2007 to 2008. Seniors proved more willing to buy lower-cost generic drugs than expected, fewer people participated in the program than expected, and competition held premiums down. Few new blockbuster drugs came on the market, so overall drug prices remained relatively constant, rather than accelerating as predicted.

Times Topics: Congressional Budget OfficeThe Congressional Budget Office’s consistent forecasting errors arose not from any partisan bias, but from its methods of projection. In analyzing initiatives meant to save money, it helps to be able to refer to similar initiatives in the past that saved money. When there aren’t enough good historical examples to go by, the estimated savings based on past experience is essentially considered to be unknown. Too often, “unknown” becomes zero — even though zero is not a logical estimate.

The budget office has particular difficulty estimating savings when it considers more than one change at once. For example, last December the office reported that it found no consistent evidence that changes in medical malpractice laws would have a measurable effect on health care spending. It also reported that increased spending on studies comparing the effectiveness of different drugs and medical treatments would yield no net savings for 10 years. Yet if both malpractice reform and comparative effectiveness studies were instituted simultaneously, they might work together to yield substantial savings; doctors would gain more confidence in the effectiveness of less aggressive treatments and, at the same time, could use those treatments with less to fear from lawsuits.

The budget office’s cautious methods may have unintended consequences in the current health care reform effort. By underestimating the savings that can come from improved Medicare payment procedures and other cost-control initiatives, the budget office leads Congress to think that politically unpopular cost-cutting initiatives will have, at best, only modest effects. This, in turn, forces Congress to believe it can pay for reform only by raising taxes, which then makes reform legislation more difficult to pass.

The Congressional Budget Office’s integrity is beyond questioning. But the record shows that it has substantially overestimated the cost of health care reform three times out of three. As Congress now works on its greatest push for reform in generations, the budget office needs to revise the methods it uses to make predictions about costs.

Note how the author also points out that the CBO may have underestimated potential savings from tort reform as well...gasp. What a conundrum for righties who are trashing the current CBO report because they think it overestimates savings to Medicare from various provisions in the dems' bill.

- wolf

 

[Ozoned]

What was the effect of the "government savings" on private health insurance?

 

[Circlenaut]

To be honest I don't know why you people cling so much to the U.S. If the U.S. goes the the tubes in the future, partly because of this bill as many of you think, than so be it! Get the hell out of here and make a new life elsewhere? It's what our ancestors did and what our decedents will do.

 

[Hayabusa Rider]

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.

So how much has Medicaid D cost so far (note in your article the estimate was about drug costs not going up as much as expected, not the total cost of the program), and what is the expected 10 year cost of the program?

 

[woolfe9999]

So how much has Medicaid D cost so far (note in your article the estimate was about drug costs not going up as much as expected, not the total cost of the program), and what is the expected 10 year cost of the program?

I'll do some digging around and check the numbers, but why, out of curiosity, have you cherry picked this particular issue out the article? The article makes the point that Medicare has been reformed 3 times, and all 3 times the CBO's estimates have been off on the pessimistic side. The most salient example, for our purposes, is where the CBO under-estimated the savings from increased fraud oversight.

I'm guessing you're ignoring the other examples because you think you "got me" on this one. I'll check and see. However, if you know the answer, you can save me the time.

- wolf

 

[Hayabusa Rider]

I'll do some digging around and check the numbers, but why, out of curiosity, have you cherry picked this particular issue out the article? The article makes the point that Medicare has been reformed 3 times, and all 3 times the CBO's estimates have been off on the pessimistic side. The most salient example, for our purposes, is where the CBO under-estimated the savings from increased fraud oversight.

I'm guessing you're ignoring the other examples because you think you "got me" on this one. I'll check and see. However, if you know the answer, you can save me the time.

- wolf

You have me confused with someone else, because I don't care if I "get" you.

I know what it was initially supposed to be, but then after it was passed it was increased. I was asking a question I'm having a problem getting the answer to and you have a lot of statistics up your sleeve. You might have had this one too.

The CBO got lucky because something completely out of it's control (drug pricing in this case) didn't go up as much as projected.

All that means is that they don't really know, and they are taking a stab at it. Well prognostication carries that risk, and yes that's what they are asked to do. It could have gone the other way.

Nevertheless, it's a bit disingenuous because it's supposed to save 190 billion or whatever, but which doesn't count the increased payments to physicians.

It looked like docs were going to bail, so they had to fix that, but Congress made sure that wasn't a part of this bill.

Voila! Money saved. Really?
No, it's a dishonest figure because it's part of the package no matter what one calls the bill.

Let's look at a few things which you might be able to explain (no sarcasm intended).

From the CBO's letter to Harry Reid:

CBO and JCT now estimate that, on balance, the direct spending and revenue effects of
enacting H.R. 3590 as passed by the Senate would yield a net reduction in federal deficits
of $118 billion over the 2010–2019 period. Approximately $65 billion of that reduction
would be on-budget; other effects related to Social Security revenues and spending as
well as spending by the U.S. Postal Service are classified as off-budget. In the estimate
that was provided on December 19, the estimated budgetary impact was a net reduction
in deficits of $132 billion, of which approximately $81 billion would be on-budget.

Note that the cut in the deficit is in large part due to changes not related to health care proper.

There was an adjustment which was explained as follows.

Tables 1 through 4 enclosed with this letter present the estimates of the direct spending,
revenue, and deficit effects of H.R. 3590, as passed by the Senate. CBO and JCT’s
assessment of the legislation’s impact on the federal budget deficit over the 2010–2019
period is summarized in Table 1. Table 2 shows federal budgetary cash flows for direct
spending and revenues associated with the legislation. Table 3 provides estimates of the
resulting changes in the number of nonelderly people in the United States who would
have health insurance and presents the primary budgetary effects of the legislation’s
provisions related to insurance coverage. Table 4 displays detailed estimates of the costs
or savings from other proposed changes (primarily to the Medicare program) that would
affect the federal government’s direct spending and some aspects of revenues. Detailed
estimates of the impact of the tax provisions in the legislation are provided by JCT in
JCX-61-09 (see www.jct.gov).2

Note that most of the savings are thorough cuts in Medicare which are apparently are going to be restored elsewhere.

Do note this as well:

Under the legislation, federal outlays for health care would increase during the
2010–2019 period, as would the federal budgetary commitment to health care.6
CBO now estimates that the federal commitment would increase by about
$210 billion over that period, rather than by $200 billion as previously estimated.
In subsequent years, however, the effects of the proposal that would tend to
decrease the federal budgetary commitment to health care would grow faster than
those that would increase it. As a result, CBO expects that the proposal would
generate a reduction in the federal budgetary commitment to health care during the
decade following 2019; that judgment is unchanged from CBO’s previous
assessment.

That's an increase in federal spending overall. I understand that, but that's not how it's being sold by DC. It's not "cutting the deficit"


Here's the problem. The whole of what is being proposed will not save money. The CBO clearly states that, except for Medicare cutbacks which are being uncut. So that part is incorrect. I believe you mentioned that yourself.

So how's the rest of this "efficiency" being provided?

Again from the CBO

a. Does not include effects on spending subject to future appropriation.
b. Includes excise tax on high-premium insurance plans.
c. These estimates reflect the effects of provisions affecting Medicare, Medicaid, and other federal health programs, and include
the effects of interactions between insurance coverage provisions and those programs.
d. The changes in revenues include effects on Social Security revenues, which are classified as off-budget. The 10-year figure of
$264 billion includes $249 billion in revenues from tax provisions (estimated by JCT) apart from receipts from the excise tax
on high-premium insurance plans and $14 billion in revenues from certain provisions affecting Medicare, Medicaid, and other
programs (estimated by CBO and JCT).
e. Off-budget effects include changes in Social Security spending and revenues as well as spending by the U.S. Postal Service.

It's coming from increased taxes, not "savings".



Now maybe I'm a bit picky here. When someone brags about "cutting the deficit" while it's doing so merely by taxing, shuffling around things unrelated to health care, and disregarding other expenditures I see that as deception. The government did the same thing with Iraq, but then it was a war to sell. Now it's "health care".

So unless you can explain how all the chest puffing is justified in light of the above I have to call it deception. Part of politics I know.

Now why should I trust them with irrevocable control over something they don't understand nearly as well as ducking numbers to look better?

 

[Ozoned]

I'm going to bump this so it doesn't get ignored. Heh heh.

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]

It's a great time to be in the insurance business!

Talk to PJabber. He has proof that Obamacare will bankrupt the insurance companies.

You two should form a comedy team.

 

[werepossum]

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.

It's generally the left squealing about the bill being a huge windfall for insurance companies and righties pointing out that lefties are, ironically, supporting the thing they hate most in an effort to cool off support. That those on the left like Pelosi are using every means fair or foul to pass this monstrosity whilst simultaneously claiming that anyone not supporting it is in the pocket of Big Insurance is either proof that they are dishonest, or proof that they are insane. You can choose. I'm betting dishonest. No way this many insurance-hating, government-loving leftists are supporting a bill to force people to support the insurance companies without knowing it's designed to ultimately destroy them.

 

[Carmen813]

It's generally the left squealing about the bill being a huge windfall for insurance companies and righties pointing out that lefties are, ironically, supporting the thing they hate most in an effort to cool off support. That those on the left like Pelosi are using every means fair or foul to pass this monstrosity whilst simultaneously claiming that anyone not supporting it is in the pocket of Big Insurance is either proof that they are dishonest, or proof that they are insane. You can choose. I'm betting dishonest. No way this many insurance-hating, government-loving leftists are supporting a bill to force people to support the insurance companies without knowing it's designed to ultimately destroy them.

Or maybe not all "leftists" think that private insurance companies should be destroyed. Like you know...me.

You can be liberal and not think government should control everything. That is actually antithetic to what liberalism was originally about. It's also not a love of government, but a hatred of perceived injustices and the belief that government can serve as an instrument of good. You should look up the term "libertarian democrat" on Wikipedia if you haven't before.

But this is a topic for another thread...

 

[woolfe9999]

You have me confused with someone else, because I don't care if I "get" you.

I know what it was initially supposed to be, but then after it was passed it was increased. I was asking a question I'm having a problem getting the answer to and you have a lot of statistics up your sleeve. You might have had this one too.

The CBO got lucky because something completely out of it's control (drug pricing in this case) didn't go up as much as projected.

All that means is that they don't really know, and they are taking a stab at it. Well prognostication carries that risk, and yes that's what they are asked to do. It could have gone the other way.

Nevertheless, it's a bit disingenuous because it's supposed to save 190 billion or whatever, but which doesn't count the increased payments to physicians.

It looked like docs were going to bail, so they had to fix that, but Congress made sure that wasn't a part of this bill.

Voila! Money saved. Really?
No, it's a dishonest figure because it's part of the package no matter what one calls the bill.

Let's look at a few things which you might be able to explain (no sarcasm intended).

From the CBO's letter to Harry Reid:


Note that the cut in the deficit is in large part due to changes not related to health care proper.

There was an adjustment which was explained as follows.

Note that most of the savings are thorough cuts in Medicare which are apparently are going to be restored elsewhere.

Do note this as well:


That's an increase in federal spending overall. I understand that, but that's not how it's being sold by DC. It's not "cutting the deficit"


Here's the problem. The whole of what is being proposed will not save money. The CBO clearly states that, except for Medicare cutbacks which are being uncut. So that part is incorrect. I believe you mentioned that yourself.

So how's the rest of this "efficiency" being provided?

Again from the CBO

It's coming from increased taxes, not "savings".



Now maybe I'm a bit picky here. When someone brags about "cutting the deficit" while it's doing so merely by taxing, shuffling around things unrelated to health care, and disregarding other expenditures I see that as deception. The government did the same thing with Iraq, but then it was a war to sell. Now it's "health care".

So unless you can explain how all the chest puffing is justified in light of the above I have to call it deception. Part of politics I know.

Now why should I trust them with irrevocable control over something they don't understand nearly as well as ducking numbers to look better?

You've made several points here. I'll address them in series.

With respect to Medicare Part D, the CBO estimate put the 10 year cost at $558 billion. The actual program started in 2006. CBO underestimated the cost in years 2008 and 2009. I do not know about 2006 and 2007, but I infer that they were basically on target those years. You're right, this could have gone either way. But there is a pattern to their estimates regarding legislation affecting Medicare that you are ignoring - they have so far always over-estimated costs and under-estimated savings. The point is actually broader than that - the CBO has a reputation for making very conservative predictions in general.

Why they have this reputation is pretty clear. When you are projecting something complex where there is a lot of "wiggle room" in the assumptions you make, naturally if you are CBO you will err on the side of caution. If your projection turns out to be too optimistic, then it damages the credibility of the CBO as an institution, whereas if the projection is too pessimistic, then everyone is happy and it is no harm and no foul. Republicans have pointed this out in the past about the CBO, specifically for Medicare Part D, that historically the CBO tends to over-estimate costs.

I think this point is important because a basic attitude I've seen in this thread is, don't trust the CBO estimates because "government programs" always run over their estimated budgets. I challenge anyone making that assertion with respect to CBO estimates to prove that this has generally been true historically. We know it hasn't been true with respect to Medicare reforms, and that CBO has a general reputation that is opposite of this.

Your next point is about the "doc fix" issue. Here you are correct, the bill does not account for a likely bill that will increase Medicare reimbursement rates, about $180 billion over 10 years, assuming that this fix will be done every year, with no other changes to Medicare. It doesn't account for that, or any other attempts to reform Medicare so as to reduce costs. So if you factor that in, then the bill might be deficit negative to the tune of 30-40 billion over the first 10 years - a pretty tiny amount. But remember the estimate is that it will save $1 trillion over the second ten years. I seriously doubt that factoring in the doc fix will significantly alter that. On balance, I will take this over an entitlement or war that isn't paid for...at all.

Your next point is that some of the savings purportedly come from items having nothing to do with healthcare - the postal service and SS are mentioned in your quote as additional "off budget savings." Are you sure these items have nothing to do with healthcare? This bill does not cut the postal service budget. Perhaps it has to do with going to electronic medical and billing records which currently clog the postal system in paper form. The SS savings I dunno, but I strongly suspect that this is somehow related to healthcare. But even if it isn't, so what? Are you seriously trying to say that you can't pay for something by cutting spending in another area? Really?

You also claim that "most" of the savings to Medicare are being "restored" elsewhere. This again is the doc fix issue. That is $180 billion out of $500 billion. It isn't "most." The remainder comes from cuts to Medicare part C and projected savings from fraud and waste reduction, which the CBO has historically underestimated. In fact, the dems are saying just that - that the CBO estimates of the savings on these items are likely too low based on history. Very much against the so-called wisdom being plied on this board, but we'll see how it comes out this time. Maybe the CBO will finally "blow it" and its estimate will turn out to be way over-optimistic.

Finally, you make a claim made by another poster in this thread, that deficit reduction means "cutting spending," by definition. It's hard to believe, but that appears to be what you said. I can't really comment on that assertion, but if you don't like paying for spending with taxes, that is a philisophical viewpoint that I'm not going to argue with, except to point out the obvious: that a dollar gained from taxation is a dollar, just like a dollar gained by cutting spending. Either reduces the deficit. If you don't like taxes, fine, neither do I. However, I'd much rather have a bill be paid for with taxes (or in this case, taxes and cuts), then not paid for at all. Which is why your comparison with Bushes' wars fails - he didn't pay for those wars. At all.

I also note that you quoted CBO saying that the bill would increase federal spending on HC over the first 10 years, but ignored the fact that the statement goes on to say that it will decrease it over the second 10. You cherry picked your own quote, though I will note that you at least posted the entire passage which is better than I expect from most people around here.

- wolf

 

[werepossum]

Or maybe not all "leftists" think that private insurance companies should be destroyed. Like you know...me.

You can be liberal and not think government should control everything. That is actually antithetic to what liberalism was originally about. It's also not a love of government, but a hatred of perceived injustices and the belief that government can serve as an instrument of good. You should look up the term "libertarian democrat" on Wikipedia if you haven't before.

But this is a topic for another thread...

Yes, I need to remember to say "progressive" and not "liberal". Liberals I usually like; they tend to default toward maximizing freedom, as do I, and we usually disagree only on how much socialism our society should have (i.e. to what degree that freedom should be infringed for another, hopefully worthy, cause.) Progressives however tend to default toward minimizing freedom, forcing everyone into lock step using the power of government to forcibly change society. Conservatives are often much the same about using government, albeit to forcibly prevent society from changing. But as I love my country as it is the people who want it to not fundamentally change bother me less than those who want to fundamentally change it beyond recognition.

 

[woolfe9999]

Yes, I need to remember to say "progressive" and not "liberal". Liberals I usually like; they tend to default toward maximizing freedom, as do I, and we usually disagree only on how much socialism our society should have (i.e. to what degree that freedom should be infringed for another, hopefully worthy, cause.) Progressives however tend to default toward minimizing freedom, forcing everyone into lock step using the power of government to forcibly change society. Conservatives are often much the same about using government, albeit to forcibly prevent society from changing. But as I love my country as it is the people who want it to not fundamentally change bother me less than those who want to fundamentally change it beyond recognition.

Funny that. Liberals now want to call themselves progressives because conservatives succeeded in turning "liberal" into a bad word during the Reagan years. Now conservatives are saying they hate progressives, but liberals are just fine. I wonder what liberals will start calling themselves in another 10 years.

- wolf

 

[shira]

It's generally the left squealing about the bill being a huge windfall for insurance companies and righties pointing out that lefties are, ironically, supporting the thing they hate most in an effort to cool off support. That those on the left like Pelosi are using every means fair or foul to pass this monstrosity whilst simultaneously claiming that anyone not supporting it is in the pocket of Big Insurance is either proof that they are dishonest, or proof that they are insane. You can choose. I'm betting dishonest. No way this many insurance-hating, government-loving leftists are supporting a bill to force people to support the insurance companies without knowing it's designed to ultimately destroy them.

Your use of the word "monstrosity" seems pretty dishonest to me. Perhaps if you offered a convincing argument as to why, exactly, a bill projected by an impartial body to reduce the federal deficit by about $1 trillion while at the same time greatly increasing the number of Americans covered by insurance is a "monstrosity" you would seem like more than just a partisan hack who hurls insults when he has nothing of value to say.

 

[sciwizam]

I would like to OP to edit his cliff's. Nowhere in the CBO report does it explicitly mention savings of $1.2 Trillion in the 2nd decade.

Any numbers given are in Page 4:

Using that same analytic approach, the combined effect of enacting H.R. 3590 and the reconciliation bill would also be to reduce federal budget deficits over the ensuing decade relative to those projected under current law—with a total effect during that decade that is in a broad range around one-half percent of GDP. The incremental effect of enacting the reconciliation bill (over and above the effect of enacting H.R. 3590 by itself) would thus be to further reduce federal budget deficits in that decade, with a total effect that is in a broad range between zero and one-quarter percent of GDP.

and that number is from the Democratic leaders, as per the news article

The Congressional Budget office put the 10-year savings at $138 billion, but Democratic leaders said that would be dwarfed by a projected $1.2 trillion in the following decade.

 

[woolfe9999]

I would like to OP to edit his cliff's. Nowhere in the CBO report does it explicitly mention savings of $1.2 Trillion in the 2nd decade.

Any numbers given are in Page 4:

and that number is from the Democratic leaders, as per the news article

That number, from the dems, IS the CBO number, translated from the way it is given by the CBO - as a percentage of GDP - into a whole number. Do you know what .5% of the total GDP from 2019 to 2029 is projected to be?

- wolf

 

[RedChief]

Funny that. Liberals now want to call themselves progressives because conservatives succeeded in turning "liberal" into a bad word during the Reagan years. Now conservatives are saying they hate progressives, but liberals are just fine. I wonder what liberals will start calling themselves in another 10 years.

- wolf

Progressives turned liberal into a bad word all by themselves. Additionally, liberals have been calling themselves progressives for going on 100 years now (on and off).

 

[Hayabusa Rider]

Wolf, my contention is still that how the program is being sold is disingenuous. If that's the case then what else are they not being honest about? I don't really care about the Reps because aren't promoting the bill. They screwed themselves with Iraq. The war "costs" weren't all that much. Yeah, right.

This is not deficit reducing and it is being precisely sold as that. Why? Obviously to put it in the best possible light.

And yes I am suspicious (with a long track record of dealing with the government, and not just from the outside) of people who's main objective seems to be 2010.

Now the deficit can be reduced by cutting spending or increasing taxes. Any bill that takes in more than it puts out will do that. If I decide to bump everyone's taxes up by 30%, that will really do it. The problem with doing that is that no one wants that to happen to them. The bill overtaxes, and how that's spun is as deficit reduction. There's no guarantee that it will remain so. I haven't met a politician who can keep his hands off a pot of money yet.

So we hear how efficient government is and in the next breath that this will cut costs. It doesn't, and while you point out that over 20 years the costs are supposed to change, I'd counter that in 1967 the cost of Medicare was supposed to be 12 billion dollars in 1990, and it was 110.

The main difference is that you are satisfied with the way this was handled, but I am not. I still believe this is the cart before the horse and that no business would survive if it functioned this way. It would run itself into the ground, and unfortunately the ground for Uncle Sam is never there. It can always cry for more and just take it.

I don't know what constitutes "waste and fraud" but considering I committed "fraud" when I forgot to write the time on a verbal order (an obscure regulation for which many were fined for the sole purpose of getting money for the state) I wonder if this is Newspeak for a witch hunt. Are we talking about fining for minor paperwork errors?

I don't know who is profiting from this "waste and fraud" but it isn't us, yet we got hit like many others when our past whoring governor wanted to look good in the headlines.

I suggest the best way to cut out waste and fraud is to slash our Representatives compensation.

 

[CPA]

Lovely, more kickbacks for votes and another marriage penalty tax.

 

[woolfe9999]

Wolf, my contention is still that how the program is being sold is disingenuous. If that's the case then what else are they not being honest about? I don't really care about the Reps because aren't promoting the bill. They screwed themselves with Iraq. The war "costs" weren't all that much. Yeah, right.

This is not deficit reducing and it is being precisely sold as that. Why? Obviously to put it in the best possible light.

And yes I am suspicious (with a long track record of dealing with the government, and not just from the outside) of people who's main objective seems to be 2010.

Now the deficit can be reduced by cutting spending or increasing taxes. Any bill that takes in more than it puts out will do that. If I decide to bump everyone's taxes up by 30%, that will really do it. The problem with doing that is that no one wants that to happen to them. The bill overtaxes, and how that's spun is as deficit reduction. There's no guarantee that it will remain so. I haven't met a politician who can keep his hands off a pot of money yet.

So we hear how efficient government is and in the next breath that this will cut costs. It doesn't, and while you point out that over 20 years the costs are supposed to change, I'd counter that in 1967 the cost of Medicare was supposed to be 12 billion dollars in 1990, and it was 110.

The main difference is that you are satisfied with the way this was handled, but I am not. I still believe this is the cart before the horse and that no business would survive if it functioned this way. It would run itself into the ground, and unfortunately the ground for Uncle Sam is never there. It can always cry for more and just take it.

I don't know what constitutes "waste and fraud" but considering I committed "fraud" when I forgot to write the time on a verbal order (an obscure regulation for which many were fined for the sole purpose of getting money for the state) I wonder if this is Newspeak for a witch hunt. Are we talking about fining for minor paperwork errors?

I don't know who is profiting from this "waste and fraud" but it isn't us, yet we got hit like many others when our past whoring governor wanted to look good in the headlines.

I suggest the best way to cut out waste and fraud is to slash our Representatives compensation.

I can't help you with your confusion about fraud. I assume you've heard of insurance fraud? Doesn't really matter if it's a private or public insurer that is being defrauded. The one cost tax payers money, and the other costs whoever is paying for health insurance premiums, typically employers and their employees. Fraud in the medical context is billing for medical services that are not given, and apparently, it happens all the time. I have personally experienced it twice as a patient. On one occasion the doctor asked me to be complicit with it and said he would deny the conversation if I ever told anyone. He wanted to bill my insurance company for extra visits which never occurred. His justification was that the insurance reimbursement rates were too low. Naturally I refused.

Medicare fraud alone is roughly estimated to cost tax payers $74 billion yearly. And that is just Medicare fraud. Doesn't include Medicaid fraud, or fraud against private insurance companies, all of which costs us money.

http://en.wikipedia.org/wiki/Medicare_fraud

You claim government can't reduce fraud because it can't do anything right. Well apparently efforts to reduce fraud in the past have saved more money than expected.

Regarding the rest of your post, there isn't much I can say. To a very large extent, your cynicism about government is justified, along with cynicism about all human institutions. But the level of blanket cynicism you possess creates a real conundrum. If you really think that everything government touches turns to shit, that it literally can do nothing right, then we have a problem. Take away all government involvement in the healthcare system. End Medicare. End Medicaid. Right? That's what, 60 million more people without health coverage. That gaff in your system which temporarily denied people coverage because they didn't have a card? They won't have any coverage at all anymore. Private insurance companies are for profit businesses, and they aren't going to insure those people for free.

Now if you don't want anything that extreme because you actually care about people's health, then we're right back to the government can do no right, so there is no apparent solution. Can you vouch for the community of medical providers, and guarentee that they will provide free services for everyone without insurance, without raising the rates of those who can pay? Do you have another solution? See that is the problem. Cynicism without solutions is just nihilism. I can't operate that way. I have to look for solutions, and that's pretty much all I can say on the matter.

- wolf

 

[boomerang]

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.

It's both absurd and foolish to think that anyone, government or private could predict anything 20 years out. It's also absurd to think the same for ten.

If the government was able to predict what was going to happen in ten years, we wouldn't be in the dire financial straits we're in right now. This is nothing more than common sense.

But by all means, continue to worship the flying spaghetti monster that is government.

 

[Fear No Evil]

Of course this is going to fail. And of course the 'progressives' are not going to take responsibility for it, they are going to say single payer is needed. Thats the entire point of this shit bill is to purposely make it fail so Bo can take it over 100%.

 

[Pens1566]

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.

I seem to recall something about those #s being fudged (by the republicans in congress) on purpose after they came out in order to make it look drastically cheaper than what CBO predicted.

 

[Carmen813]

Of course this is going to fail. And of course the 'progressives' are not going to take responsibility for it, they are going to say single payer is needed. Thats the entire point of this shit bill is to purposely make it fail so Bo can take it over 100%.

Fear No Evil, I'm going to help you out. I think people need to listen to this music while reading your posts about health care reform.



Honestly, the way to get single payer would have been to not try and reform the current system and just to allow it to collapse under it's own weight. Which is where it's headed anyway, either this bill will help save it or it won't. There doesn't seem to be any support anywhere from independent analysis that this will speed up this process.