[Orion27]

I was wondering why the health care debate is taking place behind closed doors. During the campaign,
Obama promised this debate would be carried in the open on C-Span. Why would the Democrats do this? I think they are hiding something from the American people. Here is a clip of Obama promising to have the debate on C-Span. Eight separate times!
Breitbart.tv � The C-SPAN Lie? See Eight Clips of Obama Promising Televised Healthcare Negotiations

[Big Mac]

The official Democratic line is that actually bringing a final bill to send to the president is such dirty work that there's no way to expose to the sunshine of public scrutiny and get anything accomplished at the same time. Of course, they said pretty much the same thing throughout this whole process.

[OAW]

The debate has been shown on C-SPAN. Weren't you paying attention? What's about to take place now isn't a debate ... it's a negotiation. The bills passed by the Senate and the House need to be reconciled into a single bill. Once that negotiation is completed and a single bill is produced I would fully expect that the debate on the final bill will be on C-SPAN in both the chambers of Congress.

OAW

[olePigeon]

All the reasons why I wanted the bill to pass are no longer included, so I hope it doesn't pass.

[Big Mac]

And why did you want the bill to pass? You believe in a public option?

[OAW]

Originally Posted by olePigeon 

All the reasons why I wanted the bill to pass are no longer included, so I hope it doesn't pass.

I'm not quite at that point ... but it's getting close. Ending abusive practices like denying coverage b/c o pre-existing conditions or canceling coverage once you become sick is definitely a good thing. But the bottom line in all of this is cost. The legislation as written supposedly "bends the cost curve" according to the non-partisan CBO. But that is talking about the cost to the government. That is, government spending on health care. What concerns me more are the skyrocketing premiums that are a direct cost to people. What's going to be done to keep premiums from jumping every year at two or three times the rate of inflation for no other reason than because the private insurance companies can? The public option was designed to offer a non-profit competitive check against this. If that is going to be tossed then fine. But something else needs to be done to accomplish the same goal. A nationwide insurance exchange instead of some piecemeal state-by-state system along with a repeal of the private insurance antitrust exemption is a start. The federal government at a minimum needs to set up a regulated marketplace and force the private insurance companies to actually compete IMO. If that didn't work, I certainly wouldn't be opposed to regulating their profit margins like utilities.

OAW

[besson3c]

Originally Posted by OAW 

I'm not quite at that point ... but it's getting close. Ending abusive practices like denying coverage b/c o pre-existing conditions or canceling coverage once you become sick is definitely a good thing. But the bottom line in all of this is cost. The legislation as written supposedly "bends the cost curve" according to the non-partisan CBO. But that is talking about the cost to the government. That is, government spending on health care. What concerns me more are the skyrocketing premiums that are a direct cost to people. What's going to be done to keep premiums from jumping every year at two or three times the rate of inflation for no other reason than because the private insurance companies can? The public option was designed to offer a non-profit competitive check against this. If that is going to be tossed then fine. But something else needs to be done to accomplish the same goal. A nationwide insurance exchange instead of some piecemeal state-by-state system along with a repeal of the private insurance antitrust exemption is a start. The federal government at a minimum needs to set up a regulated marketplace and force the private insurance companies to actually compete IMO. If that didn't work, I certainly wouldn't be opposed to regulating their profit margins like utilities.

OAW

Yeah, I agree with you. About the only thing left to be excited about is the preexisting conditions loophole.

Michael Pollan, the guy behind Food. Inc. and author of several food industry related books made an interesting point on the Daily Show the other day about how plugging this preexisting condition loophole might get the insurance companies interested in what people eat since they'd have a vested stake in keeping people healthy so that the unhealthy aren't a liability for them. We eat insane amounts of sugar, corn syrup, and other crap and much of this cheap food is government subsidized.

[Orion27]

Originally Posted by besson3c 

Yeah, I agree with you. About the only thing left to be excited about is the preexisting conditions loophole.

Michael Pollan, the guy behind Food. Inc. and author of several food industry related books made an interesting point on the Daily Show the other day about how plugging this preexisting condition loophole might get the insurance companies interested in what people eat since they'd have a vested stake in keeping people healthy so that the unhealthy aren't a liability for them. We eat insane amounts of sugar, corn syrup, and other crap and much of this cheap food is government subsidized.

So you admit government subsidies in this instance are harmful. Why don't we just cut the subsidies altogether? Research shows if we quarter our calorie intake will live a lot longer. This would be a true benefit. That in turn, ipso facto, would lower health care costs by preventing disease instead of treating it. That would obviate the need for government subsidies to insurance companies to cover preexisting conditions because the insurance companies could afford to offer it as a benefit. Also a little hunger is a great motivator!

[ort888]

The Health Care industry has entire beltway area in their pocket and are laughing all the way to the bank during this entire process. They own the Republicans and they own the Democrats.

The fact that normal people aren't more upset by the state of health care in this country is what shocks me. How can anyone not want this stuff reformed? Why isn't everyone more angry?

[ebuddy]

Originally Posted by OAW 

If that didn't work, I certainly wouldn't be opposed to regulating their profit margins like utilities.

One of the reasons why insurers offer so many products over and above health insurance is because there isn't a lot of money in health insurance. What shall we cut their profit margin to? What would be fair in your opinion? I think utilities are in the list, well above the profit margins of the health insurance industry.

[Big Mac]

Originally Posted by OAW 

The debate has been shown on C-SPAN. Weren't you paying attention? What's about to take place now isn't a debate ... it's a negotiation.

Thank you for pointing out that it's a negotiation because the negotiations were exactly what President Obama pledged (multiple times) to have put on CSPAN.

[Chongo]

Brain Lamb, C-SPAN CEO has called Obama's bluff and offered to dedicate all the air time needed.

[OAW]

Originally Posted by Big Mac 

Thank you for pointing out that it's a negotiation because the negotiations were exactly what President Obama pledged (multiple times) to have put on CSPAN.

Sounds like Obama is abandoning his pledge in this situation. I would imagine that the political calculus is something along this line ....

The health insurance reform debate has taken waaaaay longer than anticipated. The Republicans are universally opposed to it ... even the moderates despite the fact that the primary provisions they objected to (i.e. the public option) were abandoned in the Senate. The goal line is within striking distance. Obama (and others) want to close the deal in order to move on to other initiatives. Given that I suppose they figure that the benefits of getting the health insurance reform legislation passed soon (i.e. prior to the State of the Union address) outweighs the (valid) criticism that will ensue for not televising the negotiations. Especially if the end result is favored by the majority.

OAW

[Orion27]

Originally Posted by OAW 

Sounds like Obama is abandoning his pledge in this situation. I would imagine that the political calculus is something along this line ....

The health insurance reform debate has taken waaaaay longer than anticipated. The Republicans are universally opposed to it ... even the moderates despite the fact that the primary provisions they objected to (i.e. the public option) were abandoned in the Senate. The goal line is within striking distance. Obama (and others) want to close the deal in order to move on to other initiatives. Given that I suppose they figure that the benefits of getting the health insurance reform legislation passed soon (i.e. prior to the State of the Union address) outweighs the (valid) criticism that will ensue for not televising the negotiations. Especially if the end result is favored by the majority.

OAW

Favored by what majority? NBC poll: Public sours on health reform - First Read - msnbc.com

[OAW]

Originally Posted by ebuddy 

One of the reasons why insurers offer so many products over and above health insurance is because there isn't a lot of money in health insurance. What shall we cut their profit margin to? What would be fair in your opinion? I think utilities are in the list, well above the profit margins of the health insurance industry.

Not sure what source you were citing since you didn't provide a link. We don't know what year that represents or if that is an average over a particular time frame. Having said that, there are many health care related industries on that graphic with much higher profit margins than the hospitals and health insurance plans you cited. Drugs manufacturers being one of them. Regardless, profit margin is a function of revenues vs expenses. So healthcare insurers can raise premiums at several times the rate of inflation ... and still maintain relatively modest profit margins because they are passing on skyrocketing healthcare costs (i.e. pharmaceuticals, diagnostics, doctors, hospitals, etc.) onto consumers. So the question then becomes WHY are such costs skyrocketing? Is there any economic justification for it other than the providers can? Healthcare is a very inelastic commodity ... so prices can easily be raised year over year with little repercussion because when you are dealing with people's health (or even their life) they don't "shop around" based on price. And with HMO's and other network based healthcare you can't really do that even if you wanted to ... not if you want you want your insurance to actually cover your charges. So something has to be put in place to check against healthcare providers constantly raising prices just to "get over" on the public. If regulating health insurance providers isn't the answer fine. But something has to be done because the "free market" isn't cutting it. The bottom line is that there is no such thing as a truly "free market" when one's health is at stake. Which is why I think the fundamental problem is that the healthcare industry is organized around the profit motive like other industries ... and perhaps it shouldn't be. Or perhaps it should be but just highly regulated more than other industries (like a utility) because it is so essential to the public good. But that's a much bigger discussion than the topic at hand.

OAW

[Chongo]

This is getting bad, even CNN's Jack Cafferty is calling Obama on this.
YouTube - Jack Cafferty Rips Obama on Failed Openness Pledge: 'Just Another Lie Told for Political Expediency'
Brain Lamb on Bill Press' show
Breitbart.tv � C-SPAN CEO: White House Has Allowed Only ‘One Hour’ of Health Care Coverage

[OAW]

Originally Posted by Orion27 

Favored by what majority? NBC poll: Public sours on health reform - First Read - msnbc.com

I'll simply remind you of the key phrase ....

Originally Posted by OAW

Especially if the end result is favored by the majority.

The last time I checked we don't have a final bill.

OAW

[ort888]

If Obama went on TV to talk about how much he is opposed to shooting yourself in the face with a shotgun, do you think Tea Baggers and Republicans would start shooting themselves in defiance?

[ebuddy]

Originally Posted by ort888 

If Obama went on TV to talk about how much he is opposed to shooting yourself in the face with a shotgun, do you think Tea Baggers and Republicans would start shooting themselves in defiance?

If Democrats had done something sensible or effective in the past 12 months, do you think you'd be talking about tea baggers and Republicans?

[besson3c]

Originally Posted by ebuddy 

If Democrats had done something sensible or effective in the past 12 months, do you think you'd be talking about tea baggers and Republicans?

You can bet on it. The silliness of some of the Republicans in looking for inane things to blow whistles on started well before Obama's first day in office. Don't you remember the campaign season?

[turtle777]

Originally Posted by besson3c 

Yeah, I agree with you. About the only thing left to be excited about is the preexisting conditions loophole.

I never understood why people get so upset about treating pre-existing conditions differently.

We are talking about insurance. Insurance premiums are there to cover for a uncertain catastrophic event (risk). You pay the premiums before the catastrophic event happens.

Selling "insurance" w/o higher premiums for pre-existing conditions is akin to buying a fire insurance once your house is on fire, or buying car insurance after you've gotten into an accident.

At this point, the whole insurance idea has gone to hell. You are not covering a risk, you are covering a certain event.

To NOT charge more for a certain event than for a risk (that might never happen) completely screws up the whole insurance model.

But hey, let's have the Dems take a stab at it, I'm sure they're perfectly capable to make a bad health care system far worse than anyone could have ever imagine.

-t

[Big Mac]

Originally Posted by turtle777 

Selling "insurance" w/o higher premiums for pre-existing conditions is akin to buying a fire insurance once your house is on fire, or buying car insurance after you've gotten into an accident.

The problem is that many preexisting conditions don't just increase health insurance rates, they make one ineligible to get a private plan altogether. A person in that situation then has to either go into a high risk pool (usually very costly), get on to a group plan through an employer (which some people who aren't otherwise employer-covered can afford do on their own with DBAs and the small business group plan loophole, but most probably don't know about the option and the rest who do probably don't want to go to the trouble), or go without insurance. And the last option - going without - probably isn't a good idea, especially for those who have had health issues in the past.

The problem of preexisting condition exclusions and substantial rate-ups is largely one of the insurance industry's own creation because it could have easily solved the issue if it wanted to on its own initiative, instead of leaving low hanging fruit for Dem. demagogues. I'm not a fan of this legislation, but I do believe preexisting exclusions are a problem that should be addressed.

[turtle777]

You are right, there needs to be a smart way to deal with this, so everyone can get insurance.

However, the current proposal will bankrupt the system.

Why ? Because people will go uninsured, pay the fine (which is at this point a joke) and get cheap insurance once they get seriously ill.

It will kill the system for everyone. Thanks, Obama.

-t

[dzp111]

It's about the tier system, one which the majority of Canadians have opposed since our health care system came to being. I'm thinking that Americans are too late to resolve this issue.

Example: I needed kidney stones removed (blasted actually) two weeks ago, and stayed in a semi-bed room (2 beds) for 2 days, and I make less than 25k yearly -no cost. At the same time, my dad's boss had a leg amputated because of diabetes and is still in a room with 6 beds (3 weeks now), and he owns a business that made him a multi-millionaire.

The difference between him and I? None! Zero!

Sure he gets his meds for 2 bucks a crack while I pay up to $50.00, but that's where the 2nd tier comes in. It's not about the care, but it's about the insurance companies and the pharmaceutical ones.

There are no 'private' hospitals or health care here. The rich one gets no better care than the homeless one. It's even. Care is care, and it should be fair to all.

Mind you, my dad's boss, when he deceases will leave a fortune to his heritages. Me? I leave nothing. But at least I was cared for the same as he was (better actually).

Make care fair, at the least. Everywhere.

I hope it works out.

[ebuddy]

Originally Posted by OAW 

Not sure what source you were citing since you didn't provide a link. We don't know what year that represents or if that is an average over a particular time frame.

I think that was an annual figure from 2007. Can you cite a reference that suggests a higher profit margin than 3.3%? In fact, I think the most recent annual figures actually have them down to approximately 2.2% per Fortune Magazine. Credit ratings of the largest insurers were downgraded from stable to negative coming into 2009 and I suspect this is due in large part to the same problems you and I experience with health care in the US; cost.

Having said that, there are many health care related industries on that graphic with much higher profit margins than the hospitals and health insurance plans you cited. Drugs manufacturers being one of them.

Yes. Gas and electric utilities were above them too which stands in conflict with your idea of regulating health insurers like we do gas and electric utilities. Complaints of exorbitant health insurer profit margins is just more red meat for anti capitalism IMO. We agree that hospitals and pharmaceuticals charge more because in many cases they can, but I'm not much for demonizing them either. They're simply operating in the environment provided them by the State, not to mention the incredible burden on the systems of some States created by non US citizens.

Regardless, profit margin is a function of revenues vs expenses. So healthcare insurers can raise premiums at several times the rate of inflation ... and still maintain relatively modest profit margins because they are passing on skyrocketing healthcare costs (i.e. pharmaceuticals, diagnostics, doctors, hospitals, etc.) onto consumers.

Right. Healthcare insurers raise their premiums in order to maintain a miniscule profit margin. Your argument was in regards to their margin of profit in what I can only assume was an attempt to make a public option more appealing. The problem here is that the government would likewise need to increase premiums and cut coverages to keep up with inflation and skyrocketing healthcare costs and there would be no consumer recourse. Worse, it'd be yet another political football to kick around each election year.

So the question then becomes WHY are such costs skyrocketing? Is there any economic justification for it other than the providers can? Healthcare is a very inelastic commodity ... so prices can easily be raised year over year with little repercussion because when you are dealing with people's health (or even their life) they don't "shop around" based on price.

People aren't shopping prices because they're not paying most of them. Third parties including your employer and the government are subsidizing all, but 14 cents of every dollar spent on care. Not unlike the skyrocketing costs of college tuition for example, people will always spend their own money more carefully than they'll spend someone else's.

And with HMO's and other network based healthcare you can't really do that even if you wanted to ... not if you want you want your insurance to actually cover your charges.

Let's be clear about something here though OAW, health insurers pay out a metric ton of money for your charges. There are a couple of hot-button issues, but only a couple. Much of this can be solved so easily if we just peel away all the demagoguery that seems to permeate this discussion.

So something has to be put in place to check against healthcare providers constantly raising prices just to "get over" on the public. If regulating health insurance providers isn't the answer fine. But something has to be done because the "free market" isn't cutting it.

While greed is certainly a factor be it corporate, government, or otherwise; 46% of our health care in this country is managed by the government and if that were "cutting it", we wouldn't be having this discussion. The standard market forces that would drive competition are not at play here. One of the major problems IMO is that the market for health care is anything, but free in this country. Prior to Medicare and Medicaid (1965), health care expenditure was 6% of GDP, now it exceeds 16%. This, combined with over 50 regulations on the industry up to and including the requirements on employers all drive up the cost of healthcare. Imagine the cost of your auto insurance if they were expected to pick up the cost of topping off your windshield washer fluid, new tires every 30,000 miles, and bumper to bumper mechanical maintenance. To the patient in the healthcare arena, these are all artificially funded. Now folks are seeking out medical services for anything from restless leg syndrome to the occasional bad day while we're spending more on eating out and entertainment annually.

The bottom line is that there is no such thing as a truly "free market" when one's health is at stake.

Sure there is. For one thing, the need for health care is one of the most profound motivators for seeking gainful employment.

Which is why I think the fundamental problem is that the healthcare industry is organized around the profit motive like other industries ... and perhaps it shouldn't be. Or perhaps it should be but just highly regulated more than other industries (like a utility) because it is so essential to the public good. But that's a much bigger discussion than the topic at hand.

I have a hard time with this argument in light of how profitable utilities are, but IMO;

• We need to repeal antiquated legislation granting sole discretion of health insurers to the State.
• Subsequently, we need competition. Not one more insurer mind you, but opening the market to the 1300+ insurers already operating in this country.
• Anti-trust enforcement.
• HSAs and HSA-compatible plans that encourage rate shopping. For the most vulnerable among us, these plans can be partially subsidized by the government with policies that encourage them to shop rates such as the ability to roll subsidy-savings over to the following plan year.
• Tort reform
• Tax reform including deductions for healthcare expenditures

... to name a few.

[OAW]

ebuddy,

I think are ideas regarding health insurance reform are not as far apart as we might think.

Having said that, here's where I am on the topic. If we are not going to go with a single-payer system (like every other industrialized nation has) and if we are not going to go with a public option then I wonder if it wouldn't be a wiser to approach this from a regulatory standpoint first .... and then get into premium subsidies later only if need be? The government has the power to establish and reform the ground rules for the health insurance industry. Like I said earlier ... establish a national market and eliminate this state-by-state piecemeal system. Repeal the anti-trust exemption for insurers. Establish minimum standards for health plans. Prohibit denial of coverage for pre-existing conditions and cancellation of insurance when you get sick. Perhaps even set a cap for how much more a person can be charged in premiums (e.g. the highest rate can only be 20% more than the lowest rate, etc.) Prohibit pharmaceutical companies from charging exorbitant prices on Americans that they don't charge in other countries. Then let the private insurance companies go at it and compete.

At least the CBO scores show that the legislation under consideration will positively impact the deficit (quite unlike the Medicare prescription drug benefit pushed by the Bush Administration which didn't even attempt to pay for it). But I'm concerned that too much emphasis has been placed on subsidization and expanding coverage as opposed to fundamental reform of the health insurance industry itself.

OAW

[ebuddy]

Originally Posted by OAW 

ebuddy, I think are ideas regarding health insurance reform are not as far apart as we might think.

I actually thought the same thing when I was putting together some of the bullet points OAW. The focus of our concerns and our desired ends may differ significantly, but we cross paths on several key aspects of this issue.

Having said that, here's where I am on the topic. If we are not going to go with a single-payer system (like every other industrialized nation has) and if we are not going to go with a public option then I wonder if it wouldn't be a wiser to approach this from a regulatory standpoint first .... and then get into premium subsidies later only if need be?

It's important to note that a great deal of these single-payer systems have had to take a hard look at the level of care they're able to provide in order to remain solvent through rising costs. The result? A wealth of reforms such as those in Sweden in the 90's increasing privatization. (California alone with a population 4 times that of Sweden) The NHS and Canadian health care systems have steadily been increasing the roles of privatization in their systems as well. A number of other means have become necessary to overcome increasing costs including rationing care and waiting lists for appointments and surgery. It does little good to have a card claiming you have health care when you can't get it. Medicaid's higher rate of claims denials for example is just one reason to be skeptical of the Federal panacea.

I actually think a comprehensive package of reform with all of the points I mentioned above such as HSAs and compatible plans, repealing the McCarran-Ferguson Act of 1945, tort reform, etc... should include the subsidies first and forego the pre-existing condition mandate with a potential trigger for it later if necessary. The only regulatory measures I'd like to see as part of this package are the ones that already exist, but are not enforced as part of the state by state monopoly scheme.

The government has the power to establish and reform the ground rules for the health insurance industry. Like I said earlier ... establish a national market and eliminate this state-by-state piecemeal system.

If by "establish a national market" you mean eliminating the state-by-state piecemeal system opening the market to the hundreds of insurers that exist today, yes.

Repeal the anti-trust exemption for insurers.

Yes.

Establish minimum standards for health plans. Prohibit denial of coverage for pre-existing conditions and cancellation of insurance when you get sick. Perhaps even set a cap for how much more a person can be charged in premiums (e.g. the highest rate can only be 20% more than the lowest rate, etc.)

I'm inclined to disagree, but would be open to a trigger on some of the above if necessary.

Prohibit pharmaceutical companies from charging exorbitant prices on Americans that they don't charge in other countries. Then let the private insurance companies go at it and compete.

The reason we pay more for pharmaceuticals as you know is because they are recovering their cost of research and development, bringing new drugs to market on the backs of Americans. They're also spending an exorbitant amount on advertising and general administrative overhead and of course it's pretty hard to feel sorry for them with profit margins exceeding 11-19%. I'm in favor of decreasing regulations on new drugs including ridiculous disclaimers requiring multi-page inserts of 3.5 font no one can read and I'd like to see more generics entering the market. I'm torn on any measure that seeks to artificially limit profit because I'm not sure it's necessary. The oft derided Walmart for example is starting to penetrate this market substantially offering generics at a fraction of the cost we've grown accustomed to. Competition. Lowering costs. I believe in it OAW, I really do. This is likely where we differ.

At least the CBO scores show that the legislation under consideration will positively impact the deficit (quite unlike the Medicare prescription drug benefit pushed by the Bush Administration which didn't even attempt to pay for it). But I'm concerned that too much emphasis has been placed on subsidization and expanding coverage as opposed to fundamental reform of the health insurance industry itself.

There is so little at the CBOs disposal on the current legislation that they may very well be shooting in the dark entirely. I've often cited them when they've claimed deficit increases because of their well-documented history of woeful underestimations. If they claim a measure will increase the deficit by 'X' amount, I believe it while quietly adding 300%. If they claim a decreasing deficit from a measure that adds 20 million people to a system already proven insolvent, I just don't buy it at all.

BTW, the CBO has admitted that they've essentially double-counted savings in the Senate proposal. Medicare is funded from a separate trust fund and the savings from this fund do not go into the general budget that will fund ObamaCare. This means that instead of a $130 million surplus, we're really looking at a $170 million hole. The large print giveth, the small print taketh away.

We need measures that actually address increasing costs, in that we agree. Most are happy with their own care, they want to see the vulnerable get the care they need and they want to know the players in this industry are playing fair. I believe there are answers to both that are much less contentious and exponentially less expensive.

[ebuddy]

Originally Posted by besson3c 

You can bet on it. The silliness of some of the Republicans in looking for inane things to blow whistles on started well before Obama's first day in office. Don't you remember the campaign season?

Yeah and I remember Democrats eating their own young over it too. Figuratively and literally. You don't? Tell me, what (R) slander wasn't also employed by a (D) against Obama?

[besson3c]

Originally Posted by ebuddy 

Yeah and I remember Democrats eating their own young over it too. Figuratively and literally. You don't? Tell me, what (R) slander wasn't also employed by a (D) against Obama?

WTF dude? I didn't say that Democrats don't slander and do partisan crap as well. Why are you getting your guard up? My point was simply that there will always be committed enemies of both parties no matter how effective or ineffective they are, which is a pretty simple and obvious point.

[Shaddim]

I'm just gonna sit and wait for the health insurance companies to start filing for bankruptcy. It may be a conservative estimate, but I give them 36 months.

[ebuddy]

Originally Posted by besson3c 

WTF dude? I didn't say that Democrats don't slander and do partisan crap as well. Why are you getting your guard up? My point was simply that there will always be committed enemies of both parties no matter how effective or ineffective they are, which is a pretty simple and obvious point.

You may not recall that my initial response was to a post that was decidedly antagonistic toward teabaggers and Republicans. I don't think teabaggers and Republicans would be nearly as relevant or newsworthy had this Administration been more effective the past 12 months which is of course also pretty straight forward and obvious. The largest drops in Obama's approvals have been among independents and those not generally associated with committed partisan enemies.

You got defensive about my point which I thought odd in light of the incredibly vile post I was responding to.

[Big Mac]

Originally Posted by ebuddy 

There is so little at the CBOs disposal on the current legislation that they may very well be shooting in the dark entirely. I've often cited them when they've claimed deficit increases because of their well-documented history of woeful underestimations. If they claim a measure will increase the deficit by 'X' amount, I believe it while quietly adding 300%. If they claim a decreasing deficit from a measure that adds 20 million people to a system already proven insolvent, I just don't buy it at all.

In addition to the good points you made, it's important to note that CBO can only go by the legislative language currently offered by Congress in constructing its projections. Congress claims it will get savings from X and raise revenue from Y, and CBO has to go along with it without any evaluation of those claims - no matter how fictional they may be in reality. If you take a look at the ways in which Congress is claiming to fund this takeover, you'll see that there's essentially no chance that they will ever follow through on most of the promises being made. Most notably, they claim they're going to cut Medicare by $500 B over ten years while simultaneously expanding it - they're not going to do the former but will do the latter. And they don't include the Doc Fix, which means that even if they were to deliver on all the other promises the net impact of this legislation will worsen the deficit. So I'm going to chuckle heartily when President B.H.O. again claims this thing will be deficit neutral in the State of the Union.

[thunderous_funker]

Kudos to OAW and ebuddy for conducting the most thoughtful and reasoned discussion of the topic I've seen all year. If only the national discourse was being conducted on this level we might actually arrive at a solution that would be beneficial. You guys rock!

Top of my list would be going back to the good old days when pharma couldn't direct market prescription drugs. That change has been a disaster for everyone but the shareholders. Marketing expenditures are staggering. Not to mention that it creates all kinds of negative incentives and fundamentally undermines health care providers.

That would do a lot to normalize drug costs, which are far and away the largest contribution to healthcare cost inflation.

I also find it interesting that Walmart gets lauded for doing something (price negotiation) that gets called Socialism when Congress wants to do it on behalf of its "customers".

[Orion27]

Originally Posted by thunderous_funker 

Kudos to OAW and ebuddy for conducting the most thoughtful and reasoned discussion of the topic I've seen all year. If only the national discourse was being conducted on this level we might actually arrive at a solution that would be beneficial. You guys rock!

Top of my list would be going back to the good old days when pharma couldn't direct market prescription drugs. That change has been a disaster for everyone but the shareholders. Marketing expenditures are staggering. Not to mention that it creates all kinds of negative incentives and fundamentally undermines health care providers.

That would do a lot to normalize drug costs, which are far and away the largest contribution to healthcare cost inflation.

I also find it interesting that Walmart gets lauded for doing something (price negotiation) that gets called Socialism when Congress wants to do it on behalf of its "customers".

Good Point! I'm not a customer of Congress, I own the store! And it appears WalMart,
darling of the left, has used the power of the marketplace to lower the cost of drugs.
And I might add, efficiently, with little bureaucracy and script from my doctor.

[OAW]

Originally Posted by thunderous_funker 

Kudos to OAW and ebuddy for conducting the most thoughtful and reasoned discussion of the topic I've seen all year. If only the national discourse was being conducted on this level we might actually arrive at a solution that would be beneficial. You guys rock!

Appreciate the sentiments.

Originally Posted by thunderous_funker 

Top of my list would be going back to the good old days when pharma couldn't direct market prescription drugs. That change has been a disaster for everyone but the shareholders. Marketing expenditures are staggering. Not to mention that it creates all kinds of negative incentives and fundamentally undermines health care providers.

That would do a lot to normalize drug costs, which are far and away the largest contribution to healthcare cost inflation.

I also find it interesting that Walmart gets lauded for doing something (price negotiation) that gets called Socialism when Congress wants to do it on behalf of its "customers".

This is like a no brainer for me. I see no purpose whatsoever for pharma companies to be advertising drugs on TV when most people don't have a clue what the friggin drug is even supposed to treat! And when the Bush Administration (and the Republican controlled Congress) intentionally forbade the government from negotiating a volume discount on the Medicare Part D prescription drug program that made no sense whatsoever. Unless, of course, you are carrying the water for the pharmaceutical industry.

OAW