These are comments attached to the previous blog, I found them interesting and informative. I do not understand everything that is said, I did some digging and added some links. I am sorry that it is not as complete as I would like especially about unions.
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"Obama is supporting the tax not only because it would raise a lot of money that would go toward covering the uninsured, but also because it is a measure that many economists argue could do a lot toward reining in the forces that have been driving up medical costs."
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Explain to me please, how exactly a tax is going to "rein in the forces that have been driving up medical costs"?
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"If Republicans want to campaign against what we've done by standing up for the status quo and for insurance companies over American families and businesses, that is a fight I want to have."
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Status quo? Fight? Hmmmm
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Is anyone not Big Pharma, Big Union or the Uninsured considered the "status quo"? I know that would primarily be mostly Republicans or folks who are considered to be "wealthy". Yes Mr President, you will be in a fight. I wish you much success in your eventual defeat. From this "status quo" individual, I will fight you tooth and nail. Fight you Mr President every step of the way on this and everything else you attempt to push upon the American citizens of this nation.
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Your socialist ideals will be stopped, and those who back you will be voted out of office. You have most certainly awaken those of us who have sat back for years and permitted your kind to take over. We are awake. We are ready for the "fight".
rustyreturns
"Fight you Mr President every step of the way on this and everything else you attempt..."
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My only question is how can they sleep at night?
shepherdwong
Is anyone not Big Pharma, Big Union or the Uninsured considered the "status quo"?
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No, the "status quo" is pretty obviously the present state of health insurance, not people insured by it.
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Go find an adult with a dictionary, rusty. They'll help you out.
kevin
"If Republicans want to campaign against what we've done by standing up for the status quo and for insurance companies over American families and businesses, that is a fight I want to have."
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Didn't you see that little "and" which follows status quo and before insurance companies, kevin?
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No Obama is declaring a "fight" against anyone who presently HAS insurance, and anyone who has wealth, a job or any subsistence which puts them into the middle class or higher. Period.
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Status Quo defined, "To maintain the status quo is to keep the things the way they presently are."
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My status quo is I have insurance, I like what I have and I want to keep it. Obama is saying "no, you can't keep it, you will take what I give you".
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If you have Medicare Advantage as many of the patient's I know, then he will take it away from you, and give you what he believes to be best.
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If you have a cadillac plan insurance policy, he will tax it, which in turns cost 45% more than it currently does now, which will in turn cause your employer to drop your insurance and give you some sub-quality plan. You lose, but that is how Obama wants it now. Oh, unless you are a Union member who just received a sweetheart deal from him (Andy Stern), then you can wait until 2017 to get all of your ducks in a row so you don't lose anything.
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Nah, you protect him and defend his policies kevin, I will fight it tooth and nail. I will do everything humanly possible that he is driven out of his office. Starting with 2010 elections to rid Congress of every Democrat so that they cannot be re-elected to support his policies and programs.
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It is very clear the direction that Obama is going with all of this. His tax on Banks and Wall Street he announced today. Again, middle and upper class are screwed.
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His Cap and Trade bill, green energy my ass. It is another under the table tax on middle and upper class folks so that he can set up a big money scheme for his croonies who will run the new comodities in Chicago.
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Yea, keep on believing the lie kevin. We'll see you soon on the other side.
rustyreturns
Keep stamping your little feet, rusty. It. Is. ADORABLE!
kevin
Again, middle [...] class [is] screwed.
As opposed to how it is now, when the junk insurance we buy increases in cost at three times the rate of inflation per year, stymies our wage growth, and yet still doesn't save us from bankruptcy when something actually does go wrong. Yeah, we weren't screwed with the status quo at all. At least, not when we're healthy and deluded into thinking the insurance we never used will actually be there for us when it matters the most.
redraven937
Tea Party: Awoken to the fight, eight years after the fact. What's your platform, lower deficits? We've been in deficit every year since 2002.
orangecatholic
This is a very, very good question:
Explain to me please, how exactly a tax is going to "rein in the forces that have been driving up medical costs"?
Anybody want to answer that?
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Forget that it came from a movement conservative for a second or two.
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What assumptions let Obama argue that this is the case?
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What are those economists talking about, exactly?
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"medical costs" to whom?
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Well, fellow reality-based community members?
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Can you explain what Obama means?
stuartzechman
I have insurance, I like what I have and I want to keep it. Obama is saying "no, you can't keep it, you will take what I give you".
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This is shockingly dumb.
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I mean, this is just an atrocious level of stupidity.
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rusty, you need to STOP DRINKING THE RUBBING ALCOHOL. IT IS PICKLING YOUR BRAINS.
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If you want actual things to complain about with HCR, you should read SZ's posts.
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But you are manufacturing reasons to complain, and all that does is degrade our discourse.
Cliff
Stu - so the basic cost savings comes from incentives. The problem with "Cadillac Plans" is they're extremely easy to use with little or no cost to the member. Which means the individual incentive is to seek medical care and services that aren't necessary. That's why things like copays are important. A $20 copay is nothing when compared to the $500 or $1000 bill your doctor will send in for an office visit, but the hope is that a $20 payment is just enough to make sure you only go to the doctor when you're really sick. As you tax the high end plans, these are suddenly less attractive to employers who provide them and people eventually people will begin to receive more typical coverage, creating more incentives to only go to the doctor when sick (and you'd think that Rusty would LOVE free market incentives), thus helping bend the cost curve down.
And Rusty, I don't get why making a deal to get a provision that unions DESPISE is an example of Democrats caving to unions? If Obama caved to unions, he'd push for the House version of funding that adds additional taxes to those making more than $250,000/year instead of taxing high value plans. If anything, this says he's sticking true to his original cause of supporting a bill that will eventually lower health care costs...you know, that thing that is more than 20% of our budget?
kevpvp
kevpvp:
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So you're contending that the economists' assumption is that overuse and unnecessary use in the United States is unmatched anywhere else in the developed world, and so that's why we overspend on health care costs twice what the average OECD country spends.
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I'm contending that the prices of health care products and services are twice as high in the US as anywhere in the developed world, and so unnecessary use isn't the problem --inflationary prices are. The reason I'm proposing that the United States alone in the wealthy world experiences this wild price inflation is that we do not have an effective system of price controls, unlike these countries where there the state negotiates prices for these nations with the suppliers of health care commodities. The reason we pay $7400+ per person, and the Germans pay $3600 per person, or the Canadians pay $3900 per person, is that the prices of things like prescription drugs and medical supplies aren't effectively regulated, like they are in Germany or Canada.
...so the basic cost savings comes from incentives. The problem with "Cadillac Plans" is they're extremely easy to use with little or no cost to the member. Which means the individual incentive is to seek medical care and services that aren't necessary.
How do you know this?
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Why is the individual's incentive to get knee operations that they wouldn't normally get, or cholesterol-lowering drugs that they don't need, or stay in the hospital weeks longer than necessary? Do you believe that folks like to receive surgery that they don't need to have? If so, what data do you have that supports this claim?
Which means the individual incentive is to seek medical care and services that aren't necessary. That's why things like copays are important. A $20 copay is nothing when compared to the $500 or $1000 bill your doctor will send in for an office visit, but the hope is that a $20 payment is just enough to make sure you only go to the doctor when you're really sick.
How do patients know which treatments are necessary, and which treatments are unnecessary?
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How do ordinary people know when they've got potential melanoma, and when they've got harmless skin discoloration?
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Absent a medical diagnosis, how do folks know when they're "really sick"?
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Isn't that quite a perverse incentive, when you think about it? Why should people who have no expertise whatsoever be "incentivized" to stay away from medical care? Isn't that the opposite of what a functional health care system would be intended to accomplish?
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If the goal is to get people to use less health care, then yes, that's an incentive, one that might appeal to a certain type of economist who's just looking to plug a function into an equation that produces a less steep upward curve. If the goal is to reduce prices, that's not a terribly effective means.
If anything, this says he's sticking true to his original cause of supporting a bill that will eventually lower health care costs...you know, that thing that is more than 20% of our budget?
The problem is that the bill is intended to lower costs for insurers (private and public), raise costs for ordinary people, and leave prices alone to continue on their hyper-inflationary curve skyward.
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When we speak about lowering costs, the question that needs to be asked is "For whom?", otherwise we're not clearly thinking about the goals of reform. If the costs of health care are lowered for private insurers and Medicare/Medicaid by reducing access to health care, then insurers and the government have got themselves a lovely New Democrat partnership that works for those parties. Unfortunately, that means that the costs are raised for ordinary people, which is what you're actually (and honestly) advocating. If prices are lowered, then costs for everyone go down, but the profits of health care commodities sellers go down.
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Thanks for answering, and for reading this, kevpvp, I know that you understand what I've written here.
stuartzechman
Well kevpvp, I hate to bust your bubble and all, but stuart and I have been "debating" this issue ever since it first came out. Right here.
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Actually, stuart is the one who convinced me that OECD countries DO have the type of health care insurance "reform" which we need right here in the US. If we are going to make the changes to what we have now, then we must demand that those changes come in the form like those in Japan, Switzerland or even Germany. Otherwise, forget it.
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"The problem is that the bill is intended to lower costs for insurers (private and public), raise costs for ordinary people, and leave prices alone to continue on their hyper-inflationary curve skyward."
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As stuart says above, costs will not come down. Costs will continue to rise at the hyper-inflationary way it has been for the past 15 or 20 years. Preimums WILL continue to rise even despite higher co-pays and/or deductibles.
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No kevpvp, you should really look deep inside your Democrat soul, and ask yourself.
Is Obama, Pelosi and Reid really looking out for my best interests?
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Or is the change that Obama promised, change for those who are very close to him, that have provided the lion share of his progressivism support? And you kevpvp simply left out in the cold.
rustyreturns
"The problem with "Cadillac Plans" is they're extremely easy to use with little or no cost to the member. Which means the individual incentive is to seek medical care and services that aren't necessary."
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I'm sorry but I have a big problem with this entire premise. Perhaps economists like to go to the doctor just for the fun of it but everyone I know has to be approaching death's door. Hmmm...let's see, what medical services which require driving to a medical facility, hours of waiting with other sick people, dressing in a paper smock, embarrassment, physical pain or discomfort and then recovery from treatment, shall I seek today?
shepherdwong
Anyway, doctors and insurance companies decide what medical care and services patients get so placing the cost barriers on patients is obviously just avoiding regulating the (rich and powerful) providers, where the costs of the system are actually determined.
shepherdwong
Let me clarify my position, I don't believe that people are out seeking unnecessary care for the fun of it. I think that people go see their doctors for what they feel are valid reasons. But think of the times when you've been sick. You have a cold for a few days, do you or do you not go see the doctor. I'm willing to bet things like copays and paying coinsurance enter your mind. Now extend this out and think of more major procedures, do you get a MRI or a CT Scan? Do you look at having surgery or possibly use physical therapy instead? These are choices where money matters. If cost is of no issue, there is no incentive to think through the individual economics of the medical choices we make. I personally think the bigger issue is the fact that when faced with two equally effective procedures, a doctor/hospital's economic incentive is always to do the more expensive process, but this bill does not tackle that complex issue.
As for regulating costs, I would love to be able to buy a $5,000 luxury vehicle, but don't see that happening. Government caps on costs are only effective if economically viable and I haven't seen anything that says this is the case. Canada has cheap drugs because Americans essentially subsidizes them with our higher priced drugs. Put a cap on what can be charged in the U.S. and drug costs in places like Canada have to go up or something has to give in R&D investment.
Complex stuff, this health care....
Thanks both to Rusdy and Stu for some of the better debate on this I've seen in a while. It's nice to get away from the talking points and have actual discussion....
kevpvp
It seems to me that so-called Cadillac plans do contribute to the cost of health care, even though they are not the number one factor (perhaps not even close). True, few people would choose to have an unnecessary knee surgery. However, if it costs them nothing, they may be less likely to question a doctor that suggests one. Still, that benefit would be rare, and it would be accompanied by people questioning and occasional refusing beneficial surgeries. On the other end of the spectrum, people can and do take drugs they don't need. Especially pain medicine and antidepressants. Both very important for those who need them. And sometimes desirable to those who don't. That would continue to be the case even if drug advertising were to change, although that might help with other overused drugs. This drives up both the total spending because more drugs are sold, and the price, because of demand. It can also discourage healthy behavior. If cholesterol medicine is free, some people will decide (quite wrongly) that there are no consequences to eating tons of fatty foods. This also leads to greater health costs.
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Obviously there are drawbacks to discouraging strong health insurance plans too. Enough so that I'm not convinced that in balance the "Cadillac" tax is a good thing. For one thing, there are many people who are in such dire trouble that co-pays are a serious hardship. I don't think anyone is arguing against this, so I'll so no more for the moment.
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What the Japan example demonstrates is that this is not a magic bullet. It will not solve the whole problem. I don't truly believe it would solve even 5% of the problem. But as far as I can see, the argument does not to prove that it would not save any money.
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Of course, if they hang their hats on this and do nothing significantly stronger to contain costs, they will fail us. Which looks highly likely.
iggydwonderlla…
