The Debt Deal: There Will Be Blood on the Floor on November 23rd

Robert Laszewski

First posted 8/1/11 on Health Policy and Marketplace Review

073111_leadersinternalThe debt deal is finally done. But it really isn’t an agreement on what cuts will be made, just the process that will be used to make them.

The real work is left to the Congressional appropriators for the first $917 billion and for a super-committee of Congress for the second $1.2 trillion to $1.5 trillion in ten-year cuts.

That second tranche is where health care will make its contribution. The super-committee has to make its decisions by November 23rd and, as a practical matter, the Congress can only accept what the super-committee decides or face the consequences of the automatic $1.2 trillion fallback cuts.

When it comes to health care and the super-committee, all federal health care spending is on the table—–Medicare, Medicaid, the new law, benefits, and provider payments.

Continue reading “The Debt Deal: There Will Be Blood on the Floor on November 23rd”

Reaping What We Have Sown: The Debt Standoff

Robert Laszewski

First posted 7/27/11 on Health Policy and Marketplace Review

On this blog a month ago, I said the politicians were starting to scare me with the apparent eagerness of some to actually take the government to default to make a political point.

For weeks we have heard political leaders on both sides tell us there would be no default.

But the two sides have so backed themselves into opposite corners that they have left no opportunity to meet in the middle. Democrats say they have to have a tax increase, or failing that no cuts to entitlements. Republicans say absolutely no tax increases and they need to see entitlement cuts.

This only gets fixed if somebody capitulates. The consequences for any side doing that might be the loss of their own base going forward.

There isn’t any middle ground here because there is no middle ground left in Washington, DC. The last few elections have seen the replacement of “moderates” by evermore far right or far left senators and representatives. This process has only been exacerbated by the gerrymandering of Congressional districts to ensure they were safe for either side but at the same time leading to their coming under the control of party activists pushing their representatives either far left or far right. It also hasn’t helped that each side is so certain of their cause and only has to dial their favorite channel to be assured of that. Continue reading “Reaping What We Have Sown: The Debt Standoff”

The Awful Dichotomy Between Health Care Politics and Policy

Robert Laszewski

First posted 7/6/11 on Health Policy and Marketplace Review

Amy Goldstein has an important article in today’s Washington Post detailing the place Don Berwick, the Medicare and Medicaid administrator, finds himself in.

It is all but certain he will have to leave his post at year’s end, when his recess appointment expires, because the Senate will not confirm him for a lack of Republican support.

Berwick is one of the most respected health care experts in the country—his career has been dedicated to improving quality first and with that the cost of care. With the new law giving his agency more opportunities to experiment with new approaches and the ability to more quickly implement the things that work, he was the ideal choice.

Continue reading “The Awful Dichotomy Between Health Care Politics and Policy”

The Debt Ceiling Debate – Some Of These People Are Nuts

Robert Laszewski

First posted 6/27/11 on Health Policy and Marketplace Review

I don’t know about you but the politicians are starting to scare me with their inability to make progress in the federal debt limit discussions. Worse, is the apparent eagerness of some to actually take the government to default to make a political point.

I know a lot of conservatives say missing the August 2 deadline isn’t a big deal but I think it is.

The 2011 deficit is projected to be $1.6 trillion, or about $133 billion a month.

Said another way, the 2011 federal budget is $3.8 trillion. But federal revenues are only about $2.2 trillion—a gap of $1.6 trillion.

That means that 40 cents of every dollar the U.S. government spends in 2011 has to be borrowed!
Continue reading “The Debt Ceiling Debate – Some Of These People Are Nuts”

Neither Dems Nor Reps Care Proposals Are Supported By Past Performance

Robert Laszewski

First published 6/07/11 on Health Policy and Marketplace Review

I call your attention to Ezra Klein’s column in the Washington Post this morning.

In it he cites data that has been out there for a long time but Ezra puts some perspective on it that never occurred to me before.

Examining the Kaiser Family Foundation brief, “Health Care Spending in the United States and Selected OECD Countries” he points out, “Our government spends more [as a percentage of GDP] on health care than the governments of Japan, Australia, Norway, the United Kingdom, Spain, Italy, Canada, or Switzerland.”

The data would seem to indicate that even our single payer government-run American health care programs, Medicare and Medicaid, cost way more than similar health plans in these nations.

Continue reading “Neither Dems Nor Reps Care Proposals Are Supported By Past Performance”

Earth to Republicans: You Are In Big Trouble Over The Ryan Medicare Plan

Robert Laszewski

First published 5/25/11 on Health Policy and Marketplace Review

It should now be clear to Republicans they are in trouble over the Ryan Medicare plan.

Yesterday, they lost a seat in a solid Republican New York House district. Their candidate had benefited from lots of money and House leadership attention. The big issue was the Ryan Medicare plan.

All month, Republican Presidential candidates have been walking a tightrope over the Ryan plan–don’t embrace it but don’t criticize it either for fear of offending the base who will drive the primary outcomes next year. You only had to watch the Gingrich implosion to see what happens if you fall off that tightrope.

Continue reading “Earth to Republicans: You Are In Big Trouble Over The Ryan Medicare Plan”

The Lightweight Romney Health Plan

Robert Laszewski

First published 5/12/11 on Health Policy and Marketplace Review

Mitt Romney has outlined his new health plan. He outlined five key steps in an op-ed in USAToday. Here is a summary:

Step 1: Give states the responsibility, flexibility and resources to care for citizens who are poor, uninsured or chronically ill.who are poor, uninsured or chronically ill.

Step 2: Reform the tax code to promote the individual ownership of health insurance.

Step 3: Focus federal regulation of health care on making markets work…For example, individuals who are continuously covered for a specified period of time may not be denied access to insurance because of pre-existing conditions. And individuals should be allowed to purchase insurance across state lines, free from costly state benefit requirements. Finally, individuals and small businesses should be allowed to form purchasing pools to lower insurance costs and improve choice.

Step 4: Reform medical liability. We should cap non-economic damages in medical malpractice litigation.

Step 5: Make health care more like a consumer market and less like a government program. This can be done by strengthening health savings accounts that help consumers save for health expenses and choose cost-effective insurance.

Continue reading “The Lightweight Romney Health Plan”

Both Democrats and Republicans Would Dump Cost on Consumers Rather Than Face Providers

Robert Laszewski

First published 5/9/11 on Health Policy and Marketplace Review

A key piece of Paul Ryan’s deficit reduction plan is to change Medicare as we know it. It appears his bold Medicare premium support proposal is failing to gain traction–it is dead as part of any deficit reduction deal this year. Worse, his Medicare proposal looks to be giving Democrats lots of political ammunition for the 2012 elections.

What lies at the heart of Ryan’s Medicare difficulties is that he would all but abandon future seniors (those now under age-55) to a health care system whose age-adjusted premium support would increase each year only at a rate equal to the increase in the consumer price index while their health care costs would likely continue to increase far faster.

Continue reading “Both Democrats and Republicans Would Dump Cost on Consumers Rather Than Face Providers”

There Aren’t Enough Rich People To Pay For Medicare and Medicaid

Robert Laszewski

First published 4/21/11 on Kaiser Health News

I hear more and more of my progressive friends arguing, in the context of deficit reduction, that we should be raising taxes before getting aggressive about reducing the cost of Medicare and Medicaid — as well as Social Security.

To a point, I agree.

This country is in such a hole that it is senseless to deny that at least some new taxes will be needed to pay for all of the nation’s bailouts and accumulated debts.

Continue reading “There Aren’t Enough Rich People To Pay For Medicare and Medicaid”

The Budget Fight: It Will Be A Long Hot Summer, And Fall, And Winter

Bob Laszewski

First published 3/14/11 on Health Policy and Marketplace Review

The good news is that Democrats and Republicans are finally seriously engaged over the country’s fiscal crisis.

And, each side is presenting a starkly different course for the voters to choose from.

When it comes to the health care entitlements, Republicans want to cut the health care entitlement benefits and therefore ease the pressure on federal spending.

Obama wants to largely leave the programs in place and raise taxes–about $1 in tax increases for every dollar in cuts.

Neither touches Social Security. Obama wants to make cuts to the Pentagon’s budget—the Republicans don’t.

Continue reading “The Budget Fight: It Will Be A Long Hot Summer, And Fall, And Winter”

Changing the Game on Health Care Costs

Robert Laszewski

First published 4/10/11 on Health Policy and Marketplace Review

Last week, I posted that I was disappointed in Paul Ryan’s health care budget proposal because it lacked cost containment ideas other than the usual conservative reliance upon the market and defined contribution health care.

In my last post, Why ACOs Won’t Work, I argued that the latest health care silver bullet solution, Accountable Care Organizations (ACOs), are just a tool in a big tool box of care and cost management tools. But, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.

How do you make the American health care system efficient?

You change the game.

Continue reading “Changing the Game on Health Care Costs”

Why ACO’s Won’t Work

Robert Laszewski

First published 4/7/11 on Health Policy and Marketplace Review

First, I think Accountable Care Organizations (ACOs) are a great idea. Just like I thought HMOs were a good idea in 1988 and I thought IPAs were a good idea in 1994.

The whole notion of making providers accountable for balancing cost, medical necessity, appropriateness of care, and quality just has to be the answer.

But here’s the problem with ACOs: They are a tool in a big tool box of care and cost management tools but, like all of the other tools over the years like HMOs and IPAs, they won’t be used as they were intended because everybody—providers and insurers—can make more money in the existing so far limitless fee-for-service system.

Continue reading “Why ACO’s Won’t Work”

The Path To Prosperity – Where’s The Health Care Cost Containment?

Robert Laszewski

First published 4/5/11 on Health Policy and Marketplace Review

Paul Ryan’s overview of his proposed 2012 Budget Resolution contains an honest and compelling description of America’s debt and deficit spending dilemma.

Every American should read it.

As I read through his discussion of the huge hole we’re in and the imperative to fix it, he had me thinking that we finally have a politician willing and ready to deal with the problem. But when I got to the end of the document, I felt like there was a missing chapter—the one with the controversial and politically problematic but necessary bad news solutions.

Continue reading “The Path To Prosperity – Where’s The Health Care Cost Containment?”

Republicans Had Better Get Organized On Health Care

Robert Laszewski

First published 3/3/11 on Health Policy and Marketplace Review

If the past week is any indication, the Republicans will have real trouble come 2012 trying to convince voters they have a plan to fix the American health care system.

Last weekend, President Obama endorsed the Wyden-Brown bill that would give the states the opportunity, in 2014, to take their share of the almost $1 trillion the new health law collects and use it to craft an alternative health care plan to their liking.

Continue reading “Republicans Had Better Get Organized On Health Care”

Things Are About to Get Ugly. Republicans Plan to Defund the Health Bill Next Week

ROBERT LASZEWSKI

First published 2/9/11 on Health Policy and Marketplace Review

Word is that House Republicans will attach an amendment to the latest federal spending bill that will cut-off funding for the health care bill.

The last Congress never finalized a budget for the current fiscal year—the feds have been operating under a series of continuing resolutions. The most recent one will expire on March 4th. If another resolution is not agreed to, much of the government has to shutdown.

Continue reading “Things Are About to Get Ugly. Republicans Plan to Defund the Health Bill Next Week”