RSS Feed MenuGood news everybody! You remember that healthcare reform that was originally projected at over $1 trillion over the next 10 years, and who knows how much in the years after that?
Now there is a special price, for special customers like you! Only $871 billion! But you have to act fast to take advantage of this discount, or so insist House leaders.
House leaders have cut the cost of their health-care overhaul to around $871 billion over the next decade, Democratic sources said Tuesday night, and were working to line up votes for the package with the aim of bringing it before the full House early next month.
The $871 billion estimate — well under the $900 billion limit set by President Obama — is the latest of several versions scored by congressional budget analysts, according to a Democratic aide, speaking on condition of anonymity to discuss private talks. The measure would include a government-run insurance plan that pays providers at rates tied to Medicare, the aide added.
You wouldn’t buy a set of Ginsu knives under this kind of high-pressure tactic – and you sure should not buy the latest Dem proposal. The devil as always lies in the details, that phrase “pays providers at rates tied to Medicare.”
This gets technical, but bear with me.
Back when the Republicans still ruled the House, they pushed through a series of cuts in doctors’ Medicare reimbursement rates. Those cuts never went into effect. Instead they were rolled over year by year into the future – conveniently making future budget deficits look smaller, without ever affecting the actual current deficit in the here and now.
The doctors get their money, actual cash folding money, and the legislators get their CBO-scored reduction in future deficits. Everybody wins, except of course for unborn taxpayers. But they don’t vote.
The new Democratic majority has promised to undo those postponed GOP cuts.The cost of the so-called “doc fix”? $250-$300 billion over the next 10 years.
Democrats have until now refused to count the “doc fix” as part of the cost of healthcare. They promise to find the money somewhere, at some future date. That’s chutzpah enough.
But now look at this: to (mis)represent the cost of their public option, they are ignoring their own intention to raise Medicare payments (that’s the price of buying the AMA’s support for Obamacare) – and using the never-implemented Republican numbers as proof of their own fiscal rectitude. Amazing. And one more warning that the costs projected today will bear scant resemblance to the real costs of the plan when and if it is put into effect.
My suggestion: whatever the number you hear for the cost of this Democratic project … double it.
sinz54 // Oct 21, 2009 at 10:53 am
Correct.
The CBO scoring depends on making significant cuts to Medicare. But Congress has NEVER made significant cuts to Medicare. Terrified of the AARP.
So the bill will be passed under a false assumption, which will be proven false within a year or two.
It’s dishonest.
The truth is that if we want to cover tens of millions of currently uninsured, many of whom are uninsured because they can’t afford it on their own, it’s going to cost.
And if we want guaranteed issue without cost controls like a strong mandate, that’s going to cost too.
The steady debasement of the dollar will continue.
LFC // Oct 21, 2009 at 12:30 pm
“Who does these books? If I ran my office this way, I’d be out of business.”
– Murray Blum, reviewing the government budget (“Dave”, 1993)
LFC // Oct 21, 2009 at 12:41 pm
Seriously, I think Obama and the Dems know damn well that an eventual tax hike and cost cutting measures are going to be required to cover universal healthcare. The problem they have is that anything that requires a tax hike is instantly politically poisonous, and no reasonable cost/benefit analysis can ever be discussed. They think universal healthcare is worth the cost and they’re betting that the country will eventually agree (just like Soc Sec and Medicare which are very popular), but that can’t be said out loud.
The Republicans dodged this bullet when in power by ignoring every cost increase they ever had. Medicare expansion? Charge it! War in Afghanistan? Charge it! War in Iraq? Charge it! Increased discretionary spending? Charge it!
No serious cost-cutting proposal has been made by either party in the last 3 decades (though Clinton did manage to slow the growth of spending as compared to Reagan, Bush I, and Bush II), so future tax hikes are inevitable.
Heavy Metal Kid: Bitchin’! Hey, what’s it f***ing cost?
Ken Kessler: That’s the bitchin’ part about it! It don’t matter! If you can’t afford it, F***ING FINANCE IT!
     –”Ruthless People”, 1986
txanne // Oct 21, 2009 at 12:56 pm
“Back when the Republicans still ruled the House, they pushed through a series of cuts in doctors’ Medicare reimbursement rates. Those cuts never went into effect. Instead they were rolled over year by year into the future – conveniently making future budget deficits look smaller, without ever affecting the actual current deficit in the here and now.”
Why didnt the cuts go through? Did the Republicans not follow through with their own legislation? Unless I am totally missing the point, it seems to me that this is another Republican slight of hand, that the Democrats have to fix.
LFC // Oct 21, 2009 at 1:27 pm
Unless I am totally missing the point, it seems to me that this is another Republican slight of hand, that the Democrats have to fix.
It’s worse than a simple sleight of hand. It’s bald-faced hypocrisy. Many of the same Republican who helped pass the cut are now screaming that Medicare can’t be touched. Half of Obama’s desired Medicare cost savings could be had just by allowing the Republicans’ own reimbursement cuts to take effect.
The Dems are not doing what they should be doing in terms of honest accounting, but I think they are playing smart politics. They’ll probably get a healthcare reform bill and, as David pointed out, it won’t revoke the cut in doctor’s reimbursements. When the time comes for the Dems to revoke the cuts, they’ll propose it in a bill all on its own. The Republicans then have a choice; say that they were right all along and stick to their guns, or admit they were wrong so as not to piss of seniors. There will be no political cover to be had from the rest of the healthcare reform bill.
Personally, I’d rather see honest accounting. Of course, I’m not a politician.
midcon // Oct 21, 2009 at 2:35 pm
The problem is, everyone makes this out to be either a Republican or Democrat thing, when the simple fact is – it’s a political thing. No one wants to anger senior citizens. There’s no party affiliation associated that desire to not upset a group or class. Who wants to cut farm subsidies? Regulate Wall Street? Take on Pharma? Get big oil? Does someone out there actually believe either party is less beholden to special interests than the other? Bono (yes, that one) set up a 40 person lobby shop in DC. Do you think he cares what party a politician belongs to? How about those farmers? As long as the subsidies keep on coming they would vote a tea bag running for office! Somehow the people have gotten the impression that party affiliation makes a difference to the politicians. It only matters that they continue to “serve” the public and that their ego is stroked until they become a legend in their own minds. This party affliation crap used to be amusing, now it’s just sad.
LFC // Oct 21, 2009 at 3:59 pm
There’s no party affiliation associated that desire to not upset a group or class.
midcon, are you accusing Congress of being a huge pack of whining, spineless, self-centered bitches? Well … er … uh. Yeah, I guess there’s no arguing that one.
txanne // Oct 21, 2009 at 4:20 pm
lfc // Oct 21, 2009 at 3:59 pm
There’s no party affiliation associated that desire to not upset a group or class.n (midcon)
“midcon, are you accusing Congress of being a huge pack of whining, spineless, self-centered bitches? Well … er … uh. Yeah, I guess there’s no arguing that one.”
I concur with both statements.
However, my point is that for David Frum to brand the Democrats as “cheaters” seems disingenuous at best.
Is it not a fair political move to force the Republicans to vote to carry out their own policy?
This is something that has been done in prior years so with or without reform it has to be addresed. Why should the Democrats add it to the reform package when it will continue to be an issue either way?
Oldskool // Oct 21, 2009 at 4:47 pm
This is like a never-ending shell game. Repubs cut taxes so deeply that when Dems get in office and have to raise them, Repubs can trot out the standard “tax-and-spend-liberal” finger-pointing mantra. Those attacks are also why Dems don’t dare try to explain to every simpleton in the country that taxes have to be raised to pay the bills. One of these days, whenever Americans wise up, the tired “cut taxes” slogan will be indentified with irresponsibility, the same way the word “conservative” has now become a slur.
ottovbvs // Oct 21, 2009 at 5:17 pm
“My suggestion: whatever the number you hear for the cost of this Democratic project … double it.”
………..And what would be the multiplier for Republican projects…. like Iraq…….x8…..x10…..x20??…..the Democrat’s x2 is modest by comparison
sinz54 // Oct 21, 2009 at 5:19 pm
ottovbs: And what would be the multiplier for Republican projects…. like Iraq…….x8…..x10…..x20??…..the Democrat’s x2 is modest by comparison
As a former businessman,
I’m sure you appreciate the concept of sunk costs.
The money spent on Iraq is gone. We can’t get it back.
But let’s not add to it with more wild spending sprees that aren’t paid for.
When you’re in a hole, the first thing to do is stop digging, you know the routine.
ottovbvs // Oct 21, 2009 at 5:33 pm
sinz54 // Oct 21, 2009 at 5:19 pm
…….I was having a bit of fun at David’s expense because what he doesn’t seem to get, and neither do the Republicans in general, is that their reputation for fiscal probity and management competence is completely shot……So these sort of critiques which no one understands anyway have zero traction…..the CBO which is supposed to be neutral has scored this, I’m sure it’s full of fudge factors that are way beyond most people’s comprehension and basically it doesn’t matter a damn…….The Republicans used to play the same games……..The democrats are committed to passing some kind of universal health insurance bill….it is a fundamental part of their program so there was no surprise…….this is basically peashooter fire at a Tiger tank and a waste of time……Healthcare reform is going to pass and the Democrats are going to get all the credit for it and the Republicans are going to be perceived as the obstructionists…….it’s going to be hugely popular (Bill Kristol was right) and will ultimately aid the Dems and hinder the Republicans……That’s it.
wrs10 // Oct 21, 2009 at 5:54 pm
“Shocker: The Dems are Cheating on Healthcare Costing”
Well, who woulda thunk it?
cmhmd // Oct 21, 2009 at 6:24 pm
OK, assume it is $1.5 trillion over ten years, or 150 billion a year, and we spend $2.5 trillion a year on HC already, so that is very little money in the grand scheme of national economics. So, as Uwe Reinhardt would say, “Go explain to God why you cannot do this. He will laugh at you.”
How to pay for this? First and best answer: REPEAL THE BUSH TAX CUTS!
http://www.usnews.com/blogs/john-farrell/2009/04/15/no-tea-party-protests-for-teddy-roosevelt-republican-champion-of-the-income-tax.html
I’d advise everyone to listen to the EXCELLENT two “This American Life” episodes on HC reform:
http://cmhmd.blogspot.com/2009/10/this-american-life-hc-reform-part-2.html
Follow the links, download the MP3’s and you can make audio CDs for your car, or listen on your computer.
There are lots of answers about how we cut costs in the long run within the two shows, but I’ll give you a few easy ones:
1.) McAllen, TX and EOL Care:
http://cmhmd.blogspot.com/2009/05/annals-of-medicine-cost-conundrum.html
( That’s actually two, practice variation and EOL care)
2.) Prescription co-pays: $10 for a $20 prescription, $30 for a $600 prescription. (Unless you have a coupon from the manufacturer to make the $30 copay $0.00 – listen to the second TAL show.)
3.) George Lundberg has a few ideas
http://cmhmd.blogspot.com/2009/08/health-care-blog-how-to-rein-in-medical.html
4.) Uwe Reinhardt has a modest proposal,,,
http://healthaffairs.org/blog/2009/07/24/a-modest-proposal-on-payment-reform/
5.) Wendell Potter, too:
http://www.time.com/time/politics/article/0,8599,1920893,00.html
6.) Administrative costs:
http://cmhmd.blogspot.com/2009/07/health-affairs-2-articles-on-cost-of.html
Bottom line is, passing the bill is going to be half the battle, implementing reform in a way that is most beneficial to patients at the least cost to us as a society is next up.
But, let’s get everyone taken care of first, and avoid the 18K to 45K people dying due to lack of access to health care and THEN we’ll deal with reducing costs. Turns out, if you read the Gawande article, they may be by doing the exact same things.
Cheers,
MI-GOPer // Oct 21, 2009 at 7:57 pm
The Dems are cheating on health care costing??? Say it ain’t so Joe!
Of course they are… just like they lied about getting out of Iraq, focusing in on & doing what’s necessary to win “Obama’s Necessary War” in Afghanistan, not raising taxes, balancing the budget, stopping unemployment at 8%, using the Stimulus Spending Spree money on real, shovel ready projects, repealing DADT, ending the culutre of corruption in Washington, bringing transparency to the process of adopting new programs, building a bipartisan, cooperative spirit, working with all to improve America, etc.
Instead, we have a lying president who is the ultimate Chicago-thug styled partisan roughneck, a divided, harsh political enviroment, staggering deficits, higher unemployment, a longer-than-necessary Obama recession, widespread distruct of govt, corruption and vote fraud at levels last seen when Dem Andrew Jackson was president and a WH waging war on the press, on medicine on conservatives and losing the wars that Bush was winning.
And someone is truly concerned about them cheating on the numbers for health care? Good God, because of the Democrats, Iran will likely have a fully operational long-range nuke in 2 yrs or less.
MI-GOPer // Oct 21, 2009 at 7:59 pm
Oh… and I left off the most frightening bit: “Jimmeny Cricket Carter is considered an elder statesman again by the WH”. Ugh!
txanne // Oct 22, 2009 at 12:39 am
Ya better watch out gopher, Sarah might come after ya for revealing the main points of her book before its out. Best go underground!
MI-GOPer // Oct 22, 2009 at 7:47 am
txanne, we love the new Democrat Underground & Daily Kos talking points for pintsized Democrats: “when criticized fairly, drag out Gov Palin… then repeat as necessary”.
It sure beats the same-old, same-old talking points for pints you guys had for 8 yrs… “blah, blah, blah… Bash Bush…. blah, blah, blah… Bash Bush… blah, blah, blah… Bash Bush”.
Thanks for making it official you’re a troll in the best traditions of many, many Democrat trolls on this site.
sinz54 // Oct 22, 2009 at 9:55 am
mi-goper: And someone is truly concerned about them cheating on the numbers for health care? Good God, because of the Democrats, Iran will likely have a fully operational long-range nuke in 2 yrs or less.
Hammering away at the cost of health care is a good political tactic.
Because polls show that the skyrocketing cost of health care is one of Americans’ top concerns right now.
Not whether Iran gets a long-range nuke in a few years. Americans care about that too–but it’s a lower priority for them. Probably because it’s hypothetical (lots of things could prevent Iran from getting a long-range nuke), whereas the skyrocketing cost of health care is a reality that is hitting Americans in their wallets right now.
I’m stunned, absolutely stunned, at the cost of my medical treatment. Most of it’s being paid for by my medical insurance–which is to say, by the premiums of healthy policyholders like you. “ottovbs” or “rbottoms” would probably say I’m not worth it–just turn me into Soylent Green.
LauraNo // Oct 22, 2009 at 4:01 pm
The Dems are Cheating on Healthcare Costing
As I’m sure you’re aware, David, it’s politics. It’s how you get things done in Congress. I want to believe the cost control measures are going to happen but it is not politically effective to concentrate on those measures at this time. You should hope they happen, too. I’d like to ask, did you ever have this headline during the Bush years saying “GOP is Cheating on X Costing”? There were many opportunities to write such…
Senator Reid Is Going To Bite The Dust- Again | thelobbyist // Oct 23, 2009 at 8:42 am
[...] given Senate Majority Leader Harry Reid’s (D-NV) expectations of a victory in the vote. As David Frum and The Heritage Foundation explained, Democrats wanted to pass the bill outside of the final [...]
SFTor1 // Oct 25, 2009 at 9:47 pm
People like mi-goper never cease to amaze me. The sheer mindless noise produce by him and the likes of him are nothing but a distraction to progress.
“Obama’s necessary war in Afghanistan…” Amazing.
If he was in my party I would run him out of town on a rail.