Anyone who thinks that the Fred Hiatt Washington Post is liberal probably thinks that Linsdsey Graham is a liberal.

The way I see it, unless you address the SGR problem at the same time as you do healthcare reform, it’s not true healthcare reform.

What exactly is the SGR problem? That doctors want to make more money?

If physicians in the US haven’t noticed, there was a pretty good run up in the unemployment rate in the last couple years, a lot of people who are employed are making 50-60% of what they were before the bust, and oh yeah … if government gets out of the healthcare business altogether (and what the heck – eliminates the special tax status for cadillac healthcare policies) there is going to be a LOT less money flowing into healthcare … enough that they may have to choose between keeping the weekend place at the lake or the condo in Aspen.

The US spends about 3% of our GDP on doctors salaries. The OECD median usually varies between 1.1 and 1.4%. As with defense spending, I see this as one of those long term questions – can the US continue to spend this much more of our GDP than our global economic competitors?

In short – if the government quit spending taxpayer dollars on Medicare and Medicaid tomorrow … doctors might have slightly smaller tax bills, but their revenues would drop astronomically. They should be careful what they wish for.

The way I see it, unless you address the SGR problem at the same time as you do healthcare reform, it’s not true healthcare reform.

http://voices.washingtonpost.com/ezra-klein/2010/03/paul_ryan_and_the_true_cost_of.html

Well, the CBOs reputation –built on the ample shoulders of former Dir Doug Holtz-Eakin– for impartiality and non-partisan analysis has taken a huge hit during the Obama Health sCare battles. But I can understand how desperate any Dem is to keep the fiction of impartiality alive.

First, we had the CBO Dir called to the woodshed by the Messiah after CBO dared score the first draft of Obama Health sCare poorly. Now, we get the CBO saying they can’t score the latest Obama Health sCare plan –all 11 pages of it– without more information. Nice checkmate.

Good news for the Obami Cult. No adverse findings coming anytime soon from a group many in the MSM still think impartial, non partisan. But the truth is, the CBO scores ONLY the govt programs included in Obama Health sCare and not those actions or elements that effect the private sector –except to the extent of projecting tax revenues.

The truth is that the CBO has been living off the reputation it built back in the Holtz-Eakin days and before. It doesn’t have a good track record on its health care projections… and it’s far from “impartial” anymore.

It is highly partisan and beginning to look more like the White House OMB than an unbiased analysis group. The Dem Senate and House leaders, as well as ranking House and Senate Dem budget committee leaders and staff all have an informal say in who becomes CBO Director. The last CBO Dir is now a true Obami believer, seated deep inside the White House apparati in a choice seat of unparalleled partisan power.

The current CBO Dir, officially “chosen” by NancyP and Robert Byrd –after the advice and input from Democrats throughout Congress– is a career economist who has been most effective playing both sides of the aisle for advantage and now stands astride an organization that could be an effective tool to bolster the Democrat agenda, if he can be seduced properly… which, unfortunately, looks entirely possible for the sum of a cup of coffee with Obama Messiah.

CBO is about as impartial as MS-NBC. It’s current Director’s comments should be treated like coming from someone slightly better informed than Keith Olbermann. And in Washington, CBO’s stock is falling faster than Obama’s or Gore’s… and that’s saying a lot!

Back in 2005, the CBO was one of the success stories of our modern Congressional system. But that reputation has been frittered away by an imperial Prez (Obama) intent on winning-at-any-cost and Democrat Congressional leaders who care not for institutional impartiality or straight-shooting… they want parrots and puppets in that spot.

The CBO’s task is to examine the proposed legislation and determine the financial impact if it gets implemented as proposed. If there are double counting tricks or any other kinds of tricks in the legislation, the CBO must determine the impact those “tricks” would have if the legislation is passed. The CBO examined the Senate proposal and determined it would cut the deficit by $132 billion. This is an unalterable fact and, aside from a single statement by GOP Rep. Ryan who is deadset against reform, you cannot find any credible person that challenges the CBO’s findings.

Forgive me, but I think I will take the findings of the neutral, highly-respected non-partisan CBO over your and Rep. Ryan’s findings.

Either we keep talking past one another or you have an extemely bad memory and, possibly, a reading problem.

I am not in favor of the MA plan nor have I ever been. In the post of mine that you quoted I called the MA plan a disaster. It does nothing to control costs, although that never seemed to bother you because, for some inexplicable reason, you believed costs containment would come in the future. If it couldn’t be done when everyone had the greatest incentives to do it, it surely won’t be done after that.

I’m also not a big fan of the mandate, although as you’ve pointed out repeatedly, it’s necessary in order to get rid of denials for pre-existing conditions. As much of a disaster as the MA plan has been, it looks like a dream compared to NY’s system, which does not have a mandate. However, you should be aware that capitation works very well in many other states and it has not caused the problems you’re predicting for MA. Also, from the very start of this blog, I have said that end-of-life care and medical advances are the biggest drivers of costs. Unfortunately, that never stopped the GOP from screaming “death panels,” thereby proving their still not fit to govern.

The Democratic/Obama plans are clearly better than the MA plan or any other plan out there because they do contain some real cost containment measures, while expanding coverage. These plans don’t go far enough on cost containment, which is why I, like most other people on the Left, am not a big fan of them. These plans lack a robust PO, which is the only way you can achieve the three major goals of reform: (1) universal coverage, (2) major cost containment, and (3) better outcomes for the money we do spend. The PO is necessary because no other entity is large enough to put downward pressure on medical costs.

Of course, conservatives and GOPers are ideologically opposed to the PO despite all the empirical data that completely undermine their arguments. This is why I’ve also said that conservatives and GOPers have become flat earthers. The facts simply do not matter to them. They treat economics and public policy like religion. They accept their ideology on faith and no amount of empirical data will alter their conviction in ideas that have been proved clearly erroneous. As a believer myself, I’m not condemning faith, but I don’t think there’s a place for it outside of religion.

Could the lesson be that mandating coverage without having competition from a public option simply gives the insurance companies a guaranteed pool that they don’t even have to work to compete for? If someone is mandated by law to purchase my services … I certainly don’t have incentive to control costs.

And yet, here we go again: In MA, the total cost of health care is rising sharply; insurers are actually paying out more in claims than they’re getting in premiums; and so they have raised their insurance premiums. I just got socked with a 44% increase in my Blue Cross premium. MA now has the highest insurance premiums in the nation–AFTER four years of RomneyCare.

Why? Because the Grand Bargain that mandating universal coverage will enable young healthy policyholders to pay premiums for those with pre-existing conditions has proved FALSE.

One reason, I believe, is demographics. The baby-boom cohort of soon to be retirees is bigger than the cohort of young healthy people. For example, as I pointed out several times, my health care bill for my condition cost about $90,000 last year. That’s equal to the premiums of about 15 healthy policyholders.

The problem facing ALL entitlement programs–SS, Medicare, Medicaid, RomneyCare, ObamaCare–is demographics. The birth rate in America has slowed dramatically since the 1950s, and so there are now more aging baby-boomers than young people to pay for the needs of those retired baby-boomers. That’s going to either bankrupt those young people or force significant cuts on retirees. There ain’t no easy way out of that, brother–unless we can convince people to put away their birth control devices and get busy making more babies.

The lesson from MA is clear: Mandating everyone to have insurance will produce near-universal coverage. But it will lead to much higher costs, not lower costs.

The other reason is that studies have shown that the adoption of increasingly expensive state-of-the-art technology, especially to try to extend the lives of terminally ill patients, is a major cost driver. And here in MA, the alliance of world-class MA hospitals with the biotech companies in Cambridge and the Route 128 beltway has produced some of the most advanced–and the most expensive–medicine anywhere. Major research centers and teaching hospitals, like Massachusetts General Hospital, are going to try out the most advanced state-of-the-art treatments. And that’s expensive.

So what to do? Governor Deval Patrick has announced a plan that not only socks the insurers (nobody likes them anyway), but imposes a kind of capitation on the providers.

Capitation of providers is going to end up producing the same end result as Sarah Palin’s “death panels.” Less medical innovation, less advanced care.

The Left has this idea that if everyone can’t get a particular treatment due to its high cost, then nobody should get it. Unfortunately, if that principle had been adopted a century ago, our rate of medical progress would have been far slower.

I would also point out that when HMO’s experimented with capitation in the 1990s, there was such an outcry from doctors AND patients, all of whom hated it, that it was soon dropped. Governor Patrick’s attempts at providing government capitation on providers may end up electing a Republican governor to succeed him who will repeal it.