Weren't We Told Health Care Reform Would Contain Costs?

[we vs us]

Even adding 16mm to the Medicare rolls would be considered massive, why dispute the point just because you have an issue with the Heritage Foundation?  It's a valid description of what is going on.  

Another issue I've got with this is the assumption that just because 31mm more people will have paid access to health care that they will use it, or that it won't become abused and over-used and costs won't be greater.  It's like economic theory, it takes into account everything but human behavior which is less than predictable or reliable.  There are simply some people, regardless of cost or their ability to pay, who will avoid seeing a doctor until they are in serious deep smile with their health.

See if you can fix your link, it's not working, I'd love to see what it says.

Ok, but look.  You're projecting behavior that is literally unmeasurable until it happens.  Who really knows if the newly-insured will use the system too much, too little, or just right?  We can make somewhat educated guesses, but until it actualizes, they're just that: guesses. 

This is what galls me about the whole thread.  I can accept a negative review of HCR -- like nathan, it's been obvious to me from pretty early on that the Administration let politics trump the amount of reform we needed -- but so much of this is just pissing into the wind until 2019 or whenever.  Even though the reform was watered down (again, IMO), it's still has a jillion moving parts that won't fully come to bear for another decade. In an environment like that, a negative projection is a valid data point, but has to be taken as just that, another data point.  And a mostly premature one at that. 

But what a single negative projection isn't is proof that 1) we don't need reform, 2) that the whole reform process was useless and 3) that the bill we got wasn't a net positive. 

If you want to use this single news item as an entre into guido-style complaining about how misled you feel . . . well, that's your prerogative, but it doesn't prove very much about the actual product. 

[Conan71]

Where there's smoke there's fire, this is the tip of the iceberg, and any other useless cliche`s you can dredge up.  This bill is nothing but a legacy bill so they can say "we fixed health care".  Probably 70% of Americans actually believe that the HC system was miraculously cured with passage (by reconcilliation mind you) of the bill.  The pitch man will have been out of office between 3 to 7 years when we finally figure out what it contained and what the reality is and will be able to safely hide behind: "They modified my plan and that's why it sucks now."

This is bad business, pure and simple as it defies a whole lot of economic logic and necessarily requires a wealth shift.  It also creates a shroud of mystery in terms of benefit requirements for employers and their record keeping and tax liabilities as a result.  Creating doubt or questions in the minds of business people especially in a down economy is bad ju-ju.

"Nobody knows" is one reason companies are reluctant to hire right now.  I heard a great comment somewhere on MSNBC last night: Keynesian economics may have worked during the Great Depression but isn't now because money is out there, people need confidence in the economy and the business climate. 

You can say how health care and different tax policies shouldn't be continuing to keep unemployment so high.  All it takes is the paradigm of those who run businesses to become that current actions of the government are not pro-business, right/wrong, or ill percieved.  Those are the people who hire and even if the reality is the exact opposite of what they believe, it's their belief not reality which is governing their thinking.  If they aren't hiring and saying current government actions are why they are not, we need to listen to them.

Here's a Time article on more people listening to the debunking of Keynes by Friedman.

A monetary theorist, the bald and somewhat cherubic University of Chicago professor maintains that the U.S. and many other major nations mismanage their economies. They do so, he argues, by manipulating taxes, federal spending and money supply—techniques that were formulated by Britain's John Maynard Keynes. "Keynesian economics doesn't work," says Friedman. "But nothing is harder for men than to face facts that threaten to undermine strongly held beliefs."

Those beliefs have grown stronger in the past eight years, while the U.S. economy has expanded under the vigorous application of neo-Keynesian principles. Today, when the economy is strained by inflation, Friedman's challenge commands serious attention and growing support, and is a topic of heated debate among economists, bankers and Government officials.

Read more: http://www.time.com/time/magazine/article/0,9171,839744,00.html#ixzz0zWAgnFTE

[guido911]

Just a bit Off Topic, but Obama wants a part of Obamacare (yes I said Obamacare just to tease Nate) repealed:

Facing a backlash from small businesses over a new tax-reporting requirement in the healthcare law the president signed in March, the Obama administration is embracing the first change to the landmark legislation.

In a letter to Senate leaders, Health and Human Services Secretary Kathleen Sebelius and Treasury Secretary Timothy F. Geithner urged the Senate to back a proposal to scale back the new reporting mandate.

http://www.latimes.com/health/la-na-health-reform-change-20100914,0,5055513.story

Pelosi was right I guess. We did need to pass the bill so we could see what's in it.

[nathanm]

Ok, but look.  You're projecting behavior that is literally unmeasurable until it happens.  Who really knows if the newly-insured will use the system too much, too little, or just right?  We can make somewhat educated guesses, but until it actualizes, they're just that: guesses.  

Well, there is useful data with which to predict this. The uninsured poor who will be newly covered by Medicaid are on average healthier than those who are presently on Medicaid. Among those who will be covered, most consider themselves very health to in perfect health.

My point about the phrase the Heritage Foundation chose to use is not that there isn't an expansion of Medicare going on, but that we have known since before the bill was passed that said expansion was one of the main purposes of the bill. It wasn't hidden, it was trumpeted as getting health care to more poor people.

Also Conan, as I'm sure you're aware, the legislation does not require that existing plans change one iota. If employers or insurance companies choose to change them, they don't change.

[Conan71]

Well, there is useful data with which to predict this. The uninsured poor who will be newly covered by Medicaid are on average healthier than those who are presently on Medicaid. Among those who will be covered, most consider themselves very health to in perfect health.

My point about the phrase the Heritage Foundation chose to use is not that there isn't an expansion of Medicare going on, but that we have known since before the bill was passed that said expansion was one of the main purposes of the bill. It wasn't hidden, it was trumpeted as getting health care to more poor people.

I'm not buying that.  Typically poorer demographics don't pay close attention to nutrition, have sedentary or otherwise unhealthy lifestyles like smoking or addiction problems or risky sexual behavior as well as high pregnancy rates and riskier pregnancies because they won't seek out better pre-natal care even when it is available and paid for.

You can't cure indifference to proper use of the health system.

[nathanm]

I'm not buying that.  Typically poorer demographics don't pay close attention to nutrition, have sedentary or otherwise unhealthy lifestyles like smoking or addiction problems or risky sexual behavior

I think you are confusing the people who are already eligible for Medicaid with those who are not presently but will be in 2014.

[Conan71]

I think you are confusing the people who are already eligible for Medicaid with those who are not presently but will be in 2014.

No, simply stating what is already well known amongst poorer demographics.

[nathanm]

Pelosi was right I guess. We did need to pass the bill so we could see what's in it.

Um, that particular provision was publicized prior to passage of the bill.

Honestly, I think they're being somewhat ridiculous about it. It would be trivial for any small business accounting package to generate the necessary 1099s. There would be a burden initially as companies obtained tax ID numbers from everyone they pay and enter the information in, but going forward, it's not really an issue, nor would it be for any new payees. And at this point, if you're not using QuickBooks or something similar and you have an accountant, you're probably paying more for the accountant's time every year than you would on a QB license.

[nathanm]

No, simply stating what is already well known amongst poorer demographics.

You say that, but you have no evidence for it, whereas I do have evidence for my contention. Among the people who will be added to Medicaid, they are on average healthier than those already on Medicaid.

[Conan71]

You say that, but you have no evidence for it, whereas I do have evidence for my contention. Among the people who will be added to Medicaid, they are on average healthier than those already on Medicaid.

Post it then, I'd love to read it.

[nathanm]

Post it then, I'd love to read it.

I guess you didn't see my link earlier?

[Conan71]

I guess you didn't see my link earlier?

Finally found it.  Would you mind posting open links, my eyes have a hard time discerning an embedded hyperlink.

[nathanm]

That's not necessary any more...

[Conan71]

This relies on the idea that most people are great at self-diagnosis.

"Although close to 60% of these adults report being in excellent or very good physical health and a similar share report being in excellent or very good mental health, some of these adults may have health problems that have gone undiagnosed without medical care (Figure 5). Many of the approximately 42% who report being in good, fair or poor physical health may seek medical care for ongoing health problems once they become eligible for Medicaid."

I can see where you are drawing your conclusion from, however, the report doesn't take into consideration that out of those polled and said they are in good or very good health 50% might be smokers or use smokeless tobacco or drink to excess every day or engage in riskly sexual behavior.  Also keep in mind that with insurance, now these individuals might be more likely to seek medical attention for common colds and flu instead of allowing nature to take it's course like they have in the past.  Now physicians can get them in the system and start diagnosing conditions they never realized they had like depression, ADHD, incontinence, ED, high cholesterol, etc. and get them on the med train.

Sorry, I'm very cynical when it comes to the modern day pill pushers.

I admit to being cramped for time this afternoon and have not given the report my full attention.  It's conclusions are drawn from self-reporting of patients or potential patients which I personally don't see as being very reliable.

[nathanm]

I admit to being cramped for time this afternoon and have not given the report my full attention.  It's conclusions are drawn from self-reporting of patients or potential patients which I personally don't see as being very reliable.

Use of the medical system is by definition self reported (at least the vast majority of the time). People don't generally go to the doctor unless they have a problem. Next time you see your doctor, ask him what proportion of his patients come in for preventative care.