Off the Charts Blog | Center on Budget and Policy Priorities | “Double-Counting” Canard Quacks Again

Off the Charts Blog | Center on Budget and Policy Priorities | “Double-Counting” Canard Quacks Again:

Former Bush Administration official Charles Blahous has garnered some media attention by gussying up old, discredited arguments about the budgetary effects of health reform. But his paper adds nothing new to the debate.

Blahous claims the Congressional Budget Office’s cost estimate for the health reform law “double-counts” a considerable portion of the law’s Medicare savings. By subtracting these savings, Blahous asserts that — contrary to CBO — health reform increases the deficit.

But there’s no double-counting involved in recognizing that Medicare savings improve the status of both the federal budget and the Medicare trust funds. The outlooks for the budget and for the Medicare trust funds are two different things; some changes in law may affect one and not the other, but other changes affect both.

CBO estimates that health reform will modestly reduce the federal budget deficit. The Medicare actuary says that health reform will extend the solvency of the Hospital Insurance trust fund by eight years.

That’s no different than when a baseball player hits a home run: it adds to his team’s score and also improves his batting average. Neither situation involves double-counting.

CBO has accounted for deficit reduction in exactly the same way in previous Congresses, under both political parties. Until opponents of health reform latched onto the notion, no one accused CBO of faulty accounting.

For example, the Balanced Budget Act of 1997 and the Deficit Reduction Act of 2005 — both of which Republican Congresses approved — included Medicare savings that were counted as reducing the deficit and improving Medicare’s financial outlook. The Senate Republican Policy Committee rightly claimed credit for this result, and no one made charges of double-counting.

– Sent using Google Toolbar

Medical Progress Today: A Two-Year Look Back at PPACA – Why it’s Dangerous to Our Health

A Two-Year Look Back at PPACA – Why it’s Dangerous to Our Health
 So bad it’s good! This amazing piece, apparently from the Department of  Obtusity at the Manhattan Institute, takes a stab at criticizing PPACA. Big fail. Trying to finish up my semester here, so I will try to get back to this soon and deconstruct it, but I needed to leave a bookmark to remind me to do it. Enjoy.

How Dr. Emanuel and others think it is the responsibility of the taxpayer to pay for industry errors is beyond comprehension. If this was a pharmaceutical error, or medical device error, my guess is that the CEO of the offending companies would be hauled before Congress and affected families and patients would be called to testify against them – just like Congress did with Toyota.

Aha! Maybe that’s it. Maybe the issue is that these hospitals have a designation of “not-for-profit.” So in some people’s distorted view of the world, maybe they can do no wrong, and for-profit business enterprises can do no right. If this line of thinking is out there, then no amount of regulation will make us safe.

– Sent using Google Toolbar

Broccoli – Doctors for America

Broccoli – Doctors for America:

The health care market is unlike any other market because health care costs are unpredictable and are not meaningfully bounded on the upside. Break an arm and your costs could be in thousands of dollars. Have a heart attack and you’re in the tens of thousands of dollars. Get cancer and you could enter the hundreds of thousands of dollars category. There’s no way to prepare for such illnesses and their costs. That’s why health insurance exists, to smooth out these costs over a lifetime and to pool our resources to help those with catastrophic costs to pay for them. The purpose of mandating the purchase of health insurance is to have everyone pay into a system that they will eventually use. Equating broccoli and health insurance is specious and a sign of bad faith on the part of those making that argument. As far as I know, nobody has died because they couldn’t get their hands on some broccoli.

When broccoli is 1/6th of the economy of the nation, give me a holler. Maybe then it should be regulated.

In the meantime, what we are hearing is a deliberately misleading meme about ‘limiting principles,” AKA, “where do we draw the line?” My answer is that we don’t draw the line at health care, a fundamental human need that now accounts for one sixth of all economic activity in the US. This is clearly NOT where to draw the line. We can argue about where TO draw the line when the Federal Government tries to mandate burial insurance or some other completely random pseudo-analogy thought up by Fox News and fellow travelers.

Contra David Brooks on ObamaCare – Blog of the Century

Contra David Brooks on ObamaCare – Blog of the Century:

This last point highlights aspects of political economy which Brooks prefers to ignore. He writes that there is no way planners can know]”how Congress will undermine any painful cuts the executive branch does make.” Brooks finds this a powerful insight regarding (say) single payer. The very same point applies to his own preferred solution: the extremely complicated and politicized mechanisms required for premium support. The firms which operate Medicare Advantage serve the healthiest segment of retirees with little apparent savings to show for it. Indeed these firms have been able to lobby Congress for wasteful additional subsidies beyond those required in traditional Medicare.

Brooks is right to worry our health system’s administrative complexities and its political vulnerabilities to special-interest lobbying. He’s wrong to believe that a centralized approach to health policy created either problem. He’s also wrong to believe that health reform has made these problems worse. He might ponder, for example, why so many privileged interests from the insurance industry on down dislike or oppose the new law, and are so keen to destroy measures such as the Independent Payment Advisory Board.

As Paul Starr notes in his essential Remedy and Reaction, our overly fragmented, overly incremental approach to politics is the real culprit here. It makes our resulting health policies too complex, too costly, too vulnerable to special interest pleading.

Hamilton and his friends created an amazing political system which served us well for 200 years. That system does not always serve us well today.

Well said. I like to think of the scene in Animal House (when they walk out and say they’re not going to listen to anyone badmouth the US of A) whenever I hear someone argue that we cannot match the quality and efficiency of our European cousins, particularly those in Germany and France. Consider that they are having serious debates about how they are spending too much – while covering everyone and getting better results with no waiting times, mind you – when they are spending a third to half less of their GDP on health care than we are!

Finally, listening to the SCOTUS today, the catastrophic illness and ER visits kept coming up as the talking points about the need for insurance. As anyone in health care knows, the other key to having access is to PREVENT catastrophes and ER visits and maintain health and reduce costs for everyone!

Hurray for Health Reform – NYTimes.com

Hurray for Health Reform – NYTimes.com:  Paul Krugman

We all know how the act’s proposal that Medicare evaluate medical procedures for effectiveness became, in the fevered imagination of the right, an evil plan to create death panels. And rest assured, this lie will be back in force once the general election campaign is in full swing.

For now, however, most of the disinformation involves claims about costs. Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly. Nor are we talking about random pundits making these false claims. We are, instead, talking about people like the chairman of the House Republican Policy Committee, who issued a completely fraudulent press release after the latest budget office report.

Because the truth does not, sad to say, always prevail, there is a real chance that these lies will succeed in killing health reform before it really gets started. And that would be an immense tragedy for America, because this health reform is coming just in time.

As I said, the reform is mainly aimed at Americans who fall through the cracks in our current system — an important goal in its own right. But what makes reform truly urgent is the fact that the cracks are rapidly getting wider, because fewer and fewer jobs come with health benefits; employment-based coverage actually declined even during the “Bush boom” of 2003 to 2007, and has plunged since.

What this means is that the Affordable Care Act is the only thing protecting us from an imminent surge in the number of Americans who can’t afford essential care. So this reform had better survive — because if it doesn’t, many Americans who need health care won’t.

– Sent using Google Toolbar

“Transparency Reports” on Industry Payments to Physicians and Teaching Hospitals – — JAMA

“Transparency Reports” on Industry Payments to Physicians and Teaching Hospitals – — JAMA:

Thanks, again, Affordable Care Act

Public awareness of industry payments to physicians and teaching hospitals in the United States is about to markedly increase. As required by the “Sunshine” provisions of the Patient Protection and Affordable Care Act, by September 2013 the Centers for Medicare & Medicaid Services (CMS) is to publish “transparency reports” that disclose these industry payments on a public website; the information must be “searchable,” “clear and understandable,” and “able to be easily aggregated and downloaded.”1​ Unlike most disclosures of physician-industry relationships to date, the reports will include the amounts of payments or other “transfers of value.” Payments large and small should be revealed, including the drug or device that the payment was related to.

– Sent using Google Toolbar

New rules for health plans require clear summaries of benefits – Los Angeles Times

New rules for health plans require clear summaries of benefits – Los Angeles Times:

Moving to implement a much-anticipated consumer protection in the new healthcare law, the Obama administration issued regulations Thursday requiring health plans to describe what they cover in clear, standardized language that is understandable to consumers.

Starting this fall, insurers and employers that offer health coverage will have to provide a six-page form that summarizes basic plan information, such as deductibles and co-pays, as well as costs for using in-network and out-of-network medical services.

The forms will also include estimated out-of-pocket costs for two basic examples of care: delivering a baby and managing Type 2 diabetes.
The changes are designed to allow consumers to assess how much their care would cost under different insurance policies, and to simplify the process of evaluating health plans, a task that now can involve reviewing hundreds of pages published by insurers.
“One of the primary purposes of this is to ensure this apples-to-apples comparison across plans,” said Steve Larsen, the senior Department of Health and Human Services official overseeing insurance regulation.
The simplified forms, known as the summary of benefits and coverage, were mandated by the healthcare law signed by President Obama in March 2010.
Many consumer groups and patient advocates feared that the administration would back away from the requirement after insurers and employer groups complained that developing the forms would be costly and burdensome.

Found this via a post from Wendell Potter at Huffington Post. He notes that some advocates are calling for an illustrative case of cancer in the examples as well. I agree, as this can be among the most devastating events to a family, in every way including financially.

– Sent using Google Toolbar

Opinion | The role of faith in health-care delivery | Seattle Times Newspaper

Opinion | The role of faith in health-care delivery | Seattle Times Newspaper:

As the Catholic Church has been widening its influence and reach in American health care, it also has been flexing its muscles in health-care policy. Recently, it asserted that it should not have to provide contraception coverage to employees at church-run hospitals or universities around the country even when those employees are not Catholic, and when a large share of their salaries are paid for by tax dollars that flow through broad-based medical programs such as Medicare and Medicaid.

Moving beyond health care, the Catholic Church is also asserting its influence in ways that seek to expand religious-freedom protections to include the freedom to take broad-based taxpayer money and then spend that money in a manner that discriminates against Americans who don’t accept Catholic theology.

In Illinois, for example, the church recently asserted that its First Amendment right to freedom of religion is being compromised when its own discriminatory policies against gays make it ineligible for government contracts to find adoptive homes for children in need among well-qualified families, gay or straight.

In making these claims, the Catholic Church is seeking to transform a right that is vitally important — the freedom of people to decide for themselves which religion to follow without government interference or sponsorship — into a right for government support and funding for theology-based program implementation.

It’s one thing to say that because you’re using private funds, you don’t have to provide services that violate religious conscience. It’s another to accept public money in a market situation where “customers” don’t have free choice, and make that same assertion.

– Sent using Google Toolbar

President Obama Announces Accomodation on Birth Control – NYTimes.com

President Obama Announces Accomodation on Birth Control – NYTimes.com:

Just had to get this great Antonin Scalia quote up here…

It’s a law of politics that when you’re losing the debate, you change it. So with the economy improving and President Obama rising in polls against his likely general election opponent, Mitt Romney, it’s not surprising that the Republicans went looking for an inflammatory social issue. They came up with contraception, which apparently is really controversial even though 99 percent of women rely on it at some point in their lives.

I’m referring, of course, to the ridiculous brouhaha over the new health care rule mandating that businesses provide insurance coverage for birth control. The original version exempted religious institutions, like Catholic churches, but not religiously affiliated ones, like Catholic universities, that cater to the general public.

That concession wasn’t good enough for the U.S. Conference of Catholic Bishops. Along with such opportunists as House Speaker John Boehner and Rick Santorum, they claimed the president was disregarding the First Amendment and assaulting religious freedom. The idea was to paint Mr. Obama as irreligious, and to chip away at the health care reform law in the process. I guess they were unaware of the 1990 Supreme Court decision Employment Division v. Smith, which established that religious liberty doesn’t trump an otherwise neutral law. As Justice Antonin Scalia, that notorious atheist, wrote: “To permit this would be to make the professed doctrines of religious belief superior to the law of the land, and in effect to permit every citizen to become a law unto himself.”

– Sent using Google Toolbar

American Psychiatric Association – Health Reform

Health Reform:

No law as wide-ranging and complex as PPACA can satisfy all of the myriad concerns of psychiatrists, other physicians, health professionals, and patients. While PPACA is not perfect, APA’s Board of Trustees concluded that it warranted APA’s support. Among other provisions of importance to the practice of psychiatry, the law:

  • Extends coverage to 32 million more Americans;
  • Bars insurance companies from denying coverage based on pre-existing conditions;
  • Bars insurance companies from dropping coverage due to illness;
  • Requires insurance companies to permit enrollees to renew coverage;
  • Permits dependent children up to age 26 to be covered by their parents’ health insurance;
  • Includes mental health and substance use disorder treatment as part of the basic package of benefits in health insurance sold in state-based insurance “exchanges” created by the law;
  • Ultimately requires full parity for mental health and substance use disorder treatment in such insurance;
  • Establishes new Centers of Excellence for Depression and Bipolar Disorder;
  • Provides new research funding for postpartum depression and postpartum psychosis;
  • Ensures that patients with diagnoses of mental illness will be included in “health homes”;
  • Boosts funding for community mental health treatment options; and
  • Facilitates co-location of primary and mental health treatment centers

– Sent using Google Toolbar