Health Care Bill

[macrockett]

This video was on cnbc this morning discussing the Health Care Bill. The guest is Douglas Holtz-Eakin, former head of the CBO, which scored the HC Bill.

Toward the end he makes two points that concern him the most about the HCB. Both are key imo to understanding the limitations of the Bill as presented.

www.cnbc.com/id/15840232?video=1443191955&play=1

[macrockett]

Here is the CBO scoring (for what it is worth) of the House Reconciliation HC Bill: H.R. 4872 - Reconciliation Act of 2010

graphics8.nytimes.com/packages/pdf/us/20100318_cbo_report.pdf


Also on the House Committee Rules website, a line by line

rules.house.gov/bills_details.aspx?NewsID=4606

[slp]

What i find very comforting is to know that the Bill , if passed, will be paid for in large part by cleaning up the fraud and corruption in medicare.....yea, right.

[macrockett]

Mar 18, 2010 17:07:34 GMT -6 slp said:

What i find very comforting is to know that the Bill , if passed, will be paid for in large part by cleaning up the fraud and corruption in medicare.....yea, right.

It should also be comforting to know, slp, that the CBO has a consistent recording in accurately predicting the cost of programs such as the Health Care Bill...consistently wrong.

In fact, the process is such a joke, any politician who wants to reference CBO's work product, based on the limitation it is subjected to (see the first video on this thread), as a valid measure of future costs, is essentially lying to your face.

Such outstanding moral and ethical fabric in Washington.

[blankcheck]

Don't even get me started. This is a disaster. I have been watching this on Fox news for a long time. Hey even heard today that as of April, one Walgreens in Washington State (I believe) will no long accept new Medicare patients. It just keeps getting worse............

[casey]

One of my favorite all time bumper stickers "if you think health care is expensive now, wait until it's free!". So true. Think about it from the standpoint of our highest earning years are in front of us and unfortunately they'll all be eaten way by taxes and health care costs. Now extend that to our kids. What will they have? we're so screwed.

[macrockett]

Mar 18, 2010 19:22:36 GMT -6 blankcheck said:

Don't even get me started. This is a disaster. I have been watching this on Fox news for a long time. Hey even heard today that as of April, one Walgreens in Washington State (I believe) will no long accept new Medicare patients. It just keeps getting worse............

Yes blankcheck, if you listen to the first video above with Doug Holtz-Eakin, former director of the CBO he states "[Congress] has done nothing to change the business model of medicare service providers that will allow them to survive these cuts (talking about the $500B medicare cut over 10 years).

Also, the States are in the process of passing laws that will challenge the validity of the Federal law in requiring citizens to comply. The most extreme is Idaho, from what I hear. Read here: blog.oregonlive.com/mapesonpolitics/2010/03/idaho_gov_otter_leads_new_stat.html

I heard that 38 states plan to challenge the law.

[asmodeus]

The whole thing is nauseating.

When Brown won in Massachusetts, the consensus was that the people have spoken against Obamacare. Then Obama proclaimed that the bill deserves an "up or down vote." Now, Pelosi won't even offer that.

If this becomes law, and people refuse to purchase the mandatory insurance, will the Dems make sure these people are not treated when they show up at the emergency room?

[macrockett]

Mar 18, 2010 21:11:22 GMT -6 asmodeus said:

The whole thing is nauseating.

Indeed.

[macrockett]

another cnbc video on HC, rep Paul Ryan from WI discussing the cost of the Bill.

Around the 10 min mark he starts discussing the percentage of government spending to GDP. A truly frightening projection in the out years, if it comes to pass, that will affect out grandchildren without a doubt.

www.cnbc.com/id/15840232?video=1444628524&play=1

[sam2]

Blankcheck, Drudge posted an article from a Seattle paper yesterday, which stated the Walgreens in the entire state of Washington would stop accepting prescriptions from new Medicaid customers in April. it is a harbinger of things to come....Don't worry, I'm certain Congress will throw money at the problem --our money!

In my opinion, this is the problem with the CBO scoring. Everyone knows it is artificial. They score the bill outside of the context of reality. That's their job, but all of congress knows that the numbers on this health bill have zero value beyond providing cover for a vote.

[macrockett]

Sam2, how convenient that Congress set it up that way. Unfortunately most people have no idea of the manipulation that goes on and that CBO is a meaningless tool. Needless to say, this bill will be another black hole soon.

[macrockett]

On the States' challenge, look for many to evoke the 10th amendment. Remember your history, that all powers not given the feds are retained by the states. Unfortunately, over the years, those powers have been eroded by the commerce clause and other mechanisms in the courts.

In my opinion the more taxes that flow to Washington, as a result of the programs they create, the worse off we all are. They can make all the promises without fiscal responsibility and fund them by printing money, which they have done many times.

If anyone wants to know how that ends, just look to Europe. Greece is first in line unless the EU finds a way to bail them out. But sooner or later, all confidence in the currency is gone and the system collapses...

www.cnbc.com/id/15840232?video=1445042249&play=1 Utah Governor

[blankcheck]

Well, I hope everyone is keeping up with the "Big Vote" today. If this passes (which I feel it will), we are going to be just another step toward a socialized country.

I'm not sure if anyone read the article a week or so ago about the "coming out" groups. Basically, it was about illegal immigrants coming out to voice that they were illegal. One of our democratic leaders from Illinois ,Gueterez (?), switched his vote to yes for the health care bill. He is a big advocate for the illegal citizens. Think there was a deal cut there?

The Bismark deal, where all student loans would go through the government and the only bank that would be allowed to give out student loans would be Bismark. So in other words, the government will determine who will get loans and who will not. Another switch vote there. Think there was a deal cut?

This Health care policy is riddled with back door deals that we don't even know yet. So yes, while each school district in Illinois is facing major problems and cuts, I hope everyone is also keeping an eye on the bigger picture. If this passes today, we will wake up tomorrow one step closer to a socialized country.

[macrockett]

Here is the latest on the CBO scoring of the Reconciliation Bill from the CBO blog (this is a response to those who are skeptical of the CBO projections, like me. In the interest of full disclosure, here is their response):

cboblog.cbo.gov/

Uncertainty in Estimates for Health Care Legislation
March 19th, 2010 by Douglas Elmendorf

Yesterday CBO and the staff of the Joint Committee on Taxation (JCT) completed a preliminary estimate (posted above but here it is again www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf )of the direct spending and revenue effects of the reconciliation proposal that represents one component of the health care legislation being considered by the Congress. The other component is a bill, H.R. 3590, that the Senate passed in December.

CBO and JCT estimate that enacting the combination of the reconciliation proposal and H.R. 3590 as passed by the Senate would reduce federal budget deficits by $138 billion between 2010 and 2019. Although CBO does not generally provide cost estimates beyond the 10-year budget projection period, many Members have requested our analysis of the long-term budgetary impact of broad changes in the nation’s health care and health insurance systems. Therefore, we have developed a rough outlook for the decade following the 2010-2019 period. We estimate that the combined effect of enacting those two pieces of legislation would be to reduce federal budget deficits during that following decade relative to those projected under current law—with a total effect that is in a broad range around one-half percent of gross domestic product (GDP). That calculation is very uncertain, and the imprecision of the estimate is intended to reflect that uncertainty.

Many people have raised questions about those projections of deficit reduction and similar projections that we have made regarding earlier pieces of health legislation. Their questions often focus either on the uncertainties surrounding the various technical, behavioral, and economic factors underlying the estimates, or on uncertainties as to whether the legislation would ultimately be implemented as written.

Some analysts believe that CBO is underestimating the ultimate costs of the new subsidies to buy health insurance (which could make the legislation deficit-increasing instead of deficit-reducing). Others assert that CBO is underestimating the ultimate savings from changes in the Medicare program (which could make the legislation reduce deficits by more than we have estimated). Certainly, the budgetary impact of broad changes in the nation’s health care and health insurance systems is very uncertain. However, CBO staff, in consultation with outside experts, has devoted a great deal of care and effort to this analysis, and the agency strives to develop estimates that reflect the middle of the distribution of possible outcomes. As a result, we believe that CBO’s estimates of the net savings that would result from the legislation have a roughly equal chance of turning out to be too high or too low.

Focusing on another area of concern, some observers argue that CBO’s estimates are unrealistic because the Congress will not allow the Medicare spending cuts and future tax increases in the proposals to take effect. CBO’s responsibility to the Congress is to estimate the effects of proposals as written and not to forecast future legislation. However, the agency does try to provide information about the consequences of implementing proposals. For example, our cost estimate for the bill taken up by the Senate in December and our estimate for the House bill last October noted that inflation-adjusted Medicare spending per beneficiary would slow sharply under those proposals. We estimated that growth in such spending under the Senate bill would drop from about 4 percent per year for the past two decades to roughly 2 percent per year for the next two decades; whether such a reduction could be achieved through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care is unclear. In addition, CBO’s estimates have shown that relaxing previously enacted constraints on Medicare spending can add significantly to long-run budget deficits, as we wrote in answer to a question last fall about the effects of combining the House bill with a change in the so-called Sustainable Growth Rate mechanism for Medicare’s payments to physicians.

As we reported yesterday, budget deficits would be reduced, in our estimation, if the reconciliation proposal and Senate-passed health bill are enacted and remain unchanged throughout the next two decades. However, the legislation would maintain and put into effect a number of provisions that might be difficult to sustain over a long period of time. Whether any of its provisions—and if so, which ones—might be changed in the future is not for CBO to judge.

Today, in a letter responding to questions from Congressman Ryan, CBO described the effects on the federal budget of enacting the reconciliation proposal and the Senate-passed health bill if:

* The excise tax on insurance plans with relatively high premiums—which would take effect in 2018 and for which the thresholds would be indexed at a lower rate beginning in 2020—was never implemented; I BELIEVE THIS IS IN REFERENCE TO THE CADILLAC TAX ON SOME PRIVATE AND UNION PLANS
* The annual indexing provisions for premium subsidies offered through the insurance exchanges continued in the same way after 2018 as before—in contrast with the reconciliation proposal, which would slow the growth of subsidies after 2018; THIS REFERS TO CONTINUING INDEXING BECAUSE CONGRESS DOESN'T HAVE THE WILL TO AS COSTS GO UP.
* The adjustment to physician payment rates under Medicare that was passed by the House last fall was included; I BELIEVE THIS IS THE REIMBURSEMENT RATE TO DOCTORS FOR PROCEDURES, THAT GOES DOWN UNDER THE PLAN and
* The Independent Payment Advisory Board—which would be required, under certain circumstances, to recommend changes to the Medicare program to limit the rate of growth in that program’s spending, and whose recommendations would go into effect automatically unless blocked by subsequent legislative action—was never implemented. I BELIEVE THIS DEALS WITH CONTROL OVER COSTS OF HC BY RATIONING CARE IF THE PROGRAM'S COSTS GET OUT OF CONTROL.

We estimated that if this set of changes was made, the legislation as modified would increase federal budget deficits during the decade beyond 2019 relative to those projected under current law—with a total effect during that decade in a broad range around one-quarter percent of GDP.

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This was CBO's comments regarding the original findings:

Posted in Budget Projections, Health, Uncategorized | Comments Off
Preliminary Cost Estimate for Pending Health Care Legislation
March 18th, 2010 by Douglas Elmendorf

The Congress is considering the pending health care legislation in two components: One is a bill (H.R. 3590) that the Senate passed in December; the other is a “reconciliation” bill that would modify the Senate-passed bill in a number of ways. (In general, a “reconciliation” bill seeks to implement instructions in the Congressional budget resolution in order to achieve the budgetary goals set forth in that resolution; special parliamentary procedures apply to the consideration of such bills.)

CBO and the staff of the Joint Committee on Taxation (JCT) have just completed a preliminary estimate of the direct spending and revenue effects of the reconciliation proposal that was made public on March 18, 2010. (Direct spending is spending that would result from enactment of this proposal without any further legislation. The estimate does not encompass discretionary spending, which would be subject to future action in appropriation bills.)

The estimate is presented in three ways:

* An estimate of the budgetary effects of the reconciliation proposal, in combination with the effects of H.R. 3590, the Patient Protection and Affordable Care Act (PPACA), as passed by the Senate. The combination of those two pieces of legislation would reduce federal deficits by an estimated $138 billion over the 2010-2019 period.
* An estimate of the incremental effects of the reconciliation proposal, over and above the effects of enacting H.R. 3590 by itself. CBO and JCT estimate that enacting the reconciliation proposal would add about $20 billion to the deficit reductions over the 2010-2019 period, on top of the $118 billion in net savings attributable to the Senate-passed H.R. 3590.
* An estimate of the budgetary impact of the reconciliation proposal under the assumption that H.R. 3590 is not enacted (that is, an estimate of the bill’s impact relative to current law as of today). Although estimates on that basis have been completed for most of the provisions of the reconciliation proposal, CBO does not yet have such an estimate for all of the provisions. By CBO’s estimate, the provisions that have been analyzed so far would reduce deficits by $82 billion over the 2010-2019 period.

Although CBO completed a preliminary review of legislative language prior to its release, the agency has not thoroughly examined the reconciliation proposal to verify its consistency with the previous draft. This estimate is therefore preliminary, pending a review of the language of the reconciliation proposal, as well as further review and refinement of the budgetary projections.

The reconciliation proposal includes provisions related to health care and revenues, many of which would amend H.R. 3590; those provisions account for most of the budgetary impact of the proposal. It also includes amendments to the Higher Education Act of 1965, which authorizes most federal programs involving postsecondary education; the education provisions account for net outlay savings of about $19 billion over the 2010-2019 period.

Although CBO does not generally provide cost estimates beyond the 10-year budget projection period, certain Congressional rules require some information about the budgetary impact of legislation in subsequent decades, and many Members have requested CBO’s analyses of the long-term budgetary impact of broad changes in the nation’s health care and health insurance systems. Therefore, CBO has developed a rough outlook for the decade following the 2010-2019 period. We estimate that the combined effect of enacting H.R. 3590 and the reconciliation proposal would be to reduce federal budget deficits over the ensuing decade relative to those projected under current law—with a total effect during that decade that is in a broad range around one-half percent of gross domestic product (GDP).