Category Archives: Health Care

On Suicide

My son, Chris, committed suicide on April 24th, 2017, a few minutes after midnight with a .44 Magnum bullet to the head. No one has ever loved a child more than his mom and I loved Chris. I was lucky enough to retire when my kids were very young. I spent the best years of my life in an amazing mountain house being Mr. Mom to my angels in the Colorado mountains. Both of my kids had the most loving, supportive, parents a child could have. We were devoted to those babies, all in, with unconditional love. We still are.

When Chris put a bullet in his head, he didn’t know what hit him. Chris did not kill himself. He killed us. Only the living can die. The dead cannot die. Not only did he kill us, but he killed the world. He was such a tender soul and at the age of twenty he made a terrible, impulsive mistake not to grow up in this world. He had been plagued with anxiety since birth. He had all the loving support and professional support a troubled soul could have from kindergarten to the very last days of his life.

The reason I am writing this post is because I want those obsessed with suicidal ideation and everyone else to know that suicide is not heroic. Death is nothing to the person that is dead. Death is only death to the living. His mom and I and everyone who loved Chris live his death every day of our lives. We live in the shadow of his death. We die a little every day with him. Chris did not even know he was dead. What does this mean?

I want all to understand that hatred, envy, bitterness, resentment is surface for the living. Underneath all that is a belonging that far exceeds this erroneous, in philosophy we call metaphysical, notion that we are all absolute individuals. The opposite is true. No one that has ever lived, used language, thought – thinking IS history, culture, identity if you will, is merely ‘me’, alone. That notion only covers over our unique vulnerability, inability to be an isolated ‘me’. We run from our essential connection to each other when we imagine ourselves to be alone. We cover our inferiority with the garbs of shame when we ride momentary impulses of heroic, unmoored pride or hatred, enmity, anger, and resentment. All those things leave us emptier and emptier, as life moves on. If we give ourselves over to that, we become empty shells, husks of what could have been.

This is not just philosophical. This is emotional. This is life. Life is fundamental connection to the other for better or for worse. Our only choice is to be centered, grounded in love. And love is not simply a goosy feeling. Love is pain and how we live pain every day. Love is not letting momentary distractions take us off course. For you, young people, there will come a day when love will find you more and more immersed in pain. The pain of losing those you love will more and more, as you get older, dominate your inner ‘soulscape’. You can choose not to love or distract yourself from the pain of love but only at the cost of living an empty, futile life. There is no ‘heroic’ in love. There is only a peace beyond understanding, a satisfaction which endures, in the midst and mist of pain. To acknowledge our vulnerability to each other is to live. To run from it is to die. This is the only real choice we have. Choose wisely!

In the words of Alfred Tennyson,

I envy not in any moods

The captive void of noble rage,

The linnet born within the cage,

That never knew the summer woods:

 

I envy not the beast that takes

His licence in the field of time,

Unfetter’d by the sense of crime,

To whom a conscience never wakes;

 

Nor, what may count itself as blest,

The heart that never plighted troth

But stagnates in the weeds of sloth;

Nor any want-begotten rest.

 

I hold it true, whate’er befall;

I feel it, when I sorrow most:

‘Tis better to have loved and lost

Than never to have loved at all.

 

From: In memoriam by Alfred lord Tennyson

 

Who Said ‘Better to Have Loved and Lost than Never to Have Loved at All’?

Health Care in Louisiana and Massachusetts-Bobby Jindal and Bill Cassidy (updated note below)

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On Monday, July 2, Bill Cassidy(R), a congressional representative from Baton Rouge (LA), attacked President Obama’s Health Care Reform Act on MSNBC’s “MSNBC Live”. Thomas Roberts, the interviewer, tried to compare the Romney based health care system in Massachusetts with Louisiana’s health care system. Bill Cassidy referred to the Kaiser Family Foundation’s web site where statistics on health care are stored. Cassidy told Thomas that Massachusetts had the highest monthly premium rate in the country for health care. This is certainly true as this link from the Kaiser Family Foundation shows:

Link

However Bill has only told part of the story. Louisiana has one of the worst health care systems in the country. “Louisiana Medical News” reports:

A coalition of healthcare providers is hoping to convince the Jindal administration to use federal stimulus funds to dollars to prevent crushing Medicaid healthcare cuts.

…

The situation, as laid out in DHH’s report “A Road Map for a Healthier Louisiana” is this:

The state spent $7.4 billion on healthcare in 2009 but squandered the opportunity to improve people’s health, the report says. The fragmented delivery system – almost exclusively fee-for-service – resulted in uneven quality of care, inequitable access to care and unpredictable costs.

The system was designed to provide episodic and acute care not to promote and maintain health, the report says. Louisiana has to move to a system of care that will improve health outcomes and move the state from its perpetual ranking at or near the bottom of the nation’s health rankings while dealing with multi-billion dollar budget shortfalls and government downsizing.

“The Institute of Medicine (of the National Academy of Sciences), says it best,” according to the report. “The current system cannot do the job. Trying harder will not work. Changing systems of care will.”

Considerable evidence shows that managed, coordinated care can improve health outcomes and lead to savings; in some cases, the savings can be 20 percent, the report shows.

In a prepared statement, Greenstein said Louisiana has been on the predictable path to poor health outcomes and high healthcare costs for too long.

“It’s a path that we follow, guided by systems that are inefficient at best, and broken, at worst,” Greenstein said. “Without change, it will only worsen.”

Governor Jindal’s FY2012 budget states:

The FY 12 budget also preserves provider rates by incorporating $49.5 million State General Fund to cover the carryover increases in utilization costs from FY 2011 that are now part of the base needs of the Medicaid budget.

The Associated Press reports:

As the state’s Medicaid rolls continue to climb, Louisiana’s health agency will have $280 million less in this new budget year to cover the cost of care for patients.

That fact spells trouble, according to Louisiana’s health chief, physician and hospital groups.

The Medicaid budget for fiscal 2011, which began last week, stands at $6.5 billion, down from $6.78 billion for the fiscal year that ended June 30.

The budget requires reduced payments to physicians, hospitals and other health care providers for the 1.28 million residents enrolled in Medicaid, the state and federal government’s partnership that provides health care for the poor and uninsured.

The Associated Press also reports:

Louisiana’s health department is working on how to cut $859 million from the state’s Medicaid program for the poor and uninsured, stripping 11 percent of the funding for health services.

…

On the chopping block are charity hospitals, hospice care and Medicaid providers.

The Kaiser Family Foundation also shows these statistics on the uninsured in Louisiana:

Link

Link

The table shows that for adults 18 to 64 years old 26% of the people in Louisiana have no insurance while 6.2% do not have insurance in Massachusetts. The other table shows that for all ages 17% of the people in Louisiana are uninsured as opposed to 5% in Massachusetts.

The monthly poverty level (FPG) for a family of 3 in Louisiana is $2,933. Here is Louisiana’s Medicaid qualification requirement as a percent of the poverty level:

Non-working — 13%

Working — 20%

Medically Needy

Individual — 13%

Couple — 20%

13% of $2,933 is $381.29/month or $4,575.48/year for a family of three.

20% of $2,933 is $586.60/month or $7,039.20/year for a family of three.

Some special cases such as children or pregnant women have better qualification requirements.

In Massachusetts here are the low income guidelines for monthly premiums:

• If your income is 100% FPG or less, you do not have to pay monthly premiums.

• If your income is 150% FPG or less, you do not have to pay monthly premiums if you choose the lowest cost plan offered in your area. If you choose a higher cost plan, you will have to pay a monthly premium.

• If your income is more than 150% FPG but not more than 300% FPG, you must pay monthly premiums that depend on income, where you live, and the plan you choose.

• Everyone must pay copayments for prescription drugs.

When Bill Cassidy makes an argument based on average monthly premiums in Massachusetts he conveniently ignores the fact that Massachusetts’ premiums are income adjusted. In Louisiana they prefer to keeps large portions of their population uninsured. This is an unsustainable path for Louisiana. That cannot afford the lousy system they have.

The table below shows the increase in total spending by percent if Louisiana and Massachusetts were to cover Medicaid to 133% of the poverty line as the Health Care Reform Act requires in order to receive expanded Medicaid funding from the Federal Government:

 

Medicaid Expansion to 133% of Federal Poverty Level (FPL): Estimated Increase in Enrollment and Spending Relative to Baseline by 2019


Link

These charts clearly show that Louisiana is fighting very hard to have one of the worst health care systems in the country. The system in Louisiana is certainly on the brink of collapse as Bill Cassidy maintains. Bill Cassidy and Bobby Jindal would like to attack Romney-Care in Massachusetts which is a much better program than what Louisiana has to offer. Here is Bill Cassidy’s plan for health care in Louisiana:

•Providing greater flexibility for the use of Health Savings Accounts;

•Reforming the medical liability tort system to reduce frivolous lawsuits that drive up costs by forcing doctors to practice defensive medicine;

•Creating pooling mechanisms, like Individual Membership Associations and Association Health Plans, that provide patients greater flexibility and bargaining power;

•Providing tax credits to cover the cost of health care for low-income families;

•Allowing patients to shop for insurance across state lines;

•Providing patients who wish to opt out of federal programs (like Medicaid) vouchers to purchase private coverage;

•Allowing employers to offer discounts to incentivize participation in wellness programs; and

•Ensuring coverage for those with pre-existing conditions by strengthening high risk/reinsurance pools.

President Obama’s Health Care Reform Act already includes many of Cassidy’s ideas.(1) However, Cassidy’s plan does nothing for the uninsured and people that do not make enough money to worry about taxes. Cassidy’s Louisiana would continue to let substantial portions of people in Louisiana continue to use the emergency room for health care. This will only drive up premiums over the long term as it has in the rest of the country. Even though Louisiana has continued to cut provider reimbursement fees to attempt to make up their tremendous shortfalls, all they have really done is to demonstrate how Medicaid in Louisiana would be great if you could only find a health care professional in Louisiana that would be willing to do the work. When they make Louisiana’s problems, which they have created in Louisiana, an indictment of Massachusetts health care, they conveniently fail to acknowledge that you can find a health care professional in Massachusetts that is willing to do health care work. While criticizing Medicaid, Cassidy even seems to want Medicaid to prop up the poor health care system in Louisiana with Medicaid “vouchers”. Cassidy and Jindal can only remain silent when it comes to addressing the real problems in Louisiana because their ideology prevents them from acknowledging and effectively addressing the fundamental problems. Mitt understood this when he was governor of Massachusetts and with the Heritage Foundation crafted a program that began to acknowledge and address underlying health care problems.

Thomas Roberts should never allow politicians like Cassidy and Jindal to throw stones at Massachusetts’ health care when they live in glass houses.

—————————————————————————————————————————

(1) From the summary of the Affordable Care Act from the Kaiser Foundation:

“Providing greater flexibility for the use of Health Savings Accounts” (Bill Cassidy)

Benefit Tiers – Affordable Care Act (from link above):

“Create four benefit categories of plans plus a separate catastrophic plan to be offered through the Exchange, and in the individual and small group markets:

– Bronze plan represents minimum creditable coverage and provides the essential health benefits, cover 60% of the benefit costs of the plan, with an out-of-pocket limit equal to the Health Savings Account (HSA) current law limit ($5,950 for individuals and $11,900 for families in 2010);

– Silver plan provides the essential health benefits, covers 70% of the benefit costs of the plan, with the HSA out-of-pocket limits;

– Gold plan provides the essential health benefits, covers 80% of the benefit costs of the plan, with the HSA out-of-pocket limits;

– Platinum plan provides the essential health benefits, covers 90% of the benefit costs of the plan, with the HSA out-of-pocket limits;

– Catastrophic plan available to those up to age 30 or to those who are exempt from the mandate to purchase coverage and provides catastrophic coverage only with the coverage level set at the HAS current law levels except that prevention benefits and coverage for three primary care visits would be exempt from the deductible. This plan is only available in the individual market.

• Reduce the out-of-pocket limits for those with incomes up to 400% FPL to the following levels:

– 100-200% FPL: one-third of the HSA limits ($1,983/individual and $3,967/family);

– 200-300% FPL: one-half of the HSA limits ($2,975/individual and $5,950/family);

– 300-400% FPL: two-thirds of the HSA limits ($3,987/individual and $7,973/family).

These out-of-pocket reductions are applied within the actuarial limits of the plan and will not increase the actuarial value of the plan.”

“Reforming the medical liability tort system to reduce frivolous lawsuits that drive up costs by forcing doctors to practice defensive medicine” (Bill Cassidy)

Medical Malpractice – Affordable Care Act (from link above):

“Award five-year demonstration grants to states to develop, implement, and evaluate alternatives to current tort litigations. Preference will be given to states that have developed alternatives in consultation with relevant stakeholders and that have proposals that are likely to enhance patient safety by reducing medical errors and adverse events and are likely to improve access to liability insurance. (Funding appropriated for five years beginning in fiscal year 2011)”

“Creating pooling mechanisms, like Individual Membership Associations and Association Health Plans, that provide patients greater flexibility and bargaining power” (Bill Cassidy)

Creation and structure of health insurance exchanges – Affordable Care Act (from link above):

“Create state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Permit states to allow businesses with more than 100 employees to purchase coverage in the SHOP Exchange beginning in 2017. States may form regional Exchanges or allow more than one Exchange to operate in a state as long as each Exchange serves a distinct geographic area. (Funding available to states to establish Exchanges within one year of enactment and until January 1, 2015)”

“Providing tax credits to cover the cost of health care for low-income families” (Bill Cassidy)

Tax changes related to financing health reform – Affordable Care Act (from link above):

“• Increase the tax on distributions from a health savings account or an Archer MSA that are not used for qualified medical expenses to 20% (from 10% for HSAs and from 15% for Archer MSAs) of the disbursed amount. (Effective January 1, 2011)

• Limit the amount of contributions to a flexible spending account for medical expenses to $2,500 per year increased annually by the cost of living adjustment. (Effective January 1, 2013)

• Increase the threshold for the itemized deduction for unreimbursed medical expenses from 7.5% of adjusted gross income to 10% of adjusted gross income for regular tax purposes; waive the increase for individuals age 65 and older for tax years 2013 through 2016. (Effective January 1, 2013)”

Also, Small business tax credits related to financing health reform – Affordable Care Act (from link above):

“• Provide small employers with no more than 25 employees and average annual wages of less than $50,000 that purchase health insurance for employees with a tax credit.

– Phase I: For tax years 2010 through 2013, provide a tax credit of up to 35% of the employer’s contribution toward the employee’s health insurance premium if the employer contributes at least 50% of the total premium cost or 50% of a benchmark premium. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000. The credit phases-out as firm size and average wage increases. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 25% of the employer’s contribution toward the employee’s health insurance premium.

– Phase II: For tax years 2014 and later, for eligible small businesses that purchase coverage through the state Exchange, provide a tax credit of up to 50% of the employer’s contribution toward the employee’s health insurance premium if the employer contributes at least 50% of the total premium cost. The credit will be available for two years. The full credit will be available to employers with 10 or fewer employees and average annual wages of less than $25,000. The credit phases-out as firm size and average wage increases. Tax-exempt small businesses meeting these requirements are eligible for tax credits of up to 35% of the employer’s contribution toward the employee’s health insurance premium.”

“Allowing patients to shop for insurance across state lines” (Bill Cassidy)

Health care choice compacts and national plans – Affordable Care Act (from link above):

“Permit states to form health care choice compacts and allow insurers to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued, except for rules pertaining to market conduct, unfair trade practices, network adequacy, and consumer protections. Compacts may only be approved if it is determined that the compact will provide coverage that is at least as comprehensive and affordable as coverage provided through the state Exchanges. (Regulations issued by July 1, 2013, compacts may not take effect before January 1, 2016)”

“Providing patients who wish to opt out of federal programs (like Medicaid) vouchers to purchase private coverage” (Bill Cassidy)

Medicaid – Affordable Care Act (from link above)…This could provide a basis for Bill Cassidy’s idea:

“Provide states with new options for offering home and community-based services through a Medicaid state plan rather than through a waiver for individuals with incomes up to 300% of the maximum SSI payment and who have a higher level of need and permit states to extend full Medicaid benefits to individual receiving home and community-based services under a state plan. (Effective October 1, 2010)”

“Allowing employers to offer discounts to incentivize participation in wellness programs” (Bill Cassidy)

Wellness programs – Affordable Care Act (from link above):

“• Provide grants for up to five years to small employers that establish wellness programs. (Funds appropriated for five years beginning in fiscal year 2011)

• Provide technical assistance and other resources to evaluate employer-based wellness programs. Conduct a national worksite health policies and programs survey to assess employer-based health policies and programs. (Conduct study within two years following enactment)

• Permit employers to offer employees rewards—in the form of premium discounts, waivers of costsharing requirements, or benefits that would otherwise not be provided—of up to 30% of the cost of coverage for participating in a wellness program and meeting certain health-related standards. Employers must offer an alternative standard for individuals for whom it is unreasonably difficult or inadvisable to meet the standard. The reward limit may be increased to 50% of the cost of coverage if deemed appropriate. (Effective January 1, 2014) Establish 10-state pilot programs by July 2014 to permit participating states to apply similar rewards for participating in wellness programs in the individual market and expand demonstrations in 2017 if effective. Require a report on the effectiveness and impact of wellness programs. (Report due three years following enactment)”

“Ensuring coverage for those with pre-existing conditions by strengthening high risk/reinsurance pools” (Bill Cassidy)

Temporary high risk pools – Affordable Care Act (from link above):

“• Establish a temporary national high-risk pool to provide health coverage to individuals with pre-existing medical conditions. U.S. citizens and legal immigrants who have a pre-existing medical condition and who have been uninsured for at least six months will be eligible to enroll in the high-risk pool and receive subsidized premiums. Premiums for the pool will be established for a standard population and may vary by no more than 4 to 1 due to age; maximum cost-sharing will be limited to the current law HSA limit ($5,950/individual and $11,900/family in 2010). Appropriate $5 billion to finance the program. (Effective within 90 days of enactment until January 1, 2014)”

This clearly shows that every point Bill Cassidy brings up is already addressed. It is almost as if part of the Act was written in response to Bill Cassidy’s recommendations. Yet, Bill Cassidy vehemently opposes the Affordable Care Act. The new Republicans could have done what the older Republicans did and fashion the bill even more in the direction they wanted. Instead, they made a political issue out of it and refused to work with the Democrats. Democracy cannot work with this kind of ideologically based inflexibility. Voters would do well to vote for politicians that produce results not rhetoric.

Colorado State Budget FAQ

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Blogger – I really am not against helping the underserved. But the lines in this country as to who the truly underserved are have become increasingly murky as the poor have become big business. 30% of our state budget is huge, and will become much more under ObamaCare

This is Colorado State budget information for 2010-2011 and the previous year 2009-2010. 

In the previous year Medicaid was 22% of the budget.  For the current year it is 17.7% of the state budget.

Human Services are 9.2% of the budget.  This includes money for developmental disabilities or mental illness, juvenile delinquents, and children who are the victims of abuse and neglect.

Here are the state numbers, what would you cut and how much?  You have already said you would eliminate Social Security.  What about Medicaid, CHIP, Welfare?  What about the safety net program you mentioned.  What is that and how much percent wise are you willing to spend on this?

97% of the FY 2010-11 General Fund appropriation is devoted to just five areas of service:

  • 45.6%, K-12 Education is the largest component of the General Fund budget and was off limits when balancing in FY 2009-10 due to a required 5% General Fund increase.
  • 17.7%, Health Care Policy and Financing provides services that are mostly entitlement programs that have a counter-cyclical relationship with the economy. When the economy goes down, Medicaid enrollments go up.
  •  9.2%, Human Services are provided to the state’s most vulnerable and highest risk populations such as those with developmental disabilities or mental illness, juvenile delinquents, and children who are the victims of abuse and neglect.
  •  15.2%, Corrections, Public Safety and Judicial provides public safety services. Staffing levels that were reduced during the last recession have still not been restored. Judicial staffing was increased pursuant to HB 07-1054.
  •  9.3%, Higher Education is one of the last remaining areas of the budget where there continues to be budgetary flexibility and where federal stimulus funds have mitigated major reductions for our state’s colleges and universities.

 

http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251665650766&ssbinary=true

Previous Year Budget

 

2010 State spending & deficit in billions[6]

Total spending Pension Health care Education Welfare Protection Transport Deficit Budget gap
$19.6 $3.2 $4.4 $4.8 $1.7 $1.7 $1.2 $17.9 $1.6


a $26 billion plan to give states money for Medicaid and education that the President signed into law on August 10, 2010

http://sunshinereview.org/index.php/Colorado_state_budget

Here are the Federal numbers for Health Care Reform.  I have not seen how Health Care Reform affects the sates with the 26 billion dollar kickback but I do know this…

Here are the CBOs Long Term Budget Outlook for 2009 and 2010.  This is pre-Health Care Reform and post-Health Care Reform.  These quotes are taken from the section dealing with health care costs.

Percent of GDP Chart Projected 2035
Pre-HCR, 2009 Projection Medicare Total Spending 8%
Pre-HCR, 2009 Projection Medicaid, CHIP 5%
Post-HCR, 2010 Projection Medicare Total Spending 6%
Post-HCR, 2010 Projection Medicaid, CHIP, Subsidies 4%


Total spending for Medicare is projected to increase to 8 percent of GDP by 2035 and to 15 percent by 2080. Total spending for Medicaid is projected to increase to 5 percent of GDP by 2035 and to 7 percent by 2080. (2009 page 35 in pdf)

Under the extended-baseline scenario, which reflects current law, federal spending for those (Medicare, Medicaid, the Children’s Health Insurance Program, and the insurance subsidies) programs would grow from 5.5 percent of GDP today to about 10 percent of GDP in 2035; about 6 percent of GDP would be devoted to Medicare, and about 4 percent would be spent on Medicaid, CHIP, and the exchange subsidies. (2010 page 41 in pdf)

The Long Term Budget Outlook 2009

http://www.cbo.gov/ftpdocs/102xx/doc10297/06-25-LTBO.pdf

The Long Term Budget Outlook 2010

http://www.cbo.gov/ftpdocs/115xx/doc11579/06-30-LTBO.pdf

FAQs on Health Care Reform

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Blogger – I won’t go on too much. This entry by the Director does not instill confidence. He says that the legislation will decrease the incentive to work or work more hours because of the huge increase in Medicaid. Then he says it won’t matter TOO much, even though he said it will be the biggest effect outside the healthcare industry itself. HUH?

I am going to deal with your objections in smaller increments as I think the details matter and I do not want to put too much into one post (if possible). The speech by the director that you cite,

http://cboblog.cbo.gov/?p=1478

 referred to an update on the economic outlook …the update is here…

The Budget and Economic Outlook: An Update

http://www.cbo.gov/ftpdocs/117xx/doc11705/08-18-Update.pdf

Here is the actual quote in the report that the director referred to:

Policy changes incorporated in current law are also expected to slow the expansion of the labor supply during the next 10 years. Those changes—including the expiration of EGTRRA, JGTRRA, and provisions limiting the impact of the alternative minimum tax—will raise marginal personal tax rates during the next decade relative to what they were in the past decade and will thereby modestly reduce people’s incentive to work.  Page 65 in pdf

EGTRRA – Economic Growth and Tax Relief Reconciliation Act of 2001 by George Bush

JGTRRA – Jobs and Growth Tax Relief Reconciliation Act of 2003 by George Bush

This has nothing to do with health care but with George Bush.

In addition, CBO expects that the major health care legislation enacted in 2010 will reduce the supply of labor slightly (see Box 2-1).  Page 65 in pdf, shown below in entirety

This states that, “That net effect reflects changes in incentives in the labor market that operate in both directions” so the net effect is “roughly half a percent”. 

In the speech you referred to he is saying that labor outside the health care industry which is much larger will have the biggest impact from the half a percent.

If you read the particulars below you will see their justifications for this claim.  One thing you should remember is the big picture, 95% of the US population will have health insurance and the Federal debt will be reduced by 1.3 trillion dollars over 20 years (as opposed to what happens if these bills did not exist).  I think in each of the specific cases below I would be hard pressed to state that it would be better if we did not do it at all…what do you think?

 

The reason for this has to do with “expansion of Medicaid and the provision of subsidies that will reduce the cost of insurance obtained through the newly created exchanges, beginning in 2014.” for single people making between $14,945/year and $43,320/year and married people making between $30,429/year and $88,200/year.  So if these folks are not offered health insurance through their employer they can still get health insurance through the new health insurance exchanges and extra help with subsidies.  The subsidies decline in value as their income reaches the upper limit (at which the subsidies are zero).  They speculate that some people might work fewer hours or leave the labor market but this “will apply only to a small segment of the population”.  

They also state, “Other provisions in the legislation are also likely to diminish people’s incentives to work. Changes to the insurance market, including provisions that prohibit insurers from denying coverage to people because of preexisting conditions and that restrict how much prices can vary with an individual’s age or health status, will increase the appeal of health insurance plans offered outside the workplace for older workers. As a result, some older workers will choose to retire earlier than they otherwise would.

Additionally, the state, “People currently lose eligibility for Medicaid if their income rises above a certain level; for working parents, the median income threshold for eligibility among states was 64 percent of the FPL in 2009. The health care legislation will allow parents to work and still qualify for Medicaid until their income exceeds 138 percent of the FPL. Moreover, parents whose income exceeds the new, higher threshold may be able to work and receive the tax credits and cost-sharing reductions for insurance purchased through the exchanges. Some other provisions of the legislation may also affect decisions regarding work, but their net effect on the total labor supply will probably be small.”

The new law imposes an excise tax on “Cadillac”, high end health insurance plans.  It also add 0.9% increase for singles making over $200,000/year and married over $250,000/year.  “The net effect of that increase will probably be a slight decline in labor supply.”

Another effect would be, “Employers’ decisions to hire workers will also be affected in some cases by the health care legislation. Employers with 50 or more employees will be required to pay a penalty if they do not offer insurance or if the insurance they offer does not meet certain criteria and at least one of their workers receives a subsidy from an exchange.”  However, “Alternatively, because firms are penalized only if their full-time employees receive subsidies from exchanges, some firms may instead hire more part-time or seasonal employees.” 

Box 2-1 on page 66 of the pdf states:

The Patient Protection and Affordable Care Act (Public Law 111-148) and the Health Care Education Reconciliation Act of 2010 (P.L. 111-152) will affect some individuals’ decisions about whether and how much to work and employers’ decisions about hiring workers.  The Congressional Budget Office (CBO) estimates that the legislation, on net, will reduce the amount of labor used in the economy by a small amount—roughly half a percent—primarily by reducing the amount of labor that workers choose to supply. That net effect reflects changes in incentives in the labor market that operate in both  directions: Some provisions of the legislation will discourage people from working more hours or entering the workforce, and other provisions will encourage them to work more. Moreover, many people will be unaffected by those provisions and will face the same incentives regarding work as they do under current law.  The net reduction in the supply of labor is largely attributable to the substantial expansion of Medicaid and the provision of subsidies that will reduce the cost of insurance obtained through the newly created exchanges, beginning in 2014. In particular: The legislation  extends Medicaid eligibility to most nonelderly residents whose income is below 138 percent of the federal poverty level (FPL)— including childless adults who are currently ineligible for Medicaid in most states. (The FPL in 2010 is $10,830 for a single person and $22,050 for a family of four.)  People who purchase insurance through the new exchanges will generally be eligible for tax credits to help them pay their health insurance premiums if their income is between 138 percent and 400 percent of the FPL and they are not offered coverage through an employer. (They may also be eligible for reductions in their cost-sharing requirements.) Those subsidies decline in value as income rises and can, under some circumstances, drop sharply to zero when income exceeds 400 percent of the FPL. The expansion of Medicaid and the availability of subsidies through the exchanges will effectively increase beneficiaries’ financial resources. Those additional resources will encourage some people to work fewer hours or to withdraw from the labor market. In addition, the phase out of the subsidies as income rises will effectively increase marginal tax rates, which will also discourage work. But because most workers who are offered insurance through their jobs will be ineligible for the exchanges’ subsidies and because most people will have income that is too high to be eligible for Medicaid, those effects on financial resources and marginal tax rates will apply only to a small segment of the population. Other provisions in the legislation are also likely to diminish people’s incentives to work. Changes to the insurance market, including provisions that prohibit insurers from denying coverage to people because of preexisting conditions and that restrict how much prices can vary with an individual’s age or health status, will increase the appeal of health insurance plans offered outside the workplace for older workers. As a result, some older workers will choose to retire earlier than they otherwise would. In contrast, another feature of the Medicaid expansion removes an existing disincentive to work for many low-income individuals. People currently lose eligibility for Medicaid if their income rises above a certain level; for working parents, the median income threshold for eligibility among states was 64 percent of the FPL in 2009. The health care legislation will allow parents to work and still qualify for Medicaid until their income exceeds 138 percent of the FPL. Moreover, parents whose income exceeds the new, higher threshold may be able to work and receive the tax credits and cost-sharing reductions for insurance purchased through the exchanges. Some other provisions of the legislation may also affect decisions regarding work, but their net effect on the total labor supply will probably be small. For example, the new laws impose an excise tax on high cost health insurance plans beginning in 2018. CBO expects that the burden of the tax will, over time, be borne primarily by workers, reducing their after-tax compensation and thereby encouraging them to work more. That provision, though, will also increase the effective price of health insurance, making other goods relatively less expensive. Those “other goods” include leisure—which people “purchase” in forgone earnings by choosing to work less—so the change in relative prices will encourage people to work less. The legislation also increases Medicare’s Hospital Insurance (HI) tax by 0.9 percentage points on earnings above $200,000 ($250,000 if married and filing a joint return). The net effect of that increase will probably be a slight decline in labor supply. Employers’ decisions to hire workers will also be affected in some cases by the health care legislation. Employers with 50 or more employees will be required to pay a penalty if they do not offer insurance or if the insurance they offer does not meet certain criteria and at least one of their workers receives a subsidy from an exchange. Those penalties, whose amounts are based on the number of full-time workers in the firm, will, over time, generally be passed on to workers through reductions in wages or other forms of compensation. However, firms generally cannot reduce workers’ wages below the minimum wage, which will probably cause some employers to respond by hiring fewer low-wage workers. Alternatively, because firms are penalized only if their full-time employees receive subsidies from exchanges, some firms may instead hire more part-time or seasonal employees. More generally, the health care legislation may shape the labor market or the operations of other segments of the economy in ways that are difficult to anticipate or quantify. For example, the legislation could influence labor markets indirectly by making it easier for some employees to obtain health insurance outside the workplace and thereby enabling workers to take jobs that better match their skills. Some firms, however, might invest less in their workers—by reducing training, for example—if the probability of retaining those workers declines. To the extent that changes in the health insurance system lead to improved health status among workers, the nation’s economic productivity could be enhanced. It is not clear, however, whether such changes would have a substantial impact on overall economic productivity or output. Moreover, many of the effects of the legislation may not be felt for several years because it will take time for workers and employers to recognize and to adapt to the new incentives.

Blogger – Then he goes on to say that they PROJECT that 32 Million more people will be insured by 2019 and that that will increase services met by the healthcare industry. But then he says that the reduced spending on the previously uninsured caused by this will be minimal. HUH? I could be wrong, but doesn’t this mimic the Mass. law, and we see how that has turned out.

Here is what he stated,

Turning to the health sector, one effect of the March legislation will be to increase the amount of health care delivered to people who would have been uninsured in the absence of the law. CBO projected that 32 million fewer people will be uninsured in 2019 because of the legislation. Previous research suggests that, all else equal, gaining insurance coverage will increase an individual’s demand for health services by about 40 percent. By itself, this would represent an expansion of the health sector of the economy equal to an increase in total health services of a few percent.

The health care market segment will expand by a few percent because there are 32 million more people insured and the demand for health care services will go up by 40%.

Another effect of the March legislation will be to reduce unnecessary spending on health care for people who would be insured with or without the legislation—but probably only to a very limited extent

I think this may be what you are referring to with your “reduced spending” comment.  He is not referring to the total cost of the uninsured but to the spending done on the insured regardless of the health care reform legislation.

He cites four reasons for this:

  1. He states it will “will reduce administrative costs and increase competition among insurers”.
  2. He states that because of the “Cadillac” tax (which you correctly stated goes into effect in 2018) for high end insurance plans, employers will probably offer plans just below the threshold for the excise tax (imposed by the “Cadillac” tax).  This will lower premiums and therefore, spending.  It will also add greater cost sharing (from the excise tax) and more stringent benefit management (due to the lower premiums).
  3. “The legislation reduced payments to many Medicare providers relative to what the government would have paid under prior law. Those reductions will impose greater pressure on providers to increase efficiency in the delivery of care. As a result of those cuts in payment rates and the existing “sustainable growth rate” mechanism that governs Medicare’s payments to physicians, CBO projects that Medicare spending will increase significantly more slowly during the next two decades than it has increased during the past two decades (per beneficiary, after adjusting for overall inflation)”  The health care reform bill reduces payments to providers and therefore, slows the ever increasing costs of health care.
  4. “The legislation set up a number of experiments in delivery and payment systems to induce providers to offer higher-quality and lower-cost care.”  This is one thing I like very much which I referred to in another post.  These are pilot, test projects to evaluate the effectiveness and cost impact before it is rolled out on a larger scale. If these projects are successful the benefits will be included over and above the debt reduction of 1.3 trillion dollars over 20 years.  The CBO did not factor the test projects impact in because they do not know the outcome yet…

 Blogger – The Excise Tax (Cadillac Tax) doesn’t go into effect until 2018. He expects that many employers will answer this by giving cheaper plans, and that this will somehow make costs go down and care more efficient. How? There are NO restrictions on rate increases in ObamaCare- only a “review” and public flogging. I guess you get to keep your healthcare if you have a good job that provides it- but only some of it. I am no fan of Unions, but I can see why they fought and won to get a 5 year gap in this provision. If they are planning to pay for some of ObamaCare with this, I think they are wrong about how much $ it will garner. The only thing I can think of is that they hope this will create cheaper group provider services. Maybe, but maybe it will just mean fewer insured services.

Because historically folks on the high end do not want to pay excise taxes.  Employers will give them insurance plans whose costs are just below the excise tax threshold.  This means lower cost plans.  Since they are lower cost folks that do want to pay the excise tax and chose the lower cost plans the insurance companies will be more cost conscious about benefits.

The threshold is set at annual premiums of…

“a high-cost health plan is defined as costing more than $10,200 for an individual or $27,500 for a family, including worker and employer contributions to flexible spending or health savings accounts. The cost does not include stand-alone vision or dental benefits. The tax would not be imposed until 2018”

“For retirees and workers in high-risk professions, such as firefighters and longshoremen, the bill would set higher thresholds — $11,850 for an individual plan and $30,950 for a family plan.”

http://www.kaiserhealthnews.org/Stories/2010/March/18/Cadillac-Tax-Explainer-Update.aspx

“On average, the annual premium was $2,985 for a single person and $6,328 for a family.”

http://healthinsurance.about.com/od/healthinsurancebasics/a/cost_of_health_insurance.htm

You do not get fewer insured services.  Folks that fall into the single people making between $14,945/year and $43,320/year and married people making between $30,429/year and $88,200/year can actually get services where they had none before (no health insurance at all offered by their employer).  If you fall into the “Cadillac” folks you can get the same benefits you got before but you will pay an additional excise tax increase of 0.9%.  I really think these folks can afford that and having 95% of Americans covered kind of puts that in perspective IMO.

 Blogger – He also mentions that insurers have been regulated by the legislation and that this will reduce costs. Again, “splain that to me, Lucy? How How How will it reduce costs when costs ar not regulated? He claims it will be through competition in the nongroup market. How again? With insurance companies being exempt from interstate competition laws, how will that do anything but force more people into the local companies at whatever price they choose to provide coverage? Even if their assumption is correct, he admits that it will be minimal.

This is the reference from the remark he made, “The legislation changed the regulation of private health insurance. Those changes will reduce administrative costs and increase”

 New Market Rules Would Reduce Administrative Costs

Compared with plans that would be available in the nongroup market under current law, nongroup policies under the proposal would have lower administrative costs, largely because of the new market rules:

“Nongroup” here means private insurance like the kind self-employed folks use

• The influx of new enrollees in response to the individual mandate and new subsidies—combined with the creation of new insurance exchanges—would create larger purchasing pools that would achieve some economies of scale.

• Administrative costs would be reduced by provisions that require some standardization of benefits—for example, by limiting variation in the types of policies that could be offered and prohibiting “riders” to insurance policies (which are amendments to a policy’s terms, such as coverage exclusions for preexisting conditions); insurers incur administrative costs to implement those exclusions.

• Administrative costs would be reduced slightly by the general prohibition on medical underwriting, which is the practice of varying premiums or coverage terms to reflect the applicant’s health status; nongroup insurers incur some administrative costs to implement underwriting.

• Partly offsetting those reductions in administrative costs would be a surcharge that exchange plans would have to pay under the proposal to cover the operating costs of the exchanges.

http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf page 14 pdf

 Blogger – Then he addresses Medicare. I just have to cut & paste this because I think his rhetoric and then his admittance of the frailty of his assumption is kind of staggering.

” The legislation reduced payments to many Medicare providers relative to what the government would have paid under prior law. Those reductions will impose greater pressure on providers to increase efficiency in the delivery of care. As a result of those cuts in payment rates and the existing “sustainable growth rate” mechanism that governs Medicare’s payments to physicians, CBO projects that Medicare spending will increase significantly more slowly during the next two decades than it has increased during the past two decades (per beneficiary, after adjusting for overall inflation). We wrote last spring that it is unclear whether such a reduction in the growth rate of spending could be sustained, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or through reductions in access to care or the quality of care.”

So the cuts will force docs to reduce costs, or maybe not, and the gov’t will be spending less, but it might not be sustainable? And the reductions could very well reduce care for people who have been paying in 5% all their working lives? Not to be repetitive, but HUH?

A lot of the problems here has to do with the language these guys use.  I wish they would write cliff notes for the rest of us…The spending reductions were mentioned in an earlier post but there is nothing in all this that discusses payment reductions to doctors.  However, under the legislation prior to health care reform,

“Under current law, some of Medicare’s payments for physicians’ services are limited by a system known as the sustainable growth rate mechanism. That system is currently projected to reduce payments to physicians by about 20 percent in 2011 and more thereafter. (If legislation was enacted to override those reductions—as has happened every year since 2003—spending on Medicare would be significantly higher than projected in the baseline.) Changes to the Medicare program made by the recently enacted health care legislation will also restrain the growth of spending. Even with those constraining effects, CBO anticipates that spending for Medicare will expand faster than the economy. As a result, by the end of the decade, outlays for Medicare are projected to total $929 billion (4.0 percent of GDP), compared with $519 billion (3.5 percent of GDP) this year.”

http://www.cbo.gov/ftpdocs/117xx/doc11705/08-18-Update.pdf page 38 pdf

The reductions in cost come through the other ways previously mentioned.  So the spending reductions previously mentioned offset the increase payments to physicians that has happened every year since 2003 (thank you AMA).  If pending legislation to increase Medicare payments to physicians goes through (has not yet but I did mention the pending bill in an earlier post) the costs of Medicare could increase more than their baseline projection.  However, they also do worst case projections that would take this into account.

“the proposal includes numerous provisions that would encourage the development and dissemination of less costly ways to deliver appropriate medical services, either directly or indirectly. Examples of those provisions include the excise tax on high-premium insurance plans; the creation of a new Medicare advisory board that might limit the growth rate of Medicare spending; and certain changes in Medicare’s payment methods as well as new pilot and demonstration projects regarding other changes in payment methods (such as penalties for hospital readmissions that are deemed avoidable and incentives to coordinate patients’ care). The changes in Medicare’s payment methods could “spill over” to the private sector and decrease spending for health care relative to currently projected levels. However, the effects of those initiatives on Medicare’s spending are uncertain and would probably be small in 2016 relative to the program’s total spending, so any spillover to private insurance at that point would probably be small as well.”

http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf page 28 pdf

The sustainable part has to do with the comment they made in the report that they expect the cost of Medicare to increase slower over the next two decades than the last two decades with Health Care Reform.  Beyond two decades is a toss up and I doubt that any plan can be structured to work into perpetuity.

I do not see a reduction of care but changes must be made or insurance premiums will keep going up and companies will continue to pay less and less.  The idea is to slow the increase of costs and The Health Care Reform Act is the beginning not the end of this process.  Many Republicans and Democrats have tried and failed to begin, President Obama got it done…a start…

Blogger – I would like to quickly reference the last part of your link, markdart, to the CBO response to Sen. Ryan.

http://www.house.gov/budget_republicans/press/2007/pr20100319letter.pdf

In the March 18, 2010, preliminary analysis of the budgetary effects of the reconciliation proposal, CBO and JCT estimated that the direct spending and revenue effects of enacting that proposal together with the Senate-passed health bill (H.R. 3590) would yield a net reduction in federal deficits of $138 billion over the 2010–2019 period. Thus, the legislation’s effects on the rest of the budget—other than the cash flows of the HI trust fund—would amount to a net increase in federal deficits of $260 billion over the same period. For the decade beyond 2019, CBO expects that enacting the reconciliation proposal and the Senate-passed health bill would reduce federal budget deficits relative to those projected under current law—with a total effect during that decade in a broad range around one-half percent of GDP. The legislation would have positive effects on the cash flows of the HI trust fund in that decade that would be larger than its effects on federal budget deficits as a whole. Therefore, leaving aside the cash flows of the HI trust fund, CBO expects that the reconciliation proposal and the Senate-passed health bill would yield a net increase in budget deficits during the decade beyond 2019.  The increase in the balances of the HI trust fund that would result from enacting H.R. 3590 and the reconciliation proposal might suggest that significant additional resources—$398 billion plus additional interest to be credited to the trust fund over time—had been set aside to pay for future Medicare benefits. However, only the additional savings by the government as a whole truly increase the government’s ability to pay for future Medicare benefits or other programs, and those would be much smaller ($138 billion plus interest savings to be achieved over time). In effect, the majority of the HI trust fund savings under H.R. 3590 and the reconciliation proposal would be used to pay for other spending and therefore would not enhance the ability of the government to pay for future Medicare benefits.

I am no Rhodes scholar. I worked to provide the formal educations for my family. This confuses me. Are they saying that the legislation might make less of a deficit than would have happened without it, but that the cost (most probably) comes at the price of Medicare benefits?

My husband and son are the big brains in the family, and I am going to pick my husband’s on this tonight- I may have to backpeddle (or might have better ammo) tomorrow. But to me the  big picture is that the cost of ObamaCare is not only going to be in the wallet for most Americans, but in the ability to get quality care even if you have paid for it. That is an assumption, but no more unreasonable than the assumptions made by the CBO and those who take their projections as gospel. I have a lot of “HUH’s” that I don’t feel any better about after your post debunking the criticisms of the CBO on ObamaCare, markdart. I welcome any illumination!

This is another case of confusing language with these folks.  The name of the section that you quoted from is, “The Budgetary Impact of Enacting the Reconciliation Proposal and H.R. 3590 Excluding Cash Flows of the Hospital Insurance Trust Fund”.  The bill can be found here,

Patient Protection and Affordable Care Act

http://thomas.loc.gov/cgi-bin/bdquery/z?d111:H.R.3590:

The Hospital Insurance (HI) trust fund is the fund from which Medicare Part A benefits are paid.  The letter asked the director what would happen if this trust fund was excluded from the health care reform package.  To make a long story short the answer is not good, don’t do it.  The trust fund needs to stay with the health care reform package to make the numbers work and to keep Medicare Part A alive past 2017.

The CBO letter that responds to the criticism you brought up states,

On the basis of the economic forecast and technical assumptions underlying CBO’s March 2009 baseline, CBO projected that, under current law, the HI trust fund would be exhausted—that is, the balance of the trust fund would decline to zero—during fiscal year 2017.  Enacting the reconciliation proposal and the Senate-passed health bill would reduce net outlays for Part A of Medicare by $286 billion over the 2010–2019 period relative to that baseline, CBO estimates. Enacting that legislation would also increase HI payroll tax receipts by about $112 billion over that period, according to estimates by CBO and JCT. Together, those changes in outlays and revenues would diminish budget deficits and add $398 billion plus interest earnings to the trust fund’s balances over that 10-year period.

http://www.house.gov/budget_republicans/press/2007/pr20100319letter.pdf page 4 pdf

So, the health care reform bill adds $398 billion plus interest to the Medicare Part A trust fund.  Under the previous law that trust fund would equal 0 in 2017.  There is nothing in here about Medicare benefits.

My overall conclusion is that there is nothing in the specific arguments you made that IMO reinforces the criticisms you have.  To the contrary, I think, without the health care reform intervention, your fears are more justified.  However, I am open to and welcome more specific arguments to prove your case.

CBO: Health-care reform bill cuts deficit by $1.3 trillion over 20 years, covers 95%

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I still think the CBO projections are valid even after reading this criticism,

CBO Confirms That Without Accounting Gimmicks, Obamacare Adds to Deficits

The CBO believes that Health-care reform bill will cut the deficit by $1.3 trillion over 20 years and cover  cover 95% of the US population.

The CBO based their projections on current law and bills like to pass at the time which has passed since then…therefore, the original CBO statement stands and the criticism raysmon referenced fails.

The title, “CBO Confirms That Without Accounting Gimmicks, Obamacare Adds to Deficits”, is at best misleading and at worst heavily biased.

The criticism raysmom brought up are based on a bill that has not passed yet and likely will not which increase payments to physicians for Medicare. 

The report was also based on bills that had not passed at the time but passed subsequent to publishing the criticism article.  Details are below…

The criticisms of the CBO report are answered in detail here by the CBO,

http://www.house.gov/budget_republicans/press/2007/pr20100319letter.pdf

In short, the major criticism is based on a proposed bill originally,

H.R. 3961- Medicare Physicians Payment Reform Act of 2009 (the title was not changed even though it has nothing to do with Medicare or Physicians…my guess is that they could not get enough votes or some technical reason why they could not change the title…silly)

 http://www.govtrack.us/congress/bill.xpd?bill=h111-3961. 

However, H.R. 3961 (the one that passed) has nothing about physicians and Medicare only the Patriot Act and intelligence related matters.

The part that has not passed which increases Medicare payments to doctors,

H. Res. 903: Providing for consideration of the bill (H.R. 3962) to provide affordable, quality health care…

http://www.govtrack.us/congress/bill.xpd?bill=hr111-903

is a major argument for the criticism.  The bill will likely not pass as written.

The criticism also stated that the CBO estimate was based on this bill not passed at the time,

Patient Protection and Affordable Care Act (Cadillac tax)

http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03590:@@@L&summ2=m&

which passed subsequent to the criticism places a tax in the future on very high end insurance policies for executives and cuts Medicare payments in some cases.

My Email to the Attorney General of Colorado

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If you would like to send an email, here is the address:

attorney.general@state.co.us

Dear Mr. Sutthers,

I know you really believe in what you are doing with this law suit against the Federal Government. I know you also know that your opposition believes that this is merely a political vendetta. Obviously, nothing I can say will change your mind but I would like you to keep one thing in your mind while you are pursuing this case:

– Colorado is looking at laying off a lot of teachers in the next few years

– State budgets having been teetering on failure for quite some time

-Every fifty thousand dollars you spend on this case is a teacher that will get laid off and innumerable children that will suffer long term consequences

I hope you have resolved this issue in your mind because this is the brute fact that will proceed from your action. I, for one, will be looking intensely into what is being spent on this venture and I know many others will as well. Please act wisely as this involves more than your anger or merely your interpretation of the law – look realistically at the chance of winning the case or just making headlines at the cost of teacher’s jobs…

“I paid for my Social Security and Medicare. I don’t take government handouts.”

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Yea, you paid some money into these programs and you keep telling yourself you are not part of the BIG government program and not being totally selfish but think about this:

1. Social Security and Medicare ARE big Federal Government programs largely done by Democrats with Republicans calling it Socialism and BIG government totalitarianism. They said it was not American for the government to force them to pay for these programs. Republicans have been trying to get rid of these programs ever since. Both Medicare Advantage and Medicare Part D (prescription drug plan) were Republican plans that were gifts to insurance companies and contributed as much or more to the deficit than the new Health Care Reform package will.

Medicare Advantage does not offer any new benefits over basic Medicare without increased premiums and costs the government 14% more than the same benefits offered in basic Medicare. For the same benefits, Medicare Advantage hands out wads of case to private insurance companies to offer the same benefits as basic Medicare.

The prescription drug plan prohibits cost negations based on huge quantities that the government purchases. Bulk negotiations are regularly done in private business but the Republicans in the Bush administration wanted to make sure the drug companies got a sweetheart deal that cost you as much money over the next ten years as the cost of the Health Reform Bill.

http://www.nytimes.com/2010/02/12/opinion/12krugman.html
http://www.americansforcoordinatedhealthcare.org/the_next_healthcare_battle_cutting_medicare_advantage/pid:5

2. As an older person you are part of a high risk insurance pool. Before these programs you could not get insurance. Many older people died on the street. Private insurance companies could not make a profit on you. The cost to insure you was more than they made on premiums. The situation is even more severe now that the cost of medical care has been increasing much faster than inflation. The money you paid into these programs would not come close to covering the costs that you have accumulated for the following reasons:

a) One of the causes for the projected deficits is that the number of workers paying taxes compared to the number of people receiving benefits has fallen and is projected to fall further.

b) Increase in life expectancy without a comparable increase in the retirement age:

– Since Social Security began paying benefits in 1940, the life expectancy of the average 65-year old male and female has gone up 40% and 45% respectively.

– Benefits and taxes are automatically indexed on an annual basis to compensate for inflation and wage growth. The retirement age is not indexed to compensate for increased life expectancy.

c) The higher birth rate of the baby boom generation compared to the birth rates of succeeding generations:

– In 1960 (during the baby boom), the average birth rate per woman was 3.6. By 1975, the average birth rate had fallen to 1.77. As of 2004, it is at 2.05.

d) The increasing number of people receiving disability benefits:

– Between 1960 and 2005, the U.S. population grew by 59%. During the same period, the number of people receiving disability benefits increased by 1,109%.

e) Health care cost have increased dramatically more than what the projected cost increases

http://www.justfacts.com/socialsecurity.basics.asp
http://www.cbo.gov/ftpdocs/102xx/doc10297/06-25-LTBO.pdf

The bottom line is that you are drawing out more than you paid in. You can complain about the Federal Government all you want but you would not have any health care without the government. The numbers do not work.

3. A lot of you are in programs you never paid into like Part D (prescription drugs). My dad does not need part D because he is on a prescription drug program for veterans of WW2. He never paid into this but he is a big Republican and thinks he is not on a government program – he says he has never taken anything from the government.

4. If the commerce clause the Republicans are touting is correct then get ready to get rid of Social Security and Medicare because the big, bad government forces you to pay into it.

5. If we do nothing the deficit will rise 143 billion dollars more over the next 10 years than if we have the Health Care Reform Act according to the CBO. Health Care Reform costs less than we will pay if we do nothing. The total cost of the Health Reform Act is the same as the cost of Part D over the next 10 years and closes the doughnut hole.

http://www.cbo.gov/ftpdocs/113xx/doc11379/Manager’sAmendmenttoReconciliationProposal.pdf

I don’t know how to get through these rationalizations and justifications based on pure fantasy but I will tell you that your blindness conveniently keeps you from seeing your selfishness, greediness and the violence you are doing to others that do not have your government benefits. How does it feel to be a hypocrite?

The “Tea Party”?

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The Tea Party got its name from the Boston Tea Party.  Initially, their point was that there should be no taxation without representation.   They identified with the patriots.  Now, they like to equivocate the monarchy of England during the Revolutionary War with today’s Federal Government.   Do you see a difference?  A monarchy is NOT elected but our government (which includes the Federal Government) is elected by a majority of the people in our country.  Hey, Tea Partiers, we got the government we elected – you lost. 

Real patriots advocated democracy in the face of totalitarianism.  Terrorists advocate senseless violence in the face of democracy.  What side are you gun toting, reloading, cleaning fools on?  The rest of us pay taxes for a military and police to deal with your type.  Go ahead – go down in a blaze of ignorance – the gene pool will be better off.

And, guess what…we think the tax burden will get shifted from the middle income groups the Republicans administrations gave us to big corporations and rich folks.  Oh, I know they like to threaten that they will leave the country or pass the cost on to everyone else but I call that intimidation and black mail.  I have faith that capitalism and competition will leave those that act on these threats in the ranks of the has-beens and entrepreneurs will rise to take the spoils.  Don’t continue to be pawns of big money marketing.  They would have you act against your own interests so they come out ahead. 

Oh, and if you are on Social Security and Medicare and are against Health Care Reform you are selfish and nasty.  You are part of the problem and I think you are responsible for the death of thousands of men, women and children that have died in this country from no and/or inadequate health care.  I see faces of children when it comes to health care reform.  You and your politicians fought CHIPS and health care for decades and I see children dying from it.  If you have the gall to call yourself “pro-life” on top of this you are hopelessly lost.  Why don’t you give age the face of grace, wisdom and virtue not pettiness and hypocrisy?

Response to a Pro-Death Comment

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This is my response to a Pro-Death comment submitted for this article:

House of Representatives Passes Sweeping Health Reform Bill

http://www.nea.org/home/38621.htm#btnSubmitComment

Original Comment:

“I just wanted to let the NEA president know that because of his arrogant opinion I am no longer a member of the NEA. I went to my local NEA office today and told them I no longer want to be a member of an organization who endorse people support socialist policies/agendas. My political and moral values are more important to me than anything in the world. I am so sorry that I was a member of an association that suppossedly pushes an agenda for kids but supports many political candidates who endorse killing babies in the womb (hypocracy) and makes a mockery of ideals of our founding fathers. By the way NEA make sure you push for print in all the future history books in schools throughout the USA, Im sorry…..the U.S.S.R (United States Socialist Republic), March 21, 2010, the day Constitution was ripped into shreads by the Democratic Party of America.”

My Response:

James 2:15-17 states:

“If a brother or sister be naked and in lack of daily food, and one of you say unto them, Go in peace, be ye warmed and filled; and yet ye give them not the things needful to the body; what doth it profit? Even so faith, if it have not works, is dead in itself.”

If Jesus were here today he would add health care to food and clothing as it is certainly “things needful to the body”.

The commenter above needs to know that abortion is legal in this country and has been for quite a few decades.  Neither President Obama nor the rest of us are baby killers because mere cells are not human.  On the other hand, you kill young people because they certainly are human and since I am sure you voted for Bush and his 2 ridiculous wars you had a direct hand in killing innocent young people – you are a murderer IMO.  By the way, I did not get any choice about paying taxes for your stupid wars that killed our young people. 

 I also did not get a choice about Social Security, Medicare, drivers license, motorcycle helmets, increased taxes for booze and cigarettes but I understand that we all pay for these issues and I am willing to pay without calling my country socialist, fascist, totalitarian, etc.  You are not a patriot – you are only for this country when you get your way. 

You need to know that President Obama was elected by a majority of us to do the job he did on health care.  I will not even begin to tell you how enraged I was during both Bush and Reagan presidencies.  We the American people DO want national health care in this country and you were told when President Obama was elected and you have been told again with this bill so deal with it!  If you are so “pro-life” how can you fight against the millions without health care in this country and the hundreds of thousands of deaths that result for no care or inadequate care?  Before CHIPS and this bill you people would not even let us insure kids in this country!  You are already involuntarily paying for emergency room health care and will be paying much, much more in the near future unless something is done NOW. 

Don’t say you are “pro-life” when you fully exhibit hatred and violence for those that have already certainly been born.  You are pro-death and full of darkness and an evil god!  Go back to your cave and pray or slice up small animals or whatever you do!

A vote against Big Government is a vote for Big Business

2 Replies

Rest assured that if you are angry and want to vote against the Democrats by voting for a Republican you will be voting for Big Business.  You will be voting for Wall Street, private contractor wars and world anger and hatred for the United States.  You will be voting for more of the Bush years.  Republicans will say and do anything to get elected but their actions speak louder than words.  They are all about back room deals with Big Business. 

Here is one proof:

In 8 years controlling the executive branch and 6 years of that controlling the legislative branch, the Republicans did the only major health care initiative that I know of – the Prescription Drug Benefit known as Medicare Part D.

Take a look at this article concerning Part D:

http://taxvox.taxpolicycenter.org/blog/_archives/2009/5/14/4186168.html

The initial 10 year cost of the program by the CBO in 2003 was $395 billion.   The current 10 year cost cited below totals out at $999.9 billion.  All costs cited above are intermediate estimates.

Table III.C19.—Operations of the Part D Account in the SMI Trust Fund (Cash Basis) during Calendar Years 2004-2018

[In billions]

Income Expenditures Account
Calendar year Premium income1 General revenue2 Transfers from States3 Interest and other Total Benefit payments4 Adminis-trative expense Total Net change Balance at end of year5
Historical data:
2004 — $0.4 — — $0.4 $0.4 — $0.4 — —
2005 — 1.1 — — 1.1 1.1 — 1.1 — —
2006 $3.5 39.2 $5.5 $0.0 48.2 47.1 $0.3 47.4 $0.8 $0.8
2007 4.0 38.8 6.9 0.0 49.7 48.8 0.9 49.7 0.0 0.8
2008 5.0 37.3 7.1 0.0 49.4 49.0 0.3 49.3 0.1 0.9
Intermediate estimates:
2009 6.3 6 48.5 7.9 0.0 62.7 62.6 0.4 63.0 −0.2 0.7
2010 7.2 6 50.7 8.3 0.0 66.2 65.8 0.4 66.2 0.0 0.7
2011 8.4 55.5 8.8 0.0 72.8 72.3 0.4 72.7 0.0 0.7
2012 9.6 60.8 9.4 0.0 79.9 79.4 0.5 79.8 0.1 0.8
2013 10.6 66.1 10.1 0.0 86.8 86.2 0.5 86.7 0.1 0.9
2014 11.6 72.4 10.8 0.0 94.9 94.3 0.5 94.8 0.1 0.9
2015 13.3 6 79.9 11.5 0.0 104.8 104.2 0.5 104.8 0.1 1.0
2016 13.8 6 88.2 12.6 0.0 114.7 114.0 0.5 114.6 0.1 1.1
2017 15.9 97.4 13.9 0.0 127.3 126.6 0.5 127.2 0.1 1.2
2018 17.7 107.8 15.4 0.0 140.9 140.2 0.6 140.8 0.1 1.3
                         

 

AND:

Table III.C23.—Unfunded Part D Obligations from Program Inception through the Infinite Horizon

[Present values as of January 1, 2009; dollar amounts in trillions]

Present value As a percentage of GDP
Unfunded obligations through the infinite horizon1 $0.0 0.0 %
Expenditures 20.3 1.5
Income 20.3 1.5
Beneficiary premiums 2.5 0.2
State transfers 2.2 0.2
General revenue contributions 15.5 1.2
Unfunded obligations from program inception through 20831 0.0 0.0
Expenditures 9.4 1.2
Income 9.4 1.2
Beneficiary premiums 1.2 0.1
State transfers 1.0 0.1
General revenue contributions 7.2 0.9
       

 

15.5 trillion projected out to infinity and 7.2 trillion to 2083.

http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf

Here are some other quotes from articles:

“Just to be clear, the Medicare drug benefit was a pure giveaway with a gross cost greater than either the House or Senate health reform bills how being considered. Together the new bills would cost roughly $900 billion over the next 10 years, while Medicare Part D will cost $1 trillion.”

 “when the legislation came up for its final vote on Nov. 22, 2003, it was failing by 216 to 218 when the standard 15-minute time allowed for voting came to an end.

What followed was one of the most extraordinary events in congressional history. The vote was kept open for almost three hours while the House Republican leadership brought massive pressure to bear on the handful of principled Republicans who had the nerve to put country ahead of party. The leadership even froze the C-SPAN cameras so that no one outside the House chamber could see what was going on.”

http://www.forbes.com/2009/11/19/republican-budget-hypocrisy-health-care-opinions-columnists-bruce-bartlett.html

“By the design of the program, the federal government is not permitted to negotiate prices of drugs with the drug companies, as federal agencies do in other programs. The Veterans Administration, which is allowed to negotiate drug prices and establish a formulary, pays 58% less for drugs, on average, than Medicare Part D.[32] For example, Medicare pays $785 for a year’s supply of Lipitor (atorvastatin), while the VA pays $520. Medicare pays $1,485 for Zocor, while the VA pays $127.”

http://en.wikipedia.org/wiki/Medicare_Part_D [i]

One other thing, if you hear anyone tell you that they do not take any give outs from the government and they are on Part D – they are absolutely wrong.  We will not even have to discuss what they paid into Social Security and Medicare and how much more they are taking out because:

-they are living longer

-the increasing cost of health that was way off when it was calculated in their employment years   

They never paid anything into Part D and the money they pay for their drugs is very small compared to the cost of the drug.  The 1 trillion dollar deficit over 10 years includes what they pay.

So, here we have it – Republicans did this:

-Gave the drug companies and insurance companies a trillion dollar handout over the next 10 years

-Total Cost to the tax payer is 15.5 trillion projected out to infinity

-Made sure we could not negotiate these costs in bulk

1 trillion dollars over 10 years for Part D is 100 billion dollars a year for 10 years.  It is more than the current estimate for the Health Care Reform bill (currently priced at 900 billion for 10 years in the Senate bill)!

Hello – If you vote for a Republican you are voting for Wall Street to get away with more than they already did – do you think the United States can survive this???

Folks, we need to understand that a vote against Big Government is a vote for Big Business.

My background is in business.  I was an engineer, low and middle manager in small, intermediate and large businesses.  I know it from the inside.  My significant other retired from the GAO so I know this side as well.  Here are some observations:

Government calls it tax => Business calls it profit – it all boils down to more money you pay from your pocket!

Government has programs that are wasteful (but not nearly as many as you might think) => Big business gives huge bonuses and stock options

Government has its share of inefficient employees => Big business keeps hiring and promoting worthless people that suck up the bottom line and many stay on when the company is sold

Government is too big => Big business is too big to fail

If you think there is a “free market” that makes Big Business better than Big Government you have bought hook, line and sinker into Republican propaganda – Big Business is NO better by any of the standards you want to compare with Big Government.  The best thing we can do is keep Big Business and Big Government at each other (see http://mixermuse.com/blog/2010/01/04/free-market-eitheror-government/ ). 

You gave Bush 8 years to lavish riches on Big Business – please give the Democrats time to try to reverse and offset those years.  If you are unhappy in eight years vote them out!  If you vote them out now you may as well say goodbye to the USA because the collapse we had on Wall Street will pale in comparison to what you are going to get!

[i]   In researching this paper I found what I think are glaring mistakes for the Wikipedia Medicare Part D article cited here.  I have put these comments in the talk section for this article and plan to correct it if there are no objections.

“Current “Program costs” Section is:

As of January 2006, the expected per capita drug spending, reported by the Department of Health and Human services, was $2,250, making the total cost of the program $42.75 Billion.[6] This budget compares with revenues of $54 Billion for Pfizer and $48.6 Billion for Johnson & Johnson, the two largest pharmaceutical companies. Kaiser Family Foundation, estimates the 2006 costs at $37.4 billion.[2] Total costs through 2015 are estimated to be $724 billion. Some of these revenues will be provided by “clawback” of revenues currently provided to the states for Medicaid. The “clawback” is a mechanism by which federal expenditures that benefit states (specifically regarding dual eligibles) are reimbursed back to the federal government. This reimbursement starts at 90%, but then falls to 75% in 2015. Figures also depend on per capita estimates of dual eligible expenditures and the number of dual eligibles that receive benefits.

As of January 2008, total Medicare spending for prescription drug benefits was projected to drop from $40.5 billion in 2007 to $36 billion in 2008. One factor contributing to lower costs is the increased use of generic drugs.[4] Shortly after the release of the 2008 Medicare Trustees’ Report,[25] the Chief Actuary testified that the 10-year cost of Medicare drug benefit is 37% lower than originally projected in 2003, and 17% percent lower than last year’s projections.[26]

In August 2008, CMS estimated that the 10-year cost of the program would be $395 billion, down from the original estimate of $634 billion.[15] (note: This link is dead.) In late October 2008, USA Today reported that costs were down by $6 billion, or 12%, for the fiscal year ended September 30. Costs for the program were approximately one third less than originally predicted.[27]

Proposed New “Program costs” Section:

As of the end of year 2008, the average annual per beneficiary cost spending for Part D, reported by the Department of Health and Human Services, was $1,517 [44], making the total expenditures of the program for 2008 $49.3 (billions). Total intermediate, projected expenditures from 2009 through 2018 are estimated to be $999.9 (billions). [45]

New “Program costs” References:

44. ^ 2009 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS, Table II.B1.—Medicare Data for Calendar Year 2008, Page 5 (Page 11 in pdf)

45. ^ 2009 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS, Table III.C19.—Operations of the Part D Account in the SMI Trust Fund (Cash Basis) during Calendar Years 2004-2018, Page 120 (Page 126 in pdf)

Notes for Talk section viewers:

– There are many links that are dead in this article. The data is also very old.

– I will try to update the article one section at a time starting with the program cost section. If there are no objections or requested additions I will update the “Program costs” section on 2/1

– The hyperlink for reference 44 is http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf

– The hyperlink for refernce 45 is also http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.pdf

– Any comments or feedback is highly welcome…”