The Republican position is fairly incoherent. The major talking points are these:
- This bill uses accounting gimmicks to front load the taxes and back load the spending, which is the only reason it's deficit neutral over the ten year window.
- The Democrats are refusing to let cuts to doctor payments stand, and also, doctors don't get paid enough.
- Millions of people are going to be added to Medicaid, which is a terrible program because providers don't get paid enough. Also, it would be too expensive to add people to Medicaid.
- Medicare costs too much, and also, shouldn't be cut.
- The Republicans favor "real reform" which mostly seems to consist of liability caps.
Luckily for the Republicans, they weren't exactly playing against the varsity. The Democrats had their own set of uncompelling talking points:
- Insurance companies are evil institutions which deny everyone any care that costs more than a pack of Freedent gum. Also, they cannot control health care costs without substantial government intervention, because they spend far too much on expensive procedures.
- Ted Kennedy sure was a swell guy, wasn't he? He'd be proud of every dang one of us today. (It is impossible to exaggerate how great a role this point played. There was a five minute stretch which consisted largely of people telling Ted Kennedy's replacement that Teddy would be awfully proud of him, and him saying, "No, really, Ted would be proud of you.")
- Small- and medium-sized businesses are groaning under the weight of their health care costs. Also, starting next year, we're going to force them to give you much more generous coverage from your employer, such as coverage for non-dependent "children" up to the age of 26.
- This problem is incredibly urgent, which is why we have to pass this bill, which now takes effect in 2014, RIGHT NOW.
Goodness, Megan, is this why you haven't been posting lately? That's why we hire Congressman, to watch this stuff.
No, that would be the root canal I just had.
If I had a choice, I'd pick the root canal over C-SPAN as well.
I just assumed watching it was the root canal.
Someone has to watch the Congressmen. Megan watches CSPAN-2 so you don't have to.
my favorite part of the debate was when Harry Reid asked of the bill's opponents "what planet are you living on" since they could not see the obviousness of how this bill would increase coverage and lower costs. He seems to spend most of his life in some level of outrage, typically about something that he can't be so simple as to actually believe himself. Barney Rubble - what an actor!
Reid's outrage was trumped only by the Speaker's "Are you kidding?" response to the heretic reporter who dared to tie the US Constitution to, of all things, legislation. That is so annoying.
This may sound crazy but Bob Corker, by far, impresses me more than any other legislator on the Hill. He is rational about everything and doesn't play the typical games these fools normally play (both sides).
Meanwhile India has hit on some actual health care innovation that has driven down costs and improved quality -- capitalism!
http://online.wsj.com/article/SB125875892887958111.html
Of course nothing that would promote such an approach here in the US is currently on the table.
Bless you, Megan, for taking this one for the team. Also: it is continually depressing to be reminded that we do indeed have the government that we deserve.
It seems you are unaware of this, but the incoherency of declaring catastrophe from benefit cuts and catastrophe from spending is central to your talking points, as well.
One cannot be unaware of something that is not true. I predict the catastrophe from not making the spending cuts, not from the spending cuts themselves. It's a hell of a lot more coherent than "But I REALLY, REALLY hope we'll make the spending cuts, so why can't we pretend it's true?"
You predict catastophe from spending cuts, but oppose specific measures that would cut spending.
Q Why not negotiate drug prices? Megan: If we don't overpay for drugs to subsidize global R&D millions of people will die.
Q Why not include a strong public option(scored to save billions of $) Megan: But thats socialism! Plus I estimate, using no particular methodology that the margin of error on the CBO reports is -$1 trillion.
Q Then how about an excise tax that could simultaneously raise revenue and encourage more efficient usage of health care? Megan: That is an unfair transfer from the rich to the poor. If we want to avert catastrophe, I'll only support measures that make everyone pay equally regardless of the ability to pay.
Q Fine, if we can't incentivize private sector changes, how about we just cut inefficient Medicare programs(like Medicare advantage) and negotiate rates more aggressively? Megan: Oh no! We can't do that! It will force providers out of business.
You've ruled out all the cost saving measures on the table, but you are still doomsaying about the budget. So if there is no contradiction, please tell me, what should we be doing to deal with this "budget crisis" you keep talking about? Or is your take home message that we're all doomed and should put our remaining disposable income from now until the apocalypse into building bunkers?
Zosima, you are bizarrely conducting a dialogue with someone who is not me. Aside from price controls (which you characterize as "negotiating aggressively", I haven't said any of these things. Normative != positive
It's called a paraphrase. Ironically enough, you used the same "bizarre technique" in the post to which I was responding.
I'm really starting to get a clear picture of the asymmetry in your information. Maybe a better name would be "asymmetrical reality".
Also, retreating to the idea that you are really making positive statements with no implied advocacy is a rhetorical dodge; really a violation of the Gricean Maxims. But given the web of contradictions you weave, I can see why you might pick this tack.
Or maybe you really just forgot what you said? If you really want me to provide documentation, just ask.
Speaking of contradictions, I realized another "asymmetry" in your information. You're arguing the we can't consider the healthcare bill and the SGR separately because they have clauses that interact, yet you favor the CMS estimate which doesn't include any of the revenue mechanisms from the healthcare bill. Another case of picking the evidence to fit the policy? Certainly seems so.
Megan: I predict the catastrophe from not making the spending cuts, not from the spending cuts themselves.
Zosima: You predict catastophe from spending cuts
Yeah, I'd say you missed the boat here.
Can someone explain the apparent dichotomy between the Republican argument of front loaded taxes and back load spending, and that of the Democroats who state the CBO report shows that the program nominally is self funding for the 2020's? Are they arguing the same point, or are these two different issues? Are they referring just to cost, or the deficit?
From http://thinkprogress.org/2009/11/22/wallace-cbo-costs/
"CBO report does predict that 'federal outlays for health care would increase during the 2010-2019 period,' but the last paragraph of that same page adds that 'during the decade following the 10-year budget window, the increases and decreases in the federal budgetary commitment to health care stemming for this legislation would roughly balance out, so that there would be no significant change in the commitment.' As Sen. Arlen Specter (D-PA) pointed out, the $848 billion bill would actually 'save $130 billion in the first 10 years' and $650 billion in the next decade."
My question is: will the Senate bill be deficit neutral in the 2020's according to the CBO?
I would greatly appreciate if anyone can answer this question, because this has greatly confused me as well. On the one hand, you read that it's deficit neutral in the first ten years because of the front loading of taxes and back loading of spending. On the other hand, the CBO says money is saved after the first 10 years. Now the money saved is based on Medicare cuts (as I understand it), but assuming they take place, why are accounting gimmicks needed in the first ten years but money is saved once everything is phased in? Do the Medicare cuts not take place for some time? That's the only explanation I can think of.
Saving money and reducing the deficit obviously aren't the same thing. Reducing the deficit can also come from raising revenue. One reason (among others) for the effect you describe here likely results from the increase in tax revenue we'll see as more and more money from employers is shifted from a form that is not subject to federal taxes (payment-in-kind in the form of insurance premiums) to taxable wages. Because the Cadillac plan tax is indexed to inflation, and because health care costs are growing faster than inflation, with time an increasingly large percentage of the money employers spend on health insurance premiums will A) be subject to the tax -- itself a revenue raiser and B) will result in more money being shifted to taxable wages.* Also, because healthcare spending (especially Medicare) will account for an ever-growing portion of overall federal spending, any cuts in the way the such dollars are spent will have an outsized effect on the overall federal budget with the passage of time, at least compared to the path implied by the status quo.
*Also, while I doubt CBO is taking this into consideration, in general any substantive moves to direct GDP dollars out of healthcare should, I think, provide additional benefits to the government's finances, and that's because supply tends to drive demand in our system. A healthcare system with say, 30,000 MRI machines (which is what we get -- let's imagine -- if we start taxing insurance premiums) in 2023 instead of, say, the 38,000 MRI machines we'll end up with if we don't do anything, is a system that is under more pressure to, er, schedule extra MRI appointments. After all, somebody's gotta pay for the finance charges -- they're not giving away MRI machines, doncha know...Anyway, the taxpayers obviously end up paying for some of those extra MRI payments. Now, the savings effects from such a shift are no doubt subtle, and it may well take years for such savings to materialize into something substantial, but the small steps that are politically possible to take now are nonetheless small steps in the right direction. We're caught in vicious circle of out-of-control healthcare spending. Something's gotta give. I think the Senate bill, warts and all, is therefore a net change for the better, even without taking into consideration expanding insurance coverage toward universality, which I'm given to understand a lot of folks around here don't consider a top priority.
I have a feeling the numbers quoted by Senator Specter are anticipated cost reductions in health care, and do not have anything to do with the deficit. I'dbe interested to see those numbers if they exist.
That said, my head spins when a large bill like this comes up for a vote. In has all the trimmings of feel good legislation that kicks the can of responsibility down the road.
The promise of creating this advisory board and that deliberative panel does not make me any less skeptical.
Consider me in the group who doesn't believe insuring the uninsured a top priority. With large overall structural deficits looming at the end of the next decade, it's imperative we tackle these shortfalls first before creating yet another entitlement. I don't take joy in knowing that we have people in our country without insurance, but creating another program now while we're already on an unsustainable course merely takes benefits from tomorrow's poor in the form of debt and disperses it out today.
There was an earlier bill(I think it was a House version), that was particularly bad about front loading, and it really was the case that because of this, the scenario got worse and worse after the 10 year period.
Unfortunately, the meme has persisted and been applied to all future estimates regardless of merits.
It is true that the Senate bill also phases in gradually and with different parts at different times, but budget estimates are not the only reason to phase the provisions of a bill gradually. Most good legislation does this so people have time to adjust, and the senate bill phases in both the taxes and the benefits gradually.
It just so happens that the Senate Bill being currently debated really does bend the curve(in the CBO's estimate), thus leading to an improving estimation of the budget after the 10 year window.
"Medicare costs too much, and also, shouldn't be cut."
Apparently you missed the memo that all we have to do is cut taxes, deregulate, and replace all government safety net programs with vouchers. That's how you reduce Medicare costs without cutting benefits and solve all other problems under the sun.
"Ted Kennedy sure was a swell guy, wasn't he? He'd be proud of every dang one of us today."
I remain amazed that Dems don't understand that the worst way to get public support for universal health care -- a program that faces considerable resistance because so many are concerned about government interference with health care -- is to repeatedly link it to the guy whose entire reputation is that of a big government, big spending liberal.
They weren't trying to convince the public, they were trying to convince members of the Senate (where Ted Kennedy was a really popular dude). Not that I think it's a good or convincing argument...
Kabuki theater it was. A procedural vote was given big play for one reason, and one reason only- it was the latest attempt to build a sense of inevitability. This fact alone should tell you how desperate the leadership is about passing this at all.
I guess that I am just a bit more parochial in my views.
The big news hit of the weekend regarding the HealthCare debate occurred on the front page of the NYT.
It was actually two articles.
The first stated that the US was nearing $700 billion in debt interest payments annually by 2019.
The second stated that Senator Landrieu received promises of $300 million dollars to LA if she voted to proceed with the HealthCare debate.
I'm really tired of the expression "kabuki". I think it was 2009's "perfect storm".
If the bill passes, plenty of stuff will kick in immediately.
Furthermore, we should get this out of the way in order to move to cap-and-trade.
Plenty of stuff, indeed. Of course, he forgot to list the taxes that will also "kick in", which will delay the economic recovery.
Which are those? I really don't know.
Sam,
Here is a partial list that I found on the Heritage Foundation's web site that have been mentioned for the House and Senate bills (not necessarily in both chambers):
1. An income surtax on taxpayers earning more than $500,000 a year
2. An excise tax on high-cost "Cadillac" health insurance plans that cost more than $8,500 a year for individuals or $21,000 for families
3. An excise tax on medical devices such as wheelchairs, breast pumps, and syringes used by diabetics for insulin injections,
4. A cap on the exclusion of employer-provided health insurance without offsetting tax cuts,
5. A limit on itemized deductions for taxpayers with a top income tax rate greater than 28 percent,
6. A windfall profits tax on health insurance companies,
7. A value-added tax, which would tax the value added to a product at each stage of production,
8. An increase in the Medicare portion of the payroll tax to 3.4 percent for incomes great than $200,000 a year ($250,000 for married filers),
9. An excise tax on sugar-sweetened beverages including non-diet soda and sports drinks,
10. Higher taxes on alcoholic beverages including beer, wine, and spirits,
11. A tax on individuals without acceptable health care coverage of up to 2.5 percent of their adjusted gross income,
12. A limit on contributions to health savings accounts,
13. An 8 percent tax on all wages paid by employers that do not provide their employees health insurance that satisfies the requirements defined by the Secretary of Health and Human Services,
14. A limit on contributions to flexible spending arrangements,
15. Elimination of the deduction for expenses associated with Medicare Part D subsidies,
16. An increase in taxes on international businesses,
17. Elimination of the tax credits paper companies take for biofuels they create in their production process--the so-called "Black Liquor credit,"
18. Fees on insured and self-insured health plans,
19. A limit or repeal of the itemized deduction for medical expenses,
20. A limit on the Qualified Medical Expense definition,
21. An increase in the payroll taxes on students,
22. An extension of the Medicare payroll tax to all state and local government employees,
23. An increase in taxes on hospitals,
24. An increase in the estate tax,
25. Increased efforts to close the mythical "tax gap,"
26. A 5 percent tax on cosmetic surgery and similar procedures such as Botox treatments, tummy tucks, and face lifts,
27. A tax on drug companies,
28. An increase in the corporate tax on providers of health insurance,
29. A $500,000 deduction limitation for the compensation paid by health insurance companies to their officers, employees, and directors.
Of course, the bottom line is that to spend over a trillion dollars, and be deficit neutral, then taxes have to come in to pay for all of the increased spending from somewhere.
I was asking about the specific taxes that would kick in before 2014 in the current Senate bill.
rsbsail: of course, the bottom line is that you're either not arguing in good faith or you don't know what you're talking about. Because it's not true that taxes are required "to pay for all of the increased spending." Rather obviously, some of the new spending can be paid for by reductions elsewhere.
Well, I sure don't want people to think I'm arguing in bad faith. So you want me to dig up how much is of the spending is paid for by either taxes or cuts elsewhere? The truth is, I don't know. But I'll bet the truth is you don't either. Mainly because the bills still need to go to reconciliation. That doesn't mean I'm arguing in bad faith, or that I don't know what I'm talking about.
I do know that there was a provision to reduce Medicare payments to doctors and hospitals. About $250 B if I recall. Now strictly speaking, that is not a tax. But I bet if you ask the doctors and hospitals, that sure feels ike a tax.
Has Megan suggested any cost control measures that she would be in agreement with? Has any of the conservative commenters? Alrighty then? I see we are still in conservative/libertarian fantasy land, where no cost control measures will be needed if only we let insurance companies do anything they want.Then the giant free market ponywill painlessly lower costs.As you were.....
I'd like to call out my favorite bit of the debate, when Harry Reid made this statement:
That's right, folks. Support this health care "reform" bill, and the government will eliminate all fear of illness and death. After all, it's your "right" to live without that fear.
Dark days for the republic while such charlatans rule (GOp & DNC alike), I say.