September 2, 2014

Posts on health care

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Friday, October 30, 2009 - 11:52 AM

Here are a few initial thoughts from The Concord Coalition about the House of Representatives health care bill (H.R. 3962) and the preliminary scoring of that bill by the Congressional Budget Office (CBO):

  • It does not appear that this bill would alter the unsustainable trend of federal health care spending, often referred to as “bending the cost curve.” [1] According to CBO, “On balance, during the decade following the 10-year budget window, the bill would increase both federal outlays for health care and the federal budgetary commitment to health care, relative to the amounts under current law.” [2]
  • CBO does not make a projection of national health care expenditures (public and private) and it’s unclear if the bill would have a major impact on lowering private costs. All the usually discussed efforts to accomplish that are present in the bill, (accountable care demonstration project; medical home pilot, comparative effectiveness research and wellness,) but these score as a cost in the first 10 years. CBO does not include a specific analysis of how these initiates might play out over time and it would, in fact, be very difficult to do so. Thus, the long-term effect of these policies is highly uncertain, at best. This is the risk of expanding...
Monday, October 19, 2009 - 10:23 PM

I have written a lot in this blog about the Congressional Budget Office and their estimates (here is the latest example). Today, the Washington Post has another great article explaining the process.

Reading it, I thought about how many things we do here at Concord that depend on CBO. We have been working over the last few weeks updating all of our education exercises with CBO information and data. Next week we will be unveiling a new online budget game that also is based on CBO publications. As is our plausible baseline, chart talks and many of our issue briefs.

We do this not because CBO can see the future, but because having a neutral umpire (especially one easily searchable online!), makes what we have to say stand out--because we don't have to spend as much time worrying or...

Wednesday, October 7, 2009 - 10:37 AM

Well, it took a couple months, but those with a stake in health care reform have finally figured out that the idea of an excise tax on insurance companies instead of an any alternative tax on “real people” was no magic cure for the want-more-revenue-but-don’t-want-higher-taxes blues. From a story by Ben Smith and Patrick O’Connor in today’s Politico (emphasis added):

More than half of the Democrats in the House have signed on to a letter denouncing a key element of the Senate Finance Committee’s health care legislation as labor unions draw a line in the sand on paying for reform.

The Democrats are attacking a plan to finance expanded health care by taxing expensive health insurance plans. The plan, sometimes cast as a tax on “Cadillac” plans, would in fact include the health care plans of many public employees and union members and has triggered a revolt from Obama’s labor supporters and their many allies on the Hill.

The letter from 154 House Democrats to Speaker Nancy Pelosi urges her “to reject proposals to enact an excise tax on high-cost insurance plans that could be potentially passed on to middle-...

Thursday, September 17, 2009 - 10:28 PM

The big news this week on the health care front was the release of the Senate Finance Committee's initial draft of its health care legislation. The big interest in the budget world with this development is that it marked the first complete reform legislation with a score from CBO that shows deficit reduction, not only during the 10-year budget window but also in the years beyond.

While this is encouraging, there are a lot of caveats to keep in mind about where we are in the process. One is that the bill leaves out a quite expensive item--a fix to doctor payments under Medicare--that costs hundreds of billions. That "fix" is included in the House bill where it is not paid for. Another caveat is that the proposed Medicare Commission, an idea we at Concord support, is seemingly having more restrictions placed on it at every turn. Finally, the legislation still has a long way to go and just one amendment at some point could change the CBO scoring dramatically. Furthermore, the other bills the Finance Committee's have to be merged or conferenced with do not appear as fiscally responsible (...

Friday, September 11, 2009 - 3:42 PM

After President Obama's big health care speech this week, we have been talking here at Concord about how he makes it sound as if all we have to do to cut health care costs is cut the “waste” and “abuse” that no one should want anyway. That’s how he can claim his plan would reduce federal health spending without cutting any federal health care “benefits” -- because it wouldn’t cut any spending that actually “benefits” people.

The problem often in Washington however, is that one man’s “waste” is another man’s precious benefit. And when politicians traditionally talk about cutting "waste, fraud and abuse," they do so, in part, to duck the hard choices required to make real progress on the nation's long-term fiscal problems. That is why one of the foundational agreements among all of the members of the Fiscal Wake-Up Tour is that we can't solve our problems simply by cutting those items. (By the way, you can now watch a special set of videos on our website featuring the Fiscal Wake-Up Tour panelists speaking about health care reform.)  

When talking about health care and waste, the term does...

Friday, September 4, 2009 - 12:16 PM

Ezra Klein has a good post today discussing the problem with the costs of health care reform and how to pay for them. His point is that the structure of the bills being discussed so far lead them to not do enough to control long-term costs, and that efforts to scale them back further either achieve a lower price by delaying implementation--which just allows cost to dramatically diverge from the "pay-fors" outside the budget window--or they simply leave the currently unaffordable system relatively intact.  As David Brooks seconds in the New York Times, the effort to make reform politically palatable--in that it didn't try to dramatically change how most Americans get their health care--instead left us with proposals that are not very popular, but also don't provide the change needed to begin to fix our health care cost problems.

In some sense this is because the problems with our health care system are so dramatic, that the broader in scope the reform, the greater the chance that reform has to actually cut costs. But it is also because members of Congress have a hard time doing the right thing from a policy...

Thursday, August 20, 2009 - 5:03 PM

There is still a ton of interesting writing about health care reform coming out daily and I am sure most of you are aware of the discussions taking place in Congressional districts across the country. I thought it would be good to provide some new links that we have been looking at this week.

First, I can direct you to our new web page charting the differences in the congressional health care proposals. This chart was put together by Chuck Konigsberg, Concord's Chief Budget Counsel, who writes our weekly Washington Budget Report. Subscribe to the budget report to get updates when Congress is in session about where the health care reform debate is heading and other budget news.

Concord also has a new page devoted to health care where you can get our newest...

Thursday, August 6, 2009 - 7:40 PM

Today’s Washington Post reports that the Senate Finance Committee has come up with a bipartisan plan that contains a new revenue offset (or “pay-for”) that’s more consistent with the goals of health reform (emphasis added):

Senate negotiators are inching toward bipartisan agreement on a health-care plan that seeks middle ground on some of the thorniest issues facing Congress, offering the fragile outlines of a legislative consensus even as the political battle over reform intensifies outside Washington.

The emerging Finance Committee bill would shave about $100 billion off the projected trillion-dollar cost of the legislation over the next decade and eventually provide coverage to 94 percent of Americans, according to participants in the talks. It would expand Medicaid, crack down on insurers, abandon the government insurance option that President Obama is seeking and, for the first time, tax health-care benefits under the most generous plans. Backers say the bill would also offer the only concrete plan before Congress for reining in the skyrocketing cost of federal...

Thursday, July 30, 2009 - 11:18 AM

The Congressional Budget Office once again validates some intuition many of us had about health care reform: when you have health costs rising much faster than the economy is growing, a package that expands coverage but is unwilling to tax health benefits to pay for it is not likely to add up to a deficit-neutral plan over the longer term. The basic problem is that the cost of coverage expansion will continue to increase at the same rate as health care costs, but the tax increase offsets will only grow (at best) at the rate of economic growth. Then you have an additional problem that many of the offsets might be one-time cuts or cuts whose value does not even keep up with economic growth or inflation. 

Quoting from pages 12-13 of the report (a letter to Congressman Dave Camp (R-MI) on the House tri-committee proposal), emphasis added:

Looking ahead to the decade beyond 2019, CBO tries to evaluate the rate at which the budgetary impact of...

Tuesday, July 28, 2009 - 5:13 PM

Yesterday, experts from the Iowa Committee for Value in Healthcare -- a diverse group of Iowa health care providers, purchasers, payers, patient advocates, and policy analysts -- sent a letter to President Obama and Congressional leaders indicating the principles for value-based health care reform that should be considered in any health care legislation. 

This committee was established as part of The Concord Coalition's Fiscal Stewardship Project to suggest ways that health reform could be enhanced to create a more value-based system. As Congressional efforts toward health reform continue through the summer, value, cost and long-term savings have become more prominent aspects of the debate. Achieving value in the health care system is essential for the ...