The new HCR law won’t be able to save money while expanding access. You can’t decrease the price of healthcare services by increasing the demand for those services.

You’re quite right that the US faces a serious structural deficit problem due to medicare. And you are also right that Boehner is doing nothing to attack that problem. In that respect, he’s in the same boat as the other congresscritters. The best that can possibly be said of Boehner is that he believes he’s trying to stop congress from exacerbating this problem, one for which he has no good answer.

Now, any folks who truly believe, as you do, that the new HCR will control costs must necessarily think Boehner is the enemy. Since I don’t count myself in that group, I think Boehner is just another politician who is afraid to point out and realistically face the main problem. A leader afraid to lead, in other words. Like the rest of congress.

I meant to imply that if it is not true we’re doomed. As deciding one is doomed is an excellent way to actually become doomed, therefore it is unproductive in the extreme to act as if it is not true.

In other words:
You got a better idea? And (to bring this back to my original point) that better idea has to be something Boehner could support without implementing the public option, repealing Medicare, raising taxes, or doing any of the things the Affordable Care Act does. Because it’s a given we need to reduce costs, and Boehner is strongly opposed to all four.

You need to get past the notion that I am defending Boehner per se. And let’s skip the whole “if it’s not so, then we’re doomed” line of thought. Instead of being afraid, let’s face and understand our problem

If, as I believe, we have yet to make any substantive inroads on controlling healthcare cost growth, then it only means this: we need to face facts, try harder, and do what’s necessary. We’re only doomed to whatever extent we’re afraid to face and deal with reality. It’s the 21st century…we can solve input-output problems.

My solution? More rationing. We’ve been rationing in many ways already. This includes HMOs who set treatment protocols so that you may not get the effective treatment you need until conservative band-aid approaches have failed and 6 or 12 months has passed. It includes encouraging self-rationing via higher co-pays and crappier overall coverage. Stuff like that is well underway.

So we can stop pretending that we’re not already rationing. Then, we can face rationing with open fearless eyes. And do fair and reasonable things that help control costs further. Let’s all notice that rationing has the same root as rational. We CAN be rational about this. And we should be, Since logically, the alternative is to continue to meter out care irrationally, with wide disparities in cost and access for different folks, and ruinous cost growth.

My captcha? dare world. So there it is. I’m daring the american world to stop being pussies about facing our need to live with the fact that we can have only as much healthcare as we have resources to finance it. In that context, the argument is whether we should all face that on our own, or collectively.

Needing something to be true doesn’t make it true.

I did not mean to imply that because I needed it to be true it was necessarily true.

I meant to imply that if it is not true we’re doomed. As deciding one is doomed is an excellent way to actually become doomed, therefore it is unproductive in the extreme to act as if it is not true.

In other words:
You got a better idea? And (to bring this back to my original point) that better idea has to be something Boehner could support without implementing the public option, repealing Medicare, raising taxes, or doing any of the things the Affordable Care Act does. Because it’s a given we need to reduce costs, and Boehner is strongly opposed to all four.

Presume that’s all true. I’m missing the part where you prescribe your cure for our whiny bitchiness. America’s role as the first adopter and highest price payer for HC acts as a subsidy for folks in rationed systems and in poorer nations.

My cure for our whiny bitchiness is to claim it’s not the problem. Distorted markets are the problem.

Let’s assume we are, actually, subsidizing Canadian care. If that’s the case the logical thing to do is stop. The very, very stupid thing to do would be throw our hands up in the air, watch double-digit cost increases eat the budget, and let the Canadians reap the benefits of our spending until we finally collapse into bankruptcy.

To stop subsidizing them we must reduce health costs, and Boehner is opposed to every promising cost-cutting plan I’ve ever heard of except tort reform. And that one does not work.

Hold up. Aren’t you the same guy who spent months here arguing that HCR already incorporated many GOP ideas. How did you get from that to saying their only known idea is tort reform. Where you blowing smoke then, or are you blowing it now? Can’t be both.

It did. It’s right of bills they supported in the 70s, 1994, and MA in 2006.

But they decided to kill it for political reasons, so the current Republican leadership is unable to support it. Which means they are unable to support any plan that may fix the long-term deficit. If you re-read my posts in this thread carefully you’ll notice I talk about Boehner, not Conservatives or the GOP in general.

yadda yadda yadda boehner yadda collapse yadda doom yadda the Republicans are all evil and have no clue and only the democrats can save us. Got it. Why would I argue with that? I can’t even follow your “argument.”

The “Republicans are evil” bit is a bit of an exaggeration. In this thread I’d only mentioned two before this post, one of those was in passing and not terribly insulting, and in this post I’ve only added a few more guys (the Republican House Leadership). And I’m not calling them evil. To be frank I don’t think Boehner understands this stuff well enough to realize he’s on the wrong side. It still hasn’t sunk in that Medicare’s future costs are way more then all the chintzy little crap he so piously opposes. Even the $750 Billion the banks got, or the $800 Billion stimulus.

My argument is simple.

To fix the deficit you have to control health costs.

Boehner can’t do that because he’s on record opposing everything that could work.

Therefore Speaker Boehner would be very bad for the deficit.

No one is arguing that there are not cranks on the left, but any honest observer has to concede that there is a distinction…. . There is simply no comparison between the left and right loons.

The left tolerates its loons; the right elevates its loons.

You can point to these people as the fringe all you want, but when the fringe is elevated into a position of influence it is not because they are just very good at what they do, it is because the people doing the elevating are supporting them.

Well, if you are right, then I’m stuck among the ranks of dishonest observers. Sucks to be me, I guess. Notwithstanding my lack of credibility…

…any experienced longtime unbiased observer knows that the power and influence of fringe portions or large groups peaks when the dissatisfaction with leadership is greatest. Some 18 months after the democrats took over the Presidency, the influence of fringe conservatives within the GOP is at a peak. Not a surprising thing, nor hard to understand.

Now if Gerry is to be believed, Democrats were in no way as apoplectic after Gore lost. Even though almost 10 years later, he still can’t let that loss go. Think about it, folks.

But set your watch by the likelihood of a fringe left candidate to emerge for the 2012 cycle when once hopeful progressives can no longer continue to swallow their bitter disappointment. They were promised a unicorn that could fart rainbows, after all.

You know why I want to believe it? Because if it isn’t true we’re totally screwed.

Needing something to be true doesn’t make it true.

You know why I’m pretty sure I’m not deluding myself? because every other industrialized country manages to meet demand for health care at a much lower price then us. It follows that a) Americans are whiny bitches who demand twice the care that Brits do, or b) the American market is extremely screwed up.

Presume that’s all true. I’m missing the part where you prescribe your cure for our whiny bitchiness. America’s role as the first adopter and highest price payer for HC acts as a subsidy for folks in rationed systems and in poorer nations. If our role changes, so does everything else. By the way, notice that these other nations employ a variety of rationing formats. As I have repeated ad nauseum, the only way to hold down costs when supply is finite and demand growing strongly is to ration the supply. Like Great Britain. Make my argument for me?OK.

And I’m ok with rationing, as long as it’s done semi, umm, rationally. But you have to stand there and say that the current HCR law will reduce costs. Well, if parts of it DO reduce costs it will be because they ration the ever-more-demanded supply. And if these proposals do NOT ration the supply, then they WON’T hold down costs.

Note that, as far as b) is concerned, the number of possible reforms is finite. The only one the GP is on record as supporting (Tort Reform) has been tried many times and has never worked. The rest are present in the form of Pilot Programs in the Affordable Care Act (aka:Obamacare), or are the public option.

Hold up. Aren’t you the same guy who spent months here arguing that HCR already incorporated many GOP ideas. How did you get from that to saying their only known idea is tort reform. Where you blowing smoke then, or are you blowing it now? Can’t be both.

As to the rest:

Note that, from this line of reasoning, you can conclude several things:
1) The whole line of reasoning is invalid because magically, for no apparent reason, without any governmental prodding, health care demand will collapse allowing the budget to survive.
2) The whole line of reasoning is invalid because the people will let the Congress abolish Medicare, the VA, and all other government-funded health programs with no fuss.
3) Support for the current crop of Republicans is de facto support for the idea that the country is doomed to bankruptcy, and all pro-Republican deficit hawks are tricking themselves.

yadda yadda yadda boehner yadda collapse yadda doom yadda the Republicans are all evil and have no clue and only the democrats can save us. Got it. Why would I argue with that? I can’t even follow your “argument.”

If you want to believe that the new plan can drastically increase access without increasing aggregate demand (and thus increase costs), I am sure there’s nothing I can do to persuade you otherwise.

You know why I want to believe it?

Because if it isn’t true we’re totally screwed. Medicare cost increases will eat the budget.

You know why I’m pretty sure I’m not deluding myself? because every other industrialized country manages to meet demand for health care at a much lower price then us. It follows that a) Americans are whiny bitches who demand twice the care that Brits do, or b) the American market is extremely screwed up.

If a) is true all policy debates are meaningless because we’re doomed, therefore we might as well cover everyone until the country collapses. OTOH if b) is true the problem is potentially fixable, and could be fixed by one of the proposals in the Affordable Care Act.

Note that, as far as b) is concerned, the number of possible reforms is finite. The only one the GP is on record as supporting (Tort Reform) has been tried many times and has never worked. The rest are present in the form of Pilot Programs in the Affordable Care Act (aka:Obamacare), or are the public option.

Note that, from this line of reasoning, you can conclude several things:
1) The whole line of reasoning is invalid because magically, for no apparent reason, without any governmental prodding, health care demand will collapse allowing the budget to survive.
2) The whole line of reasoning is invalid because the people will let the Congress abolish Medicare, the VA, and all other government-funded health programs with no fuss.
3) Support for the current crop of Republicans is de facto support for the idea that the country is doomed to bankruptcy, and all pro-Republican deficit hawks are tricking themselves.

——————————————————————

As for saying “HC Cost growth has continued to rise at previous rates, but…______” I’ll give the first but:
the bill won’t be fully implemented to 2014, and even then it will take a few years to find out it’s ultimate impact.

If you want to believe that the new plan can drastically increase access without increasing aggregate demand (and thus increase costs), I am sure there’s nothing I can do to persuade you otherwise.

My sense is that you want so badly for it to be true that you have convinced yourself it’s quite possible. I’m confident that time will show that the new reform will have improved HC access greatly, but failed to make any sort of substantive dents in the enduring trend of annual HC cost growth in the 6 to 8% range. 5 years or so from now, we’ll see who was right.

I suspect that you’ll soon become used to saying something very much like “HC Cost growth has continued to rise at previous rates, but…______.” In other words, time will show me to have been right, but you’ll have excuses ready. And they’ll be ones that hold democrats largely blameless while fingerpointing at Republicans.

Like many other folks, I could care less who deserves the blame. We all need to take responsibility for trying seriously to control costs.

The MA plan only increased demand. That’s it.

The ACA tests out some ways to re-package that demand more efficiantly. For example right now if you go to a hpspital for a minor ailment, and they screw up and give you a staph infection, their profit goes up, because you need a lot more care. That’s a very stupid way to set up a market. In theory there are ways to fix this that should work. A major one is called “bundling.” If that happens the hospital gets a flat fee for fixing your minor ailment, and has to eat the cost of curing your drug-resistant staph infection. This is tricky because fairly predicting how much a prvider deserves before he actually gives a diagnosis is difficult, but they seem to have made it work in the UK. We could probably do the same thing here, but providers really hate the idea, and it would be very easy to screw up, so it’s just a pilot program.

Then there’s the whole exchange mechanism itself. In most health insurance markets there are, de facto, only a handful of insurers. Under market theory these markets are supposed to have costs higher then the supply/demand curve would indicate because they are basically monopolies. Breaking up those monopolies by forcing them to compete on an exchange should help control costs.

A third one, and probably the celeverest, is the Cadillac Tax. Right now health insurance provided by an employer is tax free. If you got a $50,000 salary, and $10,000 to lease a company car you pay income tax on $60,000. Somebody who makes $50,000 and gets a $10,000 health insurance plan, OTOH, only pays taxes on $50,000. The Cadillac Tax only applies to the most expensive plans, but it is a start in fixing this silly tax discrimionation. That distorts the market, and further divorces health costs from their equilibrium point. Note that the great thing about this from a deficit point of view is that if doesn’t work as a cost control it’ll have a lot more Cadillac plans to tax, so if the government spends a lot more on health care it will also bring in a lot more in tax money.

Boehner is on record opposing all this. He’s also opposed to the public option. This is the only idea not included in the bill (bar tort reform, which doesn’t work).

All I’m saying is that the GOP cannot balance the budget until it changes it’s tune on the ACA. Under Boehner it won’t. It’ll spew high-minded rhetoric on freedom, claim it’s fiscally responsible, but it simply cannot fix the budget problem without adopting many of the ideas in Obamacare. And, under it’s current leadership, it cannot do that.

And, kk,
I wish the accountants in the CBO only made happy judgements for us Democrats. But if you didn’t notice they say we’ve got a huge deficit this year. They also believe it’s a major problem, whereas most Democrats think this year’s deficit is irrelevant to the long-term prospects of the country. If they’re partisan shills they really suck at it.

You don’t have to agree with their conclusions on the public option, but you do have to agree that they didn’t make those conclusion because of some Democratic conspiracy. They did it because, in their proffesional opinion, a public option would save money.

They didn’t think it woul save a lot of money. Even $100 Billion is a miniscule part of health care expenses over a 10-year period. But $10 Billion a year isn’t nothing. And Boehner opposes it.

As for the competitive disadvantages of the MA plan, there’s a logical case to be made that those exist. But, in my experience, US State Governemnt taxes and regulations do very little to hinder economic growth. For example Michigan is a moderate tax state with relatively few regulations, and our near neighbor (high-tax Ohio) eats out lunch. As does Ontario. Their health system, BTW, has actually attracted business from michigan over the past cfew years. It would surprise me greatly if MA’s plan was so onerous it impacted growth in any measurable way.

@Edith
Romney had to do something on health care. A local lobby group was most of the way throught the complicated process of amending the MA Constitution to make health care a right. They agreed to drop the issue if Romney would implement a universal plan.

I’m not sure the rationalizations he used to convince himself he wasn’t being forced into it. But IMO it’s quite clear he had no choice, and he did it largely to prevent a more liberal program (ie: single-payer) from being implemented.

kk’s right that health care is very hard to do at the state level. Most state’s have populist constitutions that do things like ban deficit spending, and even a well-run public health plan is bound to run deficits some years.Tax revenue, after all, goes up and down with the economy, but people don’t stop getting sick when the economy tanks.

Just thinking out loud here; back to the drawing board. If it doesn’t provide MA with a competitive edge in say the domestic American market place, would a natioanl plan enhance the competitiveness of American businesses in an international market competing with other counties who have minimal medical requirements due to demographics?

That’s a pretty tough one. IMO, America does have little choice but to surf the globalization wave or be swamped. And in that context, America experiences much higher costs by providing healthcare. But I think America has already decided that access to decent healthcare is a moral imperative, as have most other modern industrialized nations. So I don’t think we should back away because it makes it harder for domestic companies to compete or because it makes foreign shores attractive for corporate emigration.

What I think we really need to do to enhance America’s competitiveness in the global marketplace is to be truly committed to keeping pace with the intellectual and technological growth of rest of the world as Earth continues to mature. That means both being way more serious about education in general, and also being more committed to seriously matching education to the expected demands the future will bring.

And that topic is a whole chautauqua for me, so I’ll try to give you as brief a reader’s digest version as possible. What I mean by “matching” is that we don’t simply commit more resources to education and leave much of the system largely as is. Instead, we target and privilege math and the hard sciences and specific applied technology education. And we encourage more schools to include majors that amount to developing modern technical skills. We want kids to graduate with kickass chops in MS word, spreadsheets, databases, other widely used software apps, and so on. A minor in tech troubleshooting or networking woudl also be a plus. See where I’m headed? I’m talking about widely ranging employability in the 21st century.

And if we’re parents, maybe we make support for our children’s college education at least partially conditional, and spread that idea around to other parents. We don’t just tell our kids that we’ll find some way to pay for whatever school they get into regardless of what their plan is, or whether they even have a plan. If your kid is “undecided” or wants to major in a field with grim career prospects, I have two words: state school.”

And I’m being glib there for effect. Don’t clobber me, folks. My point here is that if America makes a serious effort to straighten up and fly right about how we prepare the next generations for the upcoming economy, there’s no reason we can’t extend our dominance or at least competitiveness for another century.

And as a last note and extra added bonus, here’s some follow-up reading on higher education for the 21st century Don’t Go to Graduate School.

I view Romney’s participation as opportunistic. He wanted a major achievement for his resume, and without much say, he had to go along to get it.

Which is not to say it wasn’t a good faith effort. It was, if a bit wishful. All the folks who participated really had to hope their hopes would be fulfilled.

I would have scuttled it at the time, because I knew how great the costs would be. But arguably its a very crucial safety net for Ma residents under current circumstances, especially if you’re out of work and just lost your federal cobra subsidy with the June expiration.

I really don’t think that states should try to solve healthcare access and cost problems by themselves. I think we should work together for a federal solution, especially insofar as it takes advantage of savings based on economies of scale. As it stands, MA’s healthcare plan really does create competitive disadvantages for MA industries and for small businesses that are trying to grow. It’s not good for any MA jobseeker that local companies would choose not to hire additional workers because the healthcare costs are a dealbreaker. I think that’s pretty unfortunate.

Jim, you can spin it however you like, but the numbers don’t lie; rates were cut, revenues went up. Everything else is blather—which is to say, it’s a spin or a lie. Rates were cut, revenues increased. Period.

For a bright guy that is a really interesting thought process. Because A preceded B, A caused B. Tax cut preceded revenue increase so tax cut caused revenue increase….

So, by extension, tax cut preceded economic collapse so tax cut caused economic collapse?

Of course not. That is so simplistic as to be pointless–yet you would have us believe that the Bush tax cuts are the only cause of revenue increase. Please.

After months of decrying big deficits, this past weekend Arizona Republican congressman John Kyle was talking about how its perfectly ok to extend tax cuts for the wealthy even if it increases the deficit. The Mitch McConnel piped in with the usual “the Bush tax cuts increased revenue, because of the vibrancy of these tax cuts in the economy…..”

Anyone else see any vibrancy in the economy during the Bush years? We had 8 years of the rich getting richer, but mostly it was no job growth and declining middle class incomes. Where is the vibrancy in that?

When Reagan took office, he said that cutting taxes would lead to smaller deficits, but it led to massive deficits. Did revenues go up? Sure.

But here’s the real kicker to Simon’s argument.

When Clinton increased taxes on the top income earners REVENUES WENT UP, too. So, by Simon’s rationale, increasing taxes makes revenues go up AND deficits go down (wait for it, queue the Republicans made Clinton reduce the deficit nonsense).

This Republican fantasy about cutting taxes reduces deficits/increases revenues is voodoo economics put forward by disingenuous politicians who are just playing “starve the beast” in the worst way.

It used to be, they wanted to starve the beast so they could rationalize cutting social programs and gutting government oversight, but a funny thing happened on the way to the seats of power–they found they could gorge themselves at the public trough through deficit spending AND cut social programs and gut government oversight.

It is the Republicans who created the massive federal debt. Reagan, Bush and Bush are responsible for more than 70 percent of all federal debt.

How the GOP can still call itself fiscally conservative with a straight face–and their followers believe it–is a total mystery.

If you are truly fiscally conservative, you should be outraged that the GOP is playing you for a sucker.

“Federal revenue is lower today than it would have been without the tax cuts. There’s really no dispute among economists about that,” said Alan D. Viard, a former Bush White House economist now at the nonpartisan American Enterprise Institute. “It’s logically possible” that a tax cut could spur sufficient economic growth to pay for itself, Viard said. “But there’s no evidence that these tax cuts would come anywhere close to that.”

So the former Bush White House Economist part would be spin I guess? And if he was correct that “There’s really no dispute among economists” is that because all of them there smart people think they know more than people like Sarah who use common sense and ya betcha that makes more sense than those book learners?

Jim, you can spin it however you like, but the numbers don’t lie; rates were cut, revenues went up. Everything else is blather—which is to say, it’s a spin or a lie. Rates were cut, revenues increased. Period.

Ummm…no. It’s not spin to point out that revenues increase almost no matter what. It’s also not spin to point out that rates of growth matter.

http://www.washingtonpost.com/wp-dyn/content/article/2006/10/16/AR2006101601121_pf.html

This guy is not exactly a raging liberal.

No, the Bush tax cuts did not increase revenues. Tax cuts just don’t do that no matter how much Republicans try to claim they do.

http://www.time.com/time/magazine/article/0,9171,1692027,00.html

http://www.factcheck.org/taxes/supply-side_spin.html

http://www.cbsnews.com/8301-503544_162-20010568-503544.html

Basically, the claim that tax cuts increase revenues must be backed up by an increase in the normal trend of revenue to grow, not just a simple increase in revenues. Tax cuts when rates are extremely high, as they were when Kennedy and Reagan cut taxes, can be reasonably argued to help somewhat though external factors can sometimes make it hard to tell. But at our current relatively low rates it just isn’t so and it wasn’t when GWB was president either.

There you go again JimS, citing actual facts instead of Republican dogma.

Alas, Simon only speaks dogma…

signed
the rookie