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Attempts At Cost Containment, Except The Best One

By Big Tent Democrat, Section Other Politics
Posted on Sun Dec 20, 2009 at 08:47:44 AM EST
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Paul Krugman:

[T]he Senate bill tries a wide variety of approaches to cost containment — in fact, just about everything that has been suggested. We don’t know which of these approaches will work or how well, but that’s more than anyone has managed to achieve ever before.

(Emphasis supplied.) Actually we know the approach that has worked historically in the United States to control health care costs, the public insurance option, was stripped from the bill. The bill does some good, but it does nothing meaningful in terms of cost containment. Weak stuff from Krugman.

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    Attempts At Cost Containment, Except The Best One | 61 comments (61 topical)

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    CBO unclear on what so called (5.00 / 2) (#1)
    by MO Blue on Sun Dec 20, 2009 at 08:58:05 AM EST
    "cost containment" efforts will do to Medicare.

    Based on the longer-term extrapolation, CBO expects that inflation-adjusted Medicare spending per beneficiary would increase at an average annual rate of less than 2 percent during the next two decades under the legislation--about half of the roughly 4 percent annual growth rate of the past two decades. It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care. CBO

    I'm sure that Krugman will have the money to access quality care, but many of us will not.      

    That's pretty scary (none / 0) (#2)
    by Militarytracy on Sun Dec 20, 2009 at 09:00:15 AM EST


    Parent
    It gets even more scary because the (5.00 / 1) (#10)
    by MO Blue on Sun Dec 20, 2009 at 09:38:27 AM EST
    bill contains reductions to Medicare and Medicaid DSH(1) (Medicare Disproportionate Share) Payments $43 billion - 2010 -2019

    Many Medicare beneficiaries and other patients rely on hospitals for their care, especially teaching hospitals that serve large low-income populations. These hospitals often face substantial financial pressure: they may provide significant amounts of care to the poor and lack the surplus revenue needed to underwrite the costs associated with the provision of services.
    ...
    Most agree that DSH funds preserve access to care for Medicare and low-income populations by financially assisting the hospitals they use. link

    The Center for Advance Medicine and Siteman Cancer Center here in my area provide quality care for a large population of low income Medicare/Medicaid patients. I know that they rely heavily on DSH funds to do this.

    Parent

    I don't know how they are going to do it (5.00 / 1) (#14)
    by Militarytracy on Sun Dec 20, 2009 at 09:50:21 AM EST
    It doesn't make any sense to me and when I worked in a County hospital business office it was the only thing that kept us in the black.  And sometimes it didn't.

    Parent
    Yep (5.00 / 1) (#23)
    by MO Blue on Sun Dec 20, 2009 at 10:13:53 AM EST
    Don't know how people will get the quality of care that they are getting now. Financially, unsustainable.

    Parent
    The goal of health care economists, who (none / 0) (#34)
    by KeysDan on Sun Dec 20, 2009 at 10:42:10 AM EST
     are running the show, is to get everyone out of their Cadillac (which everyone is considered to be driving)  and into a Yugo.  The Medicare savings/efficiencies will nicely chip away from that end, for union and others younger workers the excise taxes on their "rich" plans are expected to lower benefits.  Reductions in hospital and health care professionals reimbursements and the pass-a longs will do their share.  That levels the benefits and, of course, reduces costs, right?

    Parent
    "Weak stuff from Krugman." (5.00 / 1) (#3)
    by Anne on Sun Dec 20, 2009 at 09:02:43 AM EST
    Maybe he's feeling left out, and thinks doing his best impression of the Ezra Klein/Matt Yglesias crowd will shine a little spotlight love back on him and he can be relevant again.

    I don't think his heart is really in it, though, and that moves what he's saying closer to sad and sigh-inducing than we're used to.

    I wonder if he's just so anxious to see (5.00 / 1) (#6)
    by kempis on Sun Dec 20, 2009 at 09:29:13 AM EST
    the big numbers move in the right direction that he's missing some of the consequences.

    I'm still amazed that people don't seem to realize that a lot of those newly "covered" people are going to be mightily pissed off when they have to buy private insurance that may or may not cover them adequately and, despite what Nate Silver and other nu-Dems think, will not be viewed as "affordable."

    The macro may be moving in the right direction, but it's doing so in a way that will breed resentment and backlash--and much of the "progress" will likely be un-done when the GOP is back in control.

    Parent

    BTW, one key way that would have resulted (5.00 / 5) (#4)
    by MO Blue on Sun Dec 20, 2009 at 09:05:56 AM EST
    in real cost containment was given away early in the process by the President. Negotiated prescription drug prices taken off the table as was correcting the overcharge on Medicare/Medicaid dual eligibles. Reimportation of prescription drugs was also voted down by Democrats in the Senate to honor the President's deal.

    I woke up this morning (5.00 / 3) (#5)
    by Militarytracy on Sun Dec 20, 2009 at 09:21:45 AM EST
    and my God we must have reform, but after Nelson folded and then Stupak's hissy....I find myself back to NO! on this again.  No promise for those who are born with horrible health problems that they can get decent care that won't destroy the fabric of the whole family, and dark restrictions on abortion possibilities.  I don't think I can do this.  Of course I can just have it shoved down my throat too.  Nobody with power champions those who need it most.

    I just found out about this: (5.00 / 1) (#8)
    by katiebird on Sun Dec 20, 2009 at 09:33:37 AM EST
    I'm TOTALLY shocked that this hasn't gotten any press at all:  These changes are a significant tax increase for some people!!!

    It would increase to 10 percent the threshold for deducting out-of-pocket medical expenses for most people in 2013. That's up from 7.5 percent currently; senior citizens would keep the lower threshold.

    The bill would place government limits for the first time on Flexible Spending Accounts, a tax subsidy for out-of-pocket medical costs provided by employers in benefit packages. It would set a $2,500 cap on amounts that could be deposited in the accounts in 2011 and adjust future limits for inflation. Currently, employers set their own caps, typically between $3,000 and $5,000.

    Wouldn't these changes hit the people who fall just above the subsidy level especially hard?

    Parent

    It would hit any seriously ill person (5.00 / 3) (#21)
    by MO Blue on Sun Dec 20, 2009 at 10:10:50 AM EST
    who pays taxes regardless of income. It is a back door tax that in reality breaks Obama's promise not to raise taxes on the middle class.

    The conclusion that I've come to is that this legislation is geared to move more and more of the expenses of actual care onto the backs of the consumer and increase taxable revenue of those least able to pay.

    Parent

    I would think so (none / 0) (#11)
    by Militarytracy on Sun Dec 20, 2009 at 09:44:03 AM EST


    Parent
    At this stage of things, (5.00 / 4) (#18)
    by Anne on Sun Dec 20, 2009 at 10:01:02 AM EST
    I think the differences between this almost year-long process and a slow-motion train wreck are minimal.

    I am just sick at heart for the lost opportunities that were well within reach when all of this started.  Sicker still about the vacuum of leadership on the part of the Congress, who would not stand up and do the right thing, and about the realization that Obama was all that I feared he would be, and that he "leads" from such a cowardly and craven place; his utter silence on women's right to health care for ALL of their needs is unacceptable, but not a surprise.

    The fear that is rippling through the community of people with serious health problems is palpable; how can they not now worry that their lives and their needs will be victims of an economic priority list that will have insurance companies at the top?  I wonder if it has occurred to these brainiacs that you can't encourage women to give birth to children who are damaged when there is no support for their health care.  Helloooo?

    They just do not get it.

    Parent

    BTD I'd like to apologize (5.00 / 5) (#12)
    by esmense on Sun Dec 20, 2009 at 09:45:34 AM EST
    for all the ranting I've been doing on this site over the last few days. Health care reform has been a huge issue for me, a primary voting issue, since, as a marketing professional, I worked with many regional insurers in the mid 80s, when PPOs, HMOs, etc, and were just picking up steam. Since then, as small business person and an employer, my concerns not only deepened, but have become more personal and desperate. I know what it is like, during bad economic times, as you struggle to get a new business off the ground, to watch a lump develop on your husbands neck, see the darkness under his eyes deepen, witness his fear of seeing a doctor for what will then be a "pre-existing condition" that will deny him coverage when, hopefully,in just a few more months, the small investment loan we needed is paid off and we can finally afford individual insurance. (We did finally get insurance, after 3 years without. After the waiting period, Mike went to the doctor and discovered it was thyroid cancer.) I also know how financially devasting something as simple as a pair of broken glasses, a bad tooth, a minor injury can be to my young employees. They are bright, ambitious working class kids, minorities, young people from poor rural parts of the state, graduates of the foster care system, immigrants and the children of immigrants, who  are trying to attend school, support themselves in a very high cost environment, AND, surprisingly often, send money home to help out parents and other family members who have become ill, disabled or lost jobs. Theirs are lives filled with hope, but without any margin for error.

    For several months, as this "debate" developed, I was too apprehensive and upset to really join the conversation. As we move toward the final legislative stages, and it has become apparent how little those in power are willing to risk and risk, I have become very angry. These sorry compromises break my heart.

    I've found your posts (5.00 / 2) (#35)
    by Cream City on Sun Dec 20, 2009 at 10:42:47 AM EST
    interesting and often informative, including this one; thanks.  Your young people are facing situations similar to so many of mine in an urban area, often first in the family to go to college but easily hit by medical setbacks -- yes, even just broken glasses or a broken leg or broken tooth -- that force them to drop out, and we all pay for that opportunity cost lost for decades to come.

    Parent
    meant; how little they are willing to risk and DO (none / 0) (#13)
    by esmense on Sun Dec 20, 2009 at 09:49:11 AM EST


    Parent
    Slightly OT but (5.00 / 1) (#20)
    by sleepingdogs on Sun Dec 20, 2009 at 10:10:32 AM EST
    did I really just see Axelrod on MTP say, "...no one will have to pay more than 8% of their income..." for health insurance?

    Yeah (5.00 / 1) (#29)
    by TeresaInSnow2 on Sun Dec 20, 2009 at 10:31:47 AM EST
    Isn't it grand!!!? ;-).

    Parent
    It is my understanding (5.00 / 2) (#31)
    by MO Blue on Sun Dec 20, 2009 at 10:36:38 AM EST
    that the mandate has an 8% of income cap. The way that it is structured (using the exchange as an example) is that if the premium for the silver plan (70% actuarial value) is more than 8% of your income you would be required to purchase the bronze plan (60% actuarial value) to avoid the tax. The exchange  also contains catastrophic coverage plans. I am unsure if you would be forced into that plan in order to avoid the tax.  

    Parent
    And (5.00 / 4) (#38)
    by TeresaInSnow2 on Sun Dec 20, 2009 at 11:00:40 AM EST
    if you find yourself in the 60% plan, most of the plans I've seen place the deductible at a very high, almost catastrophic insurance level.  

    Consumer Reports came up with some sample plans here.  Note that they have the bronze plan listed at 65% actuarial value.  I believe the bronze plan has now been dropped to 60% so the deductible will need to be higher than listed here (or the coinsurance higher). Also note that the deductible and max out of pocket are listed for an INDIVIDUAL.  Families will be higher.  And also note that Maximum out of pocket when you're talking about insurance typically DOES NOT include deductibles or copays.  It only includes coinsurance....

    I suspect most people who go for the 60% actuarial value plan to "avoid the tax" will not meet their deductibles...and thus, they will have health insurance and not healthcare.

    People should pay the tax, I think, under these circumstances.

    Parent

    Not only are they for an individual (none / 0) (#52)
    by nycstray on Sun Dec 20, 2009 at 12:29:47 PM EST
    they are for a 45yo individual.

    Parent
    That is even worse (5.00 / 1) (#53)
    by Militarytracy on Sun Dec 20, 2009 at 12:34:36 PM EST
    So you will never have to pay more than $400 a month for crap insurance.  That's priceless!

    Parent
    And Canadians pay around $50 a month (5.00 / 1) (#46)
    by Militarytracy on Sun Dec 20, 2009 at 12:07:01 PM EST
    for much better care than anything our government is currently offering us.........but I'm supposed to get excited knowing that if you make $50,000 a year you will never pay more than $400 a month for your insurance?

    Parent
    sane system in Canada (5.00 / 4) (#48)
    by noholib on Sun Dec 20, 2009 at 12:16:42 PM EST
    Canada has had a sane and civilized system for many decades now.  And when Canadians vote on the most popular Canadian of all time, they vote for Tommy Douglas, head of the social-democratic NDP party that pushed the Liberals from the left in order to legislate a new system in the early 1960s (if memory serves me correctly)!
    Everyone should pay taxes, and the government should finance health care, not health insurance.

    Parent
    P.S. (none / 0) (#49)
    by noholib on Sun Dec 20, 2009 at 12:18:02 PM EST
    by new system, I meant single-payer government-funded coverage for health care.  There are differences between the Canadian provinces, but this is the basic principle.

    Parent
    After all these years (5.00 / 1) (#32)
    by pluege on Sun Dec 20, 2009 at 10:36:41 AM EST
    Krugman has finally gone off the reservation. He apparently has drunk the kool-aid 'we-must-get-something-done-in-this-historic-opportunity' BS.

    If nothing passed, or best yet if certain key progressive elements passed through reconciliation, guess what, people suffering for want of decent affordable health care are NOT GOING AWAY. They will continue to suffer badly if the Senate bill is passed, and worse, by making this a 'we-have-to-fix-it-now-and-forever' frame, the garbage that passes truly will be it for at least a generation or longer - until the human suffering and patten sop to the plutocrats that this bill is becomes unavoidable once again.  

    The story of Solomon comes to mind. The 'lets have a parade obamafan club aren't going to be dancing for long once they figure out that the baby is dead.

    The 'Historic Opportunity" (5.00 / 3) (#36)
    by pluege on Sun Dec 20, 2009 at 10:45:26 AM EST
    was not a guise to force the fork over of $billions in hardworking Americans' earnings to plutocrats for indecently crap insurance plans. The Historic Opportunity was for advancing progressive ideals of equality, humanity, community - turning the country back from constantly being plundered by plutocrats to providing the labor of average Americans to average Americans. In this team obama has failed miserably. obamafans, and now Krugman ini regard to health care reform have turned the notion to crap.

    Parent
    I think it would be a good idea to look at the (none / 0) (#7)
    by steviez314 on Sun Dec 20, 2009 at 09:31:20 AM EST
    actual health care costs.

    In 2007, the US spent $2.2T on National Health Expenditures, or about 16% of GDP.  To get that down to the OECD average of about 11%, we'd have to cut our NHE by $600B.  Let's see where the money is:

    If we eliminated ALL the profits of insurance companies, and even their overhead, and even Medicare's overhead, we'd save $150B.

    Let's cut all prescription drug prices by 50%.  That saves about $100B.

    So we need to find another $350B is cost cuts.  Have to go where the money is--payments to doctors and hospitals were $1.4T.  So to get to the OECD average, we need to cut those payments by 25%.

    That's where the cost containment must be--in payment for outcomes, not services; in finding more efficent ways of delivering health care, and frankly in reducing some care.  There are many under-insured people, but there are also some OVER-insured ones.

    No one ever talks about this, but as long as the consumer of health care does not pay for the care (outside of premiums), there are always going to be some unnecessary services performed.  The marginal health care service has no cost, at least until next year's premium increase comes in the mail.

    Sure, no one wants to say "are you really, really sure you want to have that health care service?", but if that is the moral position it is also destined to result in increased costs, unless we make the effort to improve outcomes without increasing costs.

    Of course, a system like the British NHS doesn't have this problem, but that is NOT happening in the U.S.

    So, it's actually the innovative things--payment for outcomes, computerized records to gain efficiency, emphasis on preventative care, etc that will result in true cost containment, not the public option or drug reimportation.

    This is not clear thinking (5.00 / 4) (#9)
    by Big Tent Democrat on Sun Dec 20, 2009 at 09:35:57 AM EST
    imo. Nothing in the passage of this bill causes "payment for outcomes, computerized records to gain efficiency, emphasis on preventative care [. . .]"

    Pressures on the people who pay the piper AND who have the bargaining power to do something about it, that will cause efficiencies.

    You confuse the tools with the power to make use of them.

    Without reforming the payment system, you can not reform the delivery system.

    This has been the fundamental blindness of "reform advocates" imo.

    Parent

    The bill does include directives for (none / 0) (#17)
    by steviez314 on Sun Dec 20, 2009 at 10:00:44 AM EST
    Medicare to experiment with payment for quality of outcomes, as well as community health centers, along with a lot of leeway for states to try other things.

    And even the Cadillac tax is efficiency promoting, by reducing that marginally useless health care coverage.  I know you call it regressive, but maybe that's only because the threshhold is set too low, or income level isn't taken into account.  If Cadillac plans were defined by what they provide for, rather than what they cost, you'd see some of them are extravagant and inefficient.

    My other point is that all everyone talks about is insurance and drug companies and their profits, but bottom line,your efficencies and pressures mean doctors and hospitals would get 25% less.  While that may be appropriate, that's not the debate we're having.

    Parent

    "Directives to experiment" (5.00 / 1) (#19)
    by Big Tent Democrat on Sun Dec 20, 2009 at 10:02:28 AM EST
    Need I say more?

    Parent
    I think the government should ask (5.00 / 2) (#26)
    by MO Blue on Sun Dec 20, 2009 at 10:19:44 AM EST
    for volunteers rather than make seniors the guinea pigs of this experiment. You can be the first to sign up. If after a certain period of time you and the other volunteers (all those who think this is great) still have ACCESS to quality care, then I'm sure that the seniors will be willing to accept the outcomes.  

    Parent
    It's the doctors who get the payment for outcomes. (none / 0) (#28)
    by steviez314 on Sun Dec 20, 2009 at 10:27:50 AM EST
    But I'm a tad confused.  Why wouldn't doctors, seniors, youngsters or anyone want better outcomes?

    Isn't the goal of health care to provide good outcomes?  Isn't that the true measure of success, instead of how many office visits, blood tests, MRIs you got?

    Shouldn't insurance companies pay for a drug that works on you, even if not approved for that use?  Or, if you can't afford that drug, should you have to go on another one that the insurance company WILL pay for, even though it's more expensive and doesn't work as well?

    And yes, I would like to be part of that--I'd like to see a doctor who gets paid more the better I get, rather than how much services I consume.

    Parent

    This is as you have already stated an (5.00 / 2) (#39)
    by MO Blue on Sun Dec 20, 2009 at 11:04:53 AM EST
    experiment. The doctor is going to be financally encouraged to limit the number of office visits, blood tests, MRIs etc. Will that provide good outcomes for some and not so good outcomes for others. No one knows. It is an experiment. If it doesn't work, Medicare patients will be the ones who pay the price.

    Will doctors agree to this method or since this experiment will only apply to Medicare patient, will they refuse to treat Medicare patients. No one knows. It is an experiment.    

    Shouldn't insurance companies pay for a drug that works on you, even if not approved for that use?

    You bet your life they should. And I challenge you to provide me with a link to anything in this bill that will require the insurance companies to do that.

    Parent

    So, I guess from your first 2 paragraphs, you're (none / 0) (#40)
    by steviez314 on Sun Dec 20, 2009 at 11:20:20 AM EST
    happy with the status quo and we should never try to improve the health care delivery system, ever.  

    And yes, the bill does not make insurance companies do that, but that should be one the goals of improving the delivery system.

    Of course, if everyone has the "I've got mine, Jack" mindset, nothing's going anywhere.

    Parent

    First off are you currently on Medicare? (5.00 / 2) (#43)
    by MO Blue on Sun Dec 20, 2009 at 11:36:20 AM EST
    Because if you are not, your argument is "Let's experiment on seniors." You still get access to care and all the services that your private insurance currently offers. No skin off your nose if it doesn't work, your health will not be effected and you will get all the tests etc. you need.

    Also, I feel that combining things that are actually in the bill with statements like this

    Shouldn't insurance companies pay for a drug that works on you, even if not approved for that use?

    that are not, is not the most honest way to debate the subject.

    BTW, no one is a stronger advocate for REAL health care reform than I am. You, not I, IMO are advocating in support of the current failed private insurance system status quo.

    Parent

    You make 'experiment' sound like we're hooking (none / 0) (#44)
    by steviez314 on Sun Dec 20, 2009 at 11:53:31 AM EST
    people up to electrodes.

    Guess what, I also get all the health care I don't need.  A few years ago, I developed tinnitus.  Ear doctor said not much to do about it, might go away might not.

    I said why not get an MRI.  Even though he saw no medical need for one, he also had NO incentive to say no.  So he said ok, the insurance company paid, and an MRI was wasted.  This problem needs to be fixed too.

    Parent

    Nice strawman you built (none / 0) (#45)
    by MO Blue on Sun Dec 20, 2009 at 12:00:16 PM EST
    You make 'experiment' sound like we're hooking people up to electrodes.


    Parent
    BTW, you did not answer my (none / 0) (#47)
    by MO Blue on Sun Dec 20, 2009 at 12:11:14 PM EST
    question. Are you currently on Medicare?

    Parent
    No. But soon enough. (none / 0) (#54)
    by steviez314 on Sun Dec 20, 2009 at 03:07:19 PM EST
    What's the point of that question?  It's the equivalent of can you be commander in chief without having served in the military?

    The government can only have Medicare make these small delivery system "experiments" BECAUSE that is the only thing the government has payment authority over.

    Your posts point up the basic problem with health care--since no one has any marginal costs, more tests by definition are always good.

    Parent

    The point is that if you choose to demand (none / 0) (#58)
    by MO Blue on Sun Dec 20, 2009 at 05:39:19 PM EST
    a MRI that your doctor says you don't need like you did previously, you'll still get it. OTOH, a conscientious doctor might have to incur increased administration costs to justify why his/her Medicare patient really needs a MRI or other tests. Maybe they win the argument. Maybe, not. That doctor may decide that they do not want the additional hassle and refuse to treat Medicare patients. A somewhat less conscientious doctor might decide not to incur the hassle and not order or delay the tests and their patient's health will be threat, not yours.  

    It is very easy for you to decide this experimentation is just great and dandy since it won't effect your care at all.

    Your post points out the your complete lack of knowledge of what people with limited income and serious illnesses have to deal with in this  private insurance based system you want to perpetuate. You also are making an assumption that I have not incurred anything but marginal costs for health care. I have paid out more money in insurance premiums, doctor and hospital bills over the last year and a half than I had income coming in. I have seen the private insurance industry refuse lifesaving treatment that peoples doctors wanted them to have and I'll be damned if I will stand quietly by and watch Medicare adopt the same practice of deciding what test seniors need or don't need.

    And unlike you, I never demanded a test that my doctor told me I didn't need even after my large deductibles were met time and time again.  

    Parent

    I saw republican senator Coburn on C-Span where (none / 0) (#59)
    by suzieg on Sun Dec 20, 2009 at 09:34:01 PM EST
    he explained that he cannot prescribe a virtual colonoscopy for his medicare patients even if they are willing to pay for it themselves  because he's prohibited from doing so by Medicare. He was trying to pass an amendment to stop Medicare from imposing limitations on services he wants to prescribe for his patients and every democrat voted against it!

    Parent
    BTW, this experiment is being (5.00 / 2) (#41)
    by MO Blue on Sun Dec 20, 2009 at 11:21:04 AM EST
    conducted only on Medicare patients and not the total population making it less likely to work. Therefore, if it does not work and it results in substandard health care for Medicare patients, it will be used as proof positive that government run health care systems do not work.

    Parent
    Second paragraph is spot on. (none / 0) (#42)
    by oculus on Sun Dec 20, 2009 at 11:34:49 AM EST
    This is shown via CalPERS, which does monitor efficiency and outcome and does force down insurance premium prices and amount expended for health care.

    Parent
    Exactly what universe have you been (5.00 / 3) (#16)
    by MO Blue on Sun Dec 20, 2009 at 09:53:39 AM EST
    living in over the last decade.

    but as long as the consumer of health care does not pay for the care (outside of premiums), there are always going to be some unnecessary services performed.

    In my world, premiums have gone up each and every year right along with increases in deductibles and copays on services and prescription drugs. Guess what, health services have continued to skyrocket.

    Preventive care is great except when people do not avail themselves of these services because they can not afford them due to high deductibles and copays. Does anyone really know if bundling services and paying payment for outcomes will be accepted by the physicians and hospitals or will they just accept patients that have insurance that still maintains the FFS system thereby denying people with access to health care. I guess the seniors will soon find out since the government has decided that we will be the guinea pigs for this experiment.    

    Parent

    Hang on (5.00 / 2) (#22)
    by Steve M on Sun Dec 20, 2009 at 10:11:08 AM EST
    No one ever talks about this, but as long as the consumer of health care does not pay for the care (outside of premiums), there are always going to be some unnecessary services performed.

    Unless I'm mistaken, no one else in the OECD is paying for their own care either.  So this point would apply equally well to all the countries we're measuring ourselves against.

    In order to close the gap, you're saying we need to realize savings that more efficient countries aren't realizing either.

    Parent

    Or our doctors and hopitals need to make 25% (none / 0) (#24)
    by steviez314 on Sun Dec 20, 2009 at 10:15:54 AM EST
    less.

    Everyone says we needed the public option to keep insurance companies honest and lower premiums.  My point is that wasn't even enough.

    I didn't hear anyone explicitly say we need to cut doctors' incomes by 25%.

    Parent

    My point is (5.00 / 2) (#25)
    by Big Tent Democrat on Sun Dec 20, 2009 at 10:18:27 AM EST
    that nothing in this bill leads us to a situation where the buyer of services has the bargaining power to do anything about it.

    My argument is simple - the entity that has done the best at this in the United States is public insurance.

    Parent

    And I agree with that. My point is that so (none / 0) (#30)
    by steviez314 on Sun Dec 20, 2009 at 10:35:38 AM EST
    much of the debate on the public option focused on reducing the insurers' profits, keeping them honest, providing competition.

    Where is the real money is though was in the NHE on the care itself.  Ask most people and they'd say doctors are underpaid, I think.  How do we square that with that $1.4T?

    Parent

    When the choice is raising their taxes (none / 0) (#33)
    by Big Tent Democrat on Sun Dec 20, 2009 at 10:37:22 AM EST
    That's when.

    Parent
    You cannot cut doctors and hopitals income (5.00 / 2) (#27)
    by MO Blue on Sun Dec 20, 2009 at 10:27:14 AM EST
    by 25% for Medicare patients when they can get higher payments from the private insurance industry. Doctors and hospitals have the option not to treat Medicare/Medicaid patients and some are already doing that.

    Parent
    Agree except for ... (none / 0) (#55)
    by FreakyBeaky on Sun Dec 20, 2009 at 04:29:58 PM EST
    ... the public insurance option.  Could be small to start with, but like the other pilot cost containment measures in the bill, it would prove itself over time (or not), and if it did, it would (or should) be expanded.  (Excuse my poor grammatical tense, but I'm not going to bother to clean it up today).

    Also, I'd like to point out that you mostly discuss cutting medicare costs.  It's easier to cut costs paid directly by a government program such as medicare or other public insurance than it is to use an indirect method like the ever-so-wonky exchanges, so I think much or your post implies that the public option would have been a good cost containment method.  

    Parent

    Disappointing (none / 0) (#15)
    by TeresaInSnow2 on Sun Dec 20, 2009 at 09:50:21 AM EST
    I would expect this kind of "junk thinking" from the Ezras and the Nates of the world, but not from Krugman.  From him, someone I consider a very smart man, it's pure unadultered intellectual dishonesty.

    It's one thing to have a difference of opinion of the outcomes based on the facts.  It's quite another to make up the facts.  And Krugman here is making up the facts.  And I'm sure he knows it.

    I won't be reading him on any regular basis anymore.  I only hope he can still sleep at night.

    Well put. My reaction, too (none / 0) (#37)
    by Cream City on Sun Dec 20, 2009 at 10:46:28 AM EST
    was that, as Krugman is not dumb or uneducated about this, he is being dishonest.  And that is a great disappointment to us who have needed his voice.  One by one, those significant voices are jumping on the bus for fear of being put under it, too.

    Parent
    In protest, a couple of weeks ago, I sent (none / 0) (#61)
    by suzieg on Sun Dec 20, 2009 at 09:51:15 PM EST
    him his books we had bought in the past explaining that the very sight of them made us nauseated!

    Parent
    Al Franken on cost containment (none / 0) (#50)
    by Militarytracy on Sun Dec 20, 2009 at 12:19:44 PM EST
    at Orange

    Orang is ripping him HARD (5.00 / 1) (#51)
    by Militarytracy on Sun Dec 20, 2009 at 12:24:35 PM EST
    Looks like I'm not alone waking up on the grumpy side of faux reform.

    Parent
    Orange vs Franken (none / 0) (#56)
    by FreakyBeaky on Sun Dec 20, 2009 at 04:35:23 PM EST
    Gee, I wonder which of those two would make more sense. :-)

    Parent
    I'm so happy I didn't contribute to his campaign.. (none / 0) (#62)
    by suzieg on Sun Dec 20, 2009 at 09:53:02 PM EST
    he's turned out to be just as bad as the republicans he loves so much to critize - what a hypocrite!!!

    Parent
    I think it's funny ... (none / 0) (#57)
    by FreakyBeaky on Sun Dec 20, 2009 at 04:43:42 PM EST
    ... the way some of you have suddenly kicked Krugman off the reservation.  I don't agree with him 100% of the time, but I am having a very hard time squaring the comments here with anything he's actually said.

    Attempts At Cost Containment, Except The Best One | 61 comments (61 topical)

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