Repeal Has Failed

February 2nd, 2011 at 6:56 pm David Frum | 55 Comments |

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I originally wrote this column after the repeal vote failed in the House. It seems even more appropriate now that repeal has failed in the Senate.


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Next week, medicine Republicans in the House of Representatives will vote to repeal Democratic health reform. Promise kept!

Then the “Repeal-the-Job-Killing-Health-Care-Act of 2011? will proceed to the Senate. Where nothing will happen.

What then?

What should happen then is a Republican focus on the most immediately dangerous aspects of the 2010 health care law.

Let me point to two.

First, pills the health care reform enacted last year is financed in almost the most destructive possible way, with new taxes on payrolls and investment. Precisely at a time when we should be encouraging more payroll and more investment, the health care reform penalizes both.

There’s a lot to like about the basic architecture of the health reform law: universal private health insurance, subsidies for those who cannot afford it, regulation against the worst insurance abuses.

But the devil always is in the details, and it’s the details again and again that are the problem. Our highest national priority should be to slow and even reverse the direction of healthcare spending. But by appearing to load the costs of the program onto higher-income taxpayers, the Democratic plan will tempt politicians to focus on extending benefits — which go to lots of voters — without regard to costs, which appear to be paid only by a few.

If Republicans cannot repeal the healthcare law, and they cannot, they should fight at least to make that law’s costs as visible as possible. How about a health care VAT? Every time you go to the store, you’d pay the full cost of health care subsidies, right up front, where nobody can miss them. Suddenly that abstract talking point in the president’s speeches — the one about spending 17 percent of national income on health when most other industrial nations spend between 10 percent and 13 percent — will become a whole lot less abstract.

A second focus for Republicans should be this: 2011 is the year in which health-insurance companies begin to get penalized if they spend “too much” on administration or retain “too much” profit. Why is this bad?

Imagine this: You are the Sam Walton Health Insurance Company. Right now you have 100,000 customers from whom you collect $10,000 each in premiums. Wowza, that’s $10 billion in revenues, of which you disburse $8.5 billion to providers. Out of the remaining $1.5 billion you must pay your overhead of $500 million. The rest is your profit: $1 billion.

A keen-eyed analyst discovers an opportunity to force down the prices charged by a hospital chain. She claims that this squeeze could push down costs by as much as $500 million. Boom! Straight to the bottom line, a 50 percent profit opportunity!

But that mucks up your pay-out ratios doesn’t it? Instead of paying 85 percent of revenues, you are now paying only 80 percent. So either you increase spending somewhere else — or you face fines and penalties. So why get into a hassle with the hospitals? Pay the money, take your cut, do your business the easy way.

Government determines the appropriate profit level for regulated utilities. And utilities have hardened into notoriously non-innovative businesses.

Republicans should not of course act as the defenders of the insurance companies. They have to take their chances in the competitive marketplace. Instead, the Republican goal in 2011 should be to act to enhance the competitiveness of that marketplace, not restrict it — and to ensure that the costs of publicly provided health are made transparent and immediate, not concealed and postponed.

Originally published in The Week.


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55 Comments so far ↓

  • TerryF98

    Where are the JOBS! We have had everything including denying rape victims and abortion but ZIP on jobs.

    • Carney

      Will aborting the baby undo the rape? Why is abortion more justifiable in case of rape than in other instances? Is an unborn baby produced by rape less human than another unborn baby? Is one’s right to live is determined by circumstances of conception, rather than the mere fact that one is a member of homo sapiens? If so, then aren’t BORN offspring of rapists also sub-human, with less of a right to live than the rest of us, and fit to be killed if their presence or even existence somehow re-traumatizes or even offends their mothers? Isn’t someone opposed to such a carve-out in laws banning murder somehow insensitive to the suffering of rape victims, if not misogynistic, and in any case putting a silly adherence to irrelevant considerations like innocent human life over jobs and dollar bills?

      And why are most the advocates of executing the helpless innocent offspring of rapists so outraged over “punishing the child for the parents’ crime” when it comes to much milder acts such as denying citizenship to the US born offspring of illegal aliens, and deporting their parents? Why did the left / “pro choice” side of the debate support the Supreme Court’s 1977 Coker v. Georgia decision banning the death penalty for rapists, and the 2008 Kennedy v. Louisiana decision banning the death penalty even for child rapists – if they’re so eager to accuse pro-lifers of being soft on rapists?

      Sparing the guilty rapists while killing the innocent babies. Pretty much the perfect definition of injustice. That’s liberalism.

  • rbottoms

    Yes, this is so enjoyable. The GOP is pursing every crazy ass bullet point on their agenda and nothing at all about jobs. Independents are sure to be asking themselves why they though for one minute that Republicans weren’t truly insane when they gave these dimwits the majority in November.

    Next we’ll see a vote to end fluoridation of water.

  • jerseychix

    Or, as was pointed out the first time you published this…the healthcare company could decrease premiums, thereby increasing its customer base, and creating better healthcare for more people.

    But hello JOBS. Where is the focus on creating more jobs?

  • Nanotek

    TerryF98 + 1

  • ChallengingFrum

    Terry,

    how can the gop create any jobs….barrack already spent a trillion dollars in fiscal policy and 2 trillion in monetary policy creating every job in the world.

    • TerryF98

      Well, the whole GOP platform for the 2010 elections was 27/7 bleating about jobs. So you would think they actually had some ideas about how to create some. Or make a pathway to create an environment where jobs are created.

      Instead we have been treated to a shitload of idiocy to appease the base on social issues and the heath care kabuki theater. So the GOP is not serious about jobs or the economy just as they are not serious about the deficit.

      • ChallengingFrum

        Or maybe they are of the belief that we can do more than one thing at a time.

        btw i seem to remember republicans saying something about repealing healthcare reform.

        if the given the choice of one party spending 3 Trillion dollars to bring unemployment down to 9.4% (with another 9% underemployed) or a party doing nothing. I’ll take nothing.

        • medinnus

          So you would have preferred a Democratic congress who did nothing but block Bush’s unfunded wars and Medicare D? How much have those dismal failures of wars and expansion of entitlements cost the American people? Or are you one of those utter GOP hypocrites that only objects to it when its the Democrats who spend, but are fine when their party does it while lowering revenues?

        • TerryF98

          “if the given the choice of one party spending 3 Trillion dollars to bring unemployment down to 9.4% (with another 9% underemployed) or a party doing nothing. I’ll take nothing”

          You can’t argue with liars.

          The Stimulus was $850 Billion. About the same as the GOP held the country to ransom over the tax cuts for the rich.

          If you are going to throw out stupid numbers why not make it 8 Trillion?

  • balconesfault

    Frum: First, the health care reform enacted last year is financed in almost the most destructive possible way, with new taxes on payrolls and investment.

    This is a joke. The payroll tax will not come into play until 2013, will be less than 1%, and it is only on incomes in excess of $250,000 for a joint tax return and over $200,000 for any other tax filing.

    In other words, the chance of those payroll taxes costing one single job … or creating any drag on the economy … is close to nil.

    Please David. We know you’re capable of being coherent on this issue. Please embrace reality.

  • drdredel

    @jerseychix,

    Healthcare companies don’t charge arbitrary amounts based on their whims. A larger customer base isn’t exactly what they need… obviously if everyone on their roster are 22 year old joggers, that would work out great, but that’s not how it works in the real world.
    The reality is that the insurance companies charge what they need to charge in order to react to what they are being charged by the medical providers. Meanwhile, the medical providers charge whatever they want to charge since their customer ISN’T the entity being billed for the services!

    See… market capitalism breaks down when the purchaser is not exposed to the price of their purchase. The only way to reduce our overall health care costs is to, somehow, include the patient (the actual consumer) in the pain of the purchase WITHOUT denying them vital care. If the consumer becomes thrifty, then, naturally, the service agent (doctors, pharmaceuticals, hospitals) would have to react in kind and compete for business, subsequently charging less.

    As an analog, consider the medicine associated with treating your pets. Granted, if a doctor kills your dog, it’s not the same kind of tragedy as if they kill your dad, but these are medical professionals, performing advanced medical practices (including surgery) on living patients and for some reason it costs 1/20th (or less) than similar procedures on people. The only explanation for this is that people pay for these services out of pocket (usually) and so the vets can only charge what the patient can afford to pay.

    Again, however, we can’t ask people to pay if they truly can’t afford it, and the merry-go-round comes around and we’re right back where we started.

    If this was a simple problem, like all simple problems, it would have been solved long ago… and I am no fan of insurance companies of any kind– seeing them as nothing more than a very polished and regulated mafia protection racket, but it’s simply shortsighted and naive to keep blaming them as the central culprit in the medical debacle that we’re in. They’re certainly a big contributor to the problem, but they didn’t create it… they’re simply playing within it, and trying to make a buck (or a few billion of em).

    • Tony W

      “The reality is that the insurance companies charge what they need to charge in order to react to what they are being charged by the medical providers.” I don’t need to read the remainder of your post. You obviously have no idea of how this “market” works.

      Health insurance companies (and Medicare, for that matter) don’t set rates based on what they are charged by providers. The great majority of “providers” are doctors or individual hospitals. They accept what the health insurer says it will pay for a given service, and by the way many health insurance companies –this is not true of Medicare– make it extremely difficult for a physician who contracts with them even to get a copy of the insurer’s fee schedule. That’s right: physicians are expected to sign up with an insurer without even knowing what the payments will be. And the insurance contracts explicitly say that the insurer can change the prices it pays at any time.

      In many markets, the insurers have monopsony power (as does Medicare). They are not quite as beleagured as you seem to think. And, when legislation threatens to cut their profits, they simply exit a particular local market, and concentrate on greener pastures.

      It is true that in some instances (small markets with a limited number of providers) insurers can be at a disadvantage, at times –they want to be able to provide a full range of medical services for their covered persons, and there is only one hospital, etc in town. That is not the case in the areas where most of the U.S. population is concentrated; and that is why many specialists can earn more in small markets than they can in large urban areas. There’s less competition. But it is only in this limited sense that normal market mechanisms sometimes apply in health care.

      • mikewaz

        Pretty much agreed with you that the market is all kinds of screwed up and that many insurers have monopsony power in different states. A bigger company can negotiate cheaper reimbursement rates to providers because of the power of massing up people into one risk pool. A hospital can’t lose all of those people as potential patients because they fall out of the network, so they’ll accept lower rates to ensure those people have access to the hospital. The ability for insurers to dictate rates actually hurts the free market more than it helps. Ironically, the best solution I’ve found to make the market more free and competitive with more options is to strictly regulate prices. Maryland instituted a cost commission back in 1971 to establish common prices for all acute care services at hospitals and made these prices binding. This eliminates the need for insurance companies to develop networks and negotiate with providers, so insurance companies don’t have to spend tons of money and manpower on developing networks. That lowers the cost of entry and allows more competition in the market.

  • vadum

    Unless I’m missing something here, there must be a typo above. David writes:

    “I originally wrote this column after the repeal vote failed in the House. It seems even more appropriate now that repeal has failed in the Senate…”

    Yes, repeal was (narrowly) voted down in the Senate today but the repeal vote did not fail in the House.

    On January 19 the House voted 245 to 189 on passage of HR 2, the “Repealing the Job-Killing Health Care Law Act.”

    Here is the record of House roll call vote #14: http://clerk.house.gov/evs/2011/roll014.xml

    I sometimes make similar mistakes when I type fast. Not a big deal but the item should be corrected.

    • arvan

      13 votes shy of 60 is less than 80% of the way there. Hardly “narrow”. And then there’s the inevitable veto. It was a waste of time from the get go, but that was the point. The GOP has no idea how to help create jobs, so they’re trying to come up with other things to do so that they look busy.

      • ChallengingFrum

        arvan,

        are you implying that the democrats would filibuster?????Q! NO Way! That is Anti-American!! They are tearing at the fabric of our democracy. What happened to one man, one vote.

        republicans might not have found a way to create jobs but atleast they are better than the democrats who create jobs at a cost of $400,000 a head!!! Good job. Cash for Clunkers..pull demand forward. Home buyer tax credit…..now underwater…awesome! No jobs, negative equity and more debt for the grandchildern. Compassion!

        • valkayec

          @ChallengingFrum – Who? What?

          To remember the 1930s, FDR tried everything and anything to break the back of the Great Depression and get the private sector economy moving again. Some worked; some failed. What they did was throw everything against the proverbial wall. What failed to work, they dropped and tried something else. That’s what this administration has been doing.

          It seems to me the Obama Admin. has behaved similarly: seeking something that works. If I fault his Admin. on anything, it is that, unlike the FDR Admin., the Obama Admin. was and continues to be too caught up in the myth of the superiority of the financial sector.

          Regardless, we’re in a whole new environment. This is not the 1910s, the 1930s, or the 1990s. The world, particularly the business world, is moving too fast to look backwards or expect everything to slow down so we in the U.S. can catch up. Breaking the back of this middle class depression will take new ideas, based in real world economics, that no one in the political world really understands. The best prognosticator I’ve read is PIMCO’s El-Erian…and Martin Wolf of the Financial Times.

      • vadum

        Alright, arvan, fair enough re the 60-vote threshold in the Senate, but the claim that the vote in the House failed is demonstrably false. It passed the House on a vote of 245 to 189. Whatever you think of the vote or the legislation itself, David’s statement is factually incorrect and should be corrected. Unless I am missing something here, I cannot imagine he meant to write something that is completely and undeniably wrong.

  • lessadoabouteverything

    If this was a simple problem, like all simple problems, it would have been solved long ago

    I don’t know, Taiwan pays 1/3 of what we pay per capita and has perfectly fine outcomes and they solved it themselves over a short time. Of course the problem in the US is the Insurance company beast, it must be fed and there is no way it is going anywhere, but there is a reason why Japan pays half of what we do and has better outcomes (and it ain’t there diet, though it helps)

    But as to what David writes, I have no problem with reforming Obamacare to make it better, if only the Republicans negotiated in good faith from day one instead of having that idiot DeMint state it would be Obama’s Waterloo a lot more Republican provisions could have been included and it could have actually be bipartisan.

    Personally I like Sen. Wydens opt out provision, if any state can meet the minimal national standards set it doesn’t matter how they go about it. It is vastly preferable to Romney’s “so what if Texas has 26% uninsured, it is not the Federal Government’s problem”
    If Texas can meet the requirements of no denial of pre-existing conditions, insures its people, no recission, etc. I am perfectly happy if they choose to do it via a VAT, a payroll tax, or however.

    • ChallengingFrum

      less ado,

      “if only the Republicans negotiated in good faith from day one ”

      …do you mean like when barrack negotiated by saying he would spend 20 Million? to study the just the possibility of tort reform.

      how come i never hear liberals never mention the cost of education in Taiwan or japan as benchmark when discussing public schools? Thank goodness the difference there is strictly an artifact of the market and not due to evil insurance companies or any other nefarious organization. btw most large companies (1,000 employees) pay their own claims and only receive “administrative services” (network, paperwork).

      • busboy33

        “how come i never hear liberals never mention the cost of education in Taiwan or japan as benchmark when discussing public schools?”

        Are you suggesting that if we look to Tiwan for anything, we must look to Tiwan for everything?

        That’s beyond reducto ad absurdum.

      • valkayec

        how come i never hear liberals never mention the cost of education in Taiwan or japan as benchmark when discussing public schools?

        Who says liberals are not? I may not exemplify all “liberals” but those whom I know are very concerned about getting their kids the best educations possible to compete in the 21st century at the best possible price.

        Maybe you’ve been listening to the wrong media or talking to the wrong people.

  • think4yourself

    Interesting comments.

    DrDredel has a point about costs and who is paying (compare physican versus vet for similar procedures). I don’t see a solution as to how you have the patients share the costs that the public will accept (I would pay $100 for doctor visit, but my last visit cost $400 for just a basic physical. If I had employer insurance I would have paid a $10 copay – you can’t sell $100 copay to someone who has been paying only $10). Balconesfault also has a point about 1% on those over $250K that hasn’t even started yet – probably doesn’t cause serious damage to high income pocketbooks. The problem with a VAT is that it becomes awfully easy to keep increasing the tax (but I’d consider it – I don’t think any Republicans would).

    My solution to fix healthcare is one that Repubs won’t accept – set up a public option. If it strips out costs, and those savings are passed to consumers, then the private system will have to adjust by finding the inefficiencies in their system (which is health insurance, hospitals, pharmacutical, health clinics, etc.). Or the private system will change and become strictly conscierge medicine.

    The health industry is an oligopoly that has no incentive to be more efficient. A public option would give competition so they would change or perish.

  • armstp

    112th Congress: 28 bills to repeal Patient Protection Act in 11 days, but nothing to create jobs.

    Here’s a list as of today, divided by House and Senate.

    House
    H.R. 105 Dan Burton, GOP – Indiana : To repeal the Patient Protection Act & enact in its place incentives for people to buy health insurance.
    H.R. 118 John Fleming, GOP – Louisiana : To permit a state to elect not to have an American Health Care Exchange.
    H.R. 119 John Fleming, GOP – Louisiana : To prohibit hiring of irs agent to implement or enforce health insurance reform.
    H.R. 127 John Graves, GOP – Georgia : To de-authorize funding of Patient Protection Act.
    H.R. 141 Steve King, GOP – Iowa : To repeal the Patient Protection Act.
    H.R. 145 Connie Mack, GOP – Florida : To repeal the Patient Protection Act.
    H.R. 154 Ted Poe, GOP Texas : To prohibit any federal funds to be used to enforce Patient Protection Act.
    H.R. 171 Cliff Stearns, GOP – Florida :
    H.R. 2 Eric Cantor, GOP – Virginia : Repeal of Patient Protection Act.
    H.R. 38 John Fleming, GOP – Louisiana : Rescind funds authorized for Patient Protection Act.
    H.R. 9 David Drier, GOP – California : Requires Committees to look into Patient Protection Act.
    H.R. 26 David Drier, GOP – California : Repeal Patient Protection Act.
    H.R. 215 Don Young, GOP – Alaksa : Repeal Patient Protection Act.
    H.R. 19 John Carter, GOP – Texas : Disapprove rules on MLR in Patient Protection Act.
    H.R. 299 John Carter, GOP – Texas : Repeal Patient Protection Act.
    H.R. 358 Joe Pitts, GOP – Penn : Remove abortion funding from Patient Protection Act (there is none)
    H.R. 360 Michael Burgess – Texas : Amend Patient Protection Act to include President in Health Care Exchanges.
    H.R. 364 Tom Latham, GOP – Iowa : To Repeal Patient Protection Act
    H.R. 371 Marsha Blackburn, GOP – Tennessee : Repeal Title I of Patient Protection Act.
    H.R. 5 Phil Gingrey, GOP – Georgia : Repeal Patient Protection Act.
    H.R. 397 Wally Herger, GOP – California :Repeal Patient Protection Act.
    H.R. 429 Darrell Issa, GOP, California – Repeal Patient Protection Act.
    H.R. 452 Phil Roe, GOP, Tennessee – A bill to repeal Patient Protection Act.
    H.R. 450 Dave Reichert, GOP, Washington – A bill to repeal Patient Protection Act.

    Senate

    S. 19 Orrin Hatch, GOP – Repeal Health Mandate & therefore repeal patient protections.
    S. 17 Orrin Hatch, GOP – Repeal Tax on Medical Devices
    S. 16 David Vitter, GOP – Repeal Patient Protection Act
    S. 196 Chuck Grassley, GOP, Iowa – A bill to to provide congressional staff gets to participate in Exchange.
    S. 192 Jim DeMint, GOP, South Carolina – A bill to repeal health care.

    • PracticalGirl

      Very nice demonstration of how the Party of No can’t put anything forth that moves an agenda (even THEIR agenda) forward, and a great preview of things to come.

      Life was so much easier when GOPers could just chant “No, baby, no”. Now that their charged with coming up with actual policy (even fixes) they’re like deer in headlights.

  • valkayec

    I’ll say this again: Patients cannot shop frugally if they cannot learn the prices.

    For those with insurance, because insurance contracts/negotiations with health care suppliers vary, patients cannot learn what the cost is until they receive the bill. If you want people to be better shoppers of health care, then they need to know what the prices (costs) are upfront.

    Would you accept a restaurant telling you that you can only learn the cost of your meal when you get the bill, even if your employer ultimately pays the bill or pays 80% of the bill?

    If the GOP really wants consumers of health care to become better price shoppers, they need to work on figuring out how health care consumers can learn the costs before buying! No one can comparison shop if they’re not given the prices in advance.

    Second, I know Switzerland controls the costs of health providers, but the government also controls how much profit insurance companies can make on the country’s standard health insurance policy. Yet, Switzerland’s insurance companies say they are highly profitable – profits have actually gone up since national health care was enacted – and they’ve become far more efficient. So, could the U.S. learn something from the Swiss plan?

    Third, Utah instituted a few years ago a health insurance plan that enables small businesses who previously could not afford insurance for their employees to buy into state run insurance exchanges. From all I’ve read, the program is extremely popular with small businesses. My expectation is that ACA, when fully online, will work similarly for businesses as well as individuals.

    Fourth, I still believe that this bill is just the first step in dismantling (or decoupling) insurance from employers. The additional costs of health insurance coverage for employees, even though companies get a big federal tax payer paid subsidy for offering health insurance, causes U.S. product prices to be much higher.

    Employee costs are the biggest item on most company budgets and employee health care adds about 30% to the cost of each employee. As GM stated a few years ago, the cost of health care adds over $2K to the cost of an automobile. As a result, U.S. domestic manufacturers and suppliers cannot compete with companies whose governments pick up the cost of health insurance. Big corporations are know the health care & insurance market needs reform and is highly in favor of it. But they’re not sure what that reform should be. So, wouldn’t it make sense to let ACA fully take effect and come back in a couple of years when the public has grown used to the new system and take the best ideas from the rest of world? From Singapore, Hong Kong, Taiwan, Germany, and Switzerland in order to remove the costs of employee health care from business costs.

    I know there’s this whole nuevo idea of American exceptionalism and that we can’t learn anything from the rest of world because we so exceptional. But come on! Even our founding Fathers took ideas from the European Wars of Religion, English Common Law, and the European Enlightenment as well as the Iroquois Federation when writing the Declaration of Independence and Constitution. Should the U.S. now be less smart, less intelligent, less than seekers of great ideas from wherever they derive than our Founders?

    But let’s get honest here: the GOP desire to overturn ACA is not really about “freedom” or “constitutionality,” it’s about “GOP vs Dem” political games-playing, as particularly exemplified by Sen. Grassley’s “for it before against it” stances over the last few years.

    Former Reagan Solicitor General Charles Fried delivered testimony during a Senate hearing on the “The Constitutionality of the Affordable Care Act,” expressing, in no uncertain terms, his personal assessment that he is “quite sure that the health care mandate is constitutional.”

    And, lest we forget, it’s also about political (and lobbying) donations, regardless of what is best for our country.

    • mikewaz

      valkayec:

      Second, I know Switzerland controls the costs of health providers, but the government also controls how much profit insurance companies can make on the country’s standard health insurance policy. Yet, Switzerland’s insurance companies say they are highly profitable – profits have actually gone up since national health care was enacted – and they’ve become far more efficient. So, could the U.S. learn something from the Swiss plan?

      Sen. Tom Coburn has actually publicly praised Switzerland’s health insurance system as a model for an American health care system. You can read about what Sen. Coburn feels are the positive aspects of the Swiss system at http://coburn.senate.gov/public/index.cfm/news?ContentRecord_id=19d81d0b-802a-23ad-40d4-2fc53046a649. Never mind that they have an individual mandate that is arguably more strict than the mandate here; individuals who don’t provide proof of insurance may be assigned to an insurance company by the canton/community of residence of that individual. Also, note that he specifically says the following in the article:

      So can any wealthy, modern country get health care right without resorting to socialism? Yes. You never hear it touted by the media but Switzerland uses market forces, not government rules and red tape, to create a private, affordable, high-quality health-care system for its 7.5 million citizens. And it spends 40 percent less per capita than we do.

      Hear that, America? Individually mandated private insurance is not socialism!!!

      • valkayec

        Here here! Love it! Let’s get on with a system that enables the U.S. to be competitive while providing health care the people can actually afford without having to depend upon employer provided insurance!

  • lessadoabouteverything

    “how come i never hear liberals never mention the cost of education in Taiwan or japan as benchmark when discussing public schools?” I take busboys point, but I would also have no problem with analyzing the school systems of other schools and how they keep costs in line.

    valkayec, good post. Certainly there are a number of avenues we can explore for cost savings, one is to set fees based on overall treatment and not as an adhoc pay as you go which greatly increases administrative costs (does anyone have any idea how much paperwork hospitals have to do?)

    As Japan’s economy declined, more intensive control of prices and even volume through the fee schedule, plus increases in various copayment rates, led to an actual reduction of medical spending in 2002 for the first time in history. To augment established mechanisms of cost containment, case-mix-based inclusive fees for inpatient care were introduced in university hospitals in 2003 and are planned for subacute and long-term care. However, substantial reform, including the introduction of market-based medicine, is not likely to occur in other areas. Progress in making the delivery system more accountable to patients has been meaningful but slow.
    http://content.healthaffairs.org/content/23/3/26.full

  • lessadoabouteverything

    here is a primer for those interested in it comparing systems:
    http://www.npr.org/templates/story/story.php?storyId=110997469

    • KBKY

      @lessadoabouteverything
      Thanks for those links (especially the NPR comparison), very interesting and informative.

  • jorae

    “the Democratic plan will tempt politicians to focus on extending benefits”
    Per the OP

    What does that mean?

    Have you ever read the “not covered” Health Care definitions?…no cosmetic surgery, no coverage for self inflicted injuries….No coverage from the result of insurrection or revolts…..Now, you expect a Democrat is going to push a law that will pick one or all of these “not covered” items?

    If that is not what you mean by “extending benefits,” then you need to be a lot more clear…

    Next…it is absolutely absurd to have creativity in the medical insurance field. The amount going out can easily be determined by the age of your client…
    How are you going to get creative with an monetary value attached to an age statistic?

    • valkayec

      Have you ever read the “not covered” Health Care definitions?…no cosmetic surgery, no coverage for self inflicted injuries….No coverage from the result of insurrection or revolts…..Now, you expect a Democrat is going to push a law that will pick one or all of these “not covered” items?

      Well, yeah. If enough of us demand it. There’s no reason why the basic policy cannot be calibrated to cover all people – male, female, etc – at a minimum or necessary level for all people. The anything else, from pregnancy to male virility, etc. would be extra or as in Switzerland, a separate policy.

      Look we gotta get smart on health care and stop playing anti-competitive, political games. We simply don’t have that luxury any more.

  • vadum

    Why is it that almost no commenters on FrumForum actually like the Republican Party? Most of you just whine and moan about the GOP constantly and ignore the Democrats. The GOP is far from perfect but it’s not as bad as you people say it is and it’s gotten a lot better since the most recent election. The comments on this website read like a toned down version of DailyKos comments.

  • Raskolnik

    “Why is it that almost no commenters on FrumForum actually like the Republican Party?”

    Maybe because the Republican Party (as such) nominated certifiably batshit insane people like Sharron Angle and Christine O’Donnell instead of putting together a coherent policy agenda? Maybe because we love the Republican Party, but we intensely dislike what it has done to get votes in the recent past? I don’t know, just guessing here.

    • vadum

      Raskolnik: Repealing the insidious Obamacare, which eats away at the very essence of America, is crazy? If the GOP sucks, it is because of people like you. I’ve never seen such a huge collection of concern trolls on one website before. It is rather amazing. Anyway, get back to your work at the DNC, dude.

      • mikewaz

        vadum:

        Repealing the insidious Obamacare, which eats away at the very essence of America, is crazy?

        Exactly how is ObamaCares insidious? Exactly how does ObamaCares eat away at the very essence of America? Is it that it infringes on your liberty to decide whether or not to purchase health insurance? I’ve got news for you: the Supreme Court decided over 100 years ago that your individual liberty may be less important than social responsibility and the general welfare of the community. Look up Jacobson v. Massachusetts sometime.

        • sweatyb

          Clearly it’s insidious because it’s evil. Indeed, it’s baleful. Anyone can see that it’s bad and maleficent. It’s damaging, poisonous, venomous, inimical, menacing, destructive, fatal, sinister and threatening. 9 out of 10 right-thinking people understand the evil, hurtful healthcare law that was jammed, shoved, cajoled down our collective throats, esophagi, gizzards was pestiferous, malignant and ruinous.

        • vadum

          Another socialist posing as a conservative, I see. Tedious.

  • mickster99

    David asserts “new taxes on payrolls and investment”.
    How much are the taxes, who pays the taxes (employer, employee), when do they start”. Are they onerous or reasonable. What do the people who pay think of them. Are the taxes paying for something in return. What makes the moDitto taxes on investment. What should be taxed instead?

    if they spend “too much” on administration or retain “too much” profit. Why is this bad? It’s bad because too much of the cost of health care is use in the over head of trying not to pay benefits and too much profit means people are paying more for the healthcare for the benefit of CEO types and board members. Much of the premium paid for insurance goes for layer and layers of beauracracy as well as multi-million dollar salaries for those at the top. Its ok to be a rich greedy bastard on wall street but we expect Mother Teresa as top executive in the insurance business. Not that insurance is exempt from anti-trust laws so it can do all the lousy business practices that typify drug cartels.

    Really, David, you’re suppose to be spart think about. Actually consider people, the insured into your equation. Keeping costs down by eliminating the layers and big salaries. Society is more important that greed here.

  • chicago_guy

    And yet, the number of small businesses who have started offering insurance options to their employees (ahead of the requirement that they do so) is actually significantly UP in the last year. The small business owners seem to appreciate the changes in law that make offering the bennie more affordable, employees who weren’t covered now ARE covered, and the insurance companies have expanded their risk pools, which (theoretically) should help them keep costs down for everyone else.

    The longer the ACA stays as it is, the less you’ll find enthusiasm for ripping it up, unless the proposed replacement plan makes things even better. And given that the Republican plan as of now seems to be “Tort Reform!” in red letters – ignoring the fact that the most you can save by capping payouts is 1.5% of the total spending on health insurance. Meanwhile, my premiums from Humana are going up 30% a year (good thing everyone in my family is healthy, fit, and we’ve never filed a claim – I can’t imagine how much more they’d go up otherwise).

    I’m surprised that since first posting this piece, DF hasn’t fixed the obvious flaw with his example; the total failure to consider that maybe the Walton Insurance company would just, em, lower prices to their customers, the same way other businesses do.

  • jorae

    The only innovation I have ever seen, is when the government is the sole payer. The government said in Japan, we are not going to pay $2,000 for MRI’s any more. And in Japan, they invented new machines that could do an MRI for under $100

    There can be no innovation under the current insurance…Why would the Lab find equipment that cost less to run? The insurance company already pays for the $2,000 MRI…

    To get from part a to part b, the payer has to be the government with established acceptable rates to be paid per procedure. Eliminate the middle man and costs to operate comes down to just processing the claims – a fraction of the costs. It does not have to be part of the government, it can be a contract to to open market for bids..

    As you know, many years ago, Relative Value System was invented to give a unit value per procedure. That unit value relatives to where you do business….99213 is worth 20 units and you get $15.00 a unit in downtown L.A…(sample – guess on the amounts and units)…but it is already in place.

    It is flexible, and it control the source of the over billing and middle man.Right now that $250 has to be considered along with “for profit” and doubles. What what purpose in keeping the middle man? Malibu homes vs the GDP and the uninsured?

    The single payer plan solves everything.

  • talkradiosucks.com

    “Why is it that almost no commenters on FrumForum actually like the Republican Party?”

    You’re just whining. There are plenty of positive comments made about the GOP when they take positive actions. The problem is that they do this very infrequently, and people who aren’t mindless robots don’t praise political parties even when they are screwing up.

    • vadum

      talkradiosucks.com: You sound like a classic concern troll. In fact most commenters on this website sound like concern trolls.

  • vadum

    So many self-loathing Republicans in one place. Amazing.

  • lessadoabouteverything

    talkradio, amen to that. I want there to be two sane parties offering rational alternatives to each other for the American people. I don’t want nonsense about death panels and socialist re-education camps. When Republicans work in good faith things get done, like in the recent recess session in Congress: extension of the tax rates, repeal of DADT, ratification of the Start treaty. Now you can object to any of these things, but the important thing is they got debated and voted on.

  • Raskolnik

    vadum:

    Reagan made the proposal for the first START treaty, and G.H.W.B. signed it. Teddy Roosevelt was one of the earliest and most vociferous environmentalists (as many avid hunters are).

    The Republican party has stood for many things through the years. Up until relatively recently, it was actually a bulwark against Dixiecrat racism in the South. The funny thing about a lot of RINO-hunters is that they are seemingly unaware of what, precisely, it is to which they have pretentious delusions of laying exclusive claim. For example, many of them embrace an originalist rhetoric about the Founding Fathers, completely unaware that Strict Constructionism as a “school” of Constitutional interpretation is barely two or three decades old. A lot of the same people act as though the only ways to interpret the Bible are as a literal historical document that was all cut from the same cloth, completely–sometimes deliberately–ignorant of the rich tapestry that is the Bible and all the scholarship that goes into making heads or tails of it.

    I see people sometimes with shirts and signs, saying things like “it is time to water the tree of liberty,” referencing of course Thomas Jefferson’s quote about patriots and tyrants, and I always think: which are you? Which would you be, if we handed you the power?

  • Rockerbabe

    “And utilities have hardened into notoriously non-innovative businesses.:

    That’s poppycock! The utilites are not non-innovative; they are stuck between a rock and a hard place and like the GOP, refuse to constructively deal with global warming or the belief that their activities are and have been harmful to the environment. And, let’s not get into big oil’s frame of reference. For example, the utility companies just “love” nuclear power, but they are not the ones who have to deal with the effects of storing spent fuel rods; remember Yucca Mountain in NV? Why should any community have to take someone else’s nuclear waste?

    There are many utility companies that are beginning to support water, wind and solar power and have such innovations has part of their power grid; all one has to do is look in the southwest and on Indian reservations. The work on making solar power more affordable and accessable goes on and rightly so! Then there is that little black box that powers lots of building with little carbon footprint!

    The GOP has little concern for anything other than their own narrow, big business interest. Repealing healthcare is just for show; the thought of having 30-50 million Americans who would continue to be denied healthcare is an aweful big voting block to take on. Of course, the GOP and its hateful stance towards women and their healthcare needs (ie attempts to redefine rape back to the 19th century) will come back to haunt them in the future.

    Jobs. . .if one really wants jobs for our economy, then maybe the powers to be, need to have a “come to Jesus” meeting with the CEO’s and gillionaires of this country. They are the only ones who can improve the economy and so far have just failed to do that! Government spending is keeping us from a depression, but it is the businessmen who are keeping us in peril. If they can’t do any better than this, then just maybe, they need to have their subsidies shut down and given to over to the deficit reduction crowd.

  • talkradiosucks.com

    This deserves repeating:

    I see people sometimes with shirts and signs, saying things like “it is time to water the tree of liberty,” referencing of course Thomas Jefferson’s quote about patriots and tyrants, and I always think: which are you? Which would you be, if we handed you the power?

  • Rob_654

    The GOP PROMISED their supporters to repeal this health bill and so far they haven’t delivered.

    The Republicans had from 2000 to 2006 to do something about health care and what did they do?

    They gave us a multi-billion dollar – unfunded – Medicare Part D program to make the old voters happy – but they did nothing to help the people who work and produce in this country and drive the economic engine forward.

    The Republicans are not going to do anything – they are simply going to do the bidding of their Insurance Company masters…

  • valkayec

    Bruce Bartlett has some really informational links on his latest Fiscal Times blog post, regarding ACA. http://www.thefiscaltimes.com/Blogs/Bartletts-Notations/2011/02/02/Bartletts-Notations-Focus-on-Health.aspx

    By the way, did any of you know that on January 26, 272 economists signed a letter opposing repeal of the Affordable Care Act, as House Republicans have voted to do.

  • el80ne

    I would say Vadum appears as the classic troll, but that would be giving him too much credit. Only capable of hurling epithets, utterly unable to debate the issues or offer anything of substance behind his accusations when others attempt to engage him, and comprehensively devoid of ideas. Trolls at least have some imagination and retain a focus, albeit a feeble one derived from a lack of a life, that centers on getting a rise out of others. Vadum appears to lack even than.