The five biggest myths about health reform

[SBB]

http://www.marketwatch.com/story/the-five-biggest-myths-about-health-reform-2009-12-10

Here's how three experts who follow health-care policy weighed in on five of the biggest myths and half-truths about the proposed overhaul.

Assertion: It would lead to a government takeover of health care
That's hardly what the reform effort is designed to do, said Henry Aaron, senior fellow at the Brookings Institution in Washington.

"Here's a plan, the primary purpose of which is to extend private health insurance, and it's called a government takeover. It's just bizarre. It's false," he said. "Even the tiny glimmer of possible validity in that argument, which a public option would provide, is not going to be part of any final bill."

The only place government-sponsored insurance would be extended is by increasing eligibility for Medicaid, and even that proposal has limited reach, he said.

Assertion: An overhaul would lead to rationing, where more people face denials or delays in health care
"This is the big red herring of the current debate," Aaron said. "The United States is so far from having an institutional framework from which rationing could occur that it's not a discussion that has much relevance to the reality of our current system or of the system that would emerge if the bill would pass."

Assertion: The bills do nothing to address out-of-control cost growth
"The single biggest myth is that no one is thinking about cost-growth containment," Nichols said. "In fact, most of us think about little else."

Lawmakers don't talk about it as much as they're working on it, he said, "because frankly the rationing rhetoric has been so effective. The people who on the one hand historically have been in favor of fiscal rectitude who are now screaming rationing are making it very difficult to have an adult conversation about cost-growth containment."

The political challenge is to address the estimated one-third of medical spending that's wasted every year on care that doesn't improve people's health.

The bills call for the federal government, through Medicare, to send a signal and change payment incentives so that patients receive high-value care the first time, Nichols said. It's not a one-size-fits-all approach and is designed to account for regional diversity, he said, noting the proposed pilot projects and payment reforms make a serious attempt to correct "mispriced procedures."

Assertion: If you like your health insurance you can keep it
Many experts speculate that it would work out that way but caution that it's not guaranteed, especially since the two bills assess the potential problem differently. While people wouldn't be forced to change what they have, employers may decide for them if they wager they'd be better served to drop coverage and let their workers shop for policies in the new insurance marketplaces the bills envision.
"There are penalties for employers that don't provide coverage so there is this pay-or-play notion, but depending on the penalties it still might be financially beneficial to employers not to play," Zuckerman said. "In the House bill the penalties are much more severe on employers than they are in the Senate bill."

[snowcamper]

If there is so much being wasted every year, then why don't we address that first?  Why must it be combined with everything else?

And the dropping of the "public option" was reluctant, and only after that "public outcry".

Additional regulations always amount to a shift of control from the public to the government, no matter how you spin/deny it.

Rationing can happen without it being expressed directly in the legislation.  i.e.  by simply creating the "Medicare Advisory Panels", who will have the ultimate ability to deny coverage and maybe even treatment.

As for controlling costs:  The repeal of the cost-effective Medicare Advantage program certainly doesn't look like it was designed to control costs.  The closing of the "donut hole" doesn't look like it will reduce costs.  The truth is, they don't have any ideas for controlling costs that don't involve "reducing fraud and waste", which is something they should be doing anyway, without the need for additional legislation.

[RJLeeb]

If there is so much being wasted every year, then why don't we address that first?  Why must it be combined with everything else?

And the dropping of the "public option" was reluctant, and only after that "public outcry".

Additional regulations always amount to a shift of control from the public to the government, no matter how you spin/deny it.

Rationing can happen without it being expressed directly in the legislation.  i.e.  by simply creating the "Medicare Advisory Panels", who will have the ultimate ability to deny coverage and maybe even treatment.

As for controlling costs:  The repeal of the cost-effective Medicare Advantage program certainly doesn't look like it was designed to control costs.  The closing of the "donut hole" doesn't look like it will reduce costs.  The truth is, they don't have any ideas for controlling costs that don't involve "reducing fraud and waste", which is something they should be doing anyway, without the need for additional legislation.

Ding ding.  We have a winner.

Those "experts" that follow health policy...who are they?

A simple google search shows they are anything but unbiased.

[Beel]

From Jame Hamsher at Firedoglake today:

The Obama White House has been working furiously to pass an enormous transfer of wealth to the insurance companies from the start.

If this statement is true--and it would seem to be clearly true, since there is no "public option" of any kind, and that means any reform of the health care delivery system keeps the system in the hands of private enterprise--namely, the insurance industry--how does this square with the endless assertions by everyone on the Right from Limbaugh on down to Leeb that Obama is some treacherous socialist bent of transforming the US into yet another fey European-style "democracy." 

Answer--it doesn't.  What Obama-care amounts to is Bush-care, but closer to actual enactment due to the fact that progressive Democrats aren't looking deep enough into the well--and do care about the folks who will be helped by mandating health care insurance in the sense that at the low economic end, some people will be able to actually get insurance. 

As with Clinton, the real question, politically, is why in the world do Republicans think they need to oppose Obama on every turn.  He's just another one of THEM. 

[RJLeeb]

From Jame Hamsher at Firedoglake today:

The Obama White House has been working furiously to pass an enormous transfer of wealth to the insurance companies from the start.

If this statement is true--and it would seem to be clearly true, since there is no "public option of any kind, and that means any reform of the health care delivery system keeps the system in the hands of private enterprise--namely, the insurance industry--how does this square with the endless assertions by everyone on the Right from Limbaugh on down to Leeb that Obama is some treacherous socialist bent of transforming the US into yet another fey European-style "democracy." 

Answer--it doesn't.  What Obama-care amounts to is Bush-care, but closer to actual enactment due to the fact that progressive Democrats aren't looking deep enough into the well--and do care about the folks who will be helped by mandating health care insurance in the sense that at the low economic end, some people will be able to actually get insurance. 

As with Clinton, the real question, politically, is why in the world do Republicans think they need to oppose Obama on every turn.  He's just another one of THEM. 

Nice spin, but no dice.

I guess you'll be campaigning vigorously against Obama in 2012?  I fully expect to see Beel driving a hybrid around with a Nader 2012 sticker right next to the one that says "This car's carbon footprint has been offset by carbon credits".

Have you bought any carbon credits Beel?  Have you ever put your money where your mouth is?

No need to answer.  We already know.

[Beel]

As with 2008, I'll vote for the most progressive of the two possibilities, as I see them at the time.  It seems to me that with the current GOP we are guaranteed disaster.  While it is more and more clear that in the US, corporations are really the primary citizens and have the ear of which ever party is voted into office, there is still little doubt in my mind that Democrats are for the most part more concerned with the regular citizen and his life.  Barring some unforseen circumstance, I'd certainly pick Obama over Palin, Hucabee, McCain, Romney, or General Petraeus.  Got some other guy in mind?  Expect there to be a real (as opposed to fantasy) third choice?  As far as predicting who wins, I'd predict that Palin always loses, but that both Petraeus and Romney could well win in the climate of 2012, whatever that may turn out to be.  Can either be nominated by a Republican Party in the sway of rampant know-nothingism (a symptom of which would be the denialism we've been discussing on other threads)?  I don't view that as a good bet. 

[Muddylaces]

Beel,

Would you ever consider going to the library and checking out "Going Rogue?"   Call it opposition research.   



I was in Seattle last week staying at a Courtyard.   The young bartender at the hotel bar couldn't understand why I'd be reading a book from someone so stupid.   I asked him why he thought she was so stupid, knowing the answer.   He said, "She said she could see Russia from her backyard."


I won a free beer from him when I proved to him Tina Fey had said that not Palin.

[Beel]

I don't have time to read Going Rogue, or a lot of better books.  I've never thought Palin was Tina Fey.  I was appalled by her acceptance speech to the Republican Convention, I was appalled by her willingness to exploit her family, by her inability to deal with--let's admit it--softball questions such as "what do you read?", and I am mystified by her decision to resign her governorship half way through.  It seems to me very obvious that she's out for the money, wants to be a diva, loves being in the public eye beyond all reason.  Probably McCain did her a great disservice in nominating her and thus thrusting her in the public eye.  She seems to me much like a professional athlete who becomes a star before he or she is ready to deal with the complications of such a life.  I expect further publicity disasters from her.  I can't imagine that she actually wrote her current book, or is capable of writing a thoughtful book--because she seems to me to be obviously an unthoughtful person--as unthoughtful, at least, as former President Bush.  (And I can't really understand why Mr. Bush wanted to be President, for that matter.)

I don't really want to slam her over and over, and I respect that you have a different opinion of her.  I don't draw any conclusions about you from that fact about you.  But I don't think any perception-changing information about Palin could at some point be available.  I really have no idea why she is considered as a serious political candidate for any office, by anyone.  I'm sorry to say that as you disagree--it's not personal.  You seem like a reasonable person, and a likeable one.  Happy New Year to you.   

[RJLeeb]

there is still little doubt in my mind that Democrats are for the most part more concerned with the regular citizen and his life.

I admire your persistent optimism in the face of so much evidence that show it to be futile.

What makes the "progressives" the most dangerous elected officials for the regular citizen isn't their stated intentions.  Many of those are laudable, if naive.  What's unfortunate is the way they intend to go about it, i.e. ceding power to the government.

The regular citizen can never be served by robbing him of his freedom one small piece at a time.

[Muddylaces]

I don't have time to read Going Rogue, or a lot of better books.  I've never thought Palin was Tina Fey.  I was appalled by her acceptance speech to the Republican Convention, I was appalled by her willingness to exploit her family, by her inability to deal with--let's admit it--softball questions such as "what do you read?", and I am mystified by her decision to resign her governorship half way through.  It seems to me very obvious that she's out for the money, wants to be a diva, loves being in the public eye beyond all reason.  Probably McCain did her a great disservice in nominating her and thus thrusting her in the public eye.  She seems to me much like a professional athlete who becomes a star before he or she is ready to deal with the complications of such a life.  I expect further publicity disasters from her.  I can't imagine that she actually wrote her current book, or is capable of writing a thoughtful book--because she seems to me to be obviously an unthoughtful person--as unthoughtful, at least, as former President Bush.  (And I can't really understand why Mr. Bush wanted to be President, for that matter.)

I don't really want to slam her over and over, and I respect that you have a different opinion of her.  I don't draw any conclusions about you from that fact about you.  But I don't think any perception-changing information about Palin could at some point be available.  I really have no idea why she is considered as a serious political candidate for any office, by anyone.  I'm sorry to say that as you disagree--it's not personal.  You seem like a reasonable person, and a likeable one.  Happy New Year to you.   

I wouldn't expect to convert you, but most of the all the questions you posed are answered in the book.


As far as quitting the governorship, Alaska has a system where anyone can bring a ethics charge against the governor at anytime for any reason.   The Alaska governor must pay for these defenses personally.   She could not afford to keep the job.  
examples of the hundreds of frivolous ethic violations,
Wearing her husbands snowmobile jacket because it was cold.  Giving free advertisement to sponsor on the patch.
Someone brought a ethics violation against her because they felt large breasted woman in state government were wearing blouses that were too tight.

These are frivolous, but they cost the Palins $$ every time.    They are not Bush wealthy and could not absorb these costs.  

[djkelly]

Assertion: It would lead to a government takeover of health care

If the government is setting the rules about who has to be covered, what has to be covered and what prices can be that pretty much amounts to government running health care insurance.  If they set the rules so that private companies can’t survive it will lead to more people moving to the government approved plans or eventual true government run plan because there are no private plans left. 

This is a very technical analysis of the senate bill but the beginning highlights the important points.

Impermissible Ratemaking in Health-Insurance Reform: Why the Reid Bill is Unconstitutional
By Richard A. Epstein

This paper focuses on the constitutional question in the ratemaking context, by comparison to analogous regulations in the context of public-utility regulation.
One telling sign of the relevance of this analysis comes from the Congressional Budget Office ("CBO"). In a recent release, it has treated the proposal as if it nationalizes much of the private health insurance industry, most specifically because it may well require that rebates to customers kick in whenever, in its words, "medical loss ratios are less than 90 percent."[2] In plain English, the Reid Bill assumes that health-care administration, which is always costly, can be done cheaply even in the new legal environment, so cheaply in fact that these health-insurance rebates kick in whenever insurers' administrative expenses exceed 10 percent of their premium dollar. As the CBO has concluded, "this further expansion of the federal government's role in the health insurance market would make such insurance an essentially governmental program ..."

http://www.pointoflaw.com/columns/archives/2009/12/impermissible-ratemaking-in-he.php

Assertion: An overhaul would lead to rationing, where more people face denials or delays in health care
”Still, if the bill succeeds in providing millions more people access to health insurance, an increase in demand for medical services may affect some who already have coverage, depending on local market conditions, Aaron said.
"There is a possibility in some specialties and in some areas that the increase in demand could strain supply and therefore make it somewhat more difficult for those who have no problem getting a physician appointment or hospital bed to do so," he said.
Such a problem would be "relatively easy to solve," Aaron said. Opening new clinics and authorizing more health-care workers to carry out routine procedures could help ease the pinch. "It's the sort of thing we know how to do real quick and reliably." “

Medicaid providers are already limited in many areas, so much so that Medicaid recipients are still among the highest users of emergency rooms in many areas.  Significantly increasing Medicaid enrollment will only increase this problem.

If the problem is relatively easy to solve by opening new clinics and authorizing more health care workers why aren’t we doing that instead of this massive overhaul which doesn’t do that?  Increasing the number and hours for community health clinics would greatly benefit those low income people at most risk for not having access to medical care.  Of course authorizing more health care workers involves changing state licensing regulations, something the feds can’t do and something the existing health care lobbies fight very hard against.  But it would be a great place to start.

Assertion: The bills do nothing to address out-of-control cost growth
The political challenge is to address the estimated one-third of medical spending that's wasted every year on care that doesn't improve people's health.
The bills call for the federal government, through Medicare, to send a signal and change payment incentives so that patients receive high-value care the first time, Nichols said. It's not a one-size-fits-all approach and is designed to account for regional diversity, he said, noting the proposed pilot projects and payment reforms make a serious attempt to correct "mispriced procedures."
Zuckerman was more guarded about whether the bills have enough teeth to rein in costs.
"In the short run, cost-containment elements are not strong, but there are pieces in the legislation that could play out over time to contain costs," he said. "It doesn't look like the cost containment [elements] of the bill are as strong as they could be, but to say they're nonexistent is an overstatement."

Anyone who believes the federal government, through Medicare, can send a signal to change payment incentives is dreaming.  Just as is anyone who believes Medicare can cut the amounts claimed just by cutting waste, fraud and abuse.  Provisions were put into place years ago to control Medicare costs and legislation passed each year to defer those measures so that the outstanding bill is now 21%.  If it hasn’t been done in all these years why would it be any different now?  If those cuts are ever enacted we would see a very large number of doctors refuse to accept Medicare patients which is why it won’t happen.  Of course in order to pretend that the health reform bill doesn’t create a budget deficit it still counts on that 21% fee reduction to Medicare and the fix for it was moved to a separate, unfunded bill.

Medicare is unsustainable.  Until it is fixed there’s no point in expanding any government health care program.

Assertion: If you like your health insurance you can keep it
"President Obama touted this idea early and often as he campaigned to overhaul the system, but can he deliver on that promise?

Obama's pledge likely doesn't qualify as a myth, Aaron said. "In practice, the vast majority of people covered by private insurance will end up keeping their private insurance and won't notice any material change.""

I realized this statement was a joke the first time I heard it.  He can’t deliver on that promise because he doesn’t control what employers offer, at least not yet.  In practice I’m not so sure the vast majority of plans won’t be affected by the legislation.  There are many provisions about what will be required and it’s quite likely that many plans now offered will no longer be acceptable.  Of course there’s no way to know because most of the details aren’t in the bills, they’re to be decided later, after it’s implemented.

This is why one of the best reforms would be to end the business deductions for providing health insurance and provide individual deductions instead.  If people owned their own insurance they wouldn’t be restricted to what their employer offers or dependent on employment for coverage.  They’d have portability so job loss and illness would be less of an issue.  The increased market from having everyone in the individual market instead of only a small percentage would drive competition and innovation and prices would come down.

Assertion: The bills are too big, and changes should be tackled one by one instead of all at the same time
It's been 15 years since the U.S. came even remotely close to passing comprehensive health reform. While this year's attempt is ambitious, people who decry the scope of the bills underestimate how many moving parts need to work in unison to achieve the desired results, Nichols said.
"It's got to be done as a package," he said.

This is cr*p.  Many of these changes have already been implemented in various states and it’s easy to see what has worked and what hasn’t.  The sad fact is that most of them haven’t worked.  Why does anyone think they’d work any better on the national level?

Real reform instead of this bizarre conglomeration they’ve cobbled together would address separate issues and could easily be done separately.  Anyone who thinks they’re smart enough to accurately predict even the most likely outcome of the effects of all these various proposals on each other is kidding themselves. 

The other simple fact is that we simply can’t afford the proposals being made and all the accounting gimmicks in the world won’t change that.

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