Good piece Jon. As Jamie Galbraith wrote the other day, “If we’d had a CBO in the 1930s, Franklin Roosevelt could never have gotten the New Deal off the ground”.

The question I have about the HCR law is; how aware are the Democrats in the WH and the Hill that, aside from the political backlash, this law is just bad policy?

Of course, the politics are even worse. They’re leaving an enormous opening on their left for Republicans to outflank them, who can now defend the shift to their conservative base the shift with, “would you rather live with Medicare for All or Obamacare for All”. :o)

You’d think people would be protesting their representatives over all this.

The only obstacle is Washington politicians completely beholden to the powerful health care lobbies that make huge donations to their campaigns.

Seems to be all that is necessary to permanently seal a really bad deal.

What a freaking surprise! Subsidizing insurance companies is more expensive than medicare for all. Whoda thunk it?

If he shows up at a local D meet & greet on Saturday, I plan to give Hinchey a piece of my mind. He used to be one of the real folks in congress, but has been completely in the veal pen since O took office. I have sooo many factors to raise with him, and though I boiled each one down to its one- or two-sentence pith, I still have to figure out how to prioritize them as I suspect he’ll be besieged, or just walk away once I start.

Wait. I could have sworn that Obama’s public explanation for pushing this so hard was that it would help solve the looming budget spending crisis. Ah well, at least we will have that bent spending curve as businesses decide to cut insurance costs anyway they that they can.

Maybe they hope to make up the additional losses via taxes on the increased profits of the PhRMA and the rest of the health care industry. Except of course that most large corporations rarely pay much in the way of taxes.

Slightly on topic from Reuters:

April’s tax deficit of $83 billion up from $20.9 billion YoY. (Third time in 30 years)
Income was $245.3 billion, 8% below last April.
Spending was $328.0 billion, up 14% year-over-year.

tax receipts down 7.9%

Individual Income Tax down 21.5%
Total spending up 14.2%
National defense up 17%
Medicare up 39.4%
Social Security up 4.2%
General Government up 5.6%
(Not included in this list the exchange in April of about $85 billion from FICA and SS for IOUs from the Fed so that the actual total for April as a bit closer to $175 billion.)

If Medicare is rising this fast normal insurance, including the soon to be mandated kind, has far fewer constraints.

Nobody could have anticipated . . . .

Except for the people here, who did.

Anybody surprised?

So now the price tag is well over a trillion dollars, somehow I bet that is conservative and the real price tag will be doubled or tripled by the end of the decade. Luckily we are going to see a change in much of the congress in November, mostly Democrat, but also some Republican that will allow us to repeal this piece of garbage legislation.

“Bending the curve! Don’t let the perfect be the enemy of the good! Bending the curve! F*cking Ret*rds!”

Had enough?

The CBO projects mandated spending of bills, not discretionary. The upward estimate of the CBO now is because they were asked by Republicans to add in discretionary spending, which, being discretionary, is up to the appropriations committees to actually spend.

To put it more simply, the CBO was doing its job leaving out discretionary spending, because it’s not part of the mandated cost of the bill.

Jon- you forgot the “we won” $474 billion in direct government subsidies AHIP and the “up to 10 million new Medigap and Medicare Part D customers” AARP as the authors and promoters of the bill.

The for-profit hospitals really did not have much to do with it— the non-profits are, in most cases, far worse actors in the HC world— since they use their tax status to hide, well, nearly everything (case in point Banner Hospitals in AZ).

The bill as sold to us by the President and Dem leaders was a FRAUD that should be prosecutable.

FDL and, gulp, the Republicans were right on the health care bill that actually passed… it IS FAR WORSE THAN THE STATUS QUO.

and Democrats will be paying the price politically (while we pay the price literally) for a long time.

1. evisceration of pro-choice rights
2. big tax increases on middle class
3. IRS as collection agency for insurance companies (quoting Jane)
4. making Medicaid lower than second class health care
5. endless health care lobbying dollars at the expense of money going to health care (note the $600 million plus spent in 2009 alone)
6. the bill remains overwhelmingly opposed by the public — while they may not understand details, neither does Congress (reminder to Rep Waxman who had to cancel his hearing for big companies when it was realized the huge taxes on big business were, in fact, real and not some conspiracy).

Ending recissions — simple, could have been one page law requiring active fraud to cancel policy in effect
lifetime limits ending — could have been one page law requiring this for any company offering government program (through Medicare Advantage, Part D, Medicaid)
children to 26 — simply dumb… how about a pro-jobs agenda that allows adults to actually, you know, be able to afford things
expanding medicaid — stupid… second class health care, at best… Congress could not even bother to provide the same protections for women’s preventitive screenings to Medicaid patients (note CA has already stopped mammograms for women 40-49 in Medicaid — cheaper to have poor AA women die from late diagnosed breast ca, apparently)

Jason — how’s the weather in the veal pen?

Here’s what life is in the real world:

my rent is the fixed “mandatory spending”… air conditioning, in 110 Phoenix summer weather, is discretionary– so by your magical thinking, I should be able to budget for my family by not accounting for the costs of keeping the house under 98 degrees… and, if I choose not to appropriate the money to pay the electric bill, it does not matter. And if I do choose to do so, I can’t be blamed for not realizing that there are actual costs associated with living in a home.

Rube Goldberg would not be amused… at least his creations worked…

I think you’re missing the point. The CBO did what it was asked to do. This idea that the CBO is intentionally misleading people isn’t true, nor is it true that this new projection is a revision of old projections, indicating their projections were wrong. This is an estimate on spending that the CBO was never asked to evaluate before.

OT-Senate blocks attempt to raise liability limits for oil cos.

That point I agree with— but the WH and Dems pushed through the bill WITHOUT waiting for the very reasonable request to estimate discretionary, but needed, implementation costs.

I do not blame CBO — though their reports are very nuanced for the HC bills– I would not want to have been a CBO employee during the debate– the pressure from the WH must have been enormous to ensure that the words that went along with the numbers remained as bland as possible…rather than a more honest disclaimer of “this is the absolute BEST CASE SCENARIO which has exactly ZERO chance of happening…

I blame the rank dishonesty of the WH and Dem leadership on costs, PO, choice… well, gee, everything.

This year’s health care reform was written, supported, and sold to Americans by PhRMA and the for-profit hospitals.

All hospitals are for-profit… how do you think they stay in business?

Fair points, but who’s to say which is the “best” methodology?? You could argue the Democrats are misleading by not including discretionary spending or you could argue Republicans are misleading by now including it.

For me, given the track record of the debate the Democrats hand in that, I’m of the opinion it’s the Democrats who are trying to mislead since they’ve done just that with their other decisions (not implementing it for several years, etc.).

They really were obsessed with a good CBO score merely because of the big O’s stupid “I won’t sign any bill that raises the deficit a dime” statement. It boxed them in, and they used every misleading trick in the book to make it appear their bailout and guaranteed future profitability of the insurance industry didn’t raise the deficit.

Franklin Roosevelt could never have gotten the New Deal off the ground”.

Don’t forget what Biden called this, A Big F*cking Deal.

Technically there are some not for profit, but I see what you’re saying.

Technically yes, in reality little difference. Regardless, the Catholic Hospitals and the American Hospital Association were in lock-step on reform with everyone else.

Oh, forgot to mention, another great article Jon.

Dead on.

That’s one of the sad ironies of “The Pharmaceutical and Insurance Profit Protection Act”. It doesn’t address the problem of ballooning and exorbitant health care costs. Obama himself identified this as one of the critical issues in lowering our deficits.

That point I agree with— but the WH and Dems pushed through the bill WITHOUT waiting for the very reasonable request to estimate discretionary, but needed, implementation costs.

The CBO almost never projects discretionary spending because it’s just that – discretionary. You can’t say it’ll go on the balance sheet until the appropriations committee decides to put it there. This money is not spent.

So not, not a terribly reasonable request, more like a political ploy by Republicans to inflate the price tag by adding on things that aren’t actually part of the spending in the bill.

Discretionary spending is pretty much never included in these projections because appropriations has to decide to spend it. It’ll take another act of Congress – usually a budget or an omnibus spending bill – to actually spend this money. At that time, the CBO projects that cost.

Keep up the ass kissing Jason I’m sure your boss will be pleased.

Nicely nonsensical.

I know, that’s why I think you raise good and fair points.

My only point was that who’s to say that’s the “best” way??

If I were running the railroad, I would want both.

But both parties end up manipulating whichever one is the “best” for their purposes at the time. Right now, the Republicans are including it to make the D’s look like liars. (Which is pretty easy, so I don’t know why they needed to go to these lengths). And if you’re a Republican, I’m sure you’re arguing that the Democrats were misleading by not including it (even though yes the CBO almost NEVER does).

Just another of our faux arguing points to keep us from the real problem, which is that neither Democrats nor Republicans are very much interested in actaully solving the problem. Which is a shame, because there are plenty of known solutions that could fix the problem once and for all.

People don’t really have time to protest. We work 5+ days a week and barely get by. The people who need this reform aren’t at all really affected by Obama’s HC Bill. I have preexisting conditions of depression and seizures but that won’t do me much good because I am not diagnosed and nothing in the bill will help me see a doctor. It’s a completely useless and yet expensive legislation that ultimately isn’t going to help those that need it. I’m still sitting right here where I always have been, Lucky To Be Alive.

By all standards, I should be dead right now. And no one that matters truly seems to care. =/

I’m sorry, I’m being unfair. Anthony Weiner is my hero. It’s not fair to say that no one cares. At least 1 person that matters truly cares.

I love the White House spin on this how that spending wouldn’t be an expenditure:
“Authorizations for discretionary spending are not expenditures.”
I wonder if people called up their credit card companies and tried to say that their discretionary spending doesn’t count. I think it will be clear who is doing the misleading based on whether or not Obama wants the spending authorized – if he wants it, why did he try and hide the true costs other than to try and deceive people. I have a hard time believing Obama doesn’t want the billions needed to pay for the federal administrative costs, but perhaps all along he wanted HIR passed without his federal agencies able to carry it out.

Sure, it’s an interesting question. I guess “best” is very subjective, which is why the CBO restricts its projections just to what’s going to be spent as a direct consequence of the particular vote in question. If more spending would require another vote, than the CBO will estimate the cost of that vote when it comes up.

Of course the CBO wasn’t misleading anybody, they were pretty clear in what they were and weren’t estimating; as well as how unreliable their estimates were, because they were using incomplete data and assumptions that questionably reflected reality.

The CBO didn’t have to do any misleading. That was left up to you. Remember?

They’ll ‘Find‘ another $100-billion every month (or so) this year until the truth finally comes out about the cost, and then next year shows up with more costs.

Kids, the moral of today’s story is… If you need to make $115 Billion look insignificant, put it out there next to videos of an out of control oil volcano a mile under the ocean’s surface. Tennessee was washed away last week and people still haven’t noticed.

The bill as sold to us by the President and Dem leaders was a FRAUD that should be prosecutable.

I don’t think you could call it fraud.
Anyone paying attention, not in the veal pen, knew exactly what was being sold.

115 billion more than originally projected but the cost of a political victory for Rahm, priceless.

Haha LOL!!

Yeah, I saw Media Matters carrying the water on this issue earlier, and I just kept coming back to one thing:

If these costs to implement the bill exist, there are two possible outcomes.

1) We have to pay them, and thus making them discretionary was slight of hand to hide the true cost from the American people, or

2) We won’t pay them, and the bill crashes and burns in the implementation phase.

So, which is it?

What happens if we don’t pay for these implementation costs?

No argument that a butt-load of political deal making, butt kissing, and compromises were made to get this thing passed. At the end of the day, ANY bill that prohibited denials for pre-existing conditions, dropping coverage post diagnosis, and mandating coverage is a step in the right direction. As long as I (I’m a doc) am required to treat, the patient should be required to pay just like drivers must have car insurance and we must pay payroll and ss tax.

But PLEASE, can we stop referring to the the health insurance lobby as the “health care lobby.” They are not providers of health care. Doctors, nurses, hospitals, ancillary providers do the actual provision. If you want to save money, keep the middleman out and/or limit how much they can squeeze out the system.

Yeah, if Obama wanted to pay for the implementation phase he should have said what it would cost instead of doing Enron style accounting for his HIR bill. We don’t need Ken Lays in the White House who hide billions of dollars in expenses in order to deceive people. Obama could probably get a job as a Wall Street CEO – he’s shown he knows how to do his own version of Repo 105.

Fixed

“What we do know is that the new law lacks true cost control for consumers”

It includes provisions for employer cost control.

I disagree with the ‘step in the right direction’ part, both because I spent four years uninsurable and sick, at the mercy of private health insurers, and because of my bitter hatred of fascism (there’s no better term for using the IRS to collect private bills), but I would point something out:

If a person’s primary concern is assuring payment for medical services, then you’re not even coming *close* to addressing that in this bill. I’ve seen private insurers duck bills for years, and I’m sure you have too; I have a six year old medical test bill that I’m still fighting them on. So pushing a ton of people onto private insurance rolls doesn’t get you, the doctor, paid. It gets them, the insurers, Wellpoint et al, paid.

“At the end of the day, ANY bill that prohibited denials for pre-existing conditions, dropping coverage post diagnosis, and mandating coverage is a step in the right direction”

No it isn’t. Being willing to trade anything and everything to get that can end up being a really bad deal.

“As long as I (I’m a doc) am required to treat, the patient should be required to pay just like drivers must have car insurance”

So we shouldn’t have a mandate since you aren’t required to treat everyone who walks into your door. The HIR bill didn’t put mandates on doctors that they must treat anyone who wants to be treated by them.

Well, David, when are you going to address the elephant in the room that American physicians make far more money than their European counter-parts. Even the frazzled primary care docs and internal medicine docs, never mind the specialists? Corporate corruption, per se, has little to do with it; it is that medicine has become a commodity, a business, rather than a profession.

Now, I do have a partial solution. Every physician knows how to do basic health care; they know how to do an H&P, treat tonsilitis, diagnose a hernia, and so on. Doesn’t matter if you are a cardiologist, plastic surgeon, or pulmonologist. All of that was learned by the time one graduates from medical school.

Most physicians in America graduated from a public supported medical school; in other words, the tax payer paid for half the cost of their medical degree; most physicians who did a residency for their specialty were paid a stipend funded by the taxpayer. So why would it be unfair to require every physician, no matter the specialty, to provide basic medical care for, say fifty Medicare/Medicaid patients? Why would that be unfair?

Why would it be unfair for every dentist, almost all of whom went to dental school with the taxpayer subsidizing their dental education, to have to have a certain portion of their patients be Medicare/Medicaid patients? Same for psychologists and clinical social workers.

Providing basic medical care for fifty Medicare/Medicaid patients would require about two half days a month for any physician. Of course they would refer to specialists where needs be.

Where do those scary 10-year numbers come from, then? The OMB?

Just because it is not appropriated does not mean it is not authorized by law. PELL grants have a set amount that have never been appropriated fully.

What precedent did the CBO use to claim that a 90% MLR was a de facto nationalization of insurance companies? I have never heard that argument before, even for local power utilities which can be heavily regulated.