Bending the Cost Curve

[WillowTree]

So that means we should stop trying? We should give up on improving our country and the lives of Americans? We KNOW the current model of health care delivery, before "Obamacare" is severely flawed and unsustainable. Something had to be done. "Obamacare" is far from perfect, but I'll take it as a step in the right direction.

Stop trying to improve access to health care. No, Stop trying to find Government answers to it. HELL YES.

As far as this Bill being a step in the right direction. I think you are dead wrong. It is a misguided Bloated failure of an attempt. Costs are going up, and the Government is now on a hook for huge costs related to it. That is anything but a step in the right direction.

In your opinion, BESIDES cost, is there ANYTHING at all thats good in this healthcare bill? Be honest.

Yes, you get to sit on your azz and let us or mummy pay for your doctor.

 

[Oddball]

My question is entirely germane, when the track record of the feds ever containing the costs of anything --their primary argument for foisting Obunglercare upon America-- is nonexistent.

Your phony appeal to emotion, insofar as your silly allegation that I value money more than human life, is non sequitur and irrelevant....But par for the course from people who have no intellectual ammunition.

Actually, contrary to what you might have convinced yourself of, your rambling about which government agencies have been run profitably is actually not on topic with what the OP wanted to discuss which is actual techniques to lower the cost of healthcare. But keep living in your fantasy world where you are never wrong about anything. Seems like a wonderful place.

My "phony appeal" was a genuine question, why is it that you are more concerned about money than people living and dying? You won't answer that, you never do, and I don't expect you to.

What's relevant is that the OP is yammering about the feds containing costs, when history shows that they're completely incapable of doing so, no matter how many charts, graphs, statistics and bullet points full of bureaucratic doublespeak you want to throw at the conversation. Therefore, the odds of them "bending down the cost curve" remain on such a low order of probability as to make them laughable.

In the meantime, your deflection and distraction from this fact, by feebly trying to make this about me, remains notwithstanding and irrelevant, no matter how many times you employ the tactic.

 

[RDD_1210]

I'm interested in when any federal program has ever come in below cost estimates and delivered what it promised.

Start listing them.........NOW......

I'm interested in why you think money is more important than living.

Start telling me now.....

well, without money it's hard to buy groceries, heat the house and buy clothing. We could do that if you got off your lazy ass and paid for your own doctor. TIA.

I have a job, do you?

 

[RDD_1210]

My question is entirely germane, when the track record of the feds ever containing the costs of anything --their primary argument for foisting Obunglercare upon America-- is nonexistent.

Your phony appeal to emotion, insofar as your silly allegation that I value money more than human life, is non sequitur and irrelevant....But par for the course from people who have no intellectual ammunition.

Actually, contrary to what you might have convinced yourself of, your rambling about which government agencies have been run profitably is actually not on topic with what the OP wanted to discuss which is actual techniques to lower the cost of healthcare. But keep living in your fantasy world where you are never wrong about anything. Seems like a wonderful place.

My "phony appeal" was a genuine question, why is it that you are more concerned about money than people living and dying? You won't answer that, you never do, and I don't expect you to.

What's relevant is that the OP is yammering about the feds containing costs, when history shows that they're completely incapable of doing so, no matter how many charts, graphs, statistics and bullet points full of bureaucratic doublespeak you want to throw at the conversation. Therefore, the odds of them "bending down the cost curve" remain on such a low order of probability as to make them laughable.

In the meantime, your deflection and distraction from this fact, by feebly trying to make this about me, remains notwithstanding and irrelevant, no matter how many times you employ the tactic.

So what you're saying is that we both went off topic yet the fact that you felt the need to make a point of me doing it only makes you a hypocrite. Got it.

 

[Oddball]

I haven't gone off topic anywhere....You, OTOH....

The OP's assertion, backed up by nothing more than a text wall of bureuacratese, is that the feds can somehow bring down the costs of medical care, when reams of history of their meddling in other areas --the most relevant being Medicare/Medicaid-- shows that they're blowing more smoke than a '73 Pinto.

 

[boedicca]

Promoting Health and Disease Prevention

* Public Health: Reducing Tobacco Use (Tobacco is Bad for you? What the ****?! Why am I only finding out about this now?)

* Public Health: Reducing Obesity (Be in front of your Skype at 7:00 am Comrade! We want to see you do 20 Party approved Jumping Jacks. Yeah, we don't have enough Government regulation and oversight, that's why we have an Obesity Crisis. We're these serious suggestions?)

* Positive Incentives for Health (When staying alive and healthy aren't enough, we'll give you a tax credit. Again I ask, were these serious suggestions?)

Translation: Smokers, Fatties, and people who don't meet the Healthy Living Criteria will not get priority on the Rationing Lists.

 

[Greenbeard]

I seem to recall Nancy telling us it would create 5 Million jobs in the Industry, 400,000 "almost immediately" Yet this year we saw only 20,000 new Health care related private sector jobs. About the same as last year. Where are all the jobs Nancy?

I don't know what that quote is but Politifact seems to indicate she wasn't talking about health sector jobs. Regardless, that sounds like a one time statement she made, not a consistently offered rationale for this law. If that's your main hangup here, might I suggest you're missing a far bigger picture?

I realize this may be novel as well, But I can post my opinion about the existing bill on this thread If I wish.

Of course you can. But I already know what you think about the law; what I'm interested in knowing is why you think what you do. You, and many others, seem convinced this law won't bend the cost curve in the long term, and I'm curious why.

If the primary driver of unnecessary spending can be traced to volume-based incentives for care why is increasingly tying payment to quality instead of quantity not a cost control? If the primary driver of Medicare spending increases over the past decade has been chronic conditions, why is pursuing models of coordinated care (medical homes, ACOs, etc) not a reasonable cost control effort? If medicine is hampered by the lack of a solid evidence base empirically identifying best practices, why is developing and making available that evidence base not a good idea? If a significant problem (aided but not created by third party payment) is that patients demand unnecessary care, why is patient-centeredness (and, again, an evidence base easily reviewed by the consumer as well as the physician) a bad idea? If cost competition between insurers is a worthy goal, why is constructing a marketplace in which insurers compete on price (and not simply risk-shedding, as in the marketplace boedicca wants) undesirable? And if simply chopping out spending on insurance is the answer, then why is the excise tax not a powerful long-term cost control?

Broadly speaking, there are two ways you can address costs: 1) you can just stop spending (more or less indiscriminately), or 2) you can try and find ways to get better care for less money.

The first option will work, we did something like that in the last '90s and from 1994-1999 health care costs didn't grow faster than 2.8 percent per year. But people didn't like that because there was a sense that financial and not medical thinking was determining medical decisions. This strategy is predicated primarily on limiting access (even for those who have insurance) to keep spending down. I find it bizarre that some folks on the right will throw out the word "rationing" any chance they get, yet as far as I can tell the entirety of their cost control agenda (what little they have) relies on this approach--indiscriminately cutting spending based on financial and not medical decisions.

But some of the cost controls in the reform law do take this approach, namely the excise tax and the new Medicare Independent Payment Advisory Board. More than likely those will cut spending but they won't do it smartly.

That's where the dozens of other efforts in the law come in. These are where option 2--trying to find ways to deliver equivalent or better care for less money--comes in. These are things like payment reforms, relatively new delivery models, data-driven quality improvement, etc.

Frankly what we can and can not do about bending the cost curve down has been talked about at length both here and in this Nation.

I believe people consider this to be one of the most important issues related to health care in this country. But you're telling me it's tapped out, been-there-done-that, let's shut this health care discussion forum down? Come on.

The only suggestion I've seen so far in this thread (after my OP) has been that we make it easier to throw people out of risk pools and make it easier for insurers to pay for fewer procedures (and this after the suggestions in the OP were accused of being rationing, ironically). Do you think that's the best or the only thing we can do? There's no way to encourage smarter, evidence-based, data-driven medicine? Or is there just no need?

The Fact is also that Democrats did not listen to anyone else when they passed the current law.

I'm not sure what you mean. Most experts would give you a list that looks like the two I posted in the OP if you asked them about cost controls. And most of those ended up in the reform law. People like you constantly tell me there are cost controls they didn't put in there--so here's a thread offering you the chance to elaborate. What are they? Who did the Democrats not listen to? If your one suggestion is "deny more care indiscriminately and jettison expensive people," color me unimpressed. To quote that guy from Inception, "You mustn't be afraid to dream a little bigger, darling.”

 

[Oddball]

You, and many others, seem convinced this law won't bend the cost curve in the long term, and I'm curious why.

Because the feds have never ever been able to control the costs, let alone bring them down, of any non-defense operation with which they have involved themselves.

I'm curious as to why you continue to ignore the fact, in favor of the standard empty Fabian progressive technocrat promise that this time they'll finally get it right.

 

[Charles_Main]

You, and many others, seem convinced this law won't bend the cost curve in the long term, and I'm curious why.

Over 200 years of history? Please name a single Program the government has ran that was as effective or cost as little as we were told it would?

Why should we expect it to be any different this time?

When they passed Medicare these same arguments were made. That costs would spiral out of control and it would add massively to our Debt, and we were told the same BS then that we are told now. So why in gods name should we fall for it again?

That is what we want to know.

 

[RDD_1210]

You, and many others, seem convinced this law won't bend the cost curve in the long term, and I'm curious why.

When they passed Medicare these same arguments were made. That costs would spiral out of control and it would add massively to our Debt, and we were told the same BS then that we are told now. So why in gods name should we fall for it again?

Is this the same Medicare that you want your mother to be on?

 

[Oddball]

Irrelevant to the question and yet another cheap appeal to emotion.

Medicare costs in excess of 10+ (including inflation) what it was projected to, when enacted in '65.

What makes you think that the same schmucks who couldn't contain those costs have suddenly come up with the magic formula this time?...And if this is the supposed silver bullet for cost containment, how about trying it on Medicare/Medicaid first as a test bed, before imposing it upon the entire population?

 

[Greenbeard]

Over 200 years of history? Please name a single Program the government has ran that was as effective or cost as little as we were told it would?

As Jon Gabel at NORC has pointed out, you can point to at least three major national examples from the past few decades just related to health care:

• The switch to a DRG-based payment structure for Medicare in the '80s
• The Balanced Budget Act of 1997
• Medicare Part D

The three largest changes to Medicare of the past 30 years each turned out to be cheaper or save more money than contemporary CBO forecasts predicted.

Are you really arguing from the presumption that it's impossible for any health care legislation to ever save money? In other words, bending the cost curve for health care is itself an impossibility? Or is it just that there's no way to reduce provider errors, reduce waste by fostering care coordination, reduce administrative efficiency, and cut substantially into unnecessary care in a targeted way? Because that would be one of the more defeatist things I've ever heard.

Take the Medicare Participating Heart Bypass Center Demonstration. You know by how much that experiment cut costs? Ten percent. And without harming patient health (mortality actually decreased, though it wasn't clear if there was any causality there). But there was no mechanism for implementing it on a wider scale and Congress never got around to it. With the Center for Medicare and Medicaid Innovation we not only have an entity within CMS committed specifically to testing and evaluating potentially cost saving models, we have an entity empowered to extend and expand projects that are showing promise.

The promise of integrated delivery systems for cost savings is there, which is why their use and refinement should be encouraged. Just in that CCA example, you see lowered utilization rates and decelerating cost growth, all without wantonly denying care. Many states have started testing new delivery models in their Medicaid programs to save money. The patient-centered medical home program in Illinois saved the state more than $200 million over the course of two years (the American Academy of Family Physicians put the savings at twice that).

So I reject this notion that there's no money to be saved or that it's impossible to save money. There are ways to save money, probably lots of them, that don't involve simply booting people out of risk pools. But finding them won't be easy and it'll require a more systematic, scientific approach than has historically been used to look for them, as well as a commitment to using what we learn--that's part of what the CMI is being created to do.

 

[Oddball]

You can't be serious.

First of all, aside from not being a federal program, the phony "balanced budget" never existed in actual reality...It was projected out to 2002 from 1998.

Secondly, the projected costs for Medicare D didn't survive the first few weeks of scrutiny, before being adjusted upwards by scores of billions of dollars.

Best give up on the smoke-blowing text walls from know-it-all technocrats from the District of Criminals, and get a firm grip on reality.

 

[Toro]

Irrelevant to the question and yet another cheap appeal to emotion.

Medicare costs in excess of 10+ (including inflation) what it was projected to, when enacted in '65.

What makes you think that the same schmucks who couldn't contain those costs have suddenly come up with the magic formula this time?...And if this is the supposed silver bullet for cost containment, how about trying it on Medicare/Medicaid first as a test bed, before imposing it upon the entire population?

How's that any different than private forecasters? Find me a forecaster in the private industry in the 60s that forecasted healthcare costs would accelerate over the next 40 years. All corporate assumptions for actuarial pension returns over the next decade were wrong in 2000.

 

[Oddball]

Irrelevant, since private forecasters didn't sell us a 2,000+ page multi-trillion dollar bill of goods, based upon the outright lie that they're going to control costs and increase overall quality of services.

Moreover, none of those private forecasters were attempting to use the coercive force of law, to impose the purchase their product upon every American.

 

[The T]

1. Get rid of the state barriers to competition which enable a few large companies to control the markets.

Are we talking about providers or insurers? And without all-payer rate setting, how do keep the market from being dominated by a handful of insurers anyway?

In CA, out of 1,600 companies nationwide, only 6 are allowed by the state insurance commission.

Are you sure about that? A quick search of individual market plans available to someone in a random Los Angeles zip code shows:

• 3 plans available from Celtic Insurance Company
• 4 plans available from Kaiser Permanente
• 3 plans available from Health Net of California, Inc
• 7 plans available from Anthem BC Life & Health co (Anthem BC)
• 4 plans available from Blue Cross of California (Anthem BC)
• 5 plans available from PacificCare Life and Health Ins Company
• 2 plans available from Time Insurance Company
• 2 plans available from John Alden Life Insurance Company
• 3 plans available from Health Net Life Insurance Company
• 23 plans available from Blue Shield of CA Life & Health Insurance Co
• 8 plans available from Connecticut General Life Insurance Co
• 3 plans available from CA Physicians Service dba Blue Shield CA
• 1 plan available from the Guarantee Trust Life Insurance Company
• 10 plans available from Kaiser Foundation Health Plan, Inc
• 3 plans available from PacifCare of California
• 1 plan available from Aetna

And in fact a quick check of the website of the California Department of Insurance reveals the full list of health insurers licensed in the state to provide group and individual insurance coverage as well as those licensed to provide only individual coverage. It certainly isn't 6.

2. Tort Reform to get rid of the wasted costs in defensive medicine.

What kind of tort reform? The sort of collateral source rule reform that's been pursued in more than half of all states? Or the sort of joint and several liability reform that's also be implemented in most states? Or damage caps, like those implemented in most states:

I find the suggestion to try using specialized medical courts for liability cases to be intriguing. Are you open to that?

3. Reform the tax code so that health insurance and health care are personal expenditures, decoupled from employment. As are a result of #1 above, 1,600 companies competing for individual dollars will provide a wider variety of coverage, from purely catastrophic to "cadillac". Individuals will have the incentives to take care of themselves so that they don't drive up the costs of their health coverage due to obesity, smoking, etc. Set an amount that is tax deductible by the individual, and leave it at that.

So what's the cost control aspect here? People taking better care of themselves?

Whom is paying you?

 

[The T]

Irrelevant, since private forecasters didn't sell us a 2,000+ page multi-trillion dollar bill of goods, based upon the outright lie that they're going to control costs and increase overall quality of services.

Moreover, none of those private forecasters were attempting to use the coercive force of law, to impose the purchase their product upon every American.

Yep. And why The FED is tied up in court defending this affront to liberty under the guise of the 'Commerce Clause'.

 

[Toro]

Irrelevant, since private forecasters didn't sell us a 2,000+ page multi-trillion dollar bill of goods, based upon the outright lie that they're going to control costs and increase overall quality of services.

Moreover, none of those private forecasters were attempting to use the coercive force of law, to impose the purchase their product upon every American.

Show me a public forecaster who attempted to use "the coercive force of law to impose the purchase their product upon every American." Anyone will do.