OP-ED

Confused, Conflicted, Clueless and Cranky

Taylor

Humphrey Taylor is Chairman of The Harris Poll.  Prior to joining Harris, Taylor worked in Britain where he conducted all of the private political polling for the Conservative Party and was a close adviser to Prime Minister Edward Heath in the 1970 campaign and subsequently to Margaret Thatcher. After a year of debate, in which health care policy was covered in the media almost daily, very few people are even moderately well informed about the details of the proposals for health care reform.  But many of them have strong opinions.  Most people, our data would suggest, are confused, conflicted, clueless and cranky: confused because of the complexity of the many issues that are on the table; conflicted because they often favor policies that are mutually contradictory; clueless because they don’t know, let alone understand, most of what is being proposed; and cranky because Washington has failed, yet again, to provide a health reform bill they like.

The mind-boggling complexity of the system and the proposed reforms provide plenty of opportunities to attack the proposals, however unfair or unreasonable they may seem to advocates of reform.  Critics say the proposed reforms would lead to a government take-over of the system, higher taxes, less choice, lower quality, higher unemployment and rationing.

Confused? One huge problem is that the American health care “system,” as it is euphemistically called, is fiendishly complicated.  Health insurance coverage is provided by Medicare, Parts A, B, C, D, Medicare Advantage, Medicaid, employers and their insurance plans, the V.A., D.O.D., FEHBP, SCHIP, WIC, the Indian Health Service, community clinics, HMOS, PPOs, and the individual insurance market.  There are state regulated and ERISA plans.  Important federal government health care agencies include HHS, CMS, AHRQ , CDC and NIH.  There are solo, small and large practices, single and multi-specialty groups, and integrated medical systems.  Hospitals and doctors employ huge numbers of people at great expense to figure out how to get reimbursed by insurers, Medicare and Medicaid, and how to deal with uncompensated care.

Physicians are paid on a fee-for-service basis, by capitation, and by salaries, and can receive bonuses and pay-for performance incentives.  These payments come from thousands of different health plans, each with its own rules as to what is reimbursed and how.

Complexity of reform proposals

A benign dictator who wanted to reform the health care system might decide to scrap it completely and replace it with a simpler system that would be much easier to understand, much less expensive to manage and much easier to improve.  But most Washington watchers who understand the politics of health care policy believe that this is politically impossible.  Too many powerful interests are involved.  Therefore, most major reform proposals with significant support build on the system we have now rather than replace it.  They would keep employer-provided insurance, private sector health insurance, Medicare, Medicaid, the V.A., the D.O.D., and the other third-party payers.  They would keep the many government agencies that manage and regulate different parts of the system.

And then, as if the system is not complicated enough, the congressional proposals would add more complexity, new agencies, and new regulations.  One or both of the House and Senate bills would create individual and employer mandates, with new subsidies for some employers and low-income individuals, reduced subsidies for Medicare Advantage, a “public option” to compete with private sector insurance, new taxes on “Cadillac plans” and the rich, the barring of medical underwriting based on health status (pre-existing conditions and recision), and health insurance exchanges.  Those proposals would encourage, expand and make use of electronic medical records, electronic prescribing, and other health information technologies, comparative effectiveness research, quality measures, price transparency, wellness programs, “medical homes,” patient-centered care, evidence-based medicine and outcomes research.

Another whole layer of complexity relates to the need for fundamental reimbursement reform.  Our 2008 survey of health care opinion leaders for the Commonwealth Fund found a large majority who believed that this is the most important step that needs to be taken to improve the efficiency of the system and quality of care.  Reimbursement reform means changing “perverse incentives” in the way that doctors are reimbursed, reducing fee-for-service payment and moving to bundled payments, payments for episodes of care, capitation or salaried physicians.  Experts argue that this would require many  more accountable care organizations (ACOs) and medical homes.

Are your eyes glazing over?  There are probably only a few thousand health care policy wonks who fully understand all the complexity of our system and of the proposed reforms.

What most people don’t know or don’t understand

In addition to the unbelievable complexity of the health care system and reform proposals, there are some simple and very important factors that most people do not think or talk about, and probably do not believe.

Most health care economists believe that present cost and coverage trends are not politically or economically sustainable.  They believe that we will have to make really tough choices as we try to satisfy potentially infinite demand with finite resources.  For how long can health care spending increase  2½ times faster than GDP?  How many more uninsured people will we tolerate?

Some political leaders and media seem to encourage this ignorance and the simplistic belief that if only their policies were adopted we could have it all – access to high quality care at an affordable cost with no new taxes, and secure access to all needed services for the rest of our lives.  Most people seem to believe that it would be possible for everyone to have access to all the wonders of modern medicine without much higher taxes or other costs.  Most people believe that insurers should insure anyone who wants insurance, without requiring the young and the healthy to buy insurance.  Adverse selection and moral hazard are not just incomprehensible insurance jargon; few people have ever thought about the concepts.

A recent Pew survey found that only two percent of all adults could correctly answer twelve very simple questions about politics (e.g., how many Senate votes are needed to break a filibuster; who, of four well-known politicians is the Senate Majority leader).  One can only speculate as to what percentage of the public would pass a similar test of “health reform literacy.”

Conflicted?

Most people believe that the health care system “has so much wrong with it that fundamental changes are needed.”  They believe health care costs too much and that everyone should have health insurance.  So where’s the conflict?  The problem is that many people tend to support contradictory positions.  They oppose cutting benefits but don’t want their taxes , their out-of-pocket costs, or their premiums to increase.  They believe that everyone should have affordable access to every test, treatment and procedure that they or their doctors want but don’t stop to think what this would cost or how it would be paid for.  They favor universal coverage but oppose an individual mandate.  They favor an employer mandate but don’t want to make it more expensive for employers to hire people.  They favor a “public option” but oppose a “government-run insurance plan.”  They believe every patient should have access to high quality care, but don’t think the young and the healthy should to have to pay for it.

Clueless?

It is tough to win public support for proposals when very large numbers of people are misinformed and believe many of the strange criticisms made by those opposing reforms.  In recent polls, two-thirds (65%) of the public believed that “the proposed reforms would result in a government-run health care system,” even though the reforms would greatly increase the number of people with private sector insurance. More than half the public believed that the proposed reforms would “reduce the choices many people have now” (55%), that health insurance would be “too expensive for many people to buy” (52%), or “would make it harder for many people to get the care they need “ (51%).  A 45% to 30% plurality believed that “the proposed reforms would hurt Medicare.”  And more than a third (37%) that the “proposed reforms would create death panels that would decide who should live and who should die.”

The public was split 41% to 41% as to whether health care would be “rationed,” and do not realize that we already ration care by reimbursing or not reimbursing it. Large minorities believed that “Medicare will be phased out” (32%), that the “plan promotes euthanasia to keep costs down (25%), and (where did this come from?) that “the government will be able to access individual bank accounts to help pay for services” (23%).

Cranky

The polls sometimes mislead their readers by suggesting that people already have opinions when they ask questions about the details of the policy.  These polls can be useful; they can test the public’s reactions to issues and policies and the language used to present them.  But reactions to a question do not mean that people actually had opinions on the issue (let alone understood it) before they were surveyed.  However, most people do have opinions about health care reform, even if they do not know much about what is being proposed.

What is striking now is the contrast between the large 78% majority of the public who thinks that “fundamental reforms are needed” or that the “system needs to be completely rebuilt” and the hostility to the proposed reforms.  Attitudes to proposed reforms seem to have much more to do with the popularity of who is proposing them than what is being proposed.  In September 2009, we found that a 53% majority thought that President Obama’s proposed reforms were “a good thing” while a 54% majority believe the proposals of the Democrats in Congress were “a bad thing.”  But what was the difference between their policies?  Since September, support for the president’s proposals has declined along with his job rating.  And while the Democratic proposals are unpopular, the Republican proposals (whatever they are) are much more unpopular.

In conclusion

The polling data underline the truth of the advice to “keep it simple, stupid.”  Unfortunately, the system we have now is absurdly complicated and health care reform could only be simple if we nuked the system we have and re-built it from scratch.  And that won’t happen.

Rhetoric trumps substance.  In the absence of a simple, comprehensible reform, it is easy to criticize any package of reforms.  People who are misinformed and have little understanding of what is actually being proposed often hold very strong opinions.

The introduction of Social Security and Medicare (which were bitterly opposed at the time) involved relatively simple concepts that could be explained to most people.  The health reform proposals now on the table, and some of those proposed in the past, cannot.   This helps explain why so many presidents, Democratic and Republican, have failed to pass substantial health care reform that would greatly reduce the number of uninsured and help contain costs.

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30 replies »

  1. Peter, Remember I’m talking about what polls well — not what works best. From a standpoint of what works best, I prefer single payer.
    Regarding the German system — yes there is a govt. role (most of my facts come from T.R. Reid’s book), and of course, regulation will have to be a big part of any system.
    But I suspect it would poll well in the US because the US actually has experience with non-profit health insurance (the old BCBS model), doesn’t sound like “socialism,” and in many ways resembles what we have today.

  2. For those participants here who have not done so already I recommend reading anything by Prof. Reinhardt one of whose short essays in the NYTimes is referred to by Peter above. He not only has an excellent knowledge of most parts of healthcare systems in the USA and elsewhere, but he is a very good and amusing writer. The essay referred to is excellent and typical of the quality of his work. He also wrote sections of a report on NJ hospitals as the head of a commission appointed by then-Governor Corzine that is also superb.

  3. Our government is too corrupt and morally bamkrupt, not to mention really bandrupt, to be doing anything but shrinking its Healthcare footprint.

  4. “Germany’s has the distinction of being an insurance system run by not-for-profit groups that are highly competitive. Of all the “horror stories” out there, no one ever raises the German system.”
    Dennis, you seem to imply the government is not involved in the regulation of German healthcare, not so.
    http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/
    Now you just need to convince the for-profit private healthcare industry (and non-profit BCBS) to reliquish control of healthcare pricing for the German model to work here.

  5. “Canada’s system is the most applicable model for the USA, although all systems in comparably industrialized countries or less industrialized countries for that matter are worth looking at in depth.”
    True, except that Canada=single payer=government agency, and we know where that discussion leads some people to. (Yes, it’s like Medicare, but that gets lost on many people.)
    Germany’s has the distinction of being an insurance system run by not-for-profit groups that are highly competitive. Of all the “horror stories” out there, no one ever raises the German system.
    Again, I’m mentioning what polls well, not what works best. Unfortunately, all the polls taken in the USA have a “when did you stop beating your wife?” taste to them because they all start from the assumption of revising the US’s hopelessly fragmented and inefficient for-profit insurance market.

  6. No doubt about it – our healthcare system as it stands is hopelessly complicated and confusing, and this is coming from someone that makes a living from deciphering the rules to maximize reimbursement. I am an independent, but the plan that makes the most sense to me is the voucher system provided on a means tested basis. People would be free to purchase the plan that makes the most sense to them, spending as much or as little as THEY chose. Everyone would be expected to participate, young and old, sick and well. How can this happen? Simple. If you do not have insurance and cannot afford the care you need the physician or hospital has the right to refuse care. People ration care through the policies they buy or the care they can afford, it is not a matter of a third party dictating what we should have. Put healthcare power back into the hands of the people and let us decide for ourselves what is best for us and our families. We are Americans. We can make decisions. It’s time we start acting like it.

  7. “Bitterly opposed”: but Social Security passed the House 372-33, and the Senate 77-6. Medicare passed the House 313-115 and Senate 68-21.
    The fact is that even the President’s own party is barely behind this fiasco of a bill, let alone the uninformed/confused/conflicted public.

  8. Of course the public is confused. All public policy requires a balance between individual self-interest and the societal good. Striking the right moral balance is the responsibility of those who have chosen to act with integrity in public life. All the great unwashed are entitled to do is to cast a vote for the individual who they feel will balance their interests with the public good.
    A single-payer, public option is what the public wants and contradictions be damned, they will love and support it as soon as those opposed to it stop lying to them about why they cannot have it. Any senator can pretend that their stand on this issue is principaled and in the interests of their constituents but the public has no guarantee of this.
    Instead of requiring a super-majority vote or going to the heavy-handed tactic of using reconcialtion that will cost democrats in November, why not simply allow a secret ballot vote on this issue in the senate?
    A secret ballot vote would:
    1. remove the pressure being brought to bear by lobbyists and the media;
    2. allow the American people to assess the performance of the senate as a whole and decide if it is dysfunctional in determining their desires and;
    3. send a message to lobbyists that they have no right to buy the assurance of a favourable vote and that like the American people they should get comfortable with doubt about what their money can buy.

  9. “But when some dogs are getting foigras and some people are getting dog food, there is an inherent instability built in, guaranteeing failure, distrust and unrest.”
    Are Medicaid recipients getting “dog food” or “foigra”? (actually Foie Gras – archon would know, it’s French :>)
    Which are the uninsured getting? Are employees getting company paid healthcare getting the Foie Gras, maybe twice because it’s tax free, and are those paying for it themselves getting some dog food, with some Foie Gras? Would that mean that a system of equal healthcare available to all eliminate the built in “instability, distrust and unrest”?

  10. If the bill did not treat different populations as special, exempt from certain provisions, it would be easier for people to eat the dog food. But when some dogs are getting foigras and some people are getting dog food, there is an inherent instability built in, guaranteeing failure, distrust and unrest.
    Not to meniton that Constitutional requirement for equal treatment under the law, but why should that bother this bunch?

  11. “If President Obama and the Democrats want to pass a bill that the American people can feel proud about, it has to be SIMPLE and effective.”
    That is like saying that NASA should be fixing the Space Shuttle with a screwdriver and wrench from Walmart, so we can all understand and feel proud of the Space Program. Or maybe we should start over and come up with a Space Craft spec that will not exceed 11 pages.
    And by the way, if it were possible (and it isn’t) to start fresh and completely ignore the current mess instead of trying to fix it, it would take way more than 2500 pages to legislate an equitable health care system for over 300 million people.

  12. “One huge problem is that the American health care “system,” as it is euphemistically called, is fiendishly complicated. Health insurance coverage is provided by Medicare, Parts A, B, C, D, Medicare Advantage, Medicaid, employers and their insurance plans, the V.A., D.O.D., FEHBP, SCHIP, WIC, the Indian Health Service, community clinics, HMOS, PPOs, and the individual insurance market.”
    I agree 100%. The health care system itself is far too complicated for most Americans to understand even if they tried. And this health care “reform” bill is FAR too complicated too, and the people don’t understand it. It’s being picked apart by both sides, making the issue even more partisan and heated than it would be otherwise. If President Obama and the Democrats want to pass a bill that the American people can feel proud about, it has to be SIMPLE and effective.

  13. Humphrey Taylor’s lead-in is priceless,
    “Most people, our data would suggest, are confused, conflicted, clueless and cranky: confused because of the complexity of the many issues that are on the table; conflicted because they often favor policies that are mutually contradictory; clueless because they don’t know, let alone understand, most of what is being proposed; and cranky because Washington has failed, yet again, to provide a health reform bill they like.”
    To this I would add Senator Lamar Alexander’s explanation: “Our country is too big, too complicated, too decentralized for Washington, a few of us here, just to write a few rules about remaking 17 percent of the economy all at once. We don’t do comprehensive well.“
    Which leads to this verse,
    Admittedly a bit perverse.
    People are confused,
    Because care is sometimes refused,
    People are conflicted,
    Because care is sometimes restricted.
    People are clueless,
    Because care is an incomprehensible mess.
    People are cranky.
    Because of fraud, abuse, and hanky panky.
    It would be great if we could “ Keep it simple stupid!”
    But with complexity government is not a perfect cupid.

  14. “a health care system similar to Germany’s”
    Canada’s system is the most applicable model for the USA, although all systems in comparably industrialized countries or less industrialized countries for that matter are worth looking at in depth.
    That along with consideration of the vast research done on topic for decades rather than this endless political and politicized nonsense about bills that barely change the status quo, albeit extend insurance coverage and perhaps get the ball rolling for further reform. Truly appalling.

  15. I’d like to see you describe a health care system similar to Germany’s and see how it does in polls. I bet it would pass with flying colors. It’s a lot less expensive, too.

  16. It’s interesting – complexity is the friend of the bankers as well!
    Bankers know that simple rules are easily implemented; complex rules are far less readily used.
    I’m sure it’s no accident that both bankers and insurance company lobby generously.
    In fact, if you want to straighten American health; you’ll have to start by straightening American politics…

  17. *I just do not understand how reasonable and fair individuals should trust a legislative body that has not shown much if any transparency to how the legislation was created, and how some specific politicians overtly used extortion to “get my vote”.*
    Yes,
    The American public is cranky and clueless. What’s the state of the politicians? Perhaps one could describe them as “crying all the way to the bank”.
    The beauty of the situation for the politicians is – a clueless electorate is one which can be pushed in any convenient direction regardless of anger. They may know the politicians are acting against their interests but they have no idea how in particular. And the opaque “public education” that’s gone on has not changed this. Coincidence?
    The American public is like an angry bull with a bag pulled over it’s head, lurching this way and that, while circus clown hit it on the head with 2x4s. “Confused, Conflicted, Clueless and Cranky” indeed.

  18. Dr. Exhausted,
    The provisions not kicking in for 4 years is very unfortunate and it is there more than likely to make the savings look bigger than they actually are.
    By the way, the 21% cut didn’t “really” take effect today, since CMS is holding claims for 10 days until the cuts are repealed, but I’m sure you know that.
    I am sure you must also be outraged that the unemployment benefits extension failed to go through on Friday, or is that where the needs of the few unemployed need to give in to the needs of the many comfortably employed?

  19. If you are all holding your Hopes and Dreams on a BI-Partisan Bill.Well, don’t do it! These self serving,narcissistic and parasitic growths on society have little use for anyone below their stature. They live in a lavish Bubble,adorned with gifts,trips ,and special perks.
    Theirs,is a vision marred by the influences of Corporate governance and isolation from the population below their stature. They had not a single clue outside the influences of Corporate self Interest and Campaign Sponsors.
    It is not surprising, that members of either Party have been involved in stalling and obstructing any progress on the matter. It is abundantly clear to me that the polarizations of Party have made legislative matters irrelevant.
    Of Course, We can start over and over again.In another fifty years? That is fine; while Americans have the Greatest Health Care in the World.We shall find Third world Countries will actually be providing; What we have naively professed.
    The Best we can do is die at Home and save wasted Hospital Dollars and exaggerated expenses on feeding Hospital Corporation investors and Die quickly!
    No need to saddle your family with Hospital bills they don’t owe because you died.

  20. Deeds not words are what define us, Ms GA. What deeds of concern and caring for the public these politicians serve show this to us? Ram the bill through before the end of March for the Easter recess and not face the very constituents who do not support the legislation that affects the ENTIRE country? That is what Ms Pelosi’s chief of staff was caught telling people over the weekend. Now that is responsible representation!
    And telling people to sacrifice their jobs just for the sake of legislation that was not transparent in the first place? Do you read what are the facts here, ma’am?
    Yeah, like I said, the supporters do more than mystify me. They disgust me, because their deeds are about the needs of the few screw the needs of the many.
    Maybe if you were one in the majority, you might write differently. But, your deeds, by your writings, seem to reveal yourself.
    Answer me this, Ms GA or other defenders, why does it take four years for the actual impact to begin?
    Watch the spin doctors, objective readers. Hence the term, their pontifications just make the heads of rational and realistic listeners spin.
    By the way, the 21% cut in Medicare funds that have now kicked in, now that is another deed that just motivates all us doctors of the cloth to open our doors and embrace our vow of poverty.
    Every one who is NOT a doctor, not losing money in this “deal” is quick to criticize us for raising questions and asking for accountability.
    I look forward to all you non doctors treating the 30 million uncovered citizens so much more effectively than us!!!

  21. Business, you see, has seduced our politicians. Like your typical Kansas flatlander, Business is too dull to realize what is in its own best interests. They need a good PowerPoint presentation with the overhead projector to lead them to an appreciation of the burden HCR would lift from them. But what of these economists who keep droning on that we are surely doomed if we don’t reverse the decline in industrial production? How do we do that if we increase the amount of production allocated to consumption? And, when all is said and done, and all the flow charts tracked, doesn’t HCR result in increased consumption? But isn’t subordinating consumption to production just “trickle down economics”? Tantamount to proposing that we are collectively benefited if Catepillar manages to increase its share of the world market? How ethically distasteful. On the other hand, doesn’t this frenzy of Krugmanian borrowing and printing seem rather too much like self levitation?

  22. Democrats should be concerned about using the very little used reconciliation process to pass their very partisan health care reform bill. The current Senate bill is very unpopular as a result of bad policy decision on the part of Democrats combined with poor messaging. Taking out the popular public option — while fighting to keep the very unpopular individual mandate as well as the excise tax on benefits and cuts to Medicare — was an extremely stupid political as well as bad policy decision. What the Democrats are proposing just flies in the face of logic. Most people know that you can’t cover the health care costs of millions of more people while at the same time reducing costs. Even the CBO analysis has indicated that premium costs will go up not down. Not only that President Obama recently admitted that the millions of people who like their current plans may lose them if his bill passes. Not good. If the Democrats had any common sense they would kill the bill and start over with a true bipartisan bill.

  23. Let’s see Dr. Exhausted, when elected representatives put their personal reelection ahead of what they thing is good for the people, they are bastards. When someone calls on them to put the people first, she’s an “insensitive bitch”. Interesting notion…..
    And why stop there, the constituents are also “clueless, insensitive”. Hard to imagine that sensitive people would genuinely want to reduce hardship for those less fortunate. Very interesting notion…..

  24. Good analysis and relevant data from polling from Mr. Taylor.
    On the other hand, the data reiterate what is anecdotally obvious if one talks to any average USA voter in regard to almost any aspect of the USA healthcare system – near complete lack of understanding of current functioning of the healthcare system not to mention the slightest clue about what is in any bill or how that bill might affect the system overall or in most cases a particular individual within the system.
    That lack of understanding amazingly applies to many physicians as well.
    In the case of politicians in Congress it is somewhat difficult to know whether many have much of an understanding themselves or whether they simply repeat the slogans they are assigned by their Party.
    In the case of Republicans, it appears that most if not all have no clue about the system nor the slightest concern about doing anything positive that benefits the population as a whole. To a lesser extent that may hold for most Democrats as well although there is likely at least some concern about the impact on the population, but even there not that much.
    The pending bills more than not simply continue the status quo.

  25. I just do not understand how reasonable and fair individuals should trust a legislative body that has not shown much if any transparency to how the legislation was created, and how some specific politicians overtly used extortion to “get my vote”. Come on folks, when people are caught cheating or manipulating, for every act revealed, there are numerous ones that have gone unnoticed, under the radar.
    And that is why I just don’t get the supporters who want to make the issue more obtuse by using arguments like “the public doesn’t understand this” or “you have to trust the legislators to do what is right.”
    Well, there is some truth to this! I do not understand how this batch of legislators could be so reckless and insensitive, and I do want to trust my representatives, just not this current batch in office now.
    When the majority, and this is not about 50.0001% of Americans do not support this legislation as is, but moreso 60-65% do not, that should get the attention of invested representatives. The problem is, this current crop of representatives are invested. In their reelection and special interests.
    By the way, did anyone catch Nancy Pelosi asking her party members to vote for this legislation, even if it does lead to such individuals losing their seats in November? Talk about a hypocritical, insensitive bitch! She knows she is fine, because she has a clueless, insensitive constituency who will reelect her until she dies or retires. Note how I worded that! Because now that she has tasted the priesthood of Speaker, she ain’t goin’ anywhere! Well, maybe her party “colleagues” will thank her with a NO vote and then dump it on her, and if they, as the Democrats, lose majority status in November, welcome back to the Minority, you lame bitch!
    This is written by a true independent, moderate voter!!!

  26. There is nothing “confusing,” to those who will be footing the bill, about the creation of a ruinous entitlement for the primary benefit of the party faithful.

  27. fyi, there are de facto “death panels” in the Dems HCR bill. You cannot cut 500 billion from the Medicare budget and use the “savings” to help fund another entitlement program without slashing life saving Health Care Services for Seniors. That is what the analysis of Richard Foster, the chief actuary for the Centers for Medicare and Medicaid Services essentially concludes. Quote: “Over time, a sustained reduction in payment updates, based on productivity expectations that are difficult to attain, would cause Medicare payment rates to grow more slowly than, and in a way that was unrelated to, the providers’ costs of furnishing services to beneficiaries.” In other words ObamaCare is “paid for” only in the sense that Medicare’s payments to doctors are assumed in the bill to be cut by more than 20% this spring and even deeper after that. Which will be equivalent to throwing Grandma into a “death camp” so the Dems can brag about creating their vision of Health Care “utopia” on earth.
    Mr. Foster’s analysis also shows that national health spending will rise under the bills by $222 billion over the next 10 years. In other words, ObamaCare really does “bend the cost curve” up. That $222 billion is a net figure, even after accounting for the fact that most of the newly insured 18 million people will be dumped into Medicaid, “where provider payment rates are well below average.”
    This is how government price controls would work in practice, costs are cut by slashing life saving health care services to the people that need them the most. Mr. Foster says many providers will be forced to stop accepting patients who are insured by the government, as opposed to those who have private coverage “with relatively attractive payment rates.” The resulting two-tier health-care system “should be considered plausible and even probable initially.”
    As for the White House’s promise that it will reduce health spending painlessly by cutting “waste,” Mr. Foster isn’t buying it. He writes that “we find the language as it now reads is not sufficiently specific to provide estimates.”

  28. With no Public Option in the Senate Bill the House Dems who voted yes on the bill would be better off voting no now. The Public Option as configured now (in the House version) isn’t anything to be proud of anyway. IF (and that is a big IF) they do pass something, I’m sure it will be a PO in name only, as the insurance industry will once again pull the strings of their puppets and have it be setup so that the PO takes all the sick people off the for-profit companies hands, so they can have even more profits by only insuring the healthy. Anyone wanna bet on that little scenario?

  29. Those relatively simple concepts are both bankrupt. Someone simply forgot to lock the lockbox. Someone overpromised and now will have to underdeliver.
    Why would anyone trust this same sausage factory with money they did not need to give them to “hold on to”? When you ned your money do you want to have it and use it when you want it, or count on the Harry and Nancy Sausage Factory to make good on a promise you bought into?
    Pelosi can probaly find the votes she needs, since so many of her minions are toast already, they might as well go out taking one for the team.

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