From: Rachel Uchitel on
As Obama has hinted, without meaningful cost controls on major
components of our medical-health programs, the result will eventually

"Health-reform legislation would accomplish more than critics admit"

By Henry J. Aaron
The Washington Post
Friday, December 18, 2009; A31

In recent columns, Robert J. Samuelson has argued that extending
health insurance to 25 million to 35 million uninsured Americans is
undesirable unless and until health spending is controlled
["Obamacare: Buy now, pay later," Nov. 16; "A savings mirage on health
care," Dec. 14].

The simple fact is that insuring tens of millions must initially raise
health-care spending. How else could the previously uninsured enjoy an
increase in health-care services? It is, however, fair to ask whether
the bills under consideration pay for those added costs and promise
credibly to slow the long-term growth of health-care spending.

The Congressional Budget Office has answered the first question: The
House-passed bill and the one before the Senate would offset the
spending necessary to extend coverage with other spending cuts and tax
increases. These bills would reduce the deficit slightly over the
first 10 years and more later.

Samuelson disparages the budget cuts because Congress has not always
enforced promised spending reductions. Congress has, however,
repeatedly stuck with promised cuts in health-care spending -- in 1990
and 1993 as part of budget deals that helped balance the budget in
that decade, in the Balanced Budget Act of 1997 and in the Deficit
Reduction Act of 2005. Most of these cuts, like those proposed in the
health-care bills, were gradual.

In contrast, Congress has refused to enforce poorly designed, meat-ax
cuts in physicians' fees. Those cuts were so draconian that thousands
of physicians were likely to have stopped serving Medicare patients.
The poor design is regrettable. The failure to enforce a bad policy is

In his column this week, Samuelson cited a Center for American
Progress study and seemed to accept its estimates. But according to
that study, the bills under consideration would shave more than $1
trillion from national health-care spending and use half that money to
extend coverage. Yet Samuelson says that isn't good enough.

He seems to want the legislation to identify sure-fire ways to slow
the growth of health-care spending. What he does not note is that no
one has guaranteed ways to slow the growth of health-care spending and
that the pending bills include most of the ways experts believe are
likely to succeed.

The bills would simplify the administration of health insurance,
support the study of which medical procedures work best, invest in
preventive care, foster the creation of health-care organizations
accountable for a broad range of services, bundle payments for in-
patient and post-acute care, extend tests of "medical homes" that
would organize primary-care delivery, penalize hospitals with
excessive re-admission rates, reform the sale of insurance to
individuals and small groups, and more. In addition, the Senate bill
would tax high-cost health plans.

It is easy to write about the need to transform health care and the
evils of the fee-for-service system. But vague commentary does not
help transform a $2.6 trillion industry -- an entity as large as the
economy of Britain.

It does not, as the proposed legislation would do, help to spread the
team-oriented mode of health-care delivery that makes the Mayo Clinic
both a high-quality and a low-cost deliverer of health care. It does
not, as the proposed legislation would do, encourage all health
providers to use health information technology as effectively as do
Utah's Intermountain Healthcare and the Department of Veterans

It does not teach to every hospital administrator the advanced
managerial techniques that make Pennsylvania's Geisinger Health System
a leader in health-care management. It does not show private insurers
how to replace the admittedly flawed fee-for-service system.

Achieving these goals will take pilot programs, research and
experimentation of the sort that the legislation before Congress would
initiate. Enacting that legislation is the best way to slow the growth
of health-care spending. But the reforms in that legislation will take
effect slowly and they will operate against a powerful tide of
population aging and advancing medical technology that will continue
to drive up health-care spending.

Like virtually every health-care analyst, I wish the bills before
Congress did even more than they promise to do. In particular, I wish
they moved more aggressively than any of the bills now does to curb
the tax breaks for employer-financed health insurance that push up
health-care spending.

But waiting to pass reform until some undefined steps achieve
unspecified additional savings would delay actions to improve the
quality of health for all Americans. It would defer the very savings
the nation needs. And it would force tens of millions of uninsured
Americans to wait still more years (or even decades) for health
coverage they need -- and deserve.

[The writer, formerly director of economic studies at the Brookings
Institution, is a senior fellow focusing on the reform of health-care
financing; public systems such as Medicare; and tax and budget
From: Peter B on

"Rachel Uchitel" <lilhornie(a)> wrote in message
> As Obama has hinted, without meaningful cost controls on major
> components of our medical-health programs, the result will eventually

Darling, any health plan will result in us bankruptcy as well as the
prelude of greatly reduced treatments such as is found in Canada and the

From: James Fenimore on
"Health-care bill wouldn't bring real reform"

By Howard Dean
The Washington Post
Thursday, December 17, 2009; A33

IF I WERE A SENATOR, I would not vote for the current health-care
bill. Any measure that expands private insurers' monopoly over health
care and transfers millions of taxpayer dollars to private
corporations is not real health-care reform. Real reform would insert
competition into insurance markets, force insurers to cut unnecessary
administrative expenses and spend health-care dollars caring for
people. Real reform would significantly lower costs, improve the
delivery of health care and give all Americans a meaningful choice of
coverage. The current Senate bill accomplishes none of these.

Real health-care reform is supposed to eliminate discrimination based
on preexisting conditions. But the legislation allows insurance
companies to charge older Americans up to three times as much as
younger Americans, pricing them out of coverage. The bill was supposed
to give Americans choices about what kind of system they wanted to
enroll in. Instead, it fines Americans if they do not sign up with an
insurance company, which may take up to 30 percent of your premium
dollars and spend it on CEO salaries -- in the range of $20 million a
year -- and on return on equity for the company's shareholders. Few
Americans will see any benefit until 2014, by which time premiums are
likely to have doubled. In short, the winners in this bill are
insurance companies; the American taxpayer is about to be fleeced with
a bailout in a situation that dwarfs even what happened at AIG.

From the very beginning of this debate, progressives have argued that
a public option or a Medicare buy-in would restore competition and
hold the private health insurance industry accountable. Progressives
understood that a public plan would give Americans real choices about
what kind of system they wanted to be in and how they wanted to spend
their money. Yet Washington has decided, once again, that the American
people cannot be trusted to choose for themselves. Your money goes to
insurers, whether or not you want it to.

To be clear, I'm not giving up on health-care reform. The legislation
does have some good points, such as expanding Medicaid and permanently
increasing the federal government's contribution to it. It invests
critical dollars in public health, wellness and prevention programs;
extends the life of the Medicare trust fund; and allows young
Americans to stay on their parents' health-care plans until they turn
27. Small businesses struggling with rising health-care costs will
receive a tax credit, and primary-care physicians will see increases
in their Medicare and Medicaid reimbursement rates.

Improvements can still be made in the Senate, and I hope that Senate
Democrats will work on this bill as it moves to conference. If
lawmakers are interested in ensuring that government affordability
credits are spent on health-care benefits rather than insurers'
salaries, they need to require state-based exchanges, which act as
prudent purchasers and select only the most efficient insurers. Sen.
John Kerry (D-Mass.) offered this amendment during the Finance
Committee markup, and Democrats should include it in the final
legislation. A stripped-down version of the current bill that included
these provisions would be worth passing.

In Washington, when major bills near final passage, an inside-the-
Beltway mentality takes hold. Any bill becomes a victory. Clear
thinking is thrown out the window for political calculus. In the heat
of battle, decisions are being made that set an irreversible course
for how future health reform is done. The result is legislation that
has been crafted to get votes, not to reform health care.

I have worked for health-care reform all my political life. In my home
state of Vermont, we have accomplished universal health care for
children younger than 18 and real insurance reform -- which not only
bans discrimination against preexisting conditions but also prevents
insurers from charging outrageous sums for policies as a way of
keeping out high-risk people. I know health reform when I see it, and
there isn't much left in the Senate bill. I reluctantly conclude that,
as it stands, this bill would do more harm than good to the future of

[The writer is a former chairman of the Democratic National Committee
and was governor of Vermont from 1991 to 2002.]
From: AZDuffman on
On Dec 18, 11:47 am, Rachel Uchitel <lilhor...(a)> wrote:
> As Obama has hinted, without meaningful cost controls on major
> components of our medical-health programs, the result will eventually

You need to learn ECON 101. You CANNOT control the cost of
something. If you slap a control on it, supply will shrink or
dissapear. The probelm in health care is the "customer" is rarely the
person who actually pays.

Imagine if we had a truly competitive system. You would buy
"insurance" for major thigs over say $5-10,000 only. This would
greatly reduce paperwork, which will only expand under Obamacare.
Then you put what you would be putting into premiums into a Health
Savings Account. With that account you get a debit card under MC/
Visa. You use that debit card right at the doctor's office or when
you get your perscription.

Next, the doctor or clinic would be required to post prices for most
procedures right in the office and online. This should be fairly easy
since the majority of the office visit is a predictible cost. Then
you act like a consumer and compare! Just like the price on LASIK
came way down, so would other prices.

This would be far better than nationalizing the health care system and
having a "DMV Experience" at the doctor's office.

From: Citizen Jimserac on
On Dec 18, 11:53 am, "Peter B" <origin...(a)> wrote:
> "Rachel Uchitel" <lilhor...(a)> wrote in message
> news:da6cb9bf-acd9-42d3-83a7-3262bf56b50e(a)
> > As Obama has hinted, without meaningful cost controls on major
> > components of our medical-health programs, the result will eventually
> Darling, any health plan will result in us bankruptcy as well as the
> prelude of greatly reduced treatments such as is found in Canada and the
> UK.

Funny thing though, those Universal Health Care plans in Canada and UK
have been in place for DECADES and in both case were adapted by

Pretty strange for systems that apparently you think DON'T WORK? Eh?

Citizen Jimserac