Controlling Healthcare

In addition, the CBO - by law - could not score the "doctor fix" bill, which is 250 billion and is a separate piece of legislation (on purpose). You add in the 250 billion, and the short term savings is gone.

Also, this 600 billion in Medicare savings will never see the light of day. Congress has been kicking this can since 1997. Every year, Congress looks to pass this "savings" bill and every year, it fails. Why? Doctors are already taking a bath on Medicare and if they pass this "savings" bill, doctors might start turning away Medicare patients.

Of course - by law - the CBO cannot take this 600 billion that will never take place into account.

Health care reform will be quite costly and unpopular, but you know that Drum. It's all part of the trojan horse that progressives hope will lead to single payer.

I'm dying to know how many pages the final bill will be. After all, that's what's really important. /s

I continue to believe the commentators are missing the single greatest source of cost savings -- universality. This operates at both the provider and insurer levels. A huge proportion of doctor and hospital costs is driven by the uncertainty of payment: excessive billing administrators (e.g., 800 of them at 800-bed Duke U Hospital), transfers of uninsured patients between emergency rooms, searching for funding sources for uninsured patients, collection agents, multiple confusing mailings, accumulating finance charges on delayed payments, lawsuits for deadbeats. Knowing how, when and by whom the provider will be paid when the patient shows up at the door will change this dramatically, and when we have reduced this administrative waste -- as opposed to legitimate administrative costs -- it will help us focus on the pluses and minuses of other (and more radical) methods of cost control. (My guess is that other countries that get the job done better for half the cost, whether single-payer or even private-insurance-based systems, do so without many ofl these elaborate cost-control schemes.

Of course, it seems we are at 94%, and not yet 100%. I guess that's 94% of those not covered by Medicaid, SCHIP, Medicare or VA now, so as a percentage of the whole population it should be in the high 90s: 97-98%. But in order to get the full cost benefit of payment certainty for the provider, we should keep pushing towards 100.00%

At the insurer level, there will be larger pools to spread costs and reduced sums spent on seeking and fighting over pre-existing conditions. These should be strong downward forces on rates. Of course, that's where a strong, publicly-operated non-profit plan with the legal obligation to continue reducing costs and passing those reductions through for the insureds (Federal or regional if the population served is in the several tens of millions) becomes important -- to keep the pressure on translating those savings by insurers into reduced costs to the insureds. The ability of regulatory strictures against excessive profit-taking to do the job -- what some of the wonks tell us will be baked into the bill -- is at least questionable.

I would add that the biggest savings of all would come from socializing the cost of catastrophic claims. Everyone covered against very high healthcare costs, period. 100.00%. No more profit-taking on the people with really, really big health problems. In the case of private insurance companies, that profit-margin as applied in the catastrophic layer is on potential expenditures with a large margin of error built in. I'm guessing it's on the catastrophic cost layer where the lion's share of health insurance profits are allocated.

Let the for-profit private business go towards less personally-crucial gap and supplementary coverage.