Cost Containment

From the CBO Report (PDF):

[FN 11] The presence of the public plan had a more noticeable effect on CBOs estimates of federal subsidies because it was expected to exert some downward pressure on the premiums of the lower-cost plans to which those subsidies would be tied.

The total cost of the bill went up by 23 billion dollars from $848 billion to $871 billion. How much of that was due to the removal of the public option? How about that? Ezra noticed it too. I guess he can go back to saying nice things about the public option now that it is dead.

Speaking for me only

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    "Deficit hawks" are silly people (5.00 / 2) (#1)
    by s5 on Sat Dec 19, 2009 at 12:26:12 PM EST
    They made healthcare billions of dollars more expensive because they're worried about the deficit.

    and ironically enough (5.00 / 3) (#11)
    by cawaltz on Sat Dec 19, 2009 at 02:23:03 PM EST
    probably increase the deficit in the long run because the subsidies will be tied to a market that no longer has to worry about any downward pressure from a serious government option.

    To answer a question from the other thread (none / 0) (#2)
    by andgarden on Sat Dec 19, 2009 at 12:38:34 PM EST
    The CBO letter says:

    Policies purchased through the exchanges (or directly from insurers) would have to meet several requirements: In particular, insurers would have to accept all applicants, could not limit coverage for preexisting medical conditions, and could not vary premiums to reflect differences in enrollees' health.

    So the preexisting condition rules apply to adults too.

    Could not vary premiums? (none / 0) (#12)
    by gyrfalcon on Sat Dec 19, 2009 at 03:35:48 PM EST
    Seriously?  No charging three times as much for somebody with a preexisting condition, thus making a mockery of the whole idea of requiring them to cover people-- as we've all been railing about for months now?

    They'll just charge the older people more . . . . (none / 0) (#15)
    by nycstray on Sat Dec 19, 2009 at 03:43:55 PM EST
    3 times more for all people (none / 0) (#16)
    by MO Blue on Sat Dec 19, 2009 at 03:52:41 PM EST
    over 50 whether they have a preexisting condition or not.

    I'm on my state health insurance risk pool where (none / 0) (#18)
    by suzieg on Sat Dec 19, 2009 at 11:46:21 PM EST
    I'm  charged twice the going rate which is over $1480  monthly - under their bill my premiums will become unaffordable - I'm so pi$$ed  about this, I could  scream!!! I can't look  at any of them and will do everything in my power to  get them all defeated - they need a rude wake up and we need new blood who will at least respect us for a few years before they become corrupted to the bone.

    BTW, how did this get scored today (none / 0) (#3)
    by andgarden on Sat Dec 19, 2009 at 12:41:45 PM EST
    if the agreement was supposedly reached just last night?

    Nelson's stuff cost 43 million dollars (none / 0) (#4)
    by Big Tent Democrat on Sat Dec 19, 2009 at 12:43:21 PM EST
    Pretty easy calculation.

    Seriously, Nelson got nothing out of this.

    If I was someone who wanted this bill gutted and was counting on Nelson, I would be screaming about his capitulation.


    Speaking of which, I think the polls (none / 0) (#5)
    by andgarden on Sat Dec 19, 2009 at 12:44:13 PM EST
    will make this a beast to get back through the House.

    Well, my wonk on email (none / 0) (#17)
    by Cream City on Sat Dec 19, 2009 at 04:01:13 PM EST
    (as noted in earlier comments here, a wonk very involved in all this as an economist in public health, a specialist in "geriatric economics," etc.) disagrees.  Have at him, please, as I think he is missing even much bigger pictures.  But:

    That is most definitely a very incorrect conclusion to draw from the CBO estimates.  By a long shot.  One cannot compare the TOTAL cost of this version of the legislation with the TOTAL cost of the previous version and assume the difference is ALL due to dropping the public option. . . . The Reid amendment is 383 pages long, and . . . has piles and piles of provisions in it and most of these add to expenditures. . . .  I would bet you very good money that almost if not all of the increase in spending is due to other more generous provisions added to this version.  For example, there are more generous subsidies, more restrictions on out of pocket costs, more outlays to improve health, and so on.

    This is where people really have to step back and look at the broad picture.  There was much more than the public option in the bill -- it was a very small part of the proposal and would have covered a tiny number of people.  So dropping it is not going to affect the estimates much at all.

    For all of this: (none / 0) (#6)
    by andgarden on Sat Dec 19, 2009 at 01:00:15 PM EST
    By 2019, CBO and JCT estimate, the number of nonelderly people who are uninsured would be reduced by about 31 million, leaving about 23 million nonelderly residents uninsured (about one-third of whom would be unauthorized immigrants).

    Wonder which citizens are (none / 0) (#8)
    by MO Blue on Sat Dec 19, 2009 at 01:27:04 PM EST
    left uninsured.

    Presumably those for whom (none / 0) (#13)
    by gyrfalcon on Sat Dec 19, 2009 at 03:37:35 PM EST
    the difference between the premium cost and the tax penalty is a make-or-break difference in being able to pay all the other bills.

    Items of concern to me in CBO report (none / 0) (#7)
    by MO Blue on Sat Dec 19, 2009 at 01:25:43 PM EST
    o Substantially reduce the growth of Medicare's payment rates for most services.
    o deleting provisions that would increase payment rates for physicians under Medicare

    Page 5 CHANGES IN DIRECT SPENDING (OUTLAYS) - non Medicare Advantage Reductions.

    Reductions in Annual Updates to Medicare FFS (Fees For Service) Payment Rates  $186 billion - 2010 - 2019

    Medicare and Medicaid DSH(1) (Medicare Disproportionate Share) Payments $43 billion - 2010 -2019

    (1)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.

    Maintaining access to hospital care has been an important objective of the Medicare program. As the program transitioned from cost-based reimbursement to a prospective system, Medicare added a special payment adjustment to its prospective payment system (PPS) for hospitals that serve large populations of low-income patients.
    Purpose of the DSH Payment

    The original rationale for the Medicare Disproportionate Share (DSH) payment adjustment was to compensate hospitals for the higher operating costs they incur in treating a large share of low-income patients. Low-income Medicare patients tend to be sicker and more costly to treat than other Medicare patients with the same diagnosis. Higher costs also result from the need for additional staffing and services, such as translators and social workers, to care for low-income patients.

    Over time, however, a second justification for the DSH adjustment emerged. Many policy makers now view the purpose of DSH payments more broadly. Most agree that DSH funds preserve access to care for Medicare and low-income populations by financially assisting the hospitals they use. link

    Undefined Other Reductions $91 billion - 2010 - 2019

    Other Changes in Direct Spending

    Community Living Assistance Services and Supports  
    $72 billion - 2010 - 2019

    Even Democrats claim there is currently a problem with people being able to access care due to the reimbursement rates for Medicare/Medicaid. How much worse will it become if they further reduce payments to doctors and hospitals. I'm positive that the Medicare Disproportionate Share provision is what is allowing me to get care.  

    Would definitely like clarification on this (none / 0) (#9)
    by MO Blue on Sat Dec 19, 2009 at 01:28:48 PM EST
    CBO and JCT have determined that the legislation contains several intergovernmental and private-sector mandates as defined in the Unfunded Mandates Reform Act (UMRA). The total cost of those mandates to state, local, and tribal governments and the private sector would greatly exceed the thresholds established in UMRA ($69 million and $139 million, respectively, in 2009, adjusted annually for inflation).

    The Insurance Companies know they (none / 0) (#10)
    by SOS on Sat Dec 19, 2009 at 01:34:28 PM EST
    can't afford skyrocketing costs of todays Medical Treatments. If insurance is so great why don't they pay the entire bill?

    The whole freaking racket . . it's disgusting.  Basically this is a Health Insurance-Corporate bail out bill to keep their bubble-dream world afloat another 5 years.

    Looks like the Selfish, Socialistic Seniors (none / 0) (#14)
    by MO Blue on Sat Dec 19, 2009 at 03:43:35 PM EST
    may have had cause to worry about their 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.


    I still cannot believe that this is done under a (5.00 / 1) (#19)
    by suzieg on Sat Dec 19, 2009 at 11:55:32 PM EST
    democratic president and congress. The beginning of the end of Medicare accomplished by democrats for whom I have contributed, over all these past years, to get elected.  I wish I had banked the money instead in order to pay for my coming insurance increases...