What Does a Bi-Partisan HC Reform Bill Look Like

[hal2kilo]

There is widespread talk among opponents of the HC bill the democrats have failed to approach HC reform in a bi-partisan manner. So my question to opponents of the current bill is, what sort of bill would you approve of?

To make this easier, here is a recap of the elements of the current bill:

1. Subsidizes uninsured people to purchase healthcare. Sudsidies would cover about 2/3's of the premium costs.

2. Individually mandates the uninsured to purchase healthcare, with a modest penalty for those who do not purchase. Mandate applies if premium cost is at or below 8% of income.

3. Mandates larger businesses to purchase healthcare for employees, with a per employee penalty applying to those who opt out.

4. Imposes regulations that prohibit denying coverage based on pre-existing conditions, and restrictions on rescission of health benefits.

5. Imposes a variety of cost control measures, including a statewide, then later national, exchange, regulations which cap the percentage of premiums that go to overhead and profit, etc.

6. Imposes new taxes to pay for subsidies. Either a surtax on income in excess of $500,000, or on premiums above a certain limit, depending on house of senate versions.

7. Makes some cuts to Medicare Part C, and imposes some cost control measures for Medicare in general.

8. Will close the "donut hole" for seniors paying for prescription drugs under Medicare Part D.

9. Increases poverty line limit on Medicaid eligibility. Paid for mostly by federal funds, with a small portion by state funds (starting in 2017.)

These are the major provisions/impacts of the bill. Which would you get rid of or modify, and what would you add?

- wolf

It looks like the compromised POS that we have. Repubicans were never, I repeat never, interested in passing a HC bill because it would make the Democrats look good (the only reason). But, for some reason, idiots in the Democratic leadership thought that if we try to do things in the bill that would get a couple backwards Democrat Senators and one or two Repubs to go along by completely giving in to the insurance companies and not having any non-private competition we could get a bill. But it's the public be damned, party over principle. So this is what a bi-partisan bill looks like when only one side is even playing.

 

[woolfe9999]

I agree with Ronstang. Before people start making suggetsions how to fix the problems, the problems need to be indentified and understood. Let's try using a more rational business-like decision model instead the political one.

Seems to me the major root problem is our high cost. People like to compare our costs to those of other countries, typically in terms of GDP. Why are ours so much higher?

Do the various countries calculate their costs the same way so that were are sure we're comparing 'apples-to-apples'?

Which of our costs are higher and why? Until that is understood any suggested 'fix' is a stab in the dark. Is it excessive procedures? (IIRC, 50% of our costs are consumed by about 5 or 10% of the population. If so, and that is higher than Europe, that is where the focus needs to be, broad based stuff is the wrong tool etc.) Is it too many defensive medical proceedures here? If so, how to curtail that. Is our malpractrice insurance a problem, if so how does Europe etc handle that. Are our presription drug costs higher? (We know they are since they pay less per pill) If so, why and fix it. Do we have too few doctors? Why do we allow an antiquated-type cartel to have a monopoly over that area? Is our emergency room care too epxensive? If so why, what's the difference between an emergency room and a walk-in clinic other than the sign over the door?

After our problem of high cost has been effectively addressed, things like extending coverage to uninsured and/or underinsured will be easier (less expensive) to fix.

Fern

I am unclear why several people here feel that healthcare, and specifically the reasons for rising costs, have not been analyzed, identified and understood. Just because the typical voter does not understand what is causing the problem, and also does not understand very well the proposed solutions, does not mean that the solution is further study. It might point to the notion that the average voter needs to avail themselves of existing information before deciding whether or not to support a particular proposal.

There is a wealth of information online. Here is one example, a lengthy 6-part piece series of newspaper articles addressing why our costs are so high:

http://economix.blogs.nytimes.com/author/uwe-e-reinhardt/page/7/

- wolf

 

[daishi5]

I am unclear why several people here feel that healthcare, and specifically the reasons for rising costs, have not been analyzed, identified and understood. Just because the typical voter does not understand what is causing the problem, and also does not understand very well the proposed solutions, does not mean that the solution is further study. It might point to the notion that the average voter needs to avail themselves of existing information before deciding whether or not to support a particular proposal.

There is a wealth of information online. Here is one example, a lengthy 6-part piece series of newspaper articles addressing why our costs are so high:

http://economix.blogs.nytimes.com/author/uwe-e-reinhardt/page/7/

- wolf

The reason I never thought it had been analyzed is I had not seen an analysis presented. Discussions often went something like this "tort reform," "tort cots less than 1%," "cut insurance profits," "insurance profits are less than 3%," and "end the AMA" "?". A quick google search or two didn't yield much. A google scholar search might yield results, but I don't normally look for current analysis there, and never really tried. I read about it with interest, but I don't have any real desire to do in depth research. It isn't like my reps would listen to me more if I learned anything.

 

[woolfe9999]

The reason I never thought it had been analyzed is I had not seen an analysis presented. Discussions often went something like this "tort reform," "tort cots less than 1%," "cut insurance profits," "insurance profits are less than 3%," and "end the AMA" "?". A quick google search or two didn't yield much. A google scholar search might yield results, but I don't normally look for current analysis there, and never really tried. I read about it with interest, but I don't have any real desire to do in depth research. It isn't like my reps would listen to me more if I learned anything.

No, your reps wouldn't listen to you if you understood it better. But you might cast a more informed vote if you did.

My point is, there are a lot of opinions about HC reform and not many of them a particularly well informed opinions. That itself is a root cause of why this bill, or any other reform bill that has either been tried (Clintons), or is merely a proposal (i.e. the Republican plan), will never get majority support. People tend not to support things that they do not understand, and the problem with healthcare is especially acute as the issue is particularly complicated.

I don't know what to do about that as there is no way to dumb down the complexity of the issue. And I am not naive enough to believe that a high percentage of voters will study the issue carefully. What I think is that a populist poll is probably not the best indicator of whether a bill is or isn't right for the country.

- wolf

 

[JS80]

You have any ideas for controlling costs?

- wolf

Decrease demand, increase supply. Impossible as bi-partisan reform.

 

[Fern]

I am unclear why several people here feel that healthcare, and specifically the reasons for rising costs, have not been analyzed, identified and understood.
-snip-

I've read that stuff, it doesn't go near far enough.

Also looks to have been mostly ignored by Congress in crafting this bill. However, I concede they made a stab at one his elements of our higher costs: admin overhead of insurance providers. The others look to be ignored/unaddressed.

IMO, Congress would have been better served by holding public committee meetings on why our costs are higher, taking recommendations for solutions, and implementing those they felt best. Instead we hear platitudes and scape goating (evil insurance companies that kill people and pay huge salaries) while staffers work in the background producing thousands of pages most Congresspersons don't understand.

I still say their process is wrong-headed.

I still say this bill if implemented will drive our share of GDP devoted to HC upwards.

Fern

 

[Fern]

The reason I never thought it had been analyzed is I had not seen an analysis presented. Discussions often went something like this "tort reform," "tort cots less than 1%," "cut insurance profits," "insurance profits are less than 3%," and "end the AMA" "?". A quick google search or two didn't yield much. A google scholar search might yield results, but I don't normally look for current analysis there, and never really tried. I read about it with interest, but I don't have any real desire to do in depth research. It isn't like my reps would listen to me more if I learned anything.

The subject we're discussing here isn't really "has it ever been analyzed". All businesses analyze costs.

The question we're really discussing is why didn't Congress analyze it before cobbling together a bill? There is little-to-no evidence they did.

And the better method may well have implementing the cost improvement and verifying they worked before broadly extending coverage.

Fern

 

[JS80]

The subject we're discussing here isn't really "has it ever been analyzed". All businesses analyze costs.

The question we're really discussing is why didn't Congress analyze it before cobbling together a bill? There is little-to-no evidence they did.

And the better method may well have implementing the cost improvement and verifying they worked before broadly extending coverage.

Fern

It's not in their interest to accurately analyze it. They know that any analysis will show that the demand goes up, supply goes down, and prices go up. That is bad for politics and bad for passing the bill, which they want to do one way or another.

 

[fskimospy]

Looking at how difficult this is for the Democrats, I can understand how the GOP has never been able to do a big HC reform. I can't ever recall in my lifetime where the GOP has had super majorities in both Houses of Congress as well as the exec branch. BTW: Cloture in the Senate used to require 67 votes, instead of the 60 required now.

Fern

The GOP has never been particularly interested in big healthcare reform. This isn't a slam against them, just an acknowledgement of reality. They have other issues that are generally more important to them.

So far in this thread I've seen a bunch of people say what they thought a conservative health care reform bill would look like, but I haven't seen anyone describe a bipartisan one. Can anyone do it?

 

[Throckmorton]

I can't believe how many people still think the "competing across state lines" thing is a good idea. Are those people completely immune to simple explanations of why that doesn't make sense?

And what's with the tort reform stuff? It blows my mind that conservatives and libertarians would favor the government setting a an arbtirary cap on benefits that a free individual can sue for in a free nation's court system... especially considering what a small fraction of medical spending malpractice accounts for.

/facepalm

 

[woolfe9999]

The subject we're discussing here isn't really "has it ever been analyzed". All businesses analyze costs.

The question we're really discussing is why didn't Congress analyze it before cobbling together a bill? There is little-to-no evidence they did.

And the better method may well have implementing the cost improvement and verifying they worked before broadly extending coverage.

Fern

So what you're saying is that if all the people who have analyzed our healthcare system, many of whose studies are available for download online, had come to Congress to testify about their findings, then all would be well? I wonder how many voters would even watch more than 5 minutes of such a thing on C-Span before their eyes started to glaze over and they switched channels to a reality show or WWF.

- wolf

 

[woolfe9999]

I can't believe how many people still think the "competing across state lines" thing is a good idea. Are those people completely immune to simple explanations of why that doesn't make sense?

And what's with the tort reform stuff? It blows my mind that conservatives and libertarians would favor the government setting a an arbtirary cap on benefits that a free individual can sue for in a free nation's court system... especially considering what a small fraction of medical spending malpractice accounts for.

/facepalm

Tort reform is considered a liberal/leftie/socialist idea in other countries where it operates. In single payor systems they basically do not allow med mal lawsuits. You're right, the idea of putting an arbitrary cap on one class of lawsuits is totally at odds with conservative and libertarian philosophy. It basically says let's restrict access to the courts for certain types of people, and let's not have a meritocracy in health care delivery because it costs us too much to penalize doctors who screw up. Very socialist.

- wolf

 

[fskimospy]

The subject we're discussing here isn't really "has it ever been analyzed". All businesses analyze costs.

The question we're really discussing is why didn't Congress analyze it before cobbling together a bill? There is little-to-no evidence they did.

And the better method may well have implementing the cost improvement and verifying they worked before broadly extending coverage.

Fern

And where is your cause for saying there is no evidence that they did? Where do you think the bill came from? What do you think the thousands of paid staff, research assistants, etc... etc. are there for?

I'm guessing you have spent exactly zero time into looking how the individual members of Congress and the relevant committees go about drafting these bills. Be honest, did you spend even a single minute?

 

[charrison]

I can't believe how many people still think the "competing across state lines" thing is a good idea. Are those people completely immune to simple explanations of why that doesn't make sense?

you can buy alls kinds of insurance across states lines right now. Large corporations are often forced to have different plans if they have employees in different states. There is little reason not to do this.

And what's with the tort reform stuff? It blows my mind that conservatives and libertarians would favor the government setting a an arbtirary cap on benefits that a free individual can sue for in a free nation's court system... especially considering what a small fraction of medical spending malpractice accounts for.

/facepalm

Yeah that is much harder to do that what the idiots in congress are doing right now with the entire health care industry. IF you dont trust them to make small changes, how in the hell can you trust them to make big changes.

 

[Fern]

So what you're saying is that if all the people who have analyzed our healthcare system, many of whose studies are available for download online, had come to Congress to testify about their findings, then all would be well? I wonder how many voters would even watch more than 5 minutes of such a thing on C-Span before their eyes started to glaze over and they switched channels to a reality show or WWF.

- wolf

I'm talking about a process.

But frankly, I don't believe Congress is interested in it. Some of that disinterest probably rests with how they practice politics.

Your author lists the 4 below as the big reason our costs are higher:

1. Higher prices for the same health care goods and services. (I'm surprised to see "goods" in here considering their high VAT taxes, I suppose they are exempt)

2. Higher admin overhead

3. More widespread use of high cost high tech equip & proceedures

4. Defensive medicine.

Number 1 could likley have been helped by allowing importation of cheaper (US) drugs etc sold abroad at a discount. I guess this might have been unpopular with big Pharma and put a dent in campaign contributions.

I don't necessarily agree with author about #2 (he says Medicare/Medicaid claim processing is simpler than private insurance, this is complely opposite of my personal experience in medicaid/medicare billing, but whatever) but Congress has taken a stab at it IIRC.

#3 surprises me a bit. You'd think new tech & proceedures would be about doing things more efficiently and cheaply, thus driving down costs. Yet he claims otherwise, I'm thereofr suspicious that new things extend life of terminal patients. Congress doesn't wanna touch that, at least not publically.

#4. Gee, why haven't the Dems addressed that? Donors maybe?

fern

 

[Fern]

I can't believe how many people still think the "competing across state lines" thing is a good idea. Are those people completely immune to simple explanations of why that doesn't make sense?

And what's with the tort reform stuff? It blows my mind that conservatives and libertarians would favor the government setting a an arbtirary cap on benefits that a free individual can sue for in a free nation's court system... especially considering what a small fraction of medical spending malpractice accounts for.

/facepalm

Tort reform is considered a liberal/leftie/socialist idea in other countries where it operates. In single payor systems they basically do not allow med mal lawsuits. You're right, the idea of putting an arbitrary cap on one class of lawsuits is totally at odds with conservative and libertarian philosophy. It basically says let's restrict access to the courts for certain types of people, and let's not have a meritocracy in health care delivery because it costs us too much to penalize doctors who screw up. Very socialist.

- wolf

As a conservative what I support is reforming punative awards that are abitrary. I don't like arbitrary punishment in the criminal system either. It should be more uniform, what we have now is an irrational system that functions more like a lottery for tort lawyers.

Actual damages, OTOH, cannot be systematic because of the varying circumstances of each individual case.

Fern

 

[fskimospy]

As a conservative what I support is reforming punative awards that are abitrary. I don't like arbitrary punishment in the criminal system either. It should be more uniform, what we have now is an irrational system that functions more like a lottery for tort lawyers.

Actual damages, OTOH, cannot be systematic because of the varying circumstances of each individual case.

Fern

How is it arbitrary and how is it irrational? The purpose of punitive damages is to deter behavior. Since it's a tort you're not throwing anyone in jail, so how do you propose to set a fixed limit that could effectively deter behavior all the way up and down the ladder from a small doctor to a huge multinational corporation?

 

[woolfe9999]

I'm talking about a process.

But frankly, I don't believe Congress is interested in it. Some of that disinterest probably rests with how they practice politics.

Your author lists the 4 below as the big reason our costs are higher:

1. Higher prices for the same health care goods and services. (I'm surprised to see "goods" in here considering their high VAT taxes, I suppose they are exempt)

2. Higher admin overhead

3. More widespread use of high cost high tech equip & proceedures

4. Defensive medicine.

Number 1 could likley have been helped by allowing importation of cheaper (US) drugs etc sold abroad at a discount. I guess this might have been unpopular with big Pharma and put a dent in campaign contributions.

I don't necessarily agree with author about #2 (he says Medicare/Medicaid claim processing is simpler than private insurance, this is complely opposite of my personal experience in medicaid/medicare billing, but whatever) but Congress has taken a stab at it IIRC.

#3 surprises me a bit. You'd think new tech & proceedures would be about doing things more efficiently and cheaply, thus driving down costs. Yet he claims otherwise, I'm thereofr suspicious that new things extend life of terminal patients. Congress doesn't wanna touch that, at least not publically.

#4. Gee, why haven't the Dems addressed that? Donors maybe?

fern

On number 2, Medicare has a 4% overhead rate. Regardless of anyone's personal experience, that is the actual overhead rate. Private insurers have overhead/profit rates at around 10%. But that discrepancy isn't even the main issue. It isn't that government insurance is better than private. It's the fact that we have multiple payors instead of a single payor. Only with a single payor will providers not have to generate billions of pages of itemized medical bills every year, and will the insurer not have to analyze those bills. Admin costs are around a third of our medical costs, and around 16% of costs in Canada. That is a huge amount of savings that can be gained from eliminating both public and private medical bureaucracy.

- wolf

 

[Fern]

The GOP has never been particularly interested in big healthcare reform. This isn't a slam against them, just an acknowledgement of reality. They have other issues that are generally more important to them.

Could be.

I was living in Europe during most of Reagan's term(s). I assume he was intested in taxes, and the Cold War. Probably Social security reform too (aren't they all?)

Don't remember much about Bush #1 (was still in Europe for most of his term) other than "read my lips" etc.

Bush #2 was busy with 9-11 etc. (Also SS reform)

So far in this thread I've seen a bunch of people say what they thought a conservative health care reform bill would look like, but I haven't seen anyone describe a bipartisan one. Can anyone do it?

I think it's going to be a combination of cost cutting, and subsidies/credits to extend coverage to lower income types. The money likely coming from Medicare/medicaid cost containment or reduction and some taxes. I'd like to see some insurance reform, there are too many plans insufficient for major medical and, IMO, therefor pretty much worthless.

I can also see a joint effort at increasing admin efficiency. Medicare/Mediciad billing (and likely that of private insurers) is horrendous. Standardization opf billing of records looks to be helpful. I see no ideological reason to prevent joint efforts.

More competition among insurance providers is another are joint action would seem possible.

I think often it's not the objectives that causes fighting, but rather the means implemented to achieve them.

Fern

 

[charrison]

On number 2, Medicare has a 4% overhead rate. Regardless of anyone's personal experience, that is the actual overhead rate. Private insurers have overhead/profit rates at around 10%. But that discrepancy isn't even the main issue. It isn't that government insurance is better than private. It's the fact that we have multiple payors instead of a single payor. Only with a single payor will providers not have to generate billions of pages of itemized medical bills every year, and will the insurer not have to analyze those bills. Admin costs are around a third of our medical costs, and around 16% of costs in Canada. That is a huge amount of savings that can be gained from eliminating both public and private medical bureaucracy.

- wolf

And as long as the consumer is not directly paying the bills, costs will continue to rise as long as there is a 3rdparty paying the bills(insurance or govt).

 

[Fern]

On number 2, Medicare has a 4% overhead rate. Regardless of anyone's personal experience, that is the actual overhead rate.
-snip-

No it's not.

E.g., Medicare/Medicaid uses the IRS for it's billing and collection admin functions; that's not factored into the overhead costs. The private sector (employers and their accountants) also pays quite a bit to calculate medicare/medicaid etc (payroll taxes?). Not the case with private insurers. Medicare/Medicaid also basically forces the service or goods provider to hire an outside firm to audit all bills and the service provider pays for this. Not the case with private insurance.

It's "apples to oranges" until properly adjusted.

Given the huge numbers we see estimated for medicare/medicaid fraud & waste they could probably use some more administration too.

Fern

 

[Fern]

How is it arbitrary and how is it irrational? The purpose of punitive damages is to deter behavior. Since it's a tort you're not throwing anyone in jail, so how do you propose to set a fixed limit that could effectively deter behavior all the way up and down the ladder from a small doctor to a huge multinational corporation?

Actual damages is a pretty damn good deterent to unwanted behavior; being resoponsible for what you screw up is pretty effective.

You guys love to point to the European models, how are they dealing with it?

We have models in this country too. E.g., you rarely, if ever, see a tax CPA (or other tax preparer) subject to punitive damages in courts, yet the federal government has found a pretty good way, uniform penalties, for detering unwanted behavior. They apply equally to small firms and large international ones without problem.

What do they do with lawyers?

Fern

 

[Hayabusa Rider]

Kill the sick and elderly. Take their stuff.

Ok, that was harsh.

Expanding Medicaid as it is now is like spreading AIDS. Since the first of the year, it's been even worse than before.

I'd say that the first priority would be to fix those programs that we already have, and get people who are health care professionals, public health advocate, actuaries and the like working on solutions.

Once we have a comprehensive assessment of how things are, where we need to be, and how to get there, ask me what we should adopt.

 

[Carmen813]

A bipartisan health care bill looks like the pot of gold at the end of a rainbow.

 

[Hayabusa Rider]

A bipartisan health care bill looks like the pot of gold at the end of a rainbow.

Win! Money! King!