RSS Feed MenuThe Medicare buy-in would have been a disaster for reasons well explained by Yuval Levin and James Capretta:
The only plausible reason to put more people in government-run insurance would be cost control, but no one believes the federal government now knows how to control costs sensibly. Liberals say a new insurance bureaucracy should be given the power to use Medicare’s price-setting and regulatory structure to cut costs. But that structure has never successfully controlled Medicare spending because price-setting doesn’t address volume–and so creates an incentive for more and more spending. Indeed, the Obama administration admits that Medicare’s current arbitrary bureaucratic payment systems are a prime source of the inefficiency and inequity throughout the entire health sector, driving up costs for everyone. That’s why the president and his team are proposing to set up an independent Medicare commission to straighten out the mess. They know they don’t know how to do it and can only hope someone else does. So if Medicare is a big part of the problem, how is its model the solution?
To see the back of the buy-in is a great relief. The provisions in the Senate bill now remain murky. (What a great way to write major legislation!)
What we’re heading toward is a bill that creates new insurance exchanges, increases the regulation of insurers, and offers new subsidies – and pays for them mostly through accounting tricks.
It’s not good, but it’s not what we were threatened with two days ago. Thank you Joe Lieberman.
MI-GOPer // Dec 16, 2009 at 7:04 am
When Congress is nearly skimming the bottom of the polling tank for most voters, GoodOl’Joe strikes one of the few favorable majorities in the Senate: 49-43% view him favorably in CTland. Republicans like him. Independents like him. Far Left democrats hate him.
CTland voters have a very UNfavorable opinion of former DNC Chair and far Left loon leader ChrissyDodd, 54% disapprove of the mortgage weaseling fatcat democrat and he’s losing in primary matchups with even former CTland congressmen and a woman wrestling promoter! Heck, even an unnamed GOP opponent does better than ChrissyDodd.
GoodOlJoe is hardly “toast”… unless you live in the fantasy land of democrats whistling past the graveyard.
But that can’t be said for the former DNC Chair and fatcat democrat leader ChrissyDodd. Now there’s someone who is past being toast, he’s already buttered! And so is HarrygReid.
BTW> speaking of fatcat democrats, this is the longest period of time that TedKennedy has ever been sober; now that’s progress the democrats shouls crow about.
sinz54 // Dec 16, 2009 at 8:53 am
balconesfault: It looks like the main purpose of the Senate bill is going to be to pump more money into big insurance. It will do so by creating a private mandate requiring individuals to spend their own money on insurance, whether they wish to buy or not
That element of the package, at least, was in there from the beginning. A mandate was central to all the health care reform proposals except single-payer.
sinz54 // Dec 16, 2009 at 9:01 am
anniemargaret:
sdsspringy: Joe Isadore Lieberman is an Independent Democrat. Whatever that is. Not ‘one of our own.’ And he backed John “I’m Still So Proud Of Palin” McCain.
yuck.
After so long,
this is the FIRST time I’ve ever seen you get so animated and angry.
Perhaps you might feel better if I told you that Lieberman, despite his flirting with the GOP at times, has only a 15% rating from the American Conservative Union. That compares with a rating of 50% for some Southern Democrats in Congress.
Why aren’t you as upset with, say, Bobby Bright? Have you looked at HIS track record?
balconesfault // Dec 16, 2009 at 10:14 am
That element of the package, at least, was in there from the beginning. A mandate was central to all the health care reform proposals except single-payer.
Ah – but with a public option, someone could have fulfilled the mandate without paying money to private corporations.
What I find objectionable – and likely unconstitutional – is the premise that one must pay money to a private corporation in order to live in America.
I don’t mind being compelled by law to pay taxes to government, particularly when government is providing service.
Stripped of the public option, the new Senate Bill is simply Government being the heavy for shaking down citizens to benefit big insurance.
The frustration with Lieberman is because he might be liberal on any number of social issues that the American Conservative Union deems to score, on the major issues of the day in the last few years – the War in Iraq, the election of Obama over McCain, and now the creation or expansion of government programs to challenge the hegemony private insurance has over the marketplace for middle class Americans – Lieberman has stood with the Republicans.
I think I see the filibuster differently than you, however. I see voting against a bill as a way of saying “I do not support this legislation”. I see the filibuster as a way of saying “I do not believe that the proponents of this bill are honest actors, and therefore it should not even be allowed a vote”.
If Lieberman really believes that the Democratic Party are not honest actors, he should not be caucusing with it.
LauraNo // Dec 16, 2009 at 10:17 am
David,
I would appreciate if you would offer solutions instead of decrying every effort. I have not heard one idea from GOP that would actually cover most people, prevent discrimination or bring down sky-rocketing costs. It’s a fairy tale that insurance being sold across State lines would bring competition and every sensible person knows tort reform is a small, even infinitesimal drop in the bucket. Be part of the solution or sit down!
sinz54 // Dec 16, 2009 at 12:19 pm
LauraNo: I have not heard one idea from GOP that would actually cover most people, prevent discrimination or bring down sky-rocketing costs.
I’m not a Republican anymore, but I am a conservative–and with my own experience battling a life-threatening illness, I’ve come to see what some of the real cost drivers are. The die is cast by the time the hospital makes up a bill–even before it goes to the insurer.
In my view, you’re all wasting your time trying to futz around with mechanisms to finance health insurance. Even in countries with single-payer systems like Canada, health care costs are rising faster than inflation, necessitating ever stricter rationing schemes.
Instead, you need to look at medical delivery–and moving away from the fee-for-service model we’ve had in America since before any of us were born. And also bringing hospital management into the 21st century.
One big win would be to finally move away from the “Marcus Welby” model of individual doctors getting paid for each service–and incentivize doctors to move into groups of four, six, or more doctors, from which they are paid a fixed salary. An insurer can give this group a bonus, if it finds ways to improve the health and/or lower the cost of treating its patients. This would be more like a contract model between the medical group and the insurer.
Another intriguing model are these newfangled “medical homes,” in which a family physician acts as the patient’s advocate and negotiator with all his specialists. It’s an attempt to do what HMOs were supposed to do but failed–because HMOs were business models, not medical models.
Finally, studies show that medical errors cost America over $100 billion annually. Human errors creep in because many hospitals–even leading hospitals–are still hopelessly backward in how they manage patient records and physician treatment plans. In the 1990s, many businesses streamlined their bottom line with new management techniques and automated record keeping–but hospitals remained stuck in the 1970s in that regard. Reforms here could save tens of billions of dollars annually (not to mention also ending up with healthier patients).
sdspringy // Dec 16, 2009 at 1:27 pm
Howard Dean says:
We’ve gotten to this stage … in Washington where passing any bill is a victory, and that’s the problem,” Dean said. “Decisions are being about the long-term future of this country for short-term political reasons, and that’s never a good sign.”
There in a nutshell, political gain is the motivation. Not healthcare reform, not fiscal responsibility, just pure political greed. As stated by one of the leaders of the Dem progressives.
Admit it all you liberal posters, the Dem’s attempt is a joke, and a political and monetary handout to big pharma and big insurance for their support of a trash piece of legislation.
LauraNo // Dec 16, 2009 at 1:35 pm
Sinz54,
it’s my understanding that your ideas are in the Senate bill. Not the fixed salary idea, I can’t see that flying, you never know I guess, but the idea of rewarding cost effective/ health improving methods. This is what I take from this article: http://bit.ly/6JpMl6
SpartacusIsNotDead // Dec 16, 2009 at 4:15 pm
Sinz wrote: “One big win would be to finally move away from the “Marcus Welby” model of individual doctors getting paid for each service–and incentivize doctors to move into groups of four, six, or more doctors, from which they are paid a fixed salary. ”
This is already a long-established, widespread practice and it has not slowed the growth is costs.
I’m not opposed to the “medical homes” model you described, but I’m not aware of of any evidence that it will bend the cost curve. Moreover, the fact that healthcare costs in other countries are also rising faster than inflation does not support your implication that the financing models of these other countries are far superior to both the current U.S. model and the current bill in the Senate.