Fixing the Federal Budget

The Problem, Matt... (0.00 / 0)

...is that you believe in the veracity of any econometric models. First, and foremost, your assumption that the CBO's "deficit reduction" forecast is meaningful even goes beyond what the CBO says: They first doubt that congress will live up the goals set for reductions in Medicare, as they note congress has never done it before, and they also add significant caveats to their understanding of what will happen to premiums as the effects of an expanded population with nearly no payment constraints will bring.  

Secondly, if demographics are the variable concerned then would not a more rational approach be to devise a system of rational distribution - i.e. rationing via the political economy?  You know my position on all of this but, as I've said elsewhere, absent substantive reforms that actually reduce the costs of services at the margin, as opposed to reduce the spending (never mind 10 years of taxes and 7 years of benefits - more or less) I'd take England's NHS over the abomination that is now called "reform" any time.

One last thing.  The federal portion of health care spending will likely only go down if we reduce benefits to entitlement participants by reducing usage either by rationing or by reducing benefits based on age or means.  We're to chicken as a society to bring up the issue. But I've seen no study that says we can avoid it. It will happen and your generation will get the short end of the stick.  As Herb Stein said "If something can't go on forever it won't."

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by: Dave Budge @ Wed Jan 13, 2010 at 22:06:38 PM UTC

If we don't believe the econometrics... (0.00 / 0)

We shouldn't believe the assumptions behind the long-term deficit explosion either. We can't say for sure that health care inflation is going to continue as-is without retooling the system with federal policy.

And I do think that being skeptical of the models makes sense. That being said, CBO has historically underestimated deficit reductions and overestimated costs. As they should. That's prudent planning.

Obviously, we could pass this bill and be proven wrong and be back at the drawing board. But I much prefer our odds with the bill than without.

As for implementing rationing within the system, we already have rationing. The question is what are we getting from this reform to actually drive cost controls. Most of it has to do with comparative evaluations and reforming payment systems to realign incentives. Those may both reduce incidence of health care treatments applied, but the idea is to do that without generally doing anything to worsen health outcomes (and possibly even improve them).

I think I might also prefer a better funded NHS to the proposal working its way through Congress. But that isn't an option. Neither is my preferred option that mixes an NHS approach for primary care (for the vast majority of the population) with more market-driven solutions for other care and some form of single-payer for catastrophic health coverage.

I'm pretty sure either system is a largescale improvement over the status quo. And the bill we have right now (plus or minus some tweaks) is the chance we have to improve for some time.

As some Republicans have noted, making big decisions about a sector that makes up 17% of the economy is difficult. Starting from scratch with an entirely different framework and trying to teach members of Congress how to think about it would be damn near impossible.

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by: Matt Singer @ Wed Jan 13, 2010 at 22:17:14 PM UTC

[ Parent ]

How skeptical are you (0.00 / 0)

about Gruber's assumptions about the effect of the proposed excise taxes in the Senate bill? Particularly how the tax affects wages and health cost reductions? Which has everything to do with "bending the curve," worker wages, and tax collections. And of course, deficits.

Because if you aren't skeptical about Gruber, and his undisclosed relationship with the WH, then it is hard to understand why folks are outraged at the Senate's version of HC funding, via the excise tax on middle class workers. And easy to defend his work, the Senate/WH excise tax, and this reform approach in general.

We've got a whole HC reform package based upon a house of cards of opaque assumptions, studies, analyses, and defenses, all paraded around circle-jerk fashion by the administration, its mouthpieces, Congress, the media, and Senate-style HC proponents. We haven't seen this kind of Administration deception since the run-up to Bush's war in Iraq.

How can you analyze the long term deficit explosion, re health care spending, if you can't challenge the Senate and WH's basic modeling?

Amazing how $392,000 undisclosed dollars paid to a White House contractor can shift the whole debate, without anyone seeing the impropriety. If the work of a $392k paid shill can move the whole HC debate, and have huge unintended consequences, then how can we even begin to look at the effect of HC on the long term deficit problem? No wonder push has come to shove at the WH for getting a bill out of Congress.

Pissin in the wind...

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by: JC @ Wed Jan 13, 2010 at 23:11:42 PM UTC

[ Parent ]

if this passes (0.00 / 0)

by the time the insurance companies jack up our premiums AND raise our deductibles to unaffordable levels we will all qualify for community health care anyway so i guess this is one way to achieve single payer. file it under unintended consequences and call it good matt....

but don't worry, this sorry bill ran out of gas a couple of exits ago. i figure single payer govt run insurance is what's at the end of this funnel of stupidity in the long run. when all the moving parts start to fall off and the bearings spill out of it's rotten guts after a few years of life it will sputter and crash to the floor.....but like i said.

it won't pass, anyway.

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by: problembear @ Thu Jan 14, 2010 at 01:37:52 AM UTC

[ Parent ]

Simply returning (0.00 / 0)

to the pre Reagan era tax rates would go a long way toward cutting the deficit...and if I'm not mistaken, out country did quite well economically before massive tax cuts and deregulation.

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by: bigsage @ Thu Jan 14, 2010 at 15:01:27 PM UTC

Matt Singer is a Blue Dawg Capitalist (0.00 / 0)

   This comment from the author makes him an idiot.
Subsidizing the Insurance Cartel, Taxing Plans, Forced purchases, cutting Medicare and Medicaid is a 'best ever ever solution' pleeeze spare me and the nation this lunacy. It is guaranteed Windfall with no accountability for the Insurance Cartel... and you call this the 'best ever' Your brain has rotted or you are a predatory capitalist pig - WHAT?

"The current health care bill is the single biggest deficit reduction act in the history of the nation...."

          KILL THIS MONSTROSITY OF A WINDFALL FOR THE INSURANCE CARTEL - bill.

            Why Singer, do you think we are in the terrible shape financially? I know you don't and won't get it but the reason is the Insurance Cartel Predatory Capitalism. Go away Blue Dawg. Go Away.    

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by: Darwin26 @ Thu Jan 14, 2010 at 19:04:56 PM UTC

No, Matt is not a "Blue Dawg" (0.00 / 0)

Far from it.

But what this post suggests, is that a "win" is more important than fighting against the regressive elements of the current incarnation of this bill: mandate without public option; excise tax on middle class health benefits; exclusion of 4-6% of the American public from the faux "universal" health insurance provisions of reform; lack of community rating; continued loopholes; etc.,  etc.

I on the other hand, see current reform efforts, while having some good aspects, as cementing into place some horrible policy choices. Choices that will nigh be impossible to undo until our health care system begins to collapse under its own unwieldy weight, complexity, loopholes, expense, and opacity.

if you want to attack the deficit via health care spending, the only solution that will ever do it in the long run is a single payer system. And this bill does nothing to advance our country towards a rational single payer system. In that sense it is not a progressive bill. It is regressive and punitive without having any of the advantages that should come with things like a mandate, which would be choice and real universality.

Anybody who thinks that extending the current framework to the 4-6% excluded from reform is delusional. If there isn't the political will and money to do it now, their definitely won't be the political will or financing available in the near future.

We had a chance to radically alter our health care framework to deal with long term deficit, universality, and excessive health care costs, and we blew it.

But for some, having a win is more important. And that has more to do with being loyal to dem party politics than blue dawg ideology.

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by: JC @ Thu Jan 14, 2010 at 20:23:16 PM UTC

[ Parent ]

Pimp for the Insurance Cartel (0.00 / 0)

   ok i'll be sensitive to the pernicious Blue Dawgs -
    Singer is a paid PIMP for the Insurance Cartel
     his rational explains it all.
    But for sure Singer is NOT LEFT he's a Neo-Liberal.

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by: Darwin26 @ Thu Jan 14, 2010 at 23:12:36 PM UTC

Is there something you could take for that condition? (0.00 / 0)

Or would that be supporting "Big Pharma"?

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by: Rob Kailey @ Thu Jan 14, 2010 at 23:23:49 PM UTC

[ Parent ]