A glimpse of what the Senate finance committee is thinking. No public option, capping tax exclusion of employer paid premiums and some sort of tax on insurance companies based on market share. This appears to be driven by the notion that the number of customers will go up for insurance companies, so they will in turn pay a tax of sorts. However, in the first year of the plan, this raises $6 Billion, so appears to be mostly symbolic. The subsidies provided to purchase insurance would go up to 300% of poverty, less generous than the house bills. And this version does not have a 'trigger' that many say Sen. Olympia Snowe favors...whereby a public option would become available if 95% of the people in a given state couldn't find an insurance option available than cost less than 13% of their gross income.
The most surprising thing to me is that Republicans are not talking about malpractice reform. I think they are scared that if they talk about it, Obama will take them up on it.
The 'gang of six' of the Senate finance committee meets tomorrow.
The President today talked about reform in Cincinnati, and his press spokesman said that Wed. night he will 'draw some lines in the sand' which is clearest signal that Pres. Obama will be clear about what he wants on Wednesday night. It is time for that.
Update: I am actually not totally sure what this proposal does re the current tax exclusion of employer paid premiums. There is clearly a new type of tax on insurance companies based on market share....more covered then pay more. But, what I was calling a capping of tax exclusion, is being described as a tax on insurance companies that offer high deductible plans. Maybe semantics but:
*cap the tax exclusion would mean that consumers with very generous plans would pay taxes on premiums paid by employers over a certain amount;
*this seems to say if insurance companies write a policy that is more generous than say the national average, then the tax is levied on the insurance company....presumably making them less likely to sell such coverage.
So, I am not sure what the details are.....and I can't find that the text has leaked out anywhere.....lots of the usual sources are taking the day off. Oh yea, it is a holiday, but Duke has classes.
Monday, September 7, 2009
Demand v. supply side changes
Jon Gruber, from MIT, makes a clear argument that a cap of the tax exclusion of employer paid insurance premiums ALONG WITH insurance market reforms has the best chance of expanding non-elderly insurance coverage while adding cost reducing pressure. Doing just one or the other is an incomplete fix.
It seems to me that a cap of the tax exclusion of employer paid premiums has to be a part of any compromise legislation....it will make patients/consumers more aware of the true costs of their insurance choices and likely their care choices as well, and it amounts to redirecting money already in the health care portion of the economy. I would think the income tax surcharge in the House bills has just about zero chance of passing the senate, and I think that is good.
This still doesn't really address cost inflation in Medicare, which I think can only be done via an Independent Commission looking at payment rates and coverage decisions.
It seems to me that a cap of the tax exclusion of employer paid premiums has to be a part of any compromise legislation....it will make patients/consumers more aware of the true costs of their insurance choices and likely their care choices as well, and it amounts to redirecting money already in the health care portion of the economy. I would think the income tax surcharge in the House bills has just about zero chance of passing the senate, and I think that is good.
This still doesn't really address cost inflation in Medicare, which I think can only be done via an Independent Commission looking at payment rates and coverage decisions.
Friday, September 4, 2009
This Makes Sense
David Brooks makes great sense to me in this piece. Here is the article in the Atlantic to which he refers. Here is the Brookings Institute report to which he refers. Web site. Executive summary. Full report.
I think the savings potential of the electronic records is oversold. But, altering payment incentives and discussions of using cost effectiveness research are needed. And doing at least something about the tax exclusion for employer provided insurance is a must if we are going to do anything to control health care costs.
We also need an Independent Medicare Advisory Commission to start looking comprehensively at payment rates and coverage decisions. Start with this group on such a commission (Dems and Repubs represented). The last thing we need is Congress mucking the details. They need to say what rate of spending increase can we afford given other priorities. And then let the experts make it work.
I think the savings potential of the electronic records is oversold. But, altering payment incentives and discussions of using cost effectiveness research are needed. And doing at least something about the tax exclusion for employer provided insurance is a must if we are going to do anything to control health care costs.
We also need an Independent Medicare Advisory Commission to start looking comprehensively at payment rates and coverage decisions. Start with this group on such a commission (Dems and Repubs represented). The last thing we need is Congress mucking the details. They need to say what rate of spending increase can we afford given other priorities. And then let the experts make it work.
More on what if we do nothing & long term care
Howard Gleckman from the Urban Institute on what if we do nothing. Not good. Dr. Gleckman is an expert in long term care, one of my main research areas, and one that hasn't been much discussed in health reform. Also, Urban Institute is a good source of info....left and right get mad with them. They claim to be non-partisan. Here are some links to their work on long term care.
Here is something I wrote about long term care about 15 months ago. Glad I didn't launch a political career on private accounts for anything last fall....
Here is something I wrote about long term care about 15 months ago. Glad I didn't launch a political career on private accounts for anything last fall....
Thursday, September 3, 2009
Amen
Article quoting conservative health policy experts like Gail Wilensky saying we need an actual debate and not hyperbole. I am not sure, but once you have said 'they want to kill your grandma' and then later say 'well, not really, but you know what I mean' you actually start to lose some credibility. I am thinking there is a reasonable chance for a reasonable, S.1, the Snowe/Kennedy Act of 2009.....
Wednesday, September 2, 2009
President to address joint session of Congress
President Obama will address a joint session of Congress next week about health care reform. The last joint session of Congress to which a President spoke was Sept. 20, 2001, when President Bush discussed the 9/11 attacks. The one before that was President Clinton, 16 Septembers ago, talking about health care reform. The President has laid back and let Congress 'lead the way' (quotes indeed) but he will now have to lay out what he wants. There may actually be an "Obamacare" for the Republicans to oppose a week from now! Exactly what will be in the bill is being debated within the White House, apparently.
Grassley and Enzi are gone (may never been there), but Olympia Snowe will essentially write the bill along with Barack Obama if she wants to do so.
Good article on malpractice, describing the fact that cost savings from defensive medicine are likley to be modest. I agree, but think that politically, and to get the docs to come along, malpractice reform is important. I have a hunch the President will surprise folks and offer a serious reform next week.
Grassley and Enzi are gone (may never been there), but Olympia Snowe will essentially write the bill along with Barack Obama if she wants to do so.
Good article on malpractice, describing the fact that cost savings from defensive medicine are likley to be modest. I agree, but think that politically, and to get the docs to come along, malpractice reform is important. I have a hunch the President will surprise folks and offer a serious reform next week.
Tuesday, September 1, 2009
Can we afford reform? afford not to reform?
The 'we can't afford to do it, I wish we could' message seems to be increasing as an argument against any sort of reform. This is a fairly clear argument that it is the opposite; we can't afford not to do so.
Here is a familiar picture showing that deficits are increasingly driven by Medicare and Medicaid...this one with about 25 years of past data. It helps illustrate the effect of the baby boomers retiring, and how much more profound the effect is on Medicare and Medicaid than it is on Social Security (because Soc Security doesn't have a 'runaway inflation problem'). This picture should keep you awake at night if you are younger than 50.
Here is a familiar picture showing that deficits are increasingly driven by Medicare and Medicaid...this one with about 25 years of past data. It helps illustrate the effect of the baby boomers retiring, and how much more profound the effect is on Medicare and Medicaid than it is on Social Security (because Soc Security doesn't have a 'runaway inflation problem'). This picture should keep you awake at night if you are younger than 50.
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