This story will come as a surprise to no one except maybe the increasingly small handful of pundits who lie awake at night worrying about the perils of deflation:

Last month was open-enrollment season, and my wife and I got an unpleasant surprise. For 2010 we’re looking at an annual health-insurance premium that’s $1,600 higher than it is now, plus higher deductibles. Instead of flat co-pays, we’ll pay co-insurance, a share of the total costs. And this is with a plan provided by a Fortune 500 company that still spends big bucks on relatively generous benefits.

You may well be in the same boat. According to human-resources consultant Hewitt Associates, the average large-company employee will pay $4,023 in premiums and out-of-pocket costs next year — 10% more than in 2009 and more than three times the level in 2001.

Tyler Cowen published a report on health care in New Hampshire and Maine. Key quotes….

The health care reform bill before the U.S. Senate would require hospitals to publicize their standard charges for services, but New Hampshire and Maine have gone much further in trying to make health care costs more transparent to consumers.

New Hampshire and Maine are the only states with Web sites that let consumers compare costs based on insurance claims paid there.

In New Hampshire, the price variation across providers hasn’t lessened since the Web site went live in 2007.

Cowen offers a list of reasons as to why this not helped to alter costs. They are all plausible. They all fit with what I see in practice. People do not like going to facilities they do not know. Driving over an hour is cumbersome, and if in pain, difficult.

This also demonstrates that much of medicine is somewhat immune to competition. Geography and scarce/uncommon resources make it difficult to achieve competition. In this kind of situation, health insurance companies may actually be holding down costs. When the only large hospital for 70 miles ends up negotiating with the largest insurance company in the state, that insurance company has more negotiating power than any individual. What happens if go to free market reform of health care? No one knows for sure, but I think it just as likely prices go up in some areas and in some specialties, especially in places like Maine and New Hampshire. The consumer will negotiate for lower prices, the provider for higher charges. This negotiation will not always favor the patient.

In the rush of news about the various versions of the Democratic Health Care Plan, we seem to have lost track of the Republican Health Care Plan.  For those who have forgotten Grayson’s speech, the basic plan is quite simple: 1. Get Rich!  2. If you fail to get rich, then don’t get sick!  3. If you are poor and get sick anyway, then die quickly!

Although I personally favor government-supported universal health coverage, that is only an option in parts of the civilized world.  So, since that’s out for America, the next question is, what can we learn from the Republican Health Care Plan?  In the next few installments, I’ll point out some cheap and easy steps to reducing American Health Care costs.  The key to point one of the Republican Health Care Plan is unbridled greed.  But I see evidence that there are already plenty of people with unbridled greed.  “Insurance” companies, for instance. 

So, let’s focus on “Don’t get sick.”  A simple corollary of that is: “Don’t spread illness.”  When I was a kid starting about three or four years old and coughed or sneezed, my parents and other nearby adults would always scream: “Cover your mouth!”  ?? What happened?  It seems this little courtesy has gone the way of the penny post card and the four cent popsicle.  Nowadays, people on planes, trains and at the workplace just let loose with coughs and sneezes without the slightest hint of an attempt to prevent the spread of germs.  It’s disgusting.  And, costly.  If there were some sort of bonus for getting others sick, then I could understand it.  But if there is such a bonus, I haven’t been apprized of it.  So….??  What gives?  Is there some sort of tax imposed when you cover up when you sneeze or cough?  I don’t think so.  At least not yet.  So, meanwhile, here is point one to reducing Health Care Costs: COVER UP WHEN YOU SNEEZE OR COUGH.

Senate passes historic health bill – - POLITICO.com.

Fellow blogger Janice has been carrying on the good fight to control costs at her hospital. A group of us at my hospital have been doing the same in a less formal way. I generally feel as though we are fighting a losing battle. For every dollar we save, the medical entrepreneurs seem to find some way to get paid another hundred. However, over the last year, I have noted a change in my conversations about patients with some of the newer physicians on staff. In our discussions, the issue of costs is being brought up.

Just this week, I had an elderly woman with a very severely fractured shoulder which she hurt while working on her farm (these old farm ladies are tough). It was pretty clear that she had bled a lot into her shoulder, and probably still had some small amount of bleeding going on. One of the good young internists at our place had seen this lady and orchestrated her work up and management. He did a nice job. I was consulted fairly early in the process for a question about her cardiac status, so I called to discuss the patient with him. He suggested a less expensive study rather than going with the whole nine yards, many thousands of dollars work up, which would usually be the norm. He reasoned that this would cost less, but tell us what we needed to know. I agreed. In this case, no amount of testing was likely to change our management. Would it be nice to know everything? Maybe, but I could not see how it would actually help the patient. The internist agreed. We fixed her shoulder and she did fine.

For those not in the trade, it may not be apparent what a change this represents. In the good old days, the argument was often made that we should do everything thing we could to find out everything about patients before surgery. Sounds reasonable at first, yet when you do the studies you find out that a lot of these tests did nothing to affect outcomes. Worse, some tests had negative effects of their own. All while driving up costs, and salaries. Somewhere, this young physician had learned that we have choices and that these have costs. Following a cheaper course that gives us the information that we actually need, rather than doing every test you can think of makes good medical and financial sense.

I have had similar conversations with several of our younger staff over the last year. Maybe this counts as a trend.

Here are links to more stories that stick in the gut.  You know how after someone special in the house makes Christmas cookie dough and presses it into those shapes and then leaves the “presser” in the sink to clean?  Well, pick one of those up, unscrew the lid and put that cookie dough in your belly.  You know what you get?  A gut-bomb. You know it’s there and you can’t do anything about it except hope that the raw egg in it doesn’t make you puke.

Ben Nelson – Vote for Sale: SOLD

Chris Dodd – Vote for Sale: SOLD

Mary Landreaux – Vote for Sale: SOLD

The way to pass health care, I guess

It’s probably a good thing that I’m not a mathematician or I’d press into just how much money this health care bill is going to cost and when.  I do know this, that once it is signed, taxes will go up.  Once it is signed, Medicare benefits will go down and premiums will go up:

The Proof in the Pudding

I’ve tried to pinpoint just what it is about all of this that is so unnerving.  Maybe foremost is the secrecy and bribery.  Next would be absent-mindedness of spending so much money.  Also, the way it seems as if the folks in D.C. don’t realize that we have to cash the checks they write.  Funny thing about that is they increase the debt limit, spend more than ever before and still raise our taxes.  It’s almost as if the SOP up there is “spend it now, when the punishing effects kick in I’ll be dead or out of office.”

Who is thinking about the future?

(CNN) — Senate Democrats claimed a major victory this weekend after voting to end debate on their version of the health care bill.
The Senate is on track to hold a final vote on Christmas eve, but there’s still a long way to go before a bill is on President Obama’s desk.
Here are answers to some frequently asked questions about what’s in the House and Senate health care bills and what’s next.
Where does the health care debate stand?
The House passed its version of health care reform last month. The Senate, which follows different procedures than the House, is slated to vote on its version of the health care bill before Christmas.
Senate Majority Leader Harry Reid needs a simple majority of 51 votes for final passage. Assuming the bill makes it through the Senate, a conference committee will then need to iron out the differences between the House and Senate versions and merge them into one bill.
Both chambers will then need to pass the revised bill before it is sent to the president’s desk.
Read Dr. Sanjay Gupta’s take on the health care bill
Why does Obama want health care reform?
The president made health care reform his top domestic priority. He says overhauling the health care system is key to getting the economy back on track.
The president says he wants to reform health care in order to slow the growth of costs for families, businesses and the government. He also wants to ensure that all Americans have access to affordable health care, regardless of their income or medical history.
How to read a 2,000 page bill
health bill ,

The House plan is projected to guarantee coverage for 96 percent of Americans at a cost of more than $1 trillion over the next 10 years, according to the nonpartisan Congressional Budget Office.
The Senate plan is projected to cover 94 percent of Americans with an $871 billion price over the next 10 years, according to the CBO.
How will this be paid for?
The House plan imposes a 5.4 percent income tax surcharge on individuals with annual incomes over $500,000, as well as families earning more than $1 million.
The Senate plan increases the Medicare payroll tax on individuals earning more than $200,000 and couples earning more than $250,000 from the current 1.45 percent to 2.35 percent.
The Senate bill also imposes a new tax on insurers that provide so-called “Cadillac” health plans valued at more than $8,500 for individuals and $23,000 for families. The 40 percent tax would be on the value of the plan. In addition, it imposes a 10 percent tax on indoor tanning salon treatments.
Both bills call for cutting hundreds of billions of dollars from Medicare and Medicaid. Republicans say that those cuts will impair Medicare coverage, but Democrats say the savings will come from eliminating waste and fraud.
The House and Senate bills also call for fees on medical device manufacturers.
Do I have to buy health insurance?
The House and Senate bills both require individuals to buy health insurance. The House bill imposes a fine of up to 2.5 percent of a person’s income for noncompliance.
The Senate plan imposes a noncompliance fine that starts at $95 in 2010 and escalates to $750 in 2016. It also requires parents to provide health coverage for children up to age 18.
What if I can’t afford coverage?
The House and Senate plans both include a hardship exemption for poorer Americans.
Both bills subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.
With subsidies, premiums for a family of four at 133 percent of poverty ($29,326.50) would be a maximum of $440 under the House plan, while premiums for a family of four making the highest amount eligible would be a maximum of $10,584.
Under the Senate plan, with subsidies, premiums for a family of four at 133 percent of poverty would be a maximum of $821.14, while premiums for a family making the highest amount eligible would be a maximum of $8,643.60.
I own a business. Do I have to provide coverage for my employees?
The House plan requires companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.
Under the Senate plan, starting in 2013, companies with more than 50 employees would be required to pay a fee per worker if its employees rely on government subsidies to purchase coverage.
What if I have a pre-existing condition?
Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.
Both plans also bar insurers from charging higher premiums based on a person’s gender or medical history. Insurers can only vary rates based on three things: age, geography and family make-up/size.
What is a health insurance exchange?
“Health insurance exchange” refers to the marketplace of the health insurance options. Obama has defined the exchange as a “one-stop shopping marketplace where you can compare the benefits, cost and track records of a variety of plans — including a public option to increase competition and keep insurance companies honest — and choose what’s best for your family.”
The House bill creates a national health insurance exchange designed to make it easier for small businesses, self-employed and the unemployed to pool resources and purchase less expensive coverage.
The Senate bill creates state health insurance exchanges in all 50 states.
What is a health care co-op?
Nonprofit health cooperatives, or “co-ops,” are being proposed as an option to compete with the private sector and as an alternative to a government-sponsored public health insurance option. Co-ops are owned and governed by the same people they insure.
The House and Senate plans both establish “co-ops” and strip insurance companies of an antitrust exemption that has been in place since the end of World War II.
What happened to the public option?
The House bill creates a public option, which is a government-funded, government-run health care option, similar to Medicare. The public option would be a part of an insurance exchange available to people without coverage or unable to afford private coverage.
The Senate bill does not create a public option. Instead, it allows nonprofit private insurers to offer coverage with approval of Office of Personnel Management, which oversees the federal employees’ health plan.
What will happen to Medicaid?
The House and Senate bills would both significantly expand Medicaid, the government-run health care plan for the poor.
The House plan extends coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four.
The Senate plan extends coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.
Will abortion treatments be funded with federal dollars?
The House bill prohibits any health plan receiving federal subsidies from offering coverage for abortion.
The Senate plan allows states to choose whether to ban abortion coverage in health plans offered in the insurance exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.
Will illegal immigrants be covered?
The House bill mandates insurance coverage for illegal immigrants and allows illegal immigrants to enroll in the public option and to buy private coverage in the national insurance exchange, but prohibits government subsidies for such private coverage.
The Senate plan exempts illegal immigrants from the health coverage mandate, and prohibits illegal immigrants from participating in the insurance exchanges.
http://www.cnn.com/2009/POLITICS/12/21/health.care.faqs/index.html

Senate advances landmark health bill – - POLITICO.com.

Our good Wired Sister CynThesis’ anticipated essay on third party funding as an economic problem in its own right has just been published in our Featured Works section:

One is a Hermit, Two is a Conspiracy, Three is a Party

H. M. Stuart

Alexandria

Generally pleased by the recent legislation passed by the U.S. House of Representatives addressing many of the concerns of Americans regarding healthcare, Daniel Touizer, CEO of Cinergy Health wishes the legislation went further and concerned itself with what Mr. Touizer believes are crucial issues.

Explaining that “the house healthcare bill is far from perfect,” Daniel Touizer commented that, “at least it is a step towards expanding access to affordable health coverage for all Americans.”

“Unfortunately,” according to Mr. Touizer, “the House healthcare bill is radically off the mark from what meaningful health reform needs to address. While it contains elements of an effective healthcare reform bill such as emphasis on prevention and healthcare affordability, it fails to tackle the roots of rising healthcare costs.”

Daniel Touizer would like to see legislation with more of an emphasis on promoting healthier life styles and habits, as well as a reduction in the cost of medicines and drugs and hospital-based care. Also allowing consumers access to health care coverage over state lines could help increase competition and decrease prices to consumers of healthcare coverage.

Taxing medical procedures, of any kind, can have a negative effect on health care costs and access to patient care.   This tax will be the responsibility of the patient to pay and the physician to collect.

Why oppose this tax?

• Taxes the Middle-Class  
• Discriminates Against Women
• Violates Patient Privacy
• Compromises Patient Safety
• Is Arbitrary and Difficult to Administer
• Has Failed State Experience

How You Can Help

It’s simple.  By using the below resources, you can help put a stop to Senator Reid’s proposed tax on cosmetic procedures.  The tax could be implemented as soon as Jan. 1, 2010 – so the time to act is now.  You can make a difference!

Call 1-877-221-8207 NOW

…to contact your members of Congress to oppose the cosmetic tax!

I’ve been a bit busy, so I’m a little late to this. The senate just passed an amendment to the current health care bill which will include mammograms as mandated coverage.

The problem is this:

A panel of experts, appointed by the federal government, recently changed its recommendation and said that such routine mammograms should begin at age 50 rather than at age 40.

Yet, what did the politicians say? They say that is just a general guideline and that really, if the doctor says you should get it, then you should get it and it will be paid for.

The Democrats’ health care bill would generally require insurers to provide preventive treatment recommended by the expert panel, the United States Preventive Services Task Force. But lawmakers in both parties made clear that they wanted doctors to decide when a mammogram is medically necessary and that insurers should be required to cover the cost if the procedure is needed.

Now, I’m risking sounding like I’m some hater of women’s health. Who could be against mammograms? Surely, they have saved many lives. True. But this is a small example of a much, much larger problem. When a group of experts got together to determine when mammograms should be given, they came up with age 50 as the optimal cost-benefit age. This is because they determined that giving mammograms to younger women in general was a waste of health care spending. The fact is that we cannot afford to give tests to everyone in order to absolutely maximize the chances of early detection of cancer with no regard for cost. I’ve discussed this general concept earlier – it is a form of rationing. Also, more on prevention here.

You don’t have maximal car insurance because it is expensive. You don’t have a top notch security system because it is expensive. Yet, we all want maximum security, right? These things are rationed by price and over time, we get better insurance and better security for less money as businesses innovate and compete.

If we continue to want to have any test for free as early as possible, we will indeed maximize early detection and prevent a lot of cancer, but it will be really, really expensive. The problem is that for us, it will be “free” but we all will pay the bill. We cannot have “insulation” – we need insurance. Which must have its limits, somehow.

Dems may drop Medicare expansion – - POLITICO.com.

By MICHAEL GORMLEY (AP) – Nov 30, 2009 ALBANY, N.Y. — New York’s fiscal crisis is now expected to have to take another $10 million from the anti-tobacco program to help balance the state budget. Anti-smoking forces believe the proposal would end a TV ad campaign and eventually cost more in health care costs. read more here

What we read while looking for a more suitable sponsor…

• Has this climate controversy been blown out of proportion? But then what will Al Gore and Sarah Palin have to argue about?

• With a few exceptions, we’ve more or less stayed neutral on this health care disaster. Well,  Atul Gawande thinks the new bill could end up saving money. Wait, what?

• While behavioral economics has its problems, it also leads to some fascinating insights, particularly with regards to eating out at restaurants. Check out this interesting analysis of a restaurant menu.

• It has been empirically verified: Close games are more enjoyable than blowouts (well, depending on how you define enjoyable).

• It has been empirically verified: Some people choose not to own cats. Which, depending on your perspective, seems to verify this article’s thesis.

• We almost always recommend something from it, but consider reading this week’s NY Times Magazine cover to cover: It’s the 9th Annual Year in Ideas Issue and it features an interview with eminent University of Chicago Philosopher Martha Nussbaum.

• When we read Russian lit–and you know we do–we do our best to procure the translation by the husband and wife team of Richard Pevear and Larissa Volokhonsky. The Millions recently did an interview with the pair about their methods, philosophies, and future projects.

Copyright 2008 Gannett Company, Inc.All Rights Reserved

USA TODAY

December 29, 2008 Monday FINAL EDITION

SECTION: NEWS; Pg. 10A

LENGTH: 542 words

HEADLINE: Lawyers’ bills pile high, driving up health care costs

Health care costs are out of control, as we heard constantly during the presidential campaign…
Original Link:Lawyers’ Bills Pile High, Driving Up Health Care Costs – insurancebazaar.net

It is easy to cut budgets.  Not easy to cut real costs. Congress is looking for ways to pay for its expansion of medical coverage for the uninsured and underinsured. Their assumption is that most of those who are uninsured could not afford any premium payments for medical services.  They plan to pay for their plan with taxes on select groups (small businesses, the wealthy, etc.), by cutting Medicare spending and by an assortment of fees and surtaxes, such as the proposed 5% tax on cosmetic surgery procedures.  The problem with all of this is that it requires assumptions on the part of those writing these bills.  Remember, most of those actually writing these bills are 20 and 30 something staffers, not the Senators and House members themselves.  Most of these staffers have degrees in political science, social science and law. Most have never run a business, met a payroll or indeed done much of anything other than get paid by the taxpayers to do the bidding of the elected, who also feed at the public trough.

First, there is the assumption that those uninsured cannot afford to pay for insurance.  The uninsured, which number about 30 million CITIZENS, are made up of young, healthy singles and couples who CHOOSE not to spend any disposable income on health insurance, but often have the latest video device, cell phone or xBox; those who have lost jobs, and have failed to pay their COBRA premiums to maintain their employer based coverage while they look for employment, despite recent federal efforts to cover a large part of that premium (up to 75%); the truly needy, who cannot afford private coverage, but make too much money for Medicaid; those who are dysfunctional in that they qualify for Medicaid but do not take the time to even apply and get enrolled.  The solutions here are quite obvious: health insurers need to write basic, no frills policies which cover catastrophic illness and basic wellness (vaccinations and check ups); individuals need to take responsibility to actually buy health insurance or enroll in Medicaid.  No need for massive government programs here.

Second, there is the plan to selectively, target taxes to businesses and individuals with upper incomes, while allowing 98+% of the population to avoid any contribution to what is to be a national solution.  This is classic ’soak the rich’, leftist philosophy.  Sadly, as is always the case in a market economy, when there is a downtown, those inclined to socialist thought take advantage of the opportunity to advance their beliefs, discredited beliefs we think, based on the history of socialism in Europe and elsewhere.  This form of payment still divorces the majority of the citizenry from the economic realities of the program being foisted upon them.  All need to be included in any plan to pay for such an expansion of federal reach.

Third, surtaxes and fees on such things as cosmetic surgery are punitive.  They assume that only movie stars, high paid models and the rich and famous actually use cosmetic surgery services. The fact that these elective procedures, including teeth whitening, are generally not paid for by private insurance, Medicare or Medicaid, should be sufficient.  It is estimated that the majority of cosmetic procedures are performed on women that earn between $30,000 and $90,000 a year.  Hardly the polo club set.  This tax represents a dangerous foot in the door to justify actions by the federal government to decide what procedures are or are not “necessary” and what should or should not be paid for (and what should be selectively taxed).

Fourth, the now famous, or infamous, nearly $500 billion in “savings” Congress plans to achieve by cutting fraud and abuse in Medicare spending.  Be our guest.  No serious observer believes that there is this much fraud and abuse to be cut.  Yes, there is fraud, but CMS and HHS seem to be willing to merrily go along with paying out millions of dollars of fraudulent claims because they are too inept, lazy or derelict to deal with the problem.  They know where the fraud and abuse is and yet they are very late to the game in catching it.  Legitimate practitioners and facilities, have inspections, licenses, re-inspections, certifications and the like.  Get the idea.  Almost all realistic opinions believe that to achieve this much in “savings” from Medicare there will need to be major cuts in services.  Just this year, 2010, the Medicare monthly base fee rose from around $95 to $110.  That is not inclusive of surcharges on those making higher incomes (again essentially a punitive tax on what is supposed to be an insurance premium).

Finally, the wheel and deal style the Democratic leadership has embraced may in the end be their undoing or at least present major hurdles.  Promising everything to everyone and every group while expecting a minority to pay for it is a recipe destined for discord, disunity and potential failure.  It did not have to be this way.  Real, meaningful, substantive health reform was and may still be within our grasp.  However, the current leadership in Congress only knows the back room style of debate.  We remain hopeful, but optimism is fading.  Come on folks, we can do better than this . . . obi jo and jomaxx

Finding the Nerve to Cut Health Costs – http://www.nytimes.com/2009/12/09/health/policy/09leonhardt.html?emc=tnt&tntemail0=y

Botax? Nip/tuck levy to help fund health plan – http://www.msnbc.msn.com/id/34048874/ns/health-health_care/

Deals cut with health groups may be at peril – http://www.washingtonpost.com/wp-dyn/content/article/2009/12/05/AR2009120503235.html

Budget Hawks Have a Buffet of Options With Health Bill – http://www.nytimes.com/2009/11/25/health/policy/25leonhardt.html

www.blogsurfer.us

www.bloglines.com     www.blogburst.com     www.blogcatalog.com     www.clusty.com     www.reddit.com

www.digg.com     www.wikio.com     www.propeller.com     www.mashable.com     www.bing.com     www.wellsphere.com

Encouraged by the pro-active stance the United States government is taking towards changing the way health care is distributed in the country, Daniel Touizer, CEO of Cinergy Health, an alternative health care insurance provider, would like to see more innovative and common sense ideas  injected into the health care coverage Americans have access to.

Mr. Touizer, who is an entrepreneur and small business expert at the helm of Cinergy Health, is leading the way in finding solutions to some of the most perplexing health care issues now being debated in the turbulent health care discussion in the U.S.

Daniel Touizer would like to see U.S. legislation which has a stronger focus on reducing rising costs of healthcare and improving the health of Americans through better, healthier living and lifestyles.

Sen. Max Baucus (D-MT) begins by quoting Teddy Roosevelt wanting a system of “social insurance” to protect against “home life against the hazards of sickness”.

He criticizes those “who stand in the way,” “who are spreading misinformation about how health care reform will work,”  and who claim “that health care reform is about the government trying to take over health care,” raise taxes and increase costs for health care.

Then he gives ten points to refute those claims.

 http://www.c-spanvideo.org/congress/?q=node/77531&id=9068647

Text From the Congressional Record

[Page: S11988] GPO’s PDF

The ACTING PRESIDENT pro tempore. The Senator from Montana.

Mr. BAUCUS. Mr. President, before I give a statement on the bill, I wish to compliment the Senator from Maryland for standing up for and essentially helping the health care of women. As she has pointed out, women are discriminated against today in America in various ways. Her amendment addresses some of that discrimination. I very much appreciate that. I know all women in the country do. I do, too. I have a mom. I have sisters. I have women in my family, and I very much care.

I don’t know if she made this point, but about 80 percent of health care decisions made for families are made by women. It is all the more important women are not discriminated against, partly because they make so many decisions that affect health care for Americans, but second, women themselves are often discriminated against. Some States have gender ratings which discriminate against women. In other States a preexisting condition is a factor that discriminates against women.

I thank the Senator from Maryland. She has hit the nail on the head. It is another reason this health care reform is going to mean so much for so many Americans. I personally very much thank the Senator from Maryland.

In the Presidential campaign of 1912, Theodore Roosevelt’s platform said:

We pledge ourselves to work unceasingly in State and Nation for ….. the protection of home life against the hazards of sickness ….. through the adoption of a system of social insurance adapted to American use.

Today, nearly a century later, we are closer than ever to enacting meaningful health care reform.

As in Teddy Roosevelt’s time, we seek protection against the hazards of sickness. Of necessity we seek a system uniquely adapted to American use. And recognizing the daunting task still ahead of us, we pledge ourselves to work unceasingly to get the job done.

In the years since Teddy Roosevelt, some of our Nation’s greatest leaders signed up for this job. But at the same time, we have never faced a greater need to get the job done than we do today.

Why is that? Basically because health care costs are skyrocketing out of control. Every day American businesses are forced to cut benefits for their workers. Why? To remain competitive in the global marketplace. Every 30 seconds another American files for medical bankruptcy. Just think of that. Every 30 seconds another American files for medical bankruptcy. Every year, about 1.5 million families lose their homes because of health care costs. Our system is in crisis.

We have a historic need and we have a historic opportunity. We have an opportunity to enact groundbreaking reform that will finally rein in the growth of health care costs and help bring financial stability back to American families and businesses.

Unfortunately, there are some who stand in the way. Unfortunately, there are some who are spreading misinformation about how health care reform will work. On this very floor I have heard arguments that health care reform is about the government trying to take over health care. That is false.

The truth is, health care reform is about allowing patients and doctors to take back control of health care. We need to allow patients and their doctors together to take back control from the big insurance companies.

Our plan would not increase the government’s commitment to health care. But don’t just take my word for it. The nonpartisan Congressional Budget Office says:

[D]uring the decade following the 10-year budget window, the increases and decreases in the federal budgetary commitment to health care stemming from this legislation would roughly balance out, so that there would be no significant change in that commitment.

That is right, health care reform will not increase the Federal Government’s budgetary commitment to health care.

I have also heard it argued that health care reform will increase the budget deficit. That, too, is false–plainly, patently false.

The bipartisan Congressional Budget Office says our plan would reduce the Federal deficit by $130 billion within the first 10 years–reduce the deficit in the first 10 years. That trend would continue, the CBO says, over the next decade. During the next decade, CBO says our bill would reduce the deficit roughly $450 billion. That is nearly one-half trillion dollars in deficit reduction, according to the Congressional Budget Office, in the second 10 years.

I have also heard it argued that health care reform will raise taxes. That, too, is false. In fact, health care reform will provide billions of dollars in tax relief to help American families and small businesses afford quality health insurance–tax cuts.

The Joint Tax Committee–again bipartisan and which serves both the House and the Senate–tells us, for example, that our bill would provide $40 billion in the tax cuts in the year 2017 alone–$40 billion in tax cuts in the year 2017. The average affected taxpayer will get a tax cut of nearly $450. The average affected taxpayer with an income under $75,000 in 2017 will get a tax cut of more than $1,300.

Let me repeat that. The average affected taxpayer with income under $75,000 in 2017 will get a tax cut of more than $1,300. They will also get a tax cut in earlier years, but it ramps up to that amount in 2017.

In the same vein, I have heard claims that health care reform will result in an increase in higher costs for Americans. That, too, is false.

Health care reform will not result in higher costs for Americans. Health care reform is fundamentally about lowering health care costs and making quality health care affordable for all Americans. Lowering costs is what health care reform is designed to do, lowering costs; and it will achieve this objective. How? In many ways.

[Page: S11989] GPO’s PDF

GPO’s PDF First, health care reform will end abusive practices by insurance companies. Reform will stop insurance companies from denying coverage or hiking up rates for those with a preexisting condition. We stop that in this legislation. That will lower costs. Reform will stop insurance companies from dropping coverage or reducing benefits for those who get sick.

Those reforms protect consumers, and they will protect Americans and reduce premium costs for Americans who are sick. These reforms will also help lower costs for small businesses and their employees. Right now, if one employee in a small business gets sick–just one–insurance companies can double the premiums they charge the whole business. I know that is true. I have heard that time and time again from small business owners in Montana. That is just because one employee gets sick, the insurance companies jack up premiums, double the premiums they otherwise would charge the whole business. That is just wrong. We stop that in this legislation.

How else do we lower costs in this bill? Health care reform will provide billions of dollars in tax credits and reform will limit out-of-pocket costs such as copayments that insurance companies are able to charge. We limit them. This will also help to ensure Americans can afford their total health care costs and not just their premiums.

That is very important. Premiums and out-of-pocket costs are both addressed by this bill. It limits growth in premiums and also limits growth in out-of-pocket costs. So total cost–premiums plus out-of-pocket costs–for Americans will be lower under this legislation than otherwise would be.

Third, health care reform will work to repeal the hidden tax of more than $1,000 in increased premiums that American families pay each year in order to cover the cost of caring for the uninsured.

Today, millions of Americans without health insurance are too often forced to turn to emergency rooms to get the care they need, and then health care providers shift the cost of that care to other Americans with health insurance. People with insurance, therefore, pay higher premiums. By providing quality, affordable health insurance to millions more Americans, health care reform will reduce this hidden tax and reduce premiums for all Americans–$1,000 per year per family due to uncompensated care. That is that hidden tax. This bill will virtually stop that hidden tax, stop that additional $1,000 that goes to average family premiums.

How else do we reduce health care costs? By providing affordable health care to more Americans which will increase the number of Americans in the insurance market. Why? What is so good about that?

One reason is more people will have health insurance. But also it will spread the risk of paying for an accident or disease more broadly. Spreading the risk more broadly should lower premium rates for everybody. It is a basic tenet of insurance.

Fifth, health care reform will reduce costs by cutting administrative redtape. That is no small item. Today, insurance companies spend a lot of time and money finding ways to discriminate against people. They spend time and money to find ways to drop coverage, and insurance companies pass those administrative costs on to all Americans in the form of higher premiums. The figure I heard is about 18 percent of American health care dollars is administrative costs. This legislation would dramatically reduce that percentage to a much lower number. We don’t know to exactly what level yet but a much lower level. About 18 percent of total health care dollars go to pay administrative costs. That is not the case in other countries. They pay 4 to 5 percent in other countries. We have to get that down in America, and health care reform will significantly achieve that result.

Health care reform will outlaw this discrimination, and also reform will eliminate those administrative costs that go along with it. Furthermore, health care costs will work to streamline administrative procedures across the board by requiring standard enrollment forms and marketing material through insurance exchanges. That, too, will help streamline procedures. That, too, will help reduce administrative costs for providing for standard enrollment forms and also standard marketing materials through insurance exchanges. That is going to lower administrative costs and make it much easier for a person to shop and know which policy is best for him or her. With the other reforms we are making competition is more on the basis of price not just underwriting, a fancy term for denying because of a preexisting condition and putting in all those extra escape clauses insurance companies often provide in small print.

In a letter released today, the Congressional Budget Office said:

Compared with plans that would be available in the nongroup market–

And they are referring there to the individual market–

under current law, nongroup policies under the proposal would have lower administrative costs.

Let me say that again. Compared with plans that would be available in individual markets–individuals seeking insurance–under current law, individual policies under the proposal would have lower administrative costs.

Lower, not higher. Lower.

Six–another way to reduce costs. Health care reform creates insurance exchanges where consumers can easily shop and compare plans to find the right coverage. Exchanges will make it easier for Americans to choose the most efficient plans, and that will reduce their costs and put pressure on insurance companies to offer lower cost, higher quality plans.

Seven–still another way this bill reduces costs. Small business insurance exchanges will allow small companies to pool together to spread their risk and increase their buying power. More pooling available for small business insurance exchanges–this will allow small businesses to negotiate lower rates and provide more quality insurance plans with lower premiums to their employees.

Eight. Health care reform will strengthen oversight and enforcement measures to cut down on fraud, waste, and abuse in the health care system. Fraud, waste, and abuse are estimated to cost our health care system more than $60 billion every year. This bill will help reform our system to reduce fraud, waste, and abuse, which eats up way too many health care dollars.

Nine. Health care reform will move the focus of our system toward efficiency and value with payment incentives that reward quality care–not quantity and volume but reward quality care, reward outcomes. Over the long run, paying doctors and other health care providers for quality instead of quantity will reduce health care costs.

Ten. Health care reform will lower costs by working to change the focus of our health care system from treating sickness to promoting wellness. The big problem we have today is that we treat sickness. We don’t spend enough time promoting wellness. Reform will make critical investments in policies that promote healthy living and help prevent costly chronic conditions that drive up costs throughout the system.

These are just 10 examples of how health care reform will reduce health care costs and lower premiums for American consumers. There are many more, but these are those 10, as I said. On the other hand, without reform; that is, without passing this legislation, costs are guaranteed to continue to skyrocket out of control.

Since Congress failed to enact health care reform in the 1990s, health care premiums have risen eight times faster than wages. Consider that. Since the last time we attempted to pass health care reform–and failed–in the 1990s, health care premiums have risen eight times faster than wages. And if we don’t reform our health care system now, premiums will increase 84 percent in the next 7 years. And that is just premiums. What about out-of-pocket costs? Those, too, will increase at a rate much faster than wage increases.

Today, health care coverage costs the average American family more than $13,000 a year, according to the Kaiser Family Foundation. If current trends continue without reform, the average family plan will cost more than $30,000 a year in the next 10 years. That is up from $13,000 today to $30,000 10 years from now. And businesses could see their health care costs double in that same time. Without reform, our Nation’s long-term fiscal picture is almost certainly unsustainable.

[Page: S11990] GPO’s PDF

 GPO’s PDF As Peter Orszag said when he was Director of the Congressional Budget Office:

Rising health care costs represent the single most important factor influencing the Federal Government’s long-term fiscal balance.

He was right. Without reform, instead of working to reduce our national deficit and stabilize the Federal budget, we will see total health care spending nearly double to encompass one-fifth of our gross domestic product in less than 10 years. And the Congressional Budget Office projects entitlement spending will double by the year 2050.

Without reform, millions of uninsured Americans will continue to suffer. A Harvard study found that every year in America, lack of health care coverage leads to about 45,000 deaths. People without health insurance have a 40-percent higher risk of death than those with private health insurance. You have a 40-percent higher chance of death if you don’t have health insurance compared with those who do. That is 46 million Americans at risk today because they do not have health insurance. A recent Johns Hopkins study found that children without insurance have a 60-percent higher risk of death than those with private health insurance–a 60-percent higher risk of death than those with private health insurance.

Another recent Harvard study found that the risk of dying from car accidents and other traumatic injuries is 80 percent higher for those without insurance–80 percent higher. The risk of dying from car accidents and other traumatic injuries is 80 percent higher if you don’t have health insurance. In the greatest country on Earth, no American should die simply because they do not have health insurance.

So, Mr. President, we are at a crossroads in history. We have a historic opportunity to enact meaningful health care reform that will work to stabilize our economy and provide quality, affordable health care coverage for millions of Americans. We are not the first to be here, but we have come further than ever before.

We laid the groundwork in the Finance Committee and the HELP Committee. We held many hearings and countless hours of meetings on health care reform. Each committee crafted meaningful legislation and held exhaustive markups where we incorporated amendments from both sides of the aisle. We produced balanced, meaningful legislation, and I am proud–I am very proud–of the work both committees accomplished. Now we have one health care plan before us in the Senate, two basic bills merged together. We have an opportunity to debate that plan and offer amendments to make it even better. Then we will be called upon to vote.

The health care of our Nation is depending on us. The health care of our economy is depending on us. History itself is depending on us to answer the call. I am confident we will. I am confident we will at long last answer the call of history. I am confident we will soon enact meaningful health care reform that will lower costs and bring quality, affordable coverage to millions of Americans.

Report: Senate Health Bill Will Raise Costs

Republicans on Friday seized on a report by government actuaries that said the Senate health bill would cause national health costs to rise.

The report, compiled by the chief actuary at the Centers for Medicare and Medicaid Services, estimated that total health costs in the U.S. would be $234 billion higher than if the bill weren’t passed. President Barack Obama has said Democrats’ health plan would reduce the growth of health-care costs.

Sen. Chuck Grassley of Iowa, the top Republican on the Senate Finance Committee, said Democratic lawmakers were spending large sums in the health-care bill “to make things worse.” Senate Minority Leader Mitch McConnell (R., Ky.) said the report “confirms what we’ve known all along,” arguing that the bill would “increase costs, raise premiums and slash Medicare.” Democrats cited some parts of the report that were more favorable to the bill.

The report said measures in the bill to restrain Medicare costs and trim generous insurance plans “would have a significant downward impact on future health care cost growth rates,” but said those gains would be outweighed in the initial years as newly insured people sought to get more health care.

“This report is yet another clear indicator that we have to act, and act now,” said Sen. Max Baucus (D., Mont.), the chairman of the Finance Committee.

The report said 33 million more U.S. citizens and legal residents would be insured under the bill, resulting in 93% of Americans with health-insurance coverage. But it said the new demand for health care caused by the bill could prove “difficult to meet initially” because doctors and hospitals would charge higher fees in response to the new demand. The report also said the bill’s proposed cuts in Medicare spending “may be unrealistic.”

In addition to expanding coverage, the Senate bill creates a long-term-care insurance program that would provide a daily subsidy for those with disabilities and illnesses who require home-based care. The report cited a risk of “adverse selection,” saying people who were more likely to require care would be more likely to use the new insurance. That could cause insurance payouts to exceed premium revenue.

“There is a very serious risk that the problem of adverse selection would make the [long-term-care insurance] program unsustainable,” the report said.

See also:
CMS actuary warns Senate bill will cost more
A Blow to Health Reform? CMS Sees Cost Problems With Bill
Some Savings in Senate Reform Bill are Unrealistic, Says CMS Actuary
Report: Senate Bill’s Medicare Savings May be “Unrealistic
Roberts: CMMS study rebukes Reid health care bill
HHS Actuary Finds Senate Bill More Expensive Than “Unsustainable” Status Quo
Cost-saving reform measures questioned
Medicare cuts could hurt hospitals, expert warns
CMS Report Shows Reid Bill Is Worse Than Doing Nothing

So, let’s recap, Obama and the Democrats want to spend trillions of dollars to give us worse health care that costs more than not passing any health care legislation at all, what a deal!

/is there some rational reason for doing this or do Democrats just enjoy screwing the taxpayers and destroying our health care system?: