The Cellar - Impeding changes to our Health Care system

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- - Impeding changes to our Health Care system (http://cellar.org/showthread.php?t=16747)

As I stated earlier in this discussion there is no control of the Insurance Industry in any plan before Congress to radically overhall our Healthcare. I also stated that I felt like the insurance companies were making back door deals with the White House. And that due to lack of controls, the insurance industry would just pass on their costs to those who have insurance. Well it looks like the press is now documenting those very rumblings. As I have said numerous times, this plan by Congress does not fix the problems at the root of the illness in healthcare today. Even though this is coming from the very companies who would profit from the changes proposed by Congress, there is nothing to say that they will not and cannot pass on any and all increased cost to the consumer. And in fact they are now coming right out and telling us we are going to be screwed.

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WASHINGTON (AP) - Insurance companies aren't playing nice any more. Their dire message that health care legislation will drive up premiums for people who already have coverage..

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Ignagni was unequivocal in her support for the PricewaterhouseCoopers conclusions. The company is "a world-class firm" with "a stellar reputation," she said.

The study projects that the legislation would add $1,700 a year to the cost of family coverage in 2013, when most of the major provisions of the Baucus bill would be in effect.

Premiums for a single person would go up by $600 more than would be the case without the legislation, it estimated.

In 10 years' time, premiums would be $4,000 higher for a family plan, and $1,500 more for individual coverage.

Finance Committee aides to Baucus said it's impossible to predict premiums down to the dollar because there are too many variables involved.

The technical issues behind the study are complex, and it will take time for neutral experts to deliver a final judgment. The issue boils down to questions of coverage and cost shifting.

The industry is arguing that the consequences of the bill will be shifted onto those who are already covered. Insurers are not alone. Representatives of the hospital industry have raised similar concerns, though in less stark terms.

http://apnews.myway.com/article/20091012/D9B9QLO81.html

If you check the schedule for penalties for not meeting the individual mandate to purchase health insurance , you find that it's cheaper to drop your insurance and pay the penalty (they begin low, a couple hundred $ per year), and if there's a mandate that private insurer's must not deny coverage due to pre-existing medical conditions, you could simply wait till you're diagnosed with something requiring treatment, go buy some health insurance, and then drop it the minute you don't need it anymore and go back to paying a couple 2-3 hundred $ per year in penalties instead of that much and more per month for a HI plan.

Those who doubt the efficacy and sincerity of the Baucus plan might find the devil in those details.

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There is an age-old political tactic, so old and so venerated it's impossible to determine which party began it - and it's so old it may well predate both current parties - and its original authors are irrelevant because both parties have used it repeatedly, but it goes like this....

If you want/need to impose a tax, but the tax is known to be hugely unpopular among voters, certain to cost too many votes, you instead tax something or somebody those voters cannot do without, like utilities, fuel, food, etc. It works best if you impose this tax on somebody or something despised by the general tax-paying public, like, oh... big oil, big banking, big pharma, just about 'big' anything, as long as they are perceived - or can be made to be perceived - as an enemy of the common people.

So, you impose the tax on the 'big' target, they in turn pass the costs of the tax along to consumers - aka taxpayers - and the consumer/taxpayers grumble, piss, and moan, but most direct their anger at the forced middleman. In essence, the government has forced the target, via regulations and/or taxes, to become an involuntary tax collector.

Great gig.

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Originally Posted by Henry (Post 600644)

Yeppers. And the practice has been honed to a sharpe effective edge over the last 2 years.

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Originally Posted by Henry (Post 600644)

Makes sense if you completely ignore the other Senate bill and the House bill and assume the Senate Finance Committee bill will be the final bill.

And, more important, ignores the regulatory process that will follow the legislation....unless, like Merc, you think Congress writes regulations.

What the latest industry report accomplished was make a stronger case for a broader exchange with a (limited version ) of a public option as envisioned in the other bills.

BTW....welcome, Henry.

Sticking with the Baucus, bill, tHe CBO analysis of the future costs of premiums (assuming the insurance exchange in the Baucus bill) offers a much different (unbiaised) analysis than the industry’s report:

Industry report: average premiums in 2016 - $21,300
CBO report: average premiums in 2016- $14,400

http://www.cbo.gov/ftpdocs/106xx/doc...f_Premiums.pdf

At least, the CBO has the integrity to also note that the “net effect” of the proposed legislation on premiums is difficult to determine because there are too many uncertain factors...but under any scenario it reviewed, it found that premiums would be far more affordable than the industry report suggests.

The industry is running scared because the momentum is building.....so now, even Merc is shilling for the industry, posting their "analysis" as the be all and end all (of course, we dont have access to the analysis behind the industry numbers, so its taken on faith if you (he) share their views on the bill).

And then the same old rhetoric based on industry reports and partisan editorials...declaring that the Democratic's proposals will "screw" the people, even before there is a final bill and despite more objective analyses.

Ok, it is all a big lie and the insurance companies are not really going to pass on their costs to the people with insurance. They are just pretending they are going to pass those costs on and charge us more. They really aren't. They are just teasing us and daring Congress.

Sure. You go on believing that Redux. The majority of the public can see through any empty promise this Congress makes.

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Originally Posted by TheMercenary (Post 600691)

Sure. You go on believing that Redux. The majority of the public can see through any empty promise this Congress makes.

In fact, once the lies and fear-mongerng that the industry and conservatives jointly and collaboratively perpetuated throughout most of the "debate" (including the town hall meetings) have been debunked, the majority of the public are supportive of the general concepts behind the Democratic bills, including a public option.

CBO is not infalible. That is a fact you want to ignore. There are plenty of examples where it fails.

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Originally Posted by TheMercenary (Post 600694)

CBO is not infalible. That is a fact you want to ignore. There are plenty of examples where it fails.

But of course, the industry reports and the conservative/libertarian op-eds, all with an agenda to see the proposals fail, but that you cite as evidence of screwing the people ARE infallible, eh?

Keep posting more, if thats the best you got, and hey, you might really convince a few folks.

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Originally Posted by Redux (Post 600693)

So basically what you are saying is that it is a big lie and the insurance companies are not going to pass the costs on to the rest of us as they promised. Right? That really it is just "lies and fear-mongerng that the industry and conservatives jointly and collaboratively perpetuated throughout most of the "debate"". Right?

So since you brought it up, please "debunk" that the insurance companies are NOT going to pass costs on to the rest of us if the bill is passed in its current form.

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Originally Posted by Redux (Post 600695)

But of course, the industry reports and the conservative/libertarian op-eds, all with an agenda to see the proposals fail, but that you cite as factual, ARE infallible, eh?....so keep posting more and you might really convince a few folks.

Ok, please show me the track record of the CBO and how everything they have estimated has been true and really did not cost us more in the long run.

CBO Failures

Congress’s Health Care Numbers Don’t Add Up

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FOR competence and integrity, few organizations command more respect in Washington than the nonpartisan Congressional Budget Office. As health care reform makes its way through Congress, the budget office’s assessment of how much various elements might cost may determine the details of legislation, and whether it ultimately passes. But when it comes to forecasting the costs of reform, the budget office’s record is suspect. In each of the past three decades, when assessing major changes in Medicare, it has substantially underestimated the savings the changes would bring.

In the early 1980s, Congress changed the way Medicare paid hospitals so that payments would no longer be based on costs incurred. Instead, hospitals would receive a predetermined amount per admission, based on the patient’s primary medical problem. This encouraged shorter stays, led to fewer diagnostic services and reduced administrative costs. The Congressional Budget Office predicted that, from 1983 to 1986, this change would slow Medicare hospital spending (which had been rising much faster than the rate of inflation) by $10 billion, and that by 1986 total spending would be $60 billion. Actual spending in 1986 was $49 billion. The savings in 1986 alone were as much as three years of estimated savings.

Why was the budget office so far off? It had projected that the new payment strategy would increase hospital admissions, because hospitals would maximize their payments by admitting patients who were less severely ill and discharging them quickly. In short, they would make up money with faster turnover. But in the first year of the new payment system, admissions, which had been increasing, actually declined by 3.5 percent. By the third year, they had declined by 15.9 percent. It may be that the declining admissions resulted from a new and stronger program for reviewing admissions.

But the Congressional Budget Office was correct in assuming that hospital stays would grow shorter. In the first three years of the payment system, the length of Medicare patients’ hospital stays, which had been decreasing by 1 percent to 2 percent a year, fell by 17 percent. The new system also led hospitals, for the first time in decades, to cut their work forces — by 2.3 percent in the first year alone.

In the 1990s, the biggest change in Medicare came with the Balanced Budget Act of 1997, a compromise between a Republican-controlled Congress and a Democratic administration. At the time, the Congressional Budget Office forecast that, from 1998 to 2002, the act would reduce Medicare spending by $112 billion — a 9.1 percent reduction. Part of that — $36 billion worth — would come from paying skilled nursing facilities and home health care services a set fee per patient. But only a tiny fraction of the savings, about $100 million, would come from better monitoring of fraud and abuse on the part of health care providers, according to budget office projections.

The actual savings turned out to be 50 percent greater in 1998 and 113 percent greater in 1999 than the budget office forecast. Overall spending increased just 1.2 percent from 1998 to 2000, rather than 5.6 percent, as was projected. With increased monitoring for fraud and abuse, hospitals billed less aggressively. Spending for skilled nursing facilities, which had increased by 38 percent per year from 1988 to 1997, did not increase at all in 1998 and 1999. At the same time, spending for home health care services, which had been rising at the rate of 25 percent a year, fell by 52 percent. In fact, Medicare spending fell so much that Congress increased payment levels to hospitals and other providers in 1999 and 2000.

In the current decade, the major legislative change to the system was the Medicare Modernization Act of 2003, which added a prescription drug benefit. In assessing how much this new program would cost, the Congressional Budget Office assumed that prices would rise as patients demanded more drugs, and estimated that spending on the drug benefit would be $206 billion.

Actual spending was nearly 40 percent less than that. Spending on drugs declined from fiscal year 2007 to 2008. Seniors proved more willing to buy lower-cost generic drugs than expected, fewer people participated in the program than expected, and competition held premiums down. Few new blockbuster drugs came on the market, so overall drug prices remained relatively constant, rather than accelerating as predicted.

The Congressional Budget Office’s consistent forecasting errors arose not from any partisan bias, but from its methods of projection. In analyzing initiatives meant to save money, it helps to be able to refer to similar initiatives in the past that saved money. When there aren’t enough good historical examples to go by, the estimated savings based on past experience is essentially considered to be unknown. Too often, “unknown” becomes zero — even though zero is not a logical estimate.

The budget office has particular difficulty estimating savings when it considers more than one change at once. For example, last December the office reported that it found no consistent evidence that changes in medical malpractice laws would have a measurable effect on health care spending. It also reported that increased spending on studies comparing the effectiveness of different drugs and medical treatments would yield no net savings for 10 years. Yet if both malpractice reform and comparative effectiveness studies were instituted simultaneously, they might work together to yield substantial savings; doctors would gain more confidence in the effectiveness of less aggressive treatments and, at the same time, could use those treatments with less to fear from lawsuits.

The budget office’s cautious methods may have unintended consequences in the current health care reform effort. By underestimating the savings that can come from improved Medicare payment procedures and other cost-control initiatives, the budget office leads Congress to think that politically unpopular cost-cutting initiatives will have, at best, only modest effects. This, in turn, forces Congress to believe it can pay for reform only by raising taxes, which then makes reform legislation more difficult to pass.

The Congressional Budget Office’s integrity is beyond questioning. But the record shows that it has substantially overestimated the cost of health care reform three times out of three. As Congress now works on its greatest push for reform in generations, the budget office needs to revise the methods it uses to make predictions about costs.

Jon R. Gabel is a senior fellow at the National Opinion Research Center of the University of Chicago.

http://www.nytimes.com/2009/08/26/op...fice%22&st=cse

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Originally Posted by TheMercenary (Post 600697)

So since you brought it up, please "debunk" that the insurance companies are NOT going to pass costs on to the rest of us if the bill is passed in its current form.

Read up on the proposed insurance exchange (in all different versions of bills) and you might understand how the process will work with regulations to provide greater competition (thous more competitive premium pricing) as well as regulations to limit pass throughs.

Look, you can scream "screwing the people" all you want if that works for you. You can cite the CBO when you like it. as you have in the past, and criticize it when you dont and you can post your editorials and industry reports that have a bias than any objective observer would recognize.

I think the bills have taken an approach that I generally support...there are no guarantees, but IMO, they represent the best way forward.

Time will tell.

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Originally Posted by Redux (Post 600701)

Look, you can scream "screwing the people" all you want if that works for you.

I think the bills have promise...there are no guarantees, but IMO, they represent the best way forward.

Time will tell.

Now you are avoiding the questions and are unable to support your positions. Can you prove the insurance companies are actually just using "lies and fear-mongering that the industry and conservatives jointly and collaboratively perpetuated throughout most of the "debate"' and they really are not going to pass along the costs to all the rest of us that have insurance.

People like you are why the Demoncrats are beginning to fail in such a big way and they are now turning on each other. The majority don't really agree with the majority of anything. They are just a loose organization of vaguely interested parties all fighting for a piece of the power pie. And now that they have beaten the Republikins they are starting to turn on each other. Senate says no public option. Pelosi says no bill without it. So which is it. Who are you guys going to screw next? Really you are just going to start to screw each other because you can't get it together enough to pass something that addresses the root problems in the industry, you have made back door deals with Big Pharm and the Insurance Industry and now they are starting to turn on you. And yet your attitude is, "Eh, whatever, something is better than nothing." What BS. Grow some nads. Do the right thing and tell the insurance companies to fuck off and get them under control. This goes right back to what Henry said. You are just going to let them pass the bills off that screw other people as long as you can shift blame.

And now we actually have the insurance companies TELLING Us they are going to make everyone else pay for their increased costs and risk. And you guys pretend like there is nothing there. Pass it off and some conspiracy. "It's not true", "There really not going to do that, they just want to scare you."

I don't buy your bullshit and most of the American public does not either.