House Majority Leader Eric Cantor has created a Power Point presentation about Bowles-Simpson, the recommendations of the two leaders of the deficit commission. And this offers a window into Tea Party preferences for the fiscal slope and deficit deals. This is actually the key swing bloc in Congress; with President Obama on board with a grand bargain, and able to sway Democrats to his side, whether or not the deal happens could depend on whether Tea Party House Republicans get behind it. And so this Power Point provides some advance notice of the preoccupations of that bloc, as represented by Cantor, who has courted the Tea Party caucus since they took over Congress, contrasting himself with the dealmaking of John Boehner.
It actually starts off promising. Cantor correctly explains that our deficit problem is essentially a health care problem. “Health care costs are the primary driver of debt,” the Power Point reads. And Cantor explains, “It doesn’t matter what we do with defense spending, Social Security or other government programs,” because without restraining government health care costs, “we will have failed to get the deficit under control.”
I agree, and I think this is a point we can go back to again and again and again. Cantor’s own words nullify any need to drastically restructure Social Security, and the futility of wasting time on programs not essential to the deficit issue, like PBS or Planned Parenthood. I don’t totally agree about defense spending, but this is a gift from Eric Cantor that undermines the fiscal scold narrative about “runaway spending.”
Cantor also says that “economic growth matters a lot,” that the deficit shrinks in an environment of full employment, relative to a more moderate growth path. That’s absolutely true as well. “We must take into consideration what any plan does with regard to economic growth,” Cantor says. So far he’s on target.
But here’s what the National Journal correctly pegs as the key issue raised by Cantor’s Power Point:
Essentially, Cantor likes some parts of the plan that include proposals related to lower tax rates, federal retirement and reforming Social Security. But he has major beef with large portions, including the assumption that Bush-era tax cuts won’t be extended for couples making more than $250,000 annually.
So here’s what’s critical about that. Cantor wants a lower-the-rates, broaden-the-base strategy on taxes, the same strategy that Chuck Schumer has tried to stall. But he is well aware of the baseline issue.
See, Bowles-Simpson, in a bid to capture more money toward deficit reduction, assumed in their baseline that the Bush tax cuts above $250,000 would expire. That gave them another $850 billion to work with. But Republicans oppose this, instead preferring to extend all the current tax rates and make that the baseline policy. This is a significant difference, representing the starting line from which tax reform takes off. And what Cantor is saying here is that he’s not fooled. He won’t support Bowles-Simpson-like tax reform unless the full Bush-era tax cuts get extended, calling the baseline shift a “hidden tax increase” of $983 billion. He cites an Ernst and Young report showing the loss of 710,000 jobs as a result.
In addition, Cantor doesn’t like that Bowles-Simpson contains no major health care reforms for Medicare and Medicaid, and that it maintains Obamacare, the so-called “new health care entitlement.” This is a fundamental fact that goes overlooked. Bowles-Simpson is supposed to be this serious effort to tackle the debt problem. But it ignores the MAJOR DRIVER OF DEBT, health care spending. It essentially sets a growth path for health care programs at the rate of GDP plus 0.5%, similar to the Ryan premium support plan and Obama’s Independent Payment Advisory Board. But even unlike the Ryan and Obama plans, Bowles-Simpson offers no path to get to that rate of health care cost growth. It sort of waves at IPAB, but mainly it just says “get it done.” This makes Bowles-Simpson a ridiculous, magic-fairy-dust kind of deficit plan.
Cantor is right that the long-term debt problem is a health care cost problem. He even offers the two primary ways to restrain it: restricting (I would call it “bargaining”) how much you pay to health care providers, or “empower and incentivize individuals” to make decisions that control costs, i.e. turn people into “good health care shoppers.” There’s only one proven technique that has worked in every other country in the world to control health care costs, and that’s the former: bargaining as a single payer on payments to providers.
And so Cantor basically wants to throw out all of Bowles-Simpson except for the lower overall tax rates, Social Security changes and federal pension reforms. It really is mostly about tax cuts for rich people, and Cantor admits it.
Getting this back to the tax issue, this will bedevil efforts at a deal. Cantor is onto the baseline games, and he and his compatriots in the Tea Party don’t want to see any tax increase whatsoever on anyone. When the Bush tax rates expire at the end of the year, maybe this conversation changes. But Cantor calling out Bowles-Simpson on the baseline games suggests that he will view a tax increase very narrowly. Even a tax cut bill that doesn’t restore all the Bush-era tax rates will be called a tax increase by Cantor. And that makes a deal virtually impossible.




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Cantor makes the same logical error that every proponent of “consumer-driven” health care makes, which is to ignore the fact that the 20% of “consumers” who account for 80% of costs are not able, in any way shape or form, to participate in a market where they can make choices about their care – they are too ill. As for the other 80%, the cost savings will be negligible, it still does nothing to control costs, and all studies indicate that the behavioral hazard (making a poor decision regarding your care) is as deleterious as the moral hazard (overusing the system).
The pearl at the heart of the onion.
Yup, health care costs are the key. We pay at least half again as much per capita (for results that aren’t any better) than Canada, Europe, Japan, etc.
Doing something about it means confronting the sick care industry’s vested interests which are protected by their paid whores in the political class.
So that leaves cutting benefits…..or more simply, we’re f*cked.
Regarding increasing medical costs, one would think it would be easy to obtain comparative data on hospital room costs. It isn’t. This is the best that I’ve been able to get, from various sources, none of which I completely trust.
daily cost of US hospital room
1980 $127
1985 $212
2009 $2500
2012 $15,000
regarding health care expenditures
Victor Fuchs, Stanford University, has written a brief article on the explosive growth in health care expenditures from 1950 to the present. Fuchs positions this growth as “one of the most important economic trends in the United States in the post-World War II era” and supports that claim with some brief analysis and a couple of head-spinning comparisons:
– health care spending has gone from representing 4.6 percent of gross domestic product (GDP) in 1950 to more than 17 percent in 2009
– per capita expenditures (2009 adjusted dollars) has risen from $407 to $6,807 in the same time span
http://aharesourcecenter.wordpress.com/2012/04/09/faster-than-a-speeding-bullet-the-growth-in-health-expenditures-since-1950/
The idea that people should/could be good health care shoppers is absolute lunacy. Who wants to keep trying out new doctors? Who has the time to keep trying out new doctors? How do shop for the best prices in treatments if you are unconscious in the back of an ambulance? And ceteras.
I could rant on…
‘xactly. there are no honest brokers there.
Oh, I understood it was the turd in the punch bowl.
I spent 5 day in the hospital in May and the hospital cost alone was $60,000 – including the surgeon. That did not include all the tests and X-rays and CAT scans, etc. prior to the surgery.
Back in the ’80s we would have called this more Reagan trickle-down rhetoric.
Why is it the least bit interesting now?
According to the American Hospital Association, in 2011 approximately 5,754 registered hospitals existed in the U.S., housing 942,000 hospital beds along with 36,915,331 admissions.
Hospitals are just about the most dangerous places to be in the United States. Three times as many people die every year due to medical errors in hospitals as die on our highways — 100,000 deaths compared to 34,000. Also, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours.
I haven’t found any way to obtain reliable information on hospital costs, infection rates and waiting times. But I’m confident that those kinds of data will be available soon, on the web, just as information on physicians is now available.
That means that people and their insurance providers will be able to pick and choose, within limits of course, which of those 5,754 registered hospitals will continue to receive patients. The rest will go out of business, as they should.
surely you could have bargained for a better price – or gone to another facility, no? /s
Why do you think it’s been difficult getting that information?
Sounds like you got a bargain — less than 15 grand per day including the surgeon. Don’t move.
One of my workers almost cut off two fingers with a power saw last week. No overnight hospitalization, just day surgery cost $34,000.
My double coronary bypass and graft, 6 days in the hospital was $128,000 last year.
I tried but the local barber was busy. :)
Dude, never, NEVER get hurt on a Monday.
Although, some veterinarians are open then.
The Healthcare Associated Infections (HAI) Program is one of three programs in the Center for Health Care Quality of the California Department of Public Health. The Program is responsible for the surveillance, reporting, and prevention of infections in California’s general acute care hospitals as mandated by Senate Bills 739, 1058, and 158. The Program was authorized in December 2009.
HAIs are the most common complication of hospital care and are listed among the top ten leading causes of death in the United States. It is estimated that each year there are more than 1.7 million infections, 99,000 deaths, and $3.1 billion dollars in excess healthcare costs in acute care hospitals alone. Based on this data it is estimated that approximately 200,000 infections occur in California each year with an annual cost of about $600 million – $1.6 billion. The vision of the HAI Program is to eliminate HAIs for California patients.
http://www.cdph.ca.gov/programs/hai/pages/default.aspx
“. . . He even offers the two primary ways to restrain it: restricting (I would call it “bargaining”) how much you pay to health care providers, or “empower and incentivize individuals” to make decisions that control costs, i.e. turn people into “good health care shoppers.” –0–
It doesn’t matter how good of a ‘health care shopper’ a person is or how many figurative coupons they clip. If all the health care products are shitty, over-priced, and under-performing, nothing changes. It’s just treading water until financial exhaustion sets in and they drown. It has to be single-payer where the government can say to the providers, “This is what we will pay. Take it or find another career.”
Other countries have single-payer and they don’t seem to have any shortage of health care providers or hospitals.
I had a very similar experience in the fall last year for a 3 day stay. I kept saying I coulda bought a house, yes, a small house, but still…I was in shock.
Thank you for not.
We as healthcare consumers absolutely must get smarter about physicians, hospitals and appropriate care. It’s in our own best interest not to be ignorant about these matters. There is a lot of information out there and there will probably be more.
Should I have that elective surgery done, or not? is a question that only the person involved can answer and nobody else, including a physician. Hospitals? There is some information on the web. Make inquiries and then, if you can, find a physician associated with that hospital. There are ratings on physicians also. Personal care? Know the possible effects of medications and medical procedures, because otherwise the system takes over, with its own priorities, and they don’t necessarily include your best welfare.
I’m working on finding a new doctor now.
This is one of the major shortcomings of Obamacare (a misnomer, really, considering his hands-off treatment).
There should have been instituted at least some data sources that would put pressure on costs and delivery quality. At least some date sources! How much is that to ask, especially considering Obama’s (BS) campaign promises and his “vision for how technology can help connect government to its citizens and engage citizens in a democracy.”
I vented to our insurance company this morning.
Apparently it costs extra to have a doctor read the labwork that they ordered for you(yes I got sent a bill from the doctors office for reading labs, so did they apparently…… I guess next time I’ll just tell her to order them, and not bother reading them and instead send them to me. LOL I wonder if I get that option or just the option to pay the extra costs)
Oh and 5% of $286.97 (or $263.57 the allowable since I’ve yet to figure out how either number translates to actual 5% of cost) is 23.40.
Seems to me what the company did is charge the insurance company what it wanted to pay and then asked me to pay the difference.
Then there’s our new ER policy change. We have a co pay of $75 except when we don’t. Apparently I’m supposed to be asking the doctors at the ER if they are considering my trip to take a 13 year old that feel 6 feet out of a bunk bed and bruised his back an actual emergency so I can make sure the coding is accurate(and how would that have worked had he actually hurt himself because I’m pretty sure not getting a minor medical treatment is neglect)or I end up having to pay 20% (probably using the same jacked up percentage system as above) Or it could have been that perhaps this doctor (and no an ACTUAL doctor never even saw my son that day. He was seen by a physician assistant) was an out of network doctor. Then I could spend my morning or afternoon on the phone with the insurance company asking them to ask the hospital nicely not to penalize us for the fact that we had to go to the ER.
Oh and this plan is grandfathered which means we don’t get free annual exams but apparently they can change co pays, percentages and out of pockets.
Let’s hear it for efficiency where taking your kid to a doctor for treatment is secondary to worrying about his treatment being coded correctly, worrying about whether or not the doctor is in or out of network, worrying about what extras the office and its ancillary staff are going to tack on to get enough money from the insurance company and what that will mean to your final bill. I’m sure this is going to work wonders to convince people they should be obtaining preventative care. NOT.
With all due respect, the idea that if you have a heart attack that your primary concern should be shopping for a doctor is absurd.
If the system wants to be efficient then it’s ridiculous to suggest that heart surgery costs x amount of dollars accept if that surgery is being performed on someone uninsured(and yes there is an entire different scale utilized for uninsured people) or accept if you are going to an “out of network” person(ie someone unwilling to accept the 10 cents on the dollar we are willing to pay to cover the costs.)
It’s ironic that people that bitch and whine about Medicare and Medicaid because of what the government is willing to pay, all of a sudden are perfectly okay with some random private for profit entity throwing out random amounts that they are willing to pay and wham-o, it’s the best system evah.
Good luck with your search, I’m glad you have the time, energy, financial resources, and wherewithal to do it – lucky for you.
Healthcare spending is nothing (not-a-thing) like spending for a new suit, a new car, or a new house.
Only in jacked up upside down world is spending more than China, the UK, Russia, India, France, Japan, Saudi Arabia,( with Germany and Brazil thrown in for good measure) combined on defense spending a non issue in regards to making a proper budget.
We could quarter our costs and still be outspending China by a bit.
I’m actually trying to figure out how this is supposed to work. When you are having the heart attack are you supposed to call the hospital to ensure they are in network just in case you get admitted? Are you then to ask the ER doctor if he is in network and what labwork he is ordering (to ensure the guy who spent 8 years in school isn’t ordering unnecessary testing?) Do you then also ask the anesthesiologist if HE is in network and what his fees are? Do you repeat this with the staff cardiologist? The OR staff?
I mean exactly how many people are you supposed to question before you have permission to actually just be a sick person seeking help from a qualified medical professionals?
I’m pretty sure the system would be easier to navigate if we cut out the bevy of middlemen(each with their very own sets of coding and pricing guidelines) and agreed on base prices for the cost of things like medical tests and procedures.
It’s one thing to shop for an elective rhinoplasty. It’s quite another to have to experience sticker shock after being very sick.
A Modest Proposal:
Amend current admittance forms to all ERs with a single question effective January 21, 2013:
In the last Presidential election did the patient vote for either a
Republican or Democratic candidate? A check mark in the yes box
immediately transfers any and all of the patient’s bank accounts,
investments, and material or intellectual assets of any kind to the
admitting hospital or its parent company, and allows for the
garnishing of any future wages or income of any kind earned by the
patient or his or her direct family and descendants, in perpetuity.
I’m no expert on this stuff, but I’ve stayed in a few hospitals, and had family sick in the hospital, plus I have 2 friends that are doctors.
The story I got is that Medicare and HMO’s only pay a small percentage of what the doctor bills them, or in some cases it’s a set dollar amount, so the doctors increase their fees so they can be paid closer to the actual amount they say it costs them.
Now in walks an un-insured person, and he gets this very high bill, because the doctor can’t charge him less than they do to someone else…
I was told the amount billed is 12 to 16 times the amount collected by the doctor from an insured person. If you’re un-insured the bill collector wants the whole amount, but if you “work with them they’ll except 30% to 40% on the dollar still much higher than medicare or insurance companies pay. Doctors and hospitals justify this by saying most un-insured people won’t pay anyway, so the ones that do need to make up for the ones that don’t.
There has to be a better way!
I think this all started when doctors and hospitals were forced to treat everyone regardless the cost. I think hospitals should have an amount of money provided by a charity to treat people who can’t afford to pay, and doctors should donate a few hours a week to help out.
I also remember as a kid going to the doctor, and the prices were posted for many of his preventive services (Physical, blood check, etc) now you never see the cost until you get a bill in the mail.
Cantor’s presentation is great news. The greatest threat after avoiding utter disaster on all fronts by defeating Romney is avoiding disaster on the social safety net front by frustrating Obama’s desire, after re-election, for his Grand Bargain that compromises the Social Security, Medicare and Medicaid safety net. Obama is anxious to show good faith to his corporate overlords by making compromises Bush never dreamed about getting, but he and the Congressional Democrats must negotiate this sell-out with the Tea Party Republicans — and we now have some assurance that the Tea Party will not compromise. Praise be to their inflexibility. It will save us from another one of Obama’s negotiated settlements.
It’s a self fulfilling prophecy that an uninsured person isn’t going to pay when you insist on charging them large sums and insist that you can’t work with them to make payments.
Hospitals just now are starting to make changes after someone within HHS informed them that there were no laws preventing them from working with the uninsured or offering them discounts.
Then again if you offer an uninsured person a discount then you can pretty much guarantee that the insurance companies are going to want an even bigger discount or that people will start dropping insurance companies since it makes no sense to buy discounted care through a middle man when you can get it without one. I’m pretty sure that’s why the ACA requires us to get insurance. We need to feed the profit making entities even if it makes no sense.
I know several people who have had knee replacements. One woman has had two, and one had to be redone. A standard knee replacement costs an average of $45,000 in the U.S. It can be performed for $6,500-$13,000 in India.
health care, say for your two-year old with an earache and a high fever to make the point very emotionally,
is NOT an option; is not a bargaining opportunity
it is NOT something we can take or leave, like a “deal” on lettuce at kroger, or a “deal” on a new car.
health-care is often an IMMEDIATE NECESSITY with very little, or no, near-time flexibility for shopping/bargaining.
the reasonable, workable solution is to establish a first-rate gov’t health care program with gov’t docs and nurses and labs and specialists whose education and training and salaries are paid by the state and/or federal governments, similar to public education and public safety.
paid for with social security-like payments by individuals and with an any-gov’t-surplus trust fund designated for the medical, food, and education needs of any part of the citizenry that needs it.
a second medical system for those with money/great insurance could exist side-by-side with this public one.
see.
it’s simple.
why doesn’t it happen?
no political will.
why no political will?
because voters’ attentions are kept on “values” issues by republican politicians who do not give a flying damn for the health/medical well-being of their constituency – only for the financial well-being of their wealthy contributors,
and because democrat politicians routinely fake giving a flying damn for the health/medical well-being of their constituency – caring only for the financial well-being of their wealthy contributors.
Most knee replacements need to be redone. The average span of a knee replacement is around 12 years which is why its discouraged until people are older(hubby has bad knees.)
India’s system is hardly a paragon. It’s poorly regulated and it is not available to all of it’s citizens. Additionally the cost for a student to attend medical school training is A LOT less than a medical student here would pay. That being said they have almost no insurance middlemen.
This seems like a really good article that sums things up:
http://reason.com/blog/2009/09/04/a-different-sort-of-health-car
The irony, of course, is the very people who insist in competition and a free market are such wonderful concepts are the very same people that shoot down the idea that the private institutions compete against a government run option.
I say let both sides compete and let the more efficient, cost effective and popular system win.
the key to a successful public medical care delivery system would be training, repayment of schooling loans, adequate compensation,
and very low administrative costs for administering the public health care system.
the low administrative costs would be analogous to the low admin costs of well-run stock funds, or of the federal employee retirement fund – substantially less than 1%.
Why isn’t this a discussion about getting rid of Cantor on November 6 and replacing him with a Democrat who can’t possibly be worse than Cantor?
Of course, he is just one of hundreds of Republicans to be removed from office.
I hear you – I have a high deductible plan and shopping is a joke. Try calling around for an MRI. You hear the same thing everywhere: “we won’t know until we put it through”. Because they don’t, you know, deal with Blue Cross every single day. Blue Cross is also very coy.
Last year when I picked which plan to go on I tried to find out what the out of pocket would be on my prescriptions, but nobody could tell me for sure, and since I’d have to pay for it up front (at their contract rate) and get 50% back a few weeks later, I just went with the high deductible. I needed the extra cash to cover the prescriptions.
Consumer driven. I’d like my CT Scan with a side of fries, please, supersized.