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Consumers to Pay More Under Reform

The latest analysis of health care reform – out this week from bean counters at Medicare – shows reform will raise health care spending slightly over the next 10 years, not reduce it as promised by President Obama. That won’t make selling it on the stump any easier. Yet there’s a glimmer of hope in the out years of the 10-year projection that the plan will begin to “bend the cost curve.”

Here’s the real bad news for reform supporters. The private insurance market will absorb most of the increase, and most of that will fall on individuals. Employer contributions for their workers’ private insurance will actually fall $120 billion in 2019 from previous projections because of reform.

Individuals will get hit two ways. First, the actuaries at CMS are projecting a huge 9 percent increase in out-of-pocket expenses in 2018 and 2019, after the so-called “Cadillac tax” goes into effect. This is a steep excise tax on high-cost insurance plans. To avoid tax penalties, experts expect employers with such plans – which may only be high-cost because they are filled with sicker and older beneficiaries – will reduce coverage by increasing co-pays and deductibles.

A second factor driving out-of-pocket expenses higher for individuals under reform will be the insurance mandate, which will drive many people to seek coverage through the new state exchanges. CMS predicts over 30 million people will be getting insurance through the exchanges in 2019, substantially more than the 24 million projected by the Congressional Budget Office last March, when reform passed.

While low- and moderate-income individuals and families can get subsidized plans through the exchanges, most of those subsidies will only be partial. And many of previously uninsured who will be required to buy insurance won’t be eligible for a subsidy at all.

If you dig deep into the CMS numbers, though, there is a silver lining for reform supporters.

Health care’s share of the domestic economy in 2019 will be higher than it would have been had reform not passed, according to economists at the Centers for Medicare and Medicaid Services. Health care will claim 19.5 percent of gross domestic product that year, not the 19.3 percent the same group predicted last February, before reform passed.

Overall spending on health care is expected to grow by 6.3 percent on average over the decade, which is still about twice as fast as the rest of the economy.

If you dig deep into the CMS numbers, though, there is a silver lining for reform supporters. The rate of spending is expected to slow considerably near the tail end of the decade, as the initial costs of adding 32.5 million people to the ranks of the insured begin to moderate and the projected savings in Medicare take full effect. That bodes well for the second decade of reform – assuming the Democrats can keep its provisions in place.

A continued ratcheting down of payments to hospitals and physicians would jeopardize seniors’ access to services.

These latest projections also offer solace to those primarily concerned about federal taxes and Medicare solvency. Medicare spending will decline $86.4 billion from previous projections due to reforms, the report said. “The lower payments from improvements in productivity and lower Medicare Advantage payments will more than offset the phase-out of the donut hole (in the Medicare prescription drug benefit),” said Andrea Sisko, who presented the data for CMS.

The August Medicare trustees report expressed a lot of skepticism about the agency’s ability to achieve productivity savings. It warned that a continued ratcheting down of payments to hospitals and physicians would jeopardize seniors’ access to services. But Richard Foster, chief actuary for CMS, said at a press briefing yesterday that this was primarily a long-term concern. “Within the next 10 years, most experts think the productivity updates are feasible,” he said. “The real question is what happens in the longer range.”

So, if Medicare spending is going to be less than expected over the next decade because of reform, whose payments are going up? Interestingly, it’s not projected to be state and local governments, which combined will see only a $10.6 billion increase over the earlier projections because of reform, according to the CMS economists. While more than half of the uninsured will be getting coverage through Medicaid programs, the federal government is picking up 90 percent of the new Medicaid tab, with its share being offset by the savings in Medicare.

Merrill Goozner is a regular contributor to THCB. You can follow his work here and on the insightful GoozNews. This story first appeared in The Fiscal Times, a site that has been catching our eye increasingly of late.

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32 replies »

  1. Dr Vickstrom:
    Not sure if you will read this if your last post is your last attendance to this site, much less this thread itself, but you are right, and it is why at least for me, as a moderate and independent thinker politically and culturally, I tired of this polarity bashing we have to put up with. These idiots are focused on party principles first and often only, and if benefits the population at large, “oh, that’s nice.”
    I read an article today in Psychology Today that tries to draw a relationship to the pursuit of fast food to the quick fix mentalities of our culture, and that is just one element. Computers, phones, ATMs, GPSs, and whatever else is focused on immediate needs gratification, we as a species are just instinctively dependent and hedonistic, and now this alleged technology and innovations just put more figurative needles on the table to shoot up with!
    If we could fix health care and make it a better experience, it would take too much time for the majority of the participants to stay invested! Because it did not happen overnight, but, the public has elected representatives that truly reflect their mentality as a whole, and that is fix it yesterday so we can be fine and dandy!
    Well, I am a fan of George Carlin, who wisely noted it was not the politicians who suck, but, the clueless and idiotic public that voted for them! I just want to add the nefarious and clueless advocates of the system who have no real interest in the needs of the many, just the wants, of they themselves!
    Maggie Mahar, I honestly cannot read your comments any more, they are beyond absurd cheerleading. You are the testimonial to the adage “hear the lie enough and it becomes the truth”. This legislation will not save money, nor lives that might have been responsibly meant to be saved, and certainly not be efficient and efficacious.
    But, enjoy the color of the sky in your world. In mine, I call it night!!!

  2. “Then what will the liberal politicians do for their money fix?”
    Same as Republicans, corporate America, you know, the ones saying government’s not the answer – we are.

  3. “The fact that you romanticize farm chores only exposes you for what you are.”
    And that is? Do we need to wait for the continuation post next week? I sure hope that wasn’t really the finale, I don’t think I could go on not knowing how it ends.
    Is it just me or is it ironic that you follow that up with;
    “I thought I was going to get serious discussion of issues from people who knew what they were talking about, but did not. It’s just one partisan troll after the next, ad hominem attacks, followed by people who think they understand health care.”
    Ad hominem abuse (also called personal abuse or personal attacks) usually involves insulting or belittling one’s opponent in order to invalidate his or her argument, but can also involve pointing out factual but ostensible character flaws or actions which are irrelevant to the opponent’s argument. This tactic is logically fallacious because insults and even true negative facts about the opponent’s personal character have nothing to do with the logical merits of the opponent’s arguments or assertions.
    Now I will grant you that maybe you didn’t do that prior to posting on THCB, maybe you realize the person you are becomming after being exposed to THCB and want to nip it in the bud, but it is still ha ha ironic when you read it.
    What did you expect, this blog is ran by a Brit, have you seen how their parlament behaves?

  4. “the entire system collapses of it’s own greed.”
    Then what will the liberal politicians do for their money fix? If they can’t borrow billions from worthless insurance promises how are they going to fund all their socialist dreams?

  5. @Nate,
    How pathetic. Yes, choring at my grandparents’ farm was not the highlight of my life. Yes, the smell does attenuate when you live with it. I didn’t, as I only visited. The fact that you romanticize farm chores only exposes you for what you are.
    This is probably my last post at THCB. I thought I was going to get serious discussion of issues from people who knew what they were talking about, but did not. It’s just one partisan troll after the next, ad hominem attacks, followed by people who think they understand health care.
    It’s also full of a bunch of chickens who will not post with their full, real names. This is supposed to be serious, not the World of Warcraft discussion boards. My bad.

  6. As a life and health insurance agent in California, I doubt we will see to much more of these double digit rate increases. Health insurance will become a luxury for the rich, which in turn will price it even higher until the entire system collapses of it’s own greed.

  7. Nate, getting great deals on standard assembly line procedures may be one thing, yet I don’t want to put my healthcare in the hands of a car salesman that looks to lure you into the showroom with price hooks. If you think docs are hard to rate by price try dentists, I’ve had about a 90% failure rate on dentist hunting, and price is he last I consider. You may want to send your clients employees to the lowest price huckster but I wonder how the employees feel about it. and if things don’t turn out the way you expected can you just return it to the customer service counter?

  8. “Nor will it ever be “designed” that way. Would you like to see docs advertising; “$99 down, $399 per month, no interest,”
    You live a blissful like Peter, if they can do it for lasik, breast augmentation, dental work, and many other procedures why do you find it so far fetched?

  9. “..something that our current system isn’t designed to do.”
    Nor will it ever be “designed” that way. Would you like to see docs advertising; “$99 down, $399 per month, no interest, for the best by-pass surgery money can buy”? Docs don’t want to discuss price, let alone quality (if it can be defined). This isn’t retail, nor should it be.

  10. I don’t believe you can achieve productivity savings by dictating to providers – from the top down – how to practice medicine in more efficient ways. It’s akin to consultants telling a faltering Kmart to merely act like Walmart. Kmart undoubtedly would operate like Walmart if it was capable of doing so. To achieve productivity gains firms have to compete on price and quality – something that our current system isn’t designed to do.

  11. ” See Media Matters here on Peterson’s “lies” about Social Security.”
    WOW that is rich, go to a far left Soros funded propoganda site to prove the conservative is lieing. Why don’t we just ask the DNC Maggie and save the charade?
    “CBO has some hard numbers which suggest that reform will pay for itself.”
    Please who do you think falls for this any more? Yes CBO, based on the assumptions they are forced to use by the people who wrote the bill claiming it will save money, found the bill will save money. All that analysis proves is the people who wrote the assumptions did a good enough job to cover the cost on paper. A CBO estimate based on required assumptions would never hold water outside the DC propoganda wars.
    “The Affordable Care Act addresses both problems. First, the legislation establishes The Center for Medicare and Medicaid Innovation (CMI) to test pilot projects”
    We were told the same BS when they changed their name to CMS. They have been doing pilot projects for 30 years and we can all see how those have panned out. Reform has never turned out like they promised on paper and always cost 10 times as much. To ignore this fact is nilihism.
    “In other words the Secretary of HHS does not have to go through Congress: if a pilot project is successful, she can roll it out nationwide. This represents a radical change in the law.”
    Radical new opportunity for abuse and waste. Before if CMS wanted to waste money they needed to get Congress to agree, not easy to do, now these quack politicians that have never worked a day in the industry can spend billions of tax payor money on hair brained schemes Congress would never fund. Think of everything stupid congress has ever wasted money on and then imagine how much worse it would have been if some political appointee could have done it without congressional approval. And Maggie thinks that will save money….

  12. ” The comments here at THCB smell of the chicken coop.”
    Are you saying there is a problem with the way Chicken coops smell? Sounds like something a snobby big city doc would say. Suppose you got issues with the pig pen and cow manure as well?

  13. “What exactly is the meaning of “sustainable” in this context?”
    Sustainable meaning the product will never reach a price higher then the majority of customers are willing to pay.
    For example there are numerous changes underway in the way small businesses buy insurance, and none of them are just passing on the cost. Small employers are joining PEOs, self funding, and taking other steps. These are all actions the majority of small businesses refused to take 2+ years ago becuase they were willing to buy insurance at the cost without them. Now that the cost has increased and income dropped and what ever else effects their decision, has changed they have asked the market for solutions and the market has delivered them. Without customers the market would not exist so the market must always provide a product its customers can afford.
    “I’m pretty sure that without any reforms the total cost of health care would be much lower today, and so would the total number of people receiving adequate health care.”
    You would be terribly wrong but it is a common mistake made by people that don’t really know and work in the delivery of insurance. The lower the cost of health insurance the more people have it. The more people that have insurance the higher overall level of healthcare. 10 or so years ago plans started being required to cover fertility treatment which is very expensive and also leads to very many expensive births. Not being able to have a child is not a negative healthcare condition, you can live your entire life and not have a kid. The cost of mandating this coverage though raised the cost of healthcare moving thousands if not more people fromt he insured ranks to the uninsured.
    Drugs and treatments that extend life for weeks or months have cost tens of thousands of people their coverage. Again the people died just like they would have only slightly later, mandating these benefits didn’t improve anyone’s health but it did degrade many’s.
    COBRA was very poorly written, surprising isn’t it, and lead to hundreds of millions in legal expenses and BK’d some plans again costing thoudands of people insurance. Attorney fees and years in court don’t improve healthcare, if the bill had just been clearly written it all could have been avoided. Reform drives uninsurance which drives lower healthcare outcomes.
    “When the market is allowed to freely “self correct” itself until finally health care insurance and services are restricted to the healthy and the wealthy, we should see major improvements in “bending the curve” for the exceedingly efficient private sector.”
    Margalit this is just an ignorant statement and you know better. Insurance has no problem covering sick people if they are allowed to charge a fair premium that allows them to stay in business. If people were required to buy the insurance before they became sick insurance has no problem paying the bills when they do. Healthy and wealthy is a very small population and would not leave many customers. Any half inteligent business person rather make $1 for 300 million people then $10 on 100,000 of them. If someone was dumb enough to beleive your logic in that particulat statement auto insurance would only cover those that have never been in an accident. Why when your capable of having lucid debate do you insist on reverting back to mindless propogandizing? Easily disproven statements like your last one just call into question your valid points like those prior.

  14. First, Merrill is an excellent reporter and I have great respect for his work.
    But its important to recognize two things.
    –1) Any projections about what reform will cost and how much it will save are, to a large degree, wild guesstimates. No one knows how employers, employees, the uinsured, hospitals, and other care providers will behave. Will providers respond to incentives to reduce errors and waste? Will they respond to penalties if they don’t reduce errors and waste? How many people will sign up for insurance? How many will pay penalties? Where will unemployment be in 2014? Are we heading into a deflationary recession (as some suggest)?
    –2) the Fiscal Times, where this story first appeared, is owned by Pete Peterson, a far-right fiscal conservative.
    And while Mr. Peterson says he does not influence editorial policy, see this Reuters story suggesting bias in the way the paper has covered Elizabeth Warren. http://blogs.reuters.com/felix-salmon/2010/08/16/the-fiscal-times-vs-elizabeth-warren/
    (This is only one of many such stories.)
    When it comes to projections as to how much health care reform will or won’t save, Peterson is adamant that we
    must make further cuts to Medicare in order to reduce the deficit. Therefore, he downplays the savings that reform will bring.
    For many years, he has opposed “entitlement programs” including Social Security and Medicare.
    Since the 1980s, Peterson has been claiming–falsely-that SS is heading for insolvency. See Media Matters here on Peterson’s “lies” about Social Security.
    http://mediamatters.org/research/20050113000
    )
    I first became familiar with Peterson in the late 1980s, when I was covering Wall Street. There, his reputation is, at best, checkered. To quote from Fairness and Accuracy in Media: “Ken Auletta’s book, Greed and Glory, about the near collapse of Lehman Brothers in the 1980s, describes Peterson as, in the eyes of his partners, an arrogant bungler dying to make killings in leveraged buyouts, an obsessed reactionary, a name-dropping snob and, all told, so much a pill that his partners paid him $18 million to get rid of him.”
    As Fairness & Accuracy reports, he has made a “crusade of courting liberal jouranlists.” He is very clever at this, and will say whatever said jounalist wants to hear. Lately, he has been masquerading as a liberal. But his agenda never changes: to gut Social Securiity and Medicare.
    Back in 1996, Peterson was talking about privatizing Social Secruity–cut the payroll tax and let individuals invest the money in the stock market. If you recall what happened in 2000 . . . . and what has been happening recently. . . . This is one reason why some people on Wall Street view him as a crackpot.
    Turning to the question of how much reform will cost and how much money it will save. . . CBO has some hard numbers which suggest that reform will pay for itself.
    Cuts in payments to for-profit medicare advantage insurers ($132 billion); reduced payments to hospitals to help them cover the uninsured (since there will be fewer uninsured we can cut those payments)($32 bilion); new Medicare taxes on individuals earning over $200,000 ($210 billion); new fees that insurers have agreed to pay ($88 billion over 10 years); new fees pharma has agreed to pay ($27 billion); a new excise tax on devices ($???); penalities that individuals and employers will pay if 0hey decide not to sign up for insurance ($???); reduced administrative costs for insurers who will no longer need underwriters or, in most cases, insurance brokers ($????)
    Those are the savings– most of them fairly definite– that lead CBO to estimate that the reform plan would reduce the deficit by some $143 billion over ten years (2010 to 2019), (see http://www.cbo.gov/ftpdocs/113xx/doc11379/AmendReconProp.pdf, ) while expanding coverage to 32 million Americans who are now uninsured. Over the following ten years (2020 to 2029), CBO projects that reform would pare the deficit by $1.2 trillion.
    In addition, there are huge potential savings that cannot be estimated because they will flow from unprecedented structural changes in how we pay for care (moving away from fee-for service, paying for value, not volume) and how it is delivered (accountable care organizations, twice as many community clinics as an alternative to getting care at an ER, etc.)
    , Medicare Chief Actuary Richard S. Foster explains: “Many of the provisions, particularly the coverage expansions, are unprecedented . . . Consequently, little historical experience is available with which to estimate the potential impacts.” Moreover, “The behavioral responses to changes introduced by national health reform legislation are impossible to predict with certainty. In particular, the responses of individuals, employers, insurance companies, and Exchange administrators to the new coverage mandates . . .” http://www3.cms.gov/ActuarialStudies/05_HealthCareReform.asp
    Exactly. WE’re talking about trying to predict the “behavioral responses” of milions of individuals. . far into the future. And the biggest savings in the reform legislation will come from these unprecedented structural changes.
    As Peter Orszag points out
    : “The Affordable Care Act has the potential to fundamentally transform our health system into one that delivers better care at lower cost. This potential isn’t fully captured in CBO’s numbers, and that’s appropriate. CBO produces its estimates based on what has happened in the past, and we have never enacted such a fundamental transformation.”
    In other words, CBO didn’t even try to “score” these savings. And this is approprpiate. But to suggest that none of these changes will save money is to take cynicism to the point of nihilism.
    Here, Orszag is talking about deep structural changes that will change what we pay for, how we pay for it, and how health care is delivered, both under Medicare and in the private sector. Many refer to these reforms as “Medicare Modernization.” Medicare will lead the way, but private insurers have already indicated that if Medicare reform works to save dollars, they will follow. They just want Medicare to provide political cover. And if costs in the private sector slow, this puts a lid on the subsidies that middle-income families will need, lowering the cost of reform.
    Both the Medicare Payment ADvisory Commmission and Dartmouth have documented how much waste their is in the system. Fee-for-service encourages over-treatment. Errors in hospitals cost us BILLIONs. (The most expensive and most common error? Bedsores. 90% to 95% preventable. Reducing bedsores is DOABLE. Using checklists, getting docs to wash their hands–all doable. Reducing unncessary tests. Refusing to pay for preventable readmissions. All doable. We WILL save money in many areas. It’s just imppossible to project how much we will save.
    We know that it is possible to shave costs and improve care at the same time because some communities are doing it already. http://www.healthbeatblog.com/2009/08/proof-that-american-physicians-and-hospitals-can-lift-quality-and-reduce-costs.html In the summer of 2009, a conference titled “How Do They Do That? Low-Cost, High Quality Health Care in America” highlighted success in ten very different cities across the nation: Sacramento, CA; Cedar Rapids, IA; Portland, ME; Ashville, NC; Sayre, PA; Temple, TX; Richmond, VA; Everett, WA; La Crosse, WI; and Tallahassee, FL. http://healthaffairs.org/blog/2009/07/28/low-cost-high-quality-care-in-america/
    And places like Geisinger, etc., have done it.
    If we know what we need to do to rein in health care inflation, why didn’t Medicare do it a long time ago?
    Two obstacles blocked Medicare reform for many years.
    1) Congress, acting as Medicare’s “board of directors”
    2) The fact that when health care providers became more efficient, offering better care at a lower cost, they lost revenues.
    The Affordable Care Act addresses both problems. First, the legislation establishes The Center for Medicare and Medicaid Innovation (CMI) to test pilot projects, and most importantly, stipulates that “the Secretary of Health and Human Services has the authority to expand the duration and scope of a demonstration, even nationwide” assuming she determines that the expansion would reduce spending without cutting the quality of care.
    In other words the Secretary of HHS does not have to go through Congress: if a pilot project is successful, she can roll it out nationwide. This represents a radical change in the law.
    In the past, Medicare needed congressional approval, and too often lobbyists persuaded legislators to delay or derail successful initiatives. After all, one man’s waste is another man’s income stream. For example, one demonstration project that tested competitive bidding for durable medical equipment between 1999 and 2002 discovered that the program reduced Medicare expenditures by 19% from what would have been paid under existing fee schedules. Although Congress authorized the CMS to expand the program, it postponed implementation until 2010. Presumably companies that manufactured the equipment were not enthusiastic about bidding that would trim their revenues. http://healthpolicyandreform.nejm.org/?p=3108&query=home
    It is worth noting that when voting to give the Secretary of HHS this latitude Congress chose to tie to its own hands. This suggests that, in their heart of hearts, many Congressmen recognize that they themselves represent the major obstacle to true health care reform. Like Odysseus lashing himself to the mast, legislators have chosen to defend themselves against the siren song of lobbyists.
    The second problem that has blocked past efforts to eliminate Medicare waste is that when providers become more efficient, their revenues suffer. As Dr. Brent James, the chief quality officer at Intermountain Healthcare, a network of hospitals and clinics in Utah and Idaho points out: “We discovered that . . . when you achieve cost savings, the money all went back to purchasers as windfall savings. I mean, your costs drop, but your revenues drop as far or further .Don Berwick hates it when I say this, but clinical quality improvement is a fast way to the poor house if you haven’t figured out a structured way to harvest back some of those savings.” https://thehealthcareblog.com/the_health_care_blog/2007/01/matthew_holt_th.html
    Eventually, Intermountain learned how to forge contracts with commercial purchasers that recognize and reward quality improvement efforts.
    Now, under the Affordable Care Act, Medicare, too, will share savings realized by providers that qualify as “Accountable Care Organizations,” offering better care for less.
    Beginning January 1, 2012, these ACOs can qualify for bonus payments if they achieve a threshold savings amount. This is just one way that the ACA is moving away from fee-for-service payment, realigning financial incentives to reward doctors and hospitals that provide better value ) for our health care dollars.
    I could go on. But I won’t.
    I’m sorry this is such a long comment. But, on this blog, so many people keep saying that there are no savings in the legislation. . . . It’s very frustrating. As Timothy Jost says, the only way they can say that is if they have never read the bill.

  15. ” .. Working on salary at a public hospital/clinic is the only way to practice halfway moral medicine in this country, IMO ..”
    Sir, many of us disagree, given the obvious waste of resources in U.S. government facilities.
    It is easy to the “high road” with other people’s money. Just this week, Fidel Castro criticized socialism as wasteful.
    http://www.telegraph.co.uk/news/newstopics/politics/7993466/Thanks-Fidel-but-youre-50-years-too-late.html
    Just look how the U.S. productive class — seeing the gross waste of resources in D.C. today — have refused to play Mr. OweBama’s silly, amateurish law school games. Result: NO JOBS.
    On Nov. 2 — the people will judge. It will not be a pretty sight.

  16. @Rick,
    Difficult to quantify. It’s actually difficult to sort out defensive medicine from patient reassurance, although those sets do intersect. I don’t actually keep count; not my job. I do know that I would happily order an infinite number of tests/consults/hospitalizations rather than defend one lawsuit. I know that I practice defensive medicine, on one level or another, with nearly every patient I see. Sad but true. With ER patients, it is 100%.
    For docs in private practice, who own their own testing equipment, this is complicated by the conflict of interest that is self-referral, but I don’t have that incentive, thank God. Working on salary at a public hospital/clinic is the only way to practice halfway moral medicine in this country, IMO. What makes that unsavory is the defensive medicine.
    And if you wanted credibility, you’d post with your full name. The comments here at THCB smell of the chicken coop.

  17. Mary MD — “Medicine cannot be practiced by committee.”
    Reasonable improvements can be made, in a timely manner.
    But not by a motley pack of TAX-HUNGRY Harvard Law mad-dogs. Who love SOCIALISM and ordering people around.

  18. Consumers are paying for the expensive HIT systems that are not improving outcomes. Harvard researcher s Jha and Himmelfarb have already published this in peer reviewed journals.

  19. Just out of interest J.S., do you pay for your health insurance as an individual or do you get it through your employment as part of a group plan?
    >> Not OWE-bama — EARN and PAY for self.
    “So fat people can smoke cigarettes and MJ, and guzzle beer on weekends.”
    I didn’t know private health insurance denied coverage to smokers (fat or not), MJ users, and weekend beer guzzlers.
    >> how do you think HC “deform” is being paid for, viz., smokers-dopers-piggies-boozers? SAPS like me have to pay! Are you paying attention?
    “just got my STATE-REGULATED medical insurance bill — TEN PERCENT increase.”
    What were your increases before “state regulation”?
    >> HOW LONG has “regulation” been around?
    >> When was the first TAX dollar STOLEN in Obama-town (Chicago)?
    >> Can you read broadly? Are there 23% INCREASES in the pipe? Is the sun, rising today? Is the Pope Catholic? Did Maggie Mahar interview an insurance CEO in 1993? Or 1994?

  20. Just out of interest J.S., do you pay for your health insurance as an individual or do you get it through your employment as part of a group plan?
    “So fat people can smoke cigarettes and MJ, and guzzle beer on weekends.”
    I didn’t know private health insurance denied coverage to smokers (fat or not), MJ users, and weekend beer guzzlers.
    “just got my STATE-REGULATED medical insurance bill — TEN PERCENT increase.”
    What were your increases before “state regulation”?

  21. Nate — just got my STATE-REGULATED medical insurance bill — TEN PERCENT increase.
    So fat people can smoke cigarettes and MJ, and guzzle beer on weekends. What a great country! /sarcasm/
    Heck’a job, OweBama. You one-term fool.

  22. WHO LIED?
    ” .. a 30 million plus population of un/under insured ..”
    WHOA! Six months ago, it was 47 million. Who’s lying?
    The American public is NOT paying for LIES.
    REPEAL — then REAL reform.

  23. “Actually private insurance never has unsustainable rate increases, the market is self correcting, when cost are higher then people are willing to pay…”
    Nate, I don’t quite understand your reasoning.
    This self correction is nothing more than dumping the increases in price on the public, or alternately rationing care (CDHP, HMO respectively). What exactly is the meaning of “sustainable” in this context?
    I’m pretty sure that without any reforms the total cost of health care would be much lower today, and so would the total number of people receiving adequate health care. This is the reasoning behind keeping those uninsured and under-served exactly where they are today and hopefully adding a bunch more.
    When the market is allowed to freely “self correct” itself until finally health care insurance and services are restricted to the healthy and the wealthy, we should see major improvements in “bending the curve” for the exceedingly efficient private sector.

  24. “It’s clear that physician mistrust of the flawed medical liability system has a profound impact on the practice of medicine. Defensive medicine, higher health care costs and reduced access will continue until proven legal reforms restore physician trust in the medical liability system.”
    Doctor Wilson, Florida has tort reform and where are some of the highest medical costs but Miami-Dade. http://www.time.com/time/nation/article/0,8599,1899898,00.html
    Docs won’t be happy until they get complete absolution from malpractice and errors and let harmed patients absorb the costs, then continue to bill to you drop healthcare business models.

  25. “Eliminate 90% of public plan fraud”
    Even if you believe that would cut Medicare costs by enough dollars to give us sustainability, why is private insurance so expensive with (as you claim) less fraud.
    “Personal responsibility”
    Great, nice phrase, everyone can agree on that – now put it into public policy that won’t piss off all the voters.
    “eliminate cost shifting”
    So raise Medicare costs so private insurers can charge less, or so goes the argument. Bogus I believe. How does that keep you from screaming about Medicare bankrupting the nation now that they’re paying even more for care.
    “education”
    Another nice word that everyone can agree with, again put it into public policy that will actually change attitudes and the healthcare culture in time to rescue us from financial oblivion.

  26. It’s strange that nobody is running ads that they voted for this. Andy Grifith had a advertisement about this and supposibly his popularity has dropped from supporting the healthcare overhaul.
    If this overhaul is supposed to reduce costs and instead costs are going up already, then it looks like to me a clear failure.

  27. The latest Harvard estimate of unnecessary costs generated by the nation’s flawed medical liability system affirms that real money can be saved with reforms.
    It is undeniable that the liability system has failed patients but is extremely lucrative for the trial lawyers who receive the lion’s share of jury awards. The flawed system invites abuse, inefficiency and persecution of the blameless. According to a 2006 Harvard study, 40 percent of lawsuits are filed without any evidence of a medical error or patient injury. http://www.hsph.harvard.edu/faculty/articles/litigation.pdf
    It’s clear that physician mistrust of the flawed medical liability system has a profound impact on the practice of medicine. Defensive medicine, higher health care costs and reduced access will continue until proven legal reforms restore physician trust in the medical liability system.
    The American Medical Association is committed to proven medical liability reforms that are already working in states such as California and Texas. As a result of AMA advocacy on the health reform law, for the first time the government has directed $25 million to further test promising proposals like health courts and safe harbors. Testing these proposal is necessary since only proven legal reforms will restore physician trust in the medical liability system, reduce the need for defensive medicine and produce significant savings.
    Cecil Wilson, M.D.
    President American Medical Association

  28. “don’t seem to want to remember that healthcare cost was rising unsustainably before reform”
    Which reform are you referring to Peter? This one in 2010 or the dozen other reforms passed since 1965? Oddly just like every other reform before it cost are once again rising after reform passes, it’s almost like there is some link between poorly written and thought out reform and cost.
    Actually private insurance never has unsustainable rate increases, the market is self correcting, when cost are higher then people are willing to pay changes take place, first PPOs, then HMOs, and this time CDHP. The only unsustainable inflation was in the public plans which lack the benefit of any market forces.
    ” How do reform opponents propose we substantially cut costs if it isn’t forcing lower prices and less use?”
    Eliminate 90% of public plan fraud
    Personal responsibility
    eliminate cost shifting
    education
    for starters.

  29. I, for one, would love to see an MD, such as Dr. Vickstrom, quantify exactly what they spend doing so-called “defensive medicine.” Which doctors’ orders, I wonder, are given knowing that they are not supported by clinical evidence, and without concerns for the patient’s health or cost-share, yet with a concern for the doctor’s exposure to lawsuit? And at what cost to payors and patients?
    The September issue of Health Affairs contained a study which put the figure at 2.4 percent of the nation’s $2.6 trillion healthcare tab. And another study from the Cutler Institute for Health and Social Policy at the University of Southern Maine found that a 10-percent reduction in medical malpractice premiums would reduce the nation’s total medical costs by 0.120% to 0.134%.
    Here at THCB, we have Dr. Vickstrom specifically citing the burden of “defensive medicine,” so I would love to hear from him, or any other MDs that post here, on specifically what they think their share of the contribution to the scourge of “defensive medicine” really is. I’m sure it would be enlightening.

  30. Detractors of reform, who say higher costs mean it’s a failure, don’t seem to want to remember that healthcare cost was rising unsustainably before reform, and we still had 30 million uninsured. Would those who say reform hasn’t cut costs (of which I’m one), be willing to actually institute cost controls – which would include lowering prices, getting seniors and others to use less (and getting them to pay more if they could afford it), getting the fraud out of physician billings and reining in hospital costs. How do reform opponents propose we substantially cut costs if it isn’t forcing lower prices and less use? They can’t say that tort reform alone will do this. Republicans were keen to play on senior fear when fighting this reform when they knew that reducing Medicare costs would mean less freedom for seniors to use as much healthcare for free as they wanted. Are opponents of reform now saying they support a 30 million plus population of un/under insured because otherwise it’s too expensive for the rest of us, who already have subsidized healthcare?

  31. I do hope that nobody who is familiar with our health care deform is surprised at this. We got insurance reform, not health care reform. No serious efforts to contain cost. Nothing to limit defensive medicine spending. Every dollar that goes to third party profit is a dollar leeched from the system. I thoroughly expect our current health car deform to crash and burn. This is what we asked for.

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