Health Insurance Reform is not about insurance at all; if it were, you could do it for a fraction of the money proposed. It's about taking over another 17% of the US economy, putting the Federal Government directly in charge of half the GDP meaning we become wards of the State - politically and economically.
It's not your money, after all; it's the Federal Government's money and you'll get to keep what they want and spend it where they want. Taxes aren't taxes, they are patriotic contributions. Taxes shouldn't be condemned they should be praised for all the "benefits" you'll get from them.
Now be a good little ward of the State and go labor a little more for your Obamassiah...
Oh, and for our pal John Jensen (whom I'm sure will be all over this post), we KNOW that Obama promised time and again that you can keep your coverage if you want it, that you won't have to change at all. And that Obama will veto any bill that forces such a change.
I wonder if Obama will approve the current HCR bill, in light of page 92:
(A) IN GENERAL. The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 201, including the essential benefit package requirement under section 221
Meaning after 5 years your plan WILL be obsolete, since a requirement of the HCR is that ALL plans eliminate exclusions and mandate community standards (which no plans include today).
I wonder if John and his fellow talking-point Leftists (like Tim the Tax Cheat) will hold Obama's feet to the fire and demand he veto this bill?
Posted by Shanghai Dan at November 1, 2009 05:41 PMI saw it mentioned "Indian" a lot. I looked for how much.
332 of the 1990 pages contain the word "Indian."
Boggling.
Identifying the various use-cases and trying to price out the personal impact, I would agree with Geithner, is not the appropriate way to look at reform. The majority of us have employer-provided insurance which will face very little substantial impact. (There already is guaranteed issue and common premiums in the employer market.)
To answer whether someone in the individual market will pay more or less is a difficult question depending primarily on age and health. It would also depend on whether their current costs are $0 because they lack insurance by way of choice, affordability, or denial.
"If you are firmly in the middle class, recognizing significantly increased health care costs due to the Democrats' plan -- even though this is the reality you face -- you shouldn't think about it that way."
I need to point out that you did not prove this "reality." Is there evidence that this is to be the case? Health care costs would go down according to the CBO, primarily due to the Cadillac-plan tax.
The CBO has said that the largest impact of the "Cadillac-plan" tax is not more expensive plans but cheaper ones. Most of the revenue from the tax is due to increased wages by employers choosing cheaper plans. I guess this is yet another to way to look at the tax increases: they will increase employee-take home page according to the CBO. How's that for a frame?
"Our healthcare system imposes enormous burdens not just on business...."
...which is why the new House Bill apparently carries an employer mandate.....As if that's not an employer burden, Mr. Geitner??
Brain fog, Mr. Geitner?
Posted by Michele at November 1, 2009 08:15 PMTo the exclusion of the cost to individuals? Yes, of course. Obviously.
Identifying the various use-cases and trying to price out the personal impact, I would agree with Geithner, is not the appropriate way to look at reform.
You really expect us to not care about what it does to us and our families?
Really?
The majority of us have employer-provided insurance which will face very little substantial impact.
Unless you have a Cadillac plan, or make "too much" money. For five years, which is when the "grace period" ends (as if we need "grace" to choose our own health insurance?).
I need to point out that you did not prove this "reality."
It's well-known and proven separately.
Is there evidence that this is to be the case?
Yes.
Health care costs would go down according to the CBO, primarily due to the Cadillac-plan tax.
So you admit there's evidence of this tax. Then why did you ask if there was?
The CBO has said that the largest impact of the "Cadillac-plan" tax is not more expensive plans but cheaper ones.
Exactly. Those plans will cost less because they will no longer provide the better benefits. That's the point. Either you pay more or you get less.
Of course, if the Cadillac plans go away as you claim, then how can they generate this much-needed revenue?
Most of the revenue from the tax is due to increased wages by employers choosing cheaper plans.
So the government will get more money by forcing employers to give us fewer benefits. You think this is a good idea?
Wow, 332 pages? I guess for being independent nations exempt from most Federal laws they're really going to get hammered.
Or is it that Indian Health Service is so bad that it needs to be reformed even more than the non-Government run health insurance plans? If so, that's a RINGING endorsement of the ability of Government to handle the task - they so screwed up their own health insurance plan that it needs 17% of the efforts of a health insurance bill to get it "right" again!
Posted by Shanghai Dan at November 2, 2009 12:00 AMI guess this is yet another to way to look at the tax increases: they will increase employee-take home page according to the CBO. How's that for a frame?
Wait a minute, more money is left with the employers, so they will then give the money to the employees. Hey, that's trickle down! Don't you clowns on the left constantly deny that trickle down economics works? And now you're using it to justify the nationalization of health insurance and health care?
Bizarro world must have a temporal rift open again...
Posted by Shanghai Dan at November 2, 2009 12:04 AMNice "use-case" analysis. But - if you want to go the technical route:
Engineers often assess, up-front, what it is going to take to get a job done in terms of cost and schedule. For software we do SLOC estimates, processor timing and throughput estimates, risk assessment, etc. Depending on the size and scope of the job it can turn out to be an exercise in accuracy or a complete debacle. Usually the bigger the job the less accurate the initial estimates tend to be.
In the end the metrics are all collected and analyzed and rolled into the "next jobs" estimates.
Health Care, 1/6th of the US economy is as big as it gets. Rolling in the metrics from previous similar programs, medicaid, medicare, social security etc. i'd have to say the govt. has NO credibility in any of their estimates. Nothing has come in anywhere close to on budget.
Yet you continue to give them the benefit of the doubt. the govt. will NEVER come in on budget because they are not, and here is another nice technical term for you, stakeholders in the process. they have no stake in the success or failure of the program because they have no accountability - fiscally or otherwise. Just take more $$$ from the taxpayers or issue more debt.
So - no. No benefit of the doubt - ever - to government. they have lost their credibility.
Posted by ultraman at November 2, 2009 06:20 AMNo. I expect "us" to recognize that this sort of use-casing is impossible on a broad scale. I addressed this in my previous post: "To answer whether someone in the individual market will pay more or less is a difficult question depending primarily on age and health. It would also depend on whether their current costs are $0 because they lack insurance by way of choice, affordability, or denial."
"It's well-known and proven separately."
It is not well-known enough for me to accept an assertion without citation.
One obvious citation would be the PWC study that was funded by the insurance lobby, was widely discredited, and did not look at the entire reform plan. (PWC caveat-ed its own work.) It ignored things such as subsidies -- a fundamental part of the plan. Its conclusion was that a more strict individual mandate be included -- a conclusion I'm not certain would have wide support here.
"'Is there evidence that this is to be the case?' Yes."
Are you willing to provide evidence? Or, may you provide it? Or, can you provide it?
"So the government will get more money by forcing employers to give us fewer benefits. You think this is a good idea?"
The premise that government is "forcing" that outcome cannot be accepted. The government deducts -- or, doesn't tax -- health care benefits. Taxing the a portion of the most expensive plans is like de facto capping the deduction. For reference, the GOP proposed removing this deduction entirely during the 2008 campaign.
The premise that "the government will get more money" is only true because the worker "will get more money." There will be more income and payroll tax revenues because there will be more income and bigger payrolls.
This tax is the most serious effort at cost savings in the entire reform package. Very generous health insurance packages raise the cost of health care for everyone, and if we are going to get revenues from some source we might as well do it in the fashion that reduces health care cost growth.
Posted by constitutional law at November 2, 2009 12:41 PMUm. No, it's not. At all. In any way. We KNOW it is going to increase taxes on many people. We KNOW it is going to force many people to buy insurance they don't want. It's not impossible at all.
Even if what you said is true, so what? The "greater good" on this "broad scale" does not justify telling a middle-class family that you are going to use the force of government to make them pay more for hospital care for their sick child ... or worse, get fewer things covered. But that is exactly what this plan does.
I addressed this in my previous post: "To answer whether someone in the individual market will pay more or less is a difficult question depending primarily on age and health. It would also depend on whether their current costs are $0 because they lack insurance by way of choice, affordability, or denial."
And the government has no business -- no right -- to take away our choices to buy products that suit us, individually, best. That is the POINT of liberty.
It is not well-known enough for me to accept an assertion without citation.
Um. Which part? The talk about taxing "Cadillac plans" is all over the news right now, and the individual mandates have been big news for months now.
Are you willing to provide evidence? Or, may you provide it? Or, can you provide it?
Again: what is it you have a problem with? You haven't said. All I said was that it increases taxes on peoples' plans (meaning they or their company pays more, or they get fewer benefits), and that it forces people to pay for products they don't want. These are facts that everyone knows. Do you seriously need evidence for this? Are you that completely out of touch?
The premise that government is "forcing" that outcome cannot be accepted.
Shrug. You're the one who said it. You said this will lead to cheaper plans, but it will only do so by taxing people to encourage companies to take away benefits. There is no other way this tax COULD lead to cheaper plans.
The government deducts -- or, doesn't tax -- health care benefits. Taxing the a portion of the most expensive plans is like de facto capping the deduction. For reference, the GOP proposed removing this deduction entirely during the 2008 campaign.
Yes, and replacing it with a tax credit that each family can use to pay for health care however they wish. That is how it should be: rather than effectively forcing us into employer plans as we've had for decades, or trying to micromanage how people get their health care, we should let the people decide. There really should be no deduction or credit, but we can't just yank out the deduction and replace it with nothing, because it will upset the balance too much, so ... a credit it is.
The premise that "the government will get more money" is only true because the worker "will get more money."
Um, no. If all workers got the same amount of money, and no benefits were cut, the government would get more money. That is what the bill says. That is what we are talking about, the tax increase. But you're right in that it will most likely lead to a cut in benefits, rather than an increase in revenue.
So much for Obama's promise to keep your insurance plan if you like it. Of course, mandates make that promise a lie too. As does the five year "grace period" provision in the new bill.
There will be more income and payroll tax revenues because there will be more income and bigger payrolls.
Absolutely NOTHIING in this plan -- period -- increases income or jobs (except for creating new jobs to handle the new government bureaucracy, of course), so please stop making this completely bogus claim.
This tax is the most serious effort at cost savings in the entire reform package.
Lies. This does NOTHING to save costs. It CUTS BENEFITS. That doesn't decrease the cost of health care, it limits the AMOUNT of health care people are getting.
But this doubletalk is precisely why so many people, rightly, don't trust the government in this area. When your benefits are cut, the government calls it a cost savings. It's insanity.
Very generous health insurance packages raise the cost of health care for everyone
Absolute lie. There is no truth to this whatsoever. It only increases the cost -- in exchange for increased benefits -- to the people who have the plans.
Where do you get this nonsense?
You wrote, "If you are firmly in the middle class, recognizing significantly increased health care costs due to the Democrats' plan." I am asking you to prove this "reality." The individual mandate or Cadillac-tax doesn't affect the vast majority of those who are "firmly in the middle class" who already have a modest insurance plan through their employer.
---
"Shrug. You're the one who said it. You said this will lead to cheaper plans, but it will only do so by taxing people to encourage companies to take away benefits. There is no other way this tax COULD lead to cheaper plans."
I did not say that anything was "forced." "Force" is different from the expected market result. If the market decides that expensive health insurance plans are necessary, then employers will keep them.
---
"Yes, and replacing it with a tax credit that each family can use to pay for health care however they wish. That is how it should be: rather than effectively forcing us into employer plans as we've had for decades, or trying to micromanage how people get their health care, we should let the people decide. There really should be no deduction or credit, but we can't just yank out the deduction and replace it with nothing, because it will upset the balance too much, so ... a credit it is."
I agree. But we cannot cut realistically the deduction entirely and replace it with a credit because it will upset the balance too much, so ... a more incremental reform it is.
---
"Um, no. If all workers got the same amount of money, and no benefits were cut, the government would get more money."
If the market doesn't respond to market changes? That's a hypothetical not worth much discussion.
---
"Absolutely NOTHIING in this plan -- period -- increases income or jobs (except for creating new jobs to handle the new government bureaucracy, of course), so please stop making this completely bogus claim."
"Lies. This does NOTHING to save costs. It CUTS BENEFITS. That doesn't decrease the cost of health care, it limits the AMOUNT of health care people are getting."
Am I lying? The CBO disagrees with your assertion that the tax "does NOTHING." You can read about the effects of a tax on expensive insurance plans on the CBPP website.
Congressional Budget Office (CBO) Director Douglas Elmendorf has stated that changing the tax treatment of high-cost health insurance to reduce its attraction is one of "two powerful policy levers" the federal government has available to encourage changes in medical practice and thereby slow the increase in health care costs. (Changing Medicare's payment rules is the other.) "Nearly all analysts agree," CBO has reported, "that the current tax treatment of employer-based health insurance -- which exempts most payments for such insurance from both income and payroll taxes -- dampens incentives for cost control because it is open-ended."
JCT projects that only 20 percent of the revenues from the proposal in 2014 will come from the excise tax itself, with the remaining 80 percent coming from additional income and payroll taxes on the increased cash compensation that workers will receive.
---
"Very generous health insurance packages raise the cost of health care for everyone Absolute lie. There is no truth to this whatsoever. It only increases the cost -- in exchange for increased benefits -- to the people who have the plans. Where do you get this nonsense?"
One of the main drivers of high cost growth is an over-utilization of services. It is only half true to say that people pay "for increased benefits" when the entire point of insurance is cost-sharing and consumer cost-avoidance. And the entire point of employer-provided insurance is to shield the consumer from the true cost of their plan, which is subsidized by a government tax deduction.
Consider this: if hospitals can charge $1,200 for an MRI and demand is propped up by high-cost insurance plans which remove consumer cost exposure, then the cost of an MRI is not going to go down any time soon. And with plenty of medically unnecessary demand, why not charge more for MRI's? That is why the over-utilization that Cadillac-plans -- currently subsidized through a tax deduction -- affect all of our premiums as well as our Medicare spending. I think it is a modest proposal for the government to cease subsidizing plans that contribute to cost growth.
From the CBPP page linked above: In the 1990s, the University of California began charging its janitors, secretaries, professors and others employees a monthly fee for their health insurance plan -- unless they chose the least expensive one. Many switched out of the most expensive plans, often to save as little as $10 a month, notes the economist Thomas Buchmueller. The change also led insurers to compete harder for people's business, improving the quality of the cheapest plans at the expense of the insurers' profit margins.
Second, the most generous insurance plans really would become less generous, but the change would probably do nothing to harm people's health. The distinguishing feature of these gold-plated plans tends to be their lack of co-payments. The $20,400 family plan that a typical New Hampshire state employee has, for instance, includes free M.R.I's, as The Boston Globe has reported. And when M.R.I.'s are free, people tend to get more of them than their well-being requires.
The most comprehensive study of health insurance, by the RAND Corporation, bears this out. People with Cadillac plans are no healthier than people with Chevy Malibu plans. (Similarly, Americans are no healthier than citizens of rich countries that spend far less on medical care.) "Taking someone who's uninsured and giving them insurance unambiguously improves their health," says Jonathan Gruber, a health economist at M.I.T., "but taking someone who's well-insured and making them really well-insured doesn't make them any healthier."
Posted by constitutional law at November 2, 2009 03:30 PMSo I wonder how many of those "principled" leftists here will stand by their words and oppose this bill now that it is over $1 trillion AND it is not revenue neutral?
The silence will be wide and unexpected...
Posted by Shanghai Dan at November 2, 2009 03:54 PMI never implied it did. The implication is that SOME PEOPLE firmly in the middle class will see such cost increases. I was speaking about those who have the affected plans. Please read more carefully. Thanks.
I did not say that anything was "forced." "Force" is different from the expected market result.
In regards to the tax, all I said about force is was what is obviously true: "you are going to use the force of government to make them pay more for hospital care for their sick child ... or worse, get fewer things covered."
What part of that do you have a problem with?
we cannot cut realistically the deduction entirely and replace it with a credit because it will upset the balance too much
In much more positive ways than the current plan. While it will have an even more discouraging effect on "Cadillac plans" (due to the difference between the tax credit cost and the health insurance cost, plus the fact that the company isn't getting the credit), and it will have perhaps a greater impact on benefit packages, it will also give much more control over individuals' care to the individuals themselves.
It's not the best idea, but it will get more positive change. That is, if you think better care for individual families is the goal.
If the market doesn't respond to market changes? That's a hypothetical not worth much discussion.
Neither is this "market changes" nonsense you keep talking about, because these are GOVERNMENT FORCED changes. They throw out the free market and replace it with an almost completely controlled one. Normal rules don't apply.
Am I lying?
Yes.
The CBO disagrees with your assertion that the tax "does NOTHING."
I made no such assertion. I said the tax does not reduce costs, except by reducing benefits.
You can read about the effects of a tax on expensive insurance plans on the CBPP website.
So can you. If you did, you would see it says what I said: that it reduces costs BY REDUCING BENEFITS. To quote: "The proposed excise tax would make a major contribution to slowing the growth of health care costs by discouraging insurers from offering, and firms from purchasing, extremely generous health insurance coverage ..."
"Nearly all analysts agree," CBO has reported, "that the current tax treatment of employer-based health insurance -- which exempts most payments for such insurance from both income and payroll taxes -- dampens incentives for cost control because it is open-ended."
That has little to do with "Cadillac plans," but with the tax exemption as a whole. The real problem with cost controls is disassociation of the patient and doctor from the costs, and this does nothing to fix that.
One of the main drivers of high cost growth is an over-utilization of services.
Which this bill does nothing significant to address.
It is only half true to say that people pay "for increased benefits"
It's entirely true.
And the entire point of employer-provided insurance is to shield the consumer from the true cost of their plan ...
False. The entire point of it is to attract workers.
... which is subsidized by a government tax [exemption].
Which is not going away under the Democratic plan. Thank you for making my point.
If you want to really not "hide" the costs, you need to make the consumer actually pay the bills, which means that McCain had the right idea. It's a start anyway.
Right, I did not repeat your full quote after quoting it directly above that sentence. But I cited the following which responds to this assertion: Congressional Budget Office (CBO) Director Douglas Elmendorf has stated that changing the tax treatment of high-cost health insurance to reduce its attraction is one of "two powerful policy levers" the federal government has available to encourage changes in medical practice and thereby slow the increase in health care costs.
If the CBO is wrong, it would be interesting to hear why -- but I did respond directly to your charge and not just the two words I quoted.
---
"That has little to do with 'Cadillac plans,' but with the tax exemption as a whole."
The CBO director quote which you are seemingly summarizing said the deduction lacks "incentives for cost control because it is open-ended." If you weren't "summarizing" and were, in fact, disagreeing with the substance CBO's claims, it would be interesting to hear why the CBO is wrong.
---
"If you did, you would see it says what I said: that it reduces costs BY REDUCING BENEFITS."
You're right and I never disagreed. But despite their high cost and toll on the health care system in general, these extremely high cost plans do not provide better medical outcomes (see my previous CBPP citations). I do not think the government has an interest in continuing to subsidize these plans that make health care more expensive for us all and do not lead to better outcomes. (Taxing insurance companies on very expensive plans negates the deduction on the other end, effectively ending the subsidy past a certain cost. I hope we don't have to jump through semantics for this.)
---
"The real problem with cost controls is disassociation of the patient and doctor from the costs, and this does nothing to fix that."
You argued that reform "make them pay more for hospital care for their sick child ... or worse, get fewer things covered." You also argue that this plan does "nothing to fix" the "disassociation of the patient [...] from the costs." How are these arguments not in conflict?
The scenario you present that one goes from a plan with free MRI's to one that won't even cover medically necessary treatments is a bit of a stretch. But if a company went from a $24k plan to a $2k plan, then reform has minimum set of required treatments that would address most of this problem -- but this is an aspect of reform that you seem to also oppose (understandably on the grounds of personal liberty).
---
If you want to really not "hide" the costs, you need to make the consumer actually pay the bills, which means that McCain had the right idea. It's a start anyway.
I agree, but it's politically impossible. I think using basically the same revenue source but a limited way has some (not all) of the benefits of McCain's revenue plan, with the other benefits of preserving most people's current plans and getting near-universal coverage.
You seem to be saying that it is wrong for the government to disincentivize very-expensive plans, but that it is "a start" for the government to disincentivize plans that cost more than the government-provided health care tax credit. You cannot escape the vast price pressure that McCain's plan relies upon while simultaneously focusing on the modest one that Baucus' mark relies upon.
Posted by constitutional law at November 2, 2009 05:11 PMAgreeing with me.
encourage changes in medical practice and thereby slow the increase in health care costs.
Right. By encouraging a reduction in benefits. Exactly.
these extremely high cost plans do not provide better medical outcomes
That's literally none of your business. I don't care what you think is optimal for me.
I do not think the government has an interest in continuing to subsidize these plans
They shouldn't subsidize ANY plans.
that make health care more expensive for us all
They do not. They only make health care more expensive for the people who buy the plans.
You argued that reform "make them pay more for hospital care for their sick child ... or worse, get fewer things covered."
Which is obviously true.
You also argue that this plan does "nothing to fix" the "disassociation of the patient [...] from the costs."
Which is obviously true.
How are these arguments not in conflict?
Because the payments the families make are in the form of increased deductibles and so on, which are not strongly tied to the actual cost of care.
The scenario you present ...
... is completely unlike the deceitful caricature you present.
I agree, but it's politically impossible.
So is this bill. It won't pass as-is ... and if by some miracle it does, it will get overturned by the Republican Congress elected in 2010, well before it goes into effect.
You seem to be saying that it is wrong for the government to disincentivize very-expensive plans ...
Obviously,
... but that it is "a start" for the government to disincentivize plans that cost more than ...
No. Not at all. It is a "start" for the government to stop giving tax exemptions for health care AT ALL.
Obama just shifts the burden for this cost to people who have greater means. This does not accomplish any goal except for socialist "wealth sharing."
Check out 108. I am sure the lefty trolls here will be glad to know that if their daughter gets raped, there's a new Democrat program to aid victims AND THEIR PERPETRATORS. Nice.
1. Retiree Reserve Trust Fund (Section 111(d), p. 61)
2. Grant program for wellness programs to small employers (Section 112, p. 62)
3. Grant program for State health access programs (Section 114, p. 72)
4. Program of administrative simplification (Section 115, p. 76)
5. Health Benefits Advisory Committee (Section 223, p. 111)
6. Health Choices Administration (Section 241, p. 131)
7. Qualified Health Benefits Plan Ombudsman (Section 244, p. 138)
8. Health Insurance Exchange (Section 201, p. 155)
9. Program for technical assistance to employees of small businesses buying Exchange coverage (Section 305(h), p. 191)
10. Mechanism for insurance risk pooling to be established by Health Choices Commissioner (Section 306(b), p. 194)
11. Health Insurance Exchange Trust Fund (Section 307, p. 195)
12. State-based Health Insurance Exchanges (Section 308, p. 197)
13. Grant program for health insurance cooperatives (Section 310, p. 206)
14. "Public Health Insurance Option" (Section 321, p. 211)
15. Ombudsman for "Public Health Insurance Option" (Section 321(d), p. 213)
16. Account for receipts and disbursements for "Public Health Insurance Option" (Section 322(b), p. 215)
17. Telehealth Advisory Committee (Section 1191 (b), p. 589)
18. Demonstration program providing reimbursement for "culturally and linguistically appropriate services" (Section 1222, p. 617)
19. Demonstration program for shared decision making using patient decision aids (Section 1236, p. 648)
20. Accountable Care Organization pilot program under Medicare (Section 1301, p. 653)
21. Independent patient-centered medical home pilot program under Medicare (Section 1302, p. 672)
22. Community-based medical home pilot program under Medicare (Section 1302(d), p. 681)
23. Independence at home demonstration program (Section 1312, p. 718)
24. Center for Comparative Effectiveness Research (Section 1401(a), p. 734)
25. Comparative Effectiveness Research Commission (Section 1401(a), p. 738)
26. Patient ombudsman for comparative effectiveness research (Section 1401(a), p. 753)
27. Quality assurance and performance improvement program for skilled nursing facilities (Section 1412(b)(1), p. 784)
28. Quality assurance and performance improvement program for nursing facilities (Section 1412 (b)(2), p. 786)
29. Special focus facility program for skilled nursing facilities (Section 1413(a)(3), p. 796)
30. Special focus facility program for nursing facilities (Section 1413(b)(3), p. 804)
31. National independent monitor pilot program for skilled nursing facilities and nursing facilities (Section 1422, p. 859)
32. Demonstration program for approved teaching health centers with respect to Medicare GME (Section 1502(d), p. 933)
33. Pilot program to develop anti-fraud compliance systems for Medicare providers (Section 1635, p. 978)
34. Special Inspector General for the Health Insurance Exchange (Section 1647, p. 1000)
35. Medical home pilot program under Medicaid (Section 1722, p. 1058)
36. Accountable Care Organization pilot program under Medicaid (Section 1730A, p. 1073)
37. Nursing facility supplemental payment program (Section 1745, p. 1106)
38. Demonstration program for Medicaid coverage to stabilize emergency medical conditions in institutions for mental diseases (Section 1787, p. 1149)
39. Comparative Effectiveness Research Trust Fund (Section 1802, p. 1162)
40. "Identifiable office or program" within CMS to "provide for improved coordination between Medicare and Medicaid in the case of dual eligibles" (Section 1905, p. 1191)
41. Center for Medicare and Medicaid Innovation (Section 1907, p. 1198)
42. Public Health Investment Fund (Section 2002, p. 1214)
43. Scholarships for service in health professional needs areas (Section 2211, p. 1224)
44. Program for training medical residents in community-based settings (Section 2214, p. 1236)
45. Grant program for training in dentistry programs (Section 2215, p. 1240)
46. Public Health Workforce Corps (Section 2231, p. 1253)
47. Public health workforce scholarship program (Section 2231, p. 1254)
48. Public health workforce loan forgiveness program (Section 2231, p. 1258)
49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
50. Advisory Committee on Health Workforce Evaluation and Assessment (Section 2261, p. 1275)
51. Prevention and Wellness Trust (Section 2301, p. 1286)
52. Clinical Prevention Stakeholders Board (Section 2301, p. 1295)
53. Community Prevention Stakeholders Board (Section 2301, p. 1301)
54. Grant program for community prevention and wellness research (Section 2301, p. 1305)
55. Grant program for research and demonstration projects related to wellness incentives (Section 2301, p. 1305)
56. Grant program for community prevention and wellness services (Section 2301, p. 1308)
57. Grant program for public health infrastructure (Section 2301, p. 1313)
58. Center for Quality Improvement (Section 2401, p. 1322)
59. Assistant Secretary for Health Information (Section 2402, p. 1330)
60. Grant program to support the operation of school-based health clinics (Section 2511, p. 1352)
61. Grant program for nurse-managed health centers (Section 2512, p. 1361)
62. Grants for labor-management programs for nursing training (Section 2521, p. 1372)
63. Grant program for interdisciplinary mental and behavioral health training (Section 2522, p. 1382)
64. "No Child Left Unimmunized Against Influenza" demonstration grant program (Section 2524, p. 1391)
65. Healthy Teen Initiative grant program regarding teen pregnancy (Section 2526, p. 1398)
66. Grant program for interdisciplinary training, education, and services for individuals with autism (Section 2527(a), p. 1402)
67. University centers for excellence in developmental disabilities education (Section 2527(b), p. 1410)
68. Grant program to implement medication therapy management services (Section 2528, p. 1412)
69. Grant program to promote positive health behaviors in underserved communities (Section 2530, p. 1422)
70. Grant program for State alternative medical liability laws (Section 2531, p. 1431)
71. Grant program to develop infant mortality programs (Section 2532, p. 1433)
72. Grant program to prepare secondary school students for careers in health professions (Section 2533, p. 1437)
73. Grant program for community-based collaborative care (Section 2534, p. 1440)
74. Grant program for community-based overweight and obesity prevention (Section 2535, p. 1457)
75. Grant program for reducing the student-to-school nurse ratio in primary and secondary schools (Section 2536, p. 1462)
76. Demonstration project of grants to medical-legal partnerships (Section 2537, p. 1464)
77. Center for Emergency Care under the Assistant Secretary for Preparedness and Response (Section 2552, p. 1478)
78. Council for Emergency Care (Section 2552, p 1479)
79. Grant program to support demonstration programs that design and implement regionalized emergency care systems (Section 2553, p. 1480)
80. Grant program to assist veterans who wish to become emergency medical technicians upon discharge (Section 2554, p. 1487)
81. Interagency Pain Research Coordinating Committee (Section 2562, p. 1494)
82. National Medical Device Registry (Section 2571, p. 1501)
83. CLASS Independence Fund (Section 2581, p. 1597)
84. CLASS Independence Fund Board of Trustees (Section 2581, p. 1598)
85. CLASS Independence Advisory Council (Section 2581, p. 1602)
86. Health and Human Services Coordinating Committee on Women's Health (Section 2588, p. 1610)
87. National Women's Health Information Center (Section 2588, p. 1611)
88. Centers for Disease Control Office of Women's Health (Section 2588, p. 1614)
89. Agency for Healthcare Research and Quality Office of Women's Health and Gender-Based Research (Section 2588, p. 1617)
90. Health Resources and Services Administration Office of Women's Health (Section 2588, p. 1618)
91. Food and Drug Administration Office of Women's Health (Section 2588, p. 1621)
92. Personal Care Attendant Workforce Advisory Panel (Section 2589(a)(2), p. 1624)
93. Grant program for national health workforce online training (Section 2591, p. 1629)
94. Grant program to disseminate best practices on implementing health workforce investment programs (Section 2591, p. 1632)
95. Demonstration program for chronic shortages of health professionals (Section 3101, p. 1717)
96. Demonstration program for substance abuse counselor educational curricula (Section 3101, p. 1719)49. Grant program for innovations in interdisciplinary care (Section 2252, p. 1272)
97. Program of Indian community education on mental illness (Section 3101, p. 1722)
98. Intergovernmental Task Force on Indian environmental and nuclear hazards (Section 3101, p. 1754)
99. Office of Indian Men's Health (Section 3101, p. 1765)
100. Indian Health facilities appropriation advisory board (Section 3101, p. 1774)
101. Indian Health facilities needs assessment workgroup (Section 3101, p. 1775)
102. Indian Health Service tribal facilities joint venture demonstration projects (Section 3101, p. 1809)
103. Urban youth treatment center demonstration project (Section 3101, p. 1873)
104. Grants to Urban Indian Organizations for diabetes prevention (Section 3101, p. 1874)
105. Grants to Urban Indian Organizations for health IT adoption (Section 3101, p. 1877)
106. Mental health technician training program (Section 3101, p. 1898)
107. Indian youth telemental health demonstration project (Section 3101, p. 1909)
108. Program for treatment of child sexual abuse victims and perpetrators (Section 3101, p. 1925)
109. Program for treatment of domestic violence and sexual abuse (Section 3101, p. 1927)
110. Native American Health and Wellness Foundation (Section 3103, p. 1966)
111. Committee for the Establishment of the Native American Health and Wellness Foundation (Section 3103, p. 1968)
It is not true that expensive insurance plans only make health care more expensive for those who get those plans. It makes no sense to view a scheme of risk-pooling/cost-sharing in terms of individual actors and purchasers. It further makes no sense in a scheme where the direct procedural costs are hidden from actors through the very concept of insurance. Would you argue that Medicare only affects recipients of Medicare? A public option would only affect recipients of a public option? I would guess not.
I have presented the same quote from the CBPP twice regarding this specific tax policy slowing cost growth without you responding in any detail why the CBO is wrong. We can each claim whatever we'd like, but it seems well-accepted from my reading that this particular tax policy -- unpopular with unions, House democrats, and yourself -- is also good health care policy.
"... but that it is "a start" for the government to disincentivize plans that cost more than ... No. Not at all. It is a "start" for the government to stop giving tax exemptions for health care AT ALL."
But this is exactly what removing the tax exemption does. It creates a disincentive for plans that cost more than the credit to be purchased. I am saying you are very comfortable critically analyzing this reform plan's tax measures as disincentivizing generous plans, but haven't publicly recognized that this is exactly what McCain's plan does except McCain's approach was far more broad. McCain's plan to cut cost growth relies on individuals purchasing far less comprehensive insurance.
Posted by constitutional law at November 2, 2009 11:02 PMNonsense. That over-utilization only costs the plans that pay for the over-utilization. Who are you to tell them they shouldn't?
[government] certainly should take appropriate means to discourage their use
It certainly should not. It is literally none of the government's damned business, nor yours.
It is not true that expensive insurance plans only make health care more expensive for those who get those plans.
Yes, it is.
It makes no sense to view a scheme of risk-pooling/cost-sharing in terms of individual actors and purchasers.
Of course not. Instead, you look at the pools themselves. Which in this case, are the pools that are comprised of these "Cadillac" plans. I am not in the same pools that they are in.
It further makes no sense in a scheme where the direct procedural costs are hidden from actors through the very concept of insurance.
Which, as you note, has nothing to do with the issue of "Cadillac" plans, but has to do with all insurance plans.
Would you argue that Medicare only affects recipients of Medicare? A public option would only affect recipients of a public option? I would guess not.
No, but for completely different reasons. In both cases, the market is significantly affected because government subsidies and mandates artificially lower the price paid for the services, and that cost must be borne elsewhere. That doesn't apply to "Cadillac" plans, where the cost is borne by the members of the plans.
I have presented the same quote from the CBPP twice regarding this specific tax policy slowing cost growth without you responding in any detail why the CBO is wrong.
Which. This? "[T]he current tax treatment of employer-based health insurance -- which exempts most payments for such insurance from both income and payroll taxes -- dampens incentives for cost control because it is open-ended."
That -- as I said already -- is not about "Cadillac" plans. It is about nearly ALL employer-based health insurance. It does not back you up here.
"... but that it is "a start" for the government to disincentivize plans that cost more than ... No. Not at all. It is a "start" for the government to stop giving tax exemptions for health care AT ALL."
But this is exactly what removing the tax exemption does.
No. It continues massive tax exemptions for employer-based health insurance, which is what the CBO says "dampens incentives for cost control because it is open-ended." It puts a "cap" on the exemption, but it's still very high, covering more than 95 percent of all employer-based health insurance costs. You really think only cutting less than 5 percent of the exemption will un-dampen those incentives for cost control? Pull the other one.
McCain's approach was far more broad
Exactly: it actually addresses the problem rather than using the problem as an excuse to generate additional federal revenue, which is most of what this is. It's really two things: first, getting money and exploiting societal envy to do it. Second, as I mentioned in my previous post, it's about trying to put everyone into the same situation so that we will have the same interests, and therefore the same opinions.
It's about control, really. Control over your money, your mind, and your body.
McCain's plan to cut cost growth relies on individuals purchasing far less comprehensive insurance.
Entirely false.
"That over-utilization only costs the plans that pay for the over-utilization."
What's your evidence for this? It contradicts nearly all the health care experts I've ever read on the subject and ignores the substantial public financing of health care.
---
"the market is significantly affected because government subsidies and mandates artificially lower the price paid for the services, and that cost must be borne elsewhere. That doesn't apply to "Cadillac" plans, where the cost is borne by the members of the plans."
Health insurance pays less than an individual would out-of-pocket -- how is this difference not "artificial?" Government programs and insurance companies have bargaining power. It would be a dereliction for Medicare to not use its bargaining power.
This is a misunderstanding of purchasing/market power. If McDonald's buys beef at half the price of an average restaurant because its purchasing power is so high, then does that mean the rest of us are paying higher because of McDonald's? That is not how one typically views markets.
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"That doesn't apply to "Cadillac" plans, where the cost is borne by the members of the plans."
Cadillac plans "artificially" raise the price of services by creating more medically unnecessary demand for them. The cost is not borne just by members of the plan since more than a third of it is subsidized by a federal tax exclusion. If employers want to have these plans, they can get them without subsidies on the higher portion of the premium.
---
"Of course not. Instead, you look at the pools themselves. Which in this case, are the pools that are comprised of these "Cadillac" plans. I am not in the same pools that they are in."
Blue Cross pays the provider the same for an MRI regardless of which pool you're in -- Cadillac or not. If a hospital can get plenty of MRI business from Cadillac customers, why lower prices? It won't, and the premiums on your modest plan will increase to pay for the MRIs that your plan's participants use.
---
"[T]he current tax treatment of employer-based health insurance -- which exempts most payments for such insurance from both income and payroll taxes -- dampens incentives for cost control because it is open-ended. That -- as I said already -- is not about "Cadillac" plans. It is about nearly ALL employer-based health insurance. It does not back you up here."
Is there confusion as to what the phrase "open-ended" means? This quote is specifically about capping the employer benefits tax exclusion. Of course it backs me up, it is talking about nearly the same policy.
---
"it actually addresses the problem rather than using the problem as an excuse to generate additional federal revenue, which is most of what this is. It's really two things: first, getting money and exploiting societal envy to do it."
McCain's plan generates additional federal revenue to provide non-refundable tax credits for health insurance purchased through an unregulated marketplace.
Obama's plan generates additional federal revenue to provide non-refundable tax credits for health insurance purchased through a regulated marketplace.
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"McCain's plan to cut cost growth relies on individuals purchasing far less comprehensive insurance. Entirely false."
How is what I wrote "entirely false?" McCain's plan gives you $x dollars to spend on insurance so any plan above $x is plainly less attractive, just as you point out that Cadillac plans are less attractive when their tax exclusion is capped.
Posted by constitutional law at November 3, 2009 10:39 AMWhere's yours?
Health insurance pays less than an individual would out-of-pocket -- how is this difference not "artificial?"
It's wholly manufactured. It is a subsidized government agency. It is not true market competition. Obviously.
Cadillac plans "artificially" raise the price of services by creating more medically unnecessary demand for them.
Wow. So you're saying that these services, which should not be offered, cost more than they should for everyone, not just the people who get those services.
Brilliant.
The cost is not borne just by members of the plan since more than a third of it is subsidized by a federal tax exclusion.
False. Obviously. It is not actually subsidized, it is simply not taxed. There is a difference. You're just making it up as you go along here. There is no government money going to these plans like that ... unless you think all; money belongs to the government.
Blue Cross pays the provider the same for an MRI regardless of which pool you're in
So there's no problem.
If a hospital can get plenty of MRI business from Cadillac customers, why lower prices?
Because of competition, which the Democratic plan does not offer.
Of course it backs me up, it is talking about nearly the same policy.
No, because what it SAYS is that the exemption is the problem, and yet you're keeping more than 95 percent of it.
Obama's plan [is] a regulated marketplace.
Exactly. Rather than a competitive market where we can both have liberty AND have competition-driven lower prices, Obama wants to control it all, and -- if it happens at all -- lower prices through government force and "encouragement." Which won't work. At all. Just like it didn't work in Medicare.
How is what I wrote "entirely false?"
Because it doesn't do what you said, at all.
McCain's plan gives you $x dollars to spend on insurance so any plan above $x is plainly less attractive
But it's more than you are spending now. You said it relies on them spending less. Further, the plan doesn't "rely" on anything except market forces.
"constitutional law" is Jensen.
No wonder he is so ignorant of the Constitution, and common sense.
Buh bye.
Raises several questions:
Where will ruling liberals from socialist countries go for their Health Care now?
What about the Canadians bearing the brunt of rationing and waiting on endless lines for months and years, where will they go for immediate care?
Where will Americans go for their Health Care when the Government take over completely and manages the care you receive?
Imagine being thrown in jail over a health care issue!
Its time to refresh the Tree of Liberty.