What Most Needs Repealing and Replacing

Tomorrow night the House of Representatives will debate the repeal of the Patient Protection and Affordable Care Act (ACA), what many call “ObamaCare.” Some critics complain that this is a futile exercise because there is little chance of short-term success. But that’s the wrong way to look at it.

At the time of its passage, most members of Congress had no idea what was in the ACA. Nancy Pelosi was more correct than she realized when she said, “We have to pass it to see what’s in it.” Even now, we don’t know half of “what’s in it,” but we know enough to have an intelligent debate. Ideally, tomorrow night’s proceedings will be educational — in a way that the debate last spring was not.

In anticipation of the event, representatives from the National Center for Policy Analysis, the Heritage Foundation, the American Enterprise Institute, the Cato Institute and the American Action Forum will conduct a briefing on Capitol Hill tomorrow at noon. Our goal: to discuss ten structural flaws in the Affordable Care Act. We believe each of these is so potentially damaging, Congress will have to resort to major corrective action even if the critics of the ACA are not involved. Further, each must be addressed in any new attempt to create workable health care reform.

1.  An Impossible Mandate

Problem: The ACA requires individuals to buy a health insurance plan whose cost will grow at twice the rate of growth of their incomes. Not only will health care claim more and more of every family’s disposable income, the act takes away many of the tools the private sector now uses to control costs.

Solution: 1) Repeal the individual and employer mandates, 2) offer a generous tax subsidy to people to obtain insurance, but 3) allow them the freedom and flexibility to adjust their benefits and cost-sharing in order to control costs.

2.  A Bizarre System of Subsidies

Problem: The ACA offers radically different subsidies to people at the same income level, depending on where they obtain their health insurance — at work, through an exchange or through Medicaid. The subsidies (and the accompanying mandates) will cause millions of employees to lose their employer plans and may cause them to lose their jobs as well. At a minimum, these subsidies will cause a huge, uneconomical restructuring of American industry.

Solution: Offer people the same tax relief for health insurance, regardless of where it is obtained or purchased — preferably in the form of a lump-sum, refundable tax credit.

3.  Perverse Incentives for Insurers

Problem: The ACA creates perverse incentives for insurers and employers (worse than under the current system) to attract the healthy and avoid the sick, and to overprovide to the healthy (to encourage them to stay) and underprovide to the sick (to encourage them to leave).

Solution: Instead of requiring insurers to ignore the fact that some people are sicker and more costly to insure than others, adopt a system that compensates them for the higher expected costs — ideally making a high-cost enrollee just as attractive to an insurer as low-cost enrollee.

4.  Perverse Incentives for Individuals

Problem: The ACA allows individuals to remain uninsured while they are healthy (paying a small fine or no fine at all) and to enroll in a health plan after they get sick (paying the same premium everyone else is paying). No insurance pool can survive the gaming of the system that is likely to ensue.

Solution: People who remain continuously insured should not be penalized if they have to change insurers; but people who are willfully uninsured should not be able to completely free ride on others by gaming the system.

5.  Impossible Expectations/A Tattered Safety Net

Problem: The ACA aims to insure as many as 34 million uninsured people. Economic studies suggest they will try to double their consumption of medical care. Yet the act creates not one new doctor, nurse or paramedical personnel. We can expect as many as 900,000 additional emergency room visits every year — mainly by new enrollees in Medicaid — and 23 million are expected to remain uninsured. Yet, as was the case in Massachusetts, not only is there no mechanism to ensure that funding will be there for safety net institutions that will shoulder the biggest burdens, their “disproportionate share” funds are slated to be cut.

Solution: 1) Liberate the supply side of the market by allowing nurses, paramedics and pharmacists to deliver care they are competent to deliver; 2) allow Medicare and Medicaid to cover walk-in clinics at shopping malls and other unconventional care — paying market prices; 3) free doctors to provide lower-cost, higher-quality services in the manner described below; and 4) redirect unclaimed health insurance tax credits (for people who elect to remain uninsured) to the safety net institutions in the areas where they live — to provide a source of funds in case they cannot pay their own medical bills.

6.  Impossible Benefit Cuts for Seniors

Problem: The ACA’s cuts in Medicare are draconian.  By 2017, seniors in such cities as Dallas, Houston and San Antonio will lose one-third of their benefits. By 2020, Medicare nationwide will pay doctors and hospitals less than what Medicaid pays. Seniors will be lined up behind Medicaid patients at community health centers and safety net hospitals unless this is changed. Either 1) these cuts were never a serious way to fund the ACA, because Congress will cave and restore them, or 2) the elderly and the disabled will be in a separate (and inferior) health care system.

Solution: Many of the cuts to Medicare will have to be restored. However, Medicare cost increases can be slowed by empowering patients and doctors to find efficiencies and eliminate waste in the manner described below.

7.  Impossible Burden for the States

Problem: Even as the ACA requires people to obtain insurance and fines them if they do not, the states will receive no additional help if the estimated 10 million currently Medicaid-eligible people decide to enroll. Although there is substantial help for the newly eligible enrollees, the states will still face a multibillion dollar, unfunded liability the states cannot afford.

Solution: States need the opportunity and flexibility to manage their own health programs — without federal interference.  Ideally, they should receive a block grant with each state’s proportion determined by its percent of the nation’s poverty population.

8.  Lack of Portability

Problem: The single biggest health insurance problem for most Americans is the lack of portability. If history is a guide, 80% of the 78 million baby boomers will retire before they become eligible for Medicare. Two-thirds of them have no promise of postretirement health care from an employer. If they have above-average incomes, they will receive little or no tax relief when they try to purchase insurance in the newly created health insurance exchange. To make matters worse, the ACA appears to encourage employers to drop the postretirement health plans that are now in place.

Solution: 1) Allow employers to do something they are now barred from doing: purchase personally-owned, portable health insurance for their employees. Such insurance should travel with the individual — from job to job and in and out of the labor market; 2) Give retirees the same tax relief now available only to employees; and 3) Allow employers and employees to save for postretirement care in tax-free accounts.

9.  Over-Regulated Patients

Problem: The ACA forces people to spend their premium dollars on first-dollar coverage for a long list of diagnostic tests. Yet if everyone in America takes advantage of all of the free preventative care the ACA promises, family doctors will be spending all their time delivering care to basically healthy people — with no time to do anything else. At the same time, the ACA encourages the healthy to over consume care, it leaves chronic patients trapped in a third-party payment system that is fragmented, uncoordinated, wasteful and designed for everyone other than the patient.

Solution: 1) Instead of dictating deductibles and copayments, give patients greater freedom to save for their own small dollar expenses in health savings accounts, which they own and control; and let them make their own consumption decisions. 2) Allow the chronically ill access to special health accounts, following the example of Medicaid’s highly successful Cash and Counseling program, which allows home-bound, low-income disabled patients to control their own budgets and hire and fire those who provide them with services.

10.  Over-Regulated Doctors

Problem: The people in the best position to find ways to reduce costs and increase quality are the nation’s 778,000 doctors.  Yet today they are trapped in a payment system virtually dictated by Medicare. The ACA promises to make this problem worse by encouraging even more unhealthy government intervention into the practice of medicine.

Solution: Providers should be free to repackage and reprice their services under Medicare. As long as their proposals reduce costs and raise quality, Medicare should encourage resourceful, innovative attempts to create a better health care system.

John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis.  He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.

Categories: Uncategorized

Tagged as: ,

39 replies »

  1. “a single-pay system would be the most efficient using the present tax system to collect payment at source.”
    Statements like this is why liberals should just be ignored when grown up decisions are required. I would hate to see what Peter considers an inefficient system.
    “In the United States, the IRS estimated in 2007 that Americans owed $345 billion more than they paid, or about 14% of federal revenues for the fiscal year of 2007.[4]”
    It would be interesting for someone with a college degree to estiamte what would happen if you combine 10% payment fraud, like Medicare has, with 14% funding fraud like our tax system has. Is that 25.4% total fraud or would it compound differently?
    Peter if 25.4% is efficent then what would be inefficient?

  2. “where was this discussion and presentation from Republicans during the ACA debates?”
    Peter are you really that ignorant of how congress works? If Reid doesn’t allow a presentation there is nothing Republicans can do to make one but call a press conference on the steps and hope the media reprots it. Same with Pelosi. Its scary that people as poorly informed as you are actually allowed to vote.

  3. Nice projection by a lawyer, Peter, regarding fearing not having control over all 100% of your life. You know, many doctors chose medicine partially for having some autonomy, but legal intrusions have basically ruined that as an option.
    Jumping up and down shouting “hurray, hurray”, eh, Peter?
    Don’t get sick after 2014, unless you can perform surgery on yourself or figure out how to write for your own antibiotics. Or, watch a couple of segments of “1000 ways to Die” on Spike TV for some ideas of how to treat yourself.

  4. “Over regulated Doctors” resonated with me most as it is true – not one new doctor is created yet it feels like the doctors will have to spend MORE time performing heroics in paperwork than with patients.”
    Ever look at the heroics in paperwork created by the private insurance industry? Doctors always fear anything they don’t have 100% control of, that includes medicine. Bitch, bitch, get another profession and see if life gets easier.

  5. Thank you for this extremely well, thought-out post. “5. Impossible Expectations/A Tattered Safety Net” and “10. Over regulated Doctors” resonated with me most as it is true – not one new doctor is created yet it feels like the doctors will have to spend MORE time performing heroics in paperwork than with patients.
    Did you see the study/survey out yesterday regarding doctors ‘fearing’ healthcare reform? http://www.myfoxboston.com/dpp/news/national/us-doctors-fear-health-care-reform-study-claims-25-ncx-20110119
    Portability and a burden on the states are next on my list. All in all, thank you for 10 points that really summarized what the issues are.

  6. I agree, where was this discussion and presentation from Republicans during the ACA debates? I see most of John’s proposals keeping the present tiered access system so that wealthy Americans continue to get all the health care they want, and lower income citizens must still struggle for affordable care and access. His proposals also do nothing to cut national health costs.
    He also misses the facts. The fine for non-purchase of insurance is actually the GREATER of $695 to a max of $2085 or 2.5% of income – no small fine. Of course a single-pay system would be the most efficient using the present tax system to collect payment at source.
    I also like how conservatives like John talk about “Impossible Benefit Cuts for Seniors” and fear mongered seniors to oppose ACA but out of the other side of their mouths they scream how Medicare is bankrupting the country. Pick a side John.

  7. “a) any test that was done recently by another provider would be a good start. Administering medicare supps we would always see the same test being ran by multiple providers.”
    1) Incentives matter. Docs, when they financially benefit from the tests, are incented to perform them. Of course the part you miss, is the office staff time, hence money, it takes to deal with private insurers to get pre-approvals. Again, much more of my billing costs go to dealing with private insurer problems than Medicare.
    2) A lot of tests are repeated since we cannot get access to the old ones in a timely fashion. Waste? Sure, but one that will not be solved absent some govt intervention. Those tests I cannot get are at competitor hospitals.
    3) Data from private insurers is actually kind of hard to come by. Actual fraud and abuse for them is not accurately available IMO.
    4) Multiple administrations in many states have administered Medicare/Medicaid. They all have motivation to eliminate WFA. It’s jst not that easy.

  8. Thanks for the response. I was not criticizing Dr. and Dr. Schwartz, but the reporter who made the false connection between the problems the docs face and the ACA.

  9. Thank you for the disclaimer. And, it is now 2011, we still do not know the entirety of the facts to this bill, and yet it seems to be more likely truth than falsehoods about costs, and misleading conclusions by the CBO that Democrats still use as defense today.
    I just want to know, will you contact the Schwartzes to let them know they at least are not accurate in what they report to the press, because you have all the facts and know better?
    That is how your comments come across!
    Hey, I’ve been doing Locum work for the past year plus, have no investments in any health care related businesses, and take care of my patients to the best of my training and abilities, and NEVER focus on money as a driving force to treatment interventions. Naive? Yeah, a bit. Honest? Definitely. Outraged to see politicians try to drive another nail in our coffins as doctors to do our jobs responsibly and ethically appropriate. No doubt! Disgusted to see colleagues sign off on this crap legislation either for own self interest or sheer apathy and neglect? Eternally!! This legislation has as many detriments as benefits, which makes its value as much as a fecal impaction to me!!!
    It needs to be passed into the toilet, flushed, and a new meal prepared for an invested public to digest. Good laws have little detriments. This society is heading more and more to a “Logan’s Run” mentality, give it up once you hit 30 for the silent benefactors of the society who don’t practice what they preach. Is that what you want, pcp?

  10. “To tell readers to not read an article, to not make the time to independently read a legitimate story”
    All I did was make a recommendation. An article that blames “Obamacare” for the problems these two doctors have with private insurance company pre-auths is problematic, to say the least.
    “fully digested it to summarize it to your alleged conclusion it being 906”
    Nothing alleged. It’s a fact. The bill is 906 pages, with enormous margins.
    “And my guess is ‘pcp’ here has figured out how to benefit from it”
    Please note that I have NEVER said I support this bill. I’m in a two doc, non-boutique private practice. I have no idea how to “benefit” from this bill. I have never been a member of the AMA, which I think is one of the most destructive forces in medicine today. I just strongly feel that any discussion of the ACA should start from facts, not from myths.

  11. I have two issues with commenters like you in your above statements:
    1. To tell readers to not read an article, to not make the time to independently read a legitimate story, because they should take your opinion as the one and only faith is beyond presumptuous, it is demeaning, like the Democrap rhetoric behind this debate now in the first place!
    2. While I am impressed, if you truly read all of what, 2400+ pages, and fully digested it to summarize it to your alleged conclusion it being 906 “low-text density”, then why did it not get slimmed down to this 40% size figure in the first place? I’ll tell you my opinion, readers, because it is a lawyer drafted document that is literally full of sound and fury, except it signifies TOO much and using pages of excessive wording to cloak the falsehoods that are now being exposed.
    And my guess is ‘pcp’ here has figured out how to benefit from it, and adds his/her voice to distract and deflect from what are detriments in this bill.
    And, I am sick and tired of the defense that these few legitimate perks, like forcing insurers to take everyone without exception per past med history or attempting to insure those without current coverage AND looking to be covered, drown out the other facts like costs will not be contained and employers can’t provide coverage as the bill progresses, as lied to by the benefactors!
    Back at ya, pcp, I want my facts transparent and disclaimers made to the readers. Most of you advocates and apologists for this legislation are strangely silent when asked to be transparent and provide disclaimers. Responsible readers take note of that!

  12. DeterminedMD:
    If you would read the bill, as I have done, you would find that it is 906 low-text density pages. Long, but well within the normal range for a piece of legislation.
    You would do well to get your basic facts straight before beginning your rants.

  13. The article discusses the Drs. Schwartz:
    “Lately, they’ve faced their share of challenges, including some that are a result of Obamacare”
    That’s total BS, so don’t waste your time reading the article. The problems the Schwartzes (and most other doctors) are facing have nothing to do with the ACA.

  14. Also, read this link at the washington examinier by Tina Korbe today, I think it says nicely what is going on with physicians on the front line, not the disgusting false rhetoric by corporate medicine that supports this montrosity legislation, like the AMA lackies!!!!
    hope the link works!

  15. “We have to pass the bill, , ,so that you can find out what’s in it” was the sound clip you provided, Vikram.
    In a follow up comment, I said clearly that she said “you” as you noted, but how does that validate and defend the way the bill was handled and passed, SIR!? And I put those commas in the quote to show readers how she hesitates before finishing the sentence, because perhaps her superego tried to help her present this perverse intrusion into our lives as something of some value, but, her narcissist id mentality prevailed and insulted us yet further.
    And, I love your further clarifications of “Senators don’t read or write bills. Their aides do”, and “The bill has been there for months and I doubt more than few hundred from public (??) would have read it even now. NPR aired all proceedings of commitees. So good enough information was available to those interested”.
    Wow, even if it was true that NPR aired the alleged hundreds of hours it took to craft a 2400 page bill, which they did not, readers, NPR as the source, a democrat hack organization who only tows the party line (which is Vikram’s role here too by the way) is not a defense. And how can you smugly and righteously claim that our representatives do not read or write the bills that affect us? I know that is true, but how disgusting and pathetic that is the status quo in DC, and voters like you use it as a justification to support people in or running for office.
    George Carlin was totally on the mark when he noted it wasn’t the politicians who suck, but the public. The Vikrams of our community aren’t interested in public service, but just public disservice. The slogan for reelection for what slithers in DC should be, “the public sucks, screw hope, cause I am here for me!”
    By the way, sir, haven’t made a disclaimer that you are just an average citizen innocently supporting this legislation. You have an agenda, your silence validates it loudly!

  16. the only sick people I have seen cut from employer plans are dependents who went over age or kids who should never have been on the plan. Kid gets sick then you find out its really a neace or nephew or not even related some times. Unless it is that clear cut you can’t get rid of them
    Or ex spouses that were kept on fraudently

  17. “Once upon a time in the United States, we decided education of our children was the responsibility of the community, all of us,a public good. Why is it so hard to do the same with health?”
    How successful has that public good, education been? To many school districts are complete failures, they go from providing a public good to delivering immediate and measurable public harm. Do you want healthcare like an inner city school?
    “If they were simple, they would have been done already.”
    What country, or better yet planet, are you living on Steve? The fact that it is simple is one of the reasons Congress can’t get it done. Any person could name hundreds of simple things congress could fix but they never seem able to.
    Medicare pays everything sent to them then tries to figure it out later, that is the problem to be fixed, after the check has been cashed is not the time to wonder if you should have paid the bill. A simple fix is for Medicare to stop paying everything sent to it and look at the bills.
    No one ever went to jail for billing private insurance wrong or not following the administrative rules of a private insurance company. Excluding outright fraud.
    a) any test that was done recently by another provider would be a good start. Administering medicare supps we would always see the same test being ran by multiple providers.
    b) Government has been a complete failue at managing Medicare and Medicaid, they should both be privatised and the government out of them. If the states want to offer couchers they can but the federal government has no place in healthcare. So yes it would greatly reduce the role.
    Yes genuine claims will be denied, I can assure you of that. But one legit claim being denied isn’t an excuse to pay 50 billion worth of bad claims.
    reporting would actually improve, much more data could be captured and shared then is now.
    becuase HCR was never about HCR. Since 1965 its been a charade. Medicare was suppose to protect seniors from catostrophic expenses, yet it did the exact opposite, Democrats claim a bill is about some hot topic of the day but it never is when it is passed. HCR didn’t address cost yet cost is what everyone is complaining about.
    I disagree, when actual fraud is detected you can say for sure there is $X amoutn of fraud. I would estimate the 50 billion a year is low, that is just what we have caught into, it is probably mush higher.
    ” You are profitable because your clients- the employers cull out the sickest of employees for your benefit and perhaps Medicaid pays for them.”
    This is BS and you have no idea what your talking about. How do employers cull sick people off their plan and where does such ignorance come from? Employers are scared to death to fire sick people even when it is justified becuase it is so hard to win those lawsuits, and even if you do win you lose hundreds of thousands in attorney fees.
    I can think of a couple off the top of my head. I can’t think of one ever fired, how does that do your dogma?
    I dont think there is a state in the union you could get away with firing an employee with AIDS. Unless you catch them killing someone the attorneys would be lining up 1000 deep to take that case

  18. DeterminedMD, read carefully again- “We have to pass it to see what’s in it.” says the author. My 5 second clip shows that she said ‘you’ have to see. There is a big difference.
    There has to some common sense that needs to be drilled in. 1. Senators don’t read or write bills. Their aides do. 2. The bill has been there for months and I doubt more than few hundred from public would have read it even now. NPR aired all proceedings of commitees. So good enough information was available to those interested.
    Partisan hackery and self comforting thoughts of alliances and allegiances have to be left behind to find solutions. All ideas from left and right have to be utilized for wide variety of challenge. No one particular dogma or idea will solve all problems. Hence I praised and criticized the article at same time.
    Nate, as to your theory let me challenge you in different areas which should not be mixed.
    a. Healthcare: WHich tests are not useful. Of course many tests are unnecessary because body does have capacity to heal, but upfront which tests you feel have no diagnostics capability and you would deny payment?
    b. Simple admin changes to reduce fraud: More effective than what’s their currently in HCR? Search on fraud in bill and it turns up 1990 times. And your changes can be implemented without increasing government? And with no side effect what so ever such as genuine claims beind denied or diminished reporting? If so great, but how come it was not offered during HCR debate or not insisted upon in bartering during Paris Hilton tax cut?
    All estimates of fraud are speculative because fraudsters don’t report. You may not reduce fraud but oversight effort is likely to go up for sure.
    c. I have a millionth time less rules and complexity: You serve much smaller base. You are profitable because your clients- the employers cull out the sickest of employees for your benefit and perhaps Medicaid pays for them. How many AIDS patient do you pay for? Now complexity is also a result of profitability challenge. Once it degenrates to saving nickles and dimes we make complete hash of claims adjudication. Thats what probably drives to Medicare to build up tons of regulations so that they are not take for a ride in any possible way. But that builds up cost for rest and you are right about that.

  19. ” We could save 50 billion plus with some simple administrative changes to reduce fraud.”
    If they were simple, they would have been done already. The WF&A argument is always true in some ways, but not something on which to base policy. Now, if you are talking about overutilization, that is another story. Incentives matter. Physicians are incented to do more in FFS systems. We also have malpractice issues that lead to excessive testing, especially imaging, and procedures.
    “My fraud rate is less then 1/10th of medicare and we have 1/100000000 of the rules and complexity.”
    Interesting. For my billing, anesthesiology, which is pretty straightforward, our difficulties come from private insurers. Nearly all of my longer term AR and bills in collections are from the private side. I am guessing that I could cut my billing expenses in half if I had all Medicare bills. Of course I would make a lot, lot less also as private insurance pays much more.

  20. It takes a lot of gall for conservatives to pretend they were “shut out” or that “there was no debate.”
    This has been a longstanding issue in American politics for 90 years. It was the basis of the entire 2-year Dem primary process, which led to a general election campaign, and then an election. Obama ran on HCR and mainstream America supported him on it.
    To be fair, it isn’t just you. A lot of leftists were shocked and horrified and felt left out when Obama escalated the war in Afghanistan, even though he had campaigned and run on that for the previous 2-3 years also. The moral of the story is, elections matter, and paying attention during them matters even more.

  21. Good post, Lynn.
    That we ended up with the Byzantine Obamacare bill — which is really not much more than an inscrutably complex rearranging of the for-profit actuarial model health insurance industry Titanic deck chairs — is testament to the power of Karen bin al Ignagni et al of AHIPistan.
    CANDIDATE Obama called health care a “right,” i.e., a public good. But as President he’s permitted it to become a two-headed welfare program (corporate welfare and individual means-tested welfare) cemented in place by the hated Individual Mandate via which to force everyone into the pool.

  22. At the heart of the discussion is the avoidance of the question: is health care a private good or is it a public good?
    When we default to YES! We are then left with the challenge of preserving and protecting our fragmented private/public financing mechanism with some Rube Goldberg arrangement(s) with a dab of this for the left (public good folks) and dash of the market forces (for the private sector folks). This games just keeps escalating administrative costs and energizing some form of beggar thy neighbor efforts in shifting costs to employers or state government or the sick or to private individuals or the mentally ill in hopes that when the music stops there is a doctor and bed in the hospital for me. We are smarter than that and we are better than that.
    No economically developed society has solved the health care rising cost problem but the most successful at managing their national health care expenditures seem to agree the health of the population is a public good and therefore everyone’s responsibility — a public good.
    Once upon a time in the United States, we decided education of our children was the responsibility of the community, all of us,a public good. Why is it so hard to do the same with health? We all benefit from educated citizenry won’t we benefit from healthy citizens? Or are we wedded to one person’s health care cost is another person’s profits!

  23. In order to reform this system we must repeal the health insurance industries anti-trust exemption before we can do anything else.

  24. “nor are they ‘simple changes'”
    And you base this on what MG? Being that I actually administer health plans for a living I am curious what you know that I seem to be missing. My fraud rate is less then 1/10th of medicare and we have 1/100000000 of the rules and complexity. How is simplifying Medicare not simple? Unless your talking politically, would doctors be upset if they weren’t paid within X days by law, maybe but is that worth 50 billion a year?
    What do you think the real number for Medicare fraud and abuse is?
    ” This isn’t a comprehensive plan as much a series of generic bullet points that need a lot more clarity and detail.”
    Are you talking about Goodmans post or ObamaCare? I see as much meat in this post as was in ObamaCare, nothing like leaving it up to the agencies to write the law after its been passed.

  25. Nate – $50 billion from simple changes to Medicare fraud and abuse? Another BS number that is radically inflated. There are some savings there no doubt but not nearly on this scale nor are they ‘simple changes’ either.
    As Steve said, there are some compelling things here but some outright partisan hackery nonsense including No. 6, a general lack of any kind of specific details on almost any point, and a bunch of simply warmed-over ideas that have been floating around for a while. This isn’t a comprehensive plan as much a series of generic bullet points that need a lot more clarity and detail.

  26. “Where was this voice of the conservative viewpoint during the actual debate?”
    What debate? The Democrats didn’t allow any as they were afraid people would see how terrible the bill actually was.
    ” I have yet to see your plan that preserves physician fees AND cuts Medicare.”
    Steve do you include crooks with the physicians? We could save 50 billion plus with some simple administrative changes to reduce fraud. After that we could address the wasted care, every test not needed that is saved could be performed on one of the new 34 million insured. There is plenty of money to save that wouldn’t hurt providers or patients, ObamaCare doesn’t even try to address any of them.
    “But I guess most of those people are young, poor and a different skin color to most of the Heritage/AEI/NCPA/Cato gang. So screw ’em”
    Wow there is an inteligent argument. I thought Medicaid was for the poor, why exactly did the Democrats design such a terrible plan for the poor and minorities Matt? I guess your all closet racist? Your single payor and Wyden that “could have worked” like Medicare could have worked? Like Medicaid could have worked? Seems most plans you come up with, Could have worked, except they didn’t and don’t.

  27. Interesting enough on the eve of a GOP takeover. We now have a
    solution? During the year long squabble over Health Care reforms. The
    GOP worked hard to destroy and weaken Those reforms. If not stop it
    all together! Of Course ,They were doing the dirty work of the
    insurance companies. If they had not abused the powers entrusted in
    them and had not shown such malfeasance. This question could have been
    resolved at the time it was debated. These power brokers wasted energy
    and taxpayers dollars.
    You are so consumed by your profits that human life is a abstract
    concept of statistics. These are those people whom put their first
    love above quality health care for all! Their love of Money!
    Some of these concepts seem reasonable but in the end. We find the
    concerns to be profit driven. I know of no one who doesn’t want access
    to health care. So the only ones debating it are those who stand to
    see a reduction in their stock portfolios.
    Please, stop acting as if you care!

  28. By your logic, Vikram, who if I am correct has supported Democrat logic and agendas ad nausem at every thread I have read and participated this past year, legislatures should just pass bills without telling their constituients what are in them, so the public can find out later what are possible consequences? You must live in Pelosi’s district to defend her logic. “You” is such a generalization by a 5 second clip, and also, do not deny that both Democrat and Republican congresspeople echoed that they had no time, and some even admitting no interest, to read the 2400+ pages literally dumped on their desks only days before a vote.
    Hey folks, that may be the kind of representation that satisfies the Vikrams of our community, but we need to marginalize and minimize their mentality! Fairly pathetic defense there, sir!
    By the way, the point is that if you have illness NOW, the legislation really won’t benefit you so much as this prior Congress led you to believe. Sounds like it has the potential to discriminate, eh? You want to put trust and faith in the insurance industry that supported the passage of this crap? A profit driven industry was so short sighted to not see consequences sooner than later? I think they paid someone to read the bill, and they figured out how to take advantage of it and stay ahead.
    Hmmm, but we don’t know where your alliances lie, do we, Vikram?

  29. “…many of the tools the private sector now uses to control costs.”
    Since they have so clearly been working SO well for SO long.

  30. Wow Mr. Holt–I had no idea you hated young, poor, and non-white people so much.

  31. Good and bizzare logic mixed together and outright lying.
    Pelosi said- “now we have to pass the bill so that ‘you’ find out whats in it.” Lies may have speed, but truth has endurance and now opposition to ACA is reducing.
    Perverse incentive is almost there in every field, like in doctors interest to have a sickly population.
    When we try to regulate it system becomes unwieldy.
    Living up with unwieldy system is a need.
    Financing and healthcare issue also have been mixed up in the article.
    Most objections are against the financing parts, which is valid objection because no likes paying. Financing will always be tough, but it has to be weighed against benefits.
    The rant against preventive healthcare is odd. The idea is that preventive care will help avoid doctor visits later. So what is the doctor telling now?

  32. so conservative (small c) Americans on both sides of the aisle won’t put up with a comprehensive realistic way to get ut of an employer & union based systems to universal coverage and rein in the health care systems excesses. There was a sensible moderate position on this using market mechanisms from Wyden Bennet, and a sensible single payer version. Either could have worked. neither was given any political chance.
    So what exactly did Goodman and his fellow traveler Heritage, AEI, Cato crowd, who have all been fiddling with petty solutions that will never fix the overall problem for the past 15 years, expect?
    Instead we got the best available bill given the politics of the country. It’s incomplete and pretty crappy–and lots of it needs fixing including in some ways Goodman suggests. But it’s way better than the alternative of no bill. Which is apparently what Goodman and crowd seem to want.
    Lets be crystal clear. The main part of this bill is a transfer of subsidies so that there’s some shot that 50 million people may get some kind of insurance coverage. With “Repeal and Replace”, that won’t happen.
    But I guess most of those people are young, poor and a different skin color to most of the Heritage/AEI/NCPA/Cato gang. So screw ’em

  33. The first-dollar coverage of preventive care was probably a result of health plans lobbying while looking forward to how best to manipulate the selection within the exchanges.

  34. “Where was this voice of the conservative viewpoint during the actual debate?” From what I saw and heard, suppressed and ignored by the Democrat majority, that almost said word for word “we are going to do to you what you did to us 4 years earlier when you(Republicans) has the majority.”
    778,000 doctors, I assume most of them actively practicing? If so, just remember readers, only about 20% are members of the AMA, who was outwardly supportive of this legislation, fairly much on their own as a physician organization mind you, so do the math: little more than 150,000 are members, and I doubt that even 75% of them supported it, so what is gleemed from this population, conservativey? If half the population of all doctors support it, irregardless of AMA involvement, only about 390,000 are supporters, and I doubt that number in my conversations with colleagues these past 6 or more months, which would compose about 0.1% of our population.
    Granted, a crucial part of the population in this debate as they (and I) are major players to what will be provided in whatever DC does legislate at the end of this discussion. But, the question at the end of the day, which both was and still is, why weren’t we as the majority of such a crucial group invited to the table back in 2009? Same reason as their republican counterparts: Democrats just wanted blind, loyal allies who would do Democrat bidding and just gain benefits, not debating and focusing on the welfare of the public and concerned providers.
    Which is why not only does this legislation need to go to the circular file on the floor, but if there is any sensible and realistic alternative drafted by Republicans, it better involve us practicing and invested providers, or, here we go again two years later!!!
    By the way, what kind of alleged representation and leadership champions the idea of signing something first and reading it later!? Do you do that with important contracts and committments in your lives as people? I guess all you Democrats, especially constituients in Pelosi’s district, must believe that faulty reasoning, voting back her and her ilk of supports for yet another congressional session! And she was fairly much given complete support as voted minority leader for this session. Wow, what other business or organization would survive such basic failure in practice skills and leadership??
    Think about that disgusting rhetoric: sign it and then read it later. Defend that rationale in a court room! Is it in poor taste for the judge and jury to laugh in the face of that defense!?!? I know I would be snickering at the very least. And this is the logic of a representative for what, 20 plus years and Speaker of the House for the last 4? And applauded and lauded by her peers? Shameful is a nice word here! And I am sure supporters and apologists will chime in quickly, and yet inadequately!

  35. I actually like some of these ideas. I will admit to being pleasantly surprised by some, but then you get to number 6. This is clearly partisan hackery, and does not belong on the list. Your constantly appealing to seniors for votes in the guise of protecting Medicare is disingenuous. Any other plan that reduces Medicare spending faces the same issue. I have yet to see your plan that preserves physician fees AND cuts Medicare.

  36. Where was this voice of the conservative viewpoint during the actual debate? Not even a whisper of “Death Panels???”

  37. There are a variety of problems. The Exchange subsidies that are up to six times higher than the tax exclusion will cause many low-income workers to migrate to jobs that don’t provide benefits so they can get the higher subsidy in the Exchange (and higher take home pay from their employer). This will segment the labor market. The rule that firms employing less than 51 workers are exempt from the employer mandate will encourage small firms to avoid growing beyond that size. The individual mandate that legal residents must have comprehensive coverage (coupled with guaranteed issue regulations) and a relatively low fine will encourage gaming the system. Expanding Medicaid (while cutting Medicare fees) will reduce access to doctors for the poor and for seniors; likely resulting in a two-tiered health care system (one for privately insured, one for publically insured).
    There are too many perverse incentives in the Patient Protection and Affordable Care Act. These will have to be addressed.