Posted on 11/15/2014 5:10:06 AM PST by Cincinatus' Wife
The United States stands on the verge of the most significant change to our health care system since the 1965 introduction of Medicare. The bill that was passed by the House and a parallel bill before the Senate would cover most uninsured Americans, saving thousands of lives each year and putting an end to our status as the only developed country that places so many of its citizens at risk for medical bankruptcy. Moreover, the bills would accomplish this aim while reducing the federal deficit over the next decade and beyond. They would reform insurance markets, lower administrative costs, increase people's insurance choices, and provide “insurance for the insured” by disallowing medical underwriting and the exclusion of preexisting conditions. And the Senate bill in particular would move us closer to taming the uncontrolled increase in health care spending that threatens to bankrupt our society.
Despite the many reasons to be excited about this legislative breakthrough, skeptics abound. Their criticism is only going to get louder as the bill is debated on the Senate floor over the next few weeks. But the primary criticisms of the bills are largely unwarranted.
One common refrain of opponents of reform is that it represents a government takeover of health care. But reformers made the key decision at the start of this process to eschew a government-driven redesign of our health care system in favor of building on the private insurance system that works for most Americans. The primary role of the government in this reform is as a financier of the tax credits that individuals will use to purchase health insurance from private companies through state-organized exchanges. In Massachusetts, which passed a similar reform in 2006, private health insurance has expanded dramatically. The public insurance alternative that is included in the Senate bill simply adds another competitor — on a level playing field — to the insurance market, and the Congressional Budget Office (CBO) projects that it will enroll only a tiny minority of Americans.1
A second criticism is that the bills are budget busters. This is simply incorrect. Both bills are completely paid for — indeed, both would reduce the deficit by more than $100 billion over the coming decade. And the CBO estimates that both would reduce the deficit even more in the long run, particularly the Senate bill with its strong cost-containment measures.1 Some argue that the bills won't reduce the deficit because Congress won't follow through on its cost-reduction plans, as it has failed to do with the sustainable-growth-rate program for Medicare's physician payments. But this one example has been ridiculously overused, given the sizable Medicare reductions that Congress has made in the past; the proposed reduction in Medicare spending is less than half of the percentage reduction enacted in 1997, for example.2 To oppose a bill because of a misplaced fear that the government cannot keep its promises is essentially to shut down the legislative process.
In addition, some claim that the bills are an attack on Medicare and argue that it is unfair to pay for expanded coverage by reducing overpayments to hospitals and to the private insurers that offer Medicare Advantage plans. It's ironic that the people taking this position are often the same ones who make the first criticism (Medicare, after all, is a government-run insurance system) or the second (if the government will never follow through on its promises, we needn't worry about reduced payments). In any case, there is substantial evidence that reducing these overpayments will not harm the health of Medicare patients — just the pocketbooks of those who profit from them. This reform would simply use market bidding to set the reimbursement rate for Medicare Advantage plans, rather than setting administrative prices, which have traditionally been much too high; and it would reduce payments to hospitals by a small percentage, while tying them to outcome measures. Moreover, the dollars that are raised will save thousands of lives each year by increasing insurance coverage among the nonelderly.
The bills are also said to impose unaffordable mandates on individuals. Without the individual mandate, fundamental insurance-market reform is impossible and we cannot cover the majority of the uninsured. But an individual mandate without financial assistance for low-income families is unethical. Both bills contain billions of dollars in subsidies to help families pay for health insurance — and an exclusion from the mandate for families that still find coverage unaffordable. Rather than imposing an unaffordable mandate, these bills would finally guarantee that almost all Americans could find affordable insurance.
Some argue that the bills would harm the privately insured. But although a primary focus of reform has been on helping the uninsured, the bills also deliver enormous benefits to the privately insured. Americans who previously purchased insurance in an overpriced, unpredictable nongroup insurance market will have the ease and certainty of buying through an organized marketplace where insurance loads are lower, prices do not vary according to health status, and preexisting conditions cannot be excluded from coverage. CBO data show that the average enrollee in the new exchanges will either pay substantially less or obtain more generous coverage than the average person in today's nongroup insurance market.3 Employees of small businesses that enroll in the exchange will also benefit from the lower prices and wide variety of health plan choices available to larger groups, and their employers will benefit from a small-business tax credit. Employees in large businesses will benefit from a shifting of their employers' money from excessively expensive insurance to increased wages. Most important for the insured, this reform will start us down the road to fundamental cost control, which will reduce costs for everyone in the long run.
Some critics also argue, however, that the bills don't do enough to control costs. This argument ignores fundamental reforms in the Senate bill in particular, which includes a four-pronged attack on health care costs. First, it imposes a tax on high-cost insurance plans that will put pressure on insurers and employers to keep the cost of insurance down, while delivering $234 billion in wage income to workers over the next decade.4 Second, it includes funds and a structure for comparative-effectiveness research that will provide the information necessary to guide our health care system toward care that works and away from care that doesn't. Third, it establishes a Medicare advisory board with the power to set rates (subject to an up-or-down vote by Congress) if costs grow too rapidly. Finally, it sets up an innovation center within the Centers for Medicare and Medicaid Services and launches pilot projects to explore alternative reimbursement and organizational structures that could transform the delivery of care.
This argument also misses the important point that universal coverage is vital for cost control. Most of the reforms that are aimed at controlling costs work through changes in the ways in which insurers reimburse and organize care. These changes can't work if an ever-growing proportion of our population lacks insurance. Moreover, as we have seen in Massachusetts, dealing with the problem of the uninsured allows policymakers to focus more single-mindedly on cost control: after our universal-coverage law passed, the state moved aggressively to set up a cost-control commission that recommended important changes in provider reimbursement.5
The current bills are not perfect. The Senate bill has a mandate that's too weak and doesn't provide generous enough insurance to low-income individuals, and the House bill doesn't do enough to control costs. Nevertheless, passage of a hybrid of these bills would be a major accomplishment and a turning point for our dysfunctional health care system. We should constructively support Congress's efforts to create a combined bill, rather than leveling unsubstantiated criticisms from the sidelines.
Financial and other disclosures provided by the author are available with the full text of this article at NEJM.org.
This article (10.1056/NEJMp0911715) was published on December 2, 2009, at NEJM.org.
All lies. We know that as a fact.
When you look up “pack of lies” online, this article by Herr Gruber should pop up. Virtually NOTHING he says here about ObamaCare turns out to be true.
This guy’s absolutely full of s***.
...and the horse he road in on.
kiss off Jonathan you nimrod
Why didn't anyone notice it at the time?
Oh... Wait!
"The primary role of the government in this reform is as a financier of the tax credits that individuals will use to purchase health insurance from private companies through state-organized exchanges.
Nov. 15, 2014: “....The weeklong #GruberGate, as it has been dubbed on Twitter, comes just as the Massachusetts Health Connector prepares to relaunch its website today for open enrollment after a devastating year that saw residents struggling to sign up for health plans.
Gruber, a Connector board member, told Bay Staters on Thursday to “give us another chance,” but Archambault said the professor is the last thing the embattled panel needs as it seeks credibility.
“It does raise big questions about his ongoing involvement in Massachusetts, sitting on the board,” Archambault said.
Gruber did not return an email seeking comment yesterday and there was no answer at his Massachusetts Institute of Technology office. He has declined multiple requests for interviews this week with the Herald. “
http://www.freerepublic.com/focus/f-news/3227275/posts
BUMP!
He goes by Jim Gruber? Can’t blame him, although, if he’s trying to hide, he should have changed the last name instead.
The Tea-Party and the GOP need to really fan the flames on this. This is documented proof of what we all have known - the Dem’s lie to get their socialist agenda passed. This is just another in a long list.
The Dem’s succeed by building what is a self-reinforcing cycle:
1. Determine what socialist issue they want to promote, and laws they want to pass.
2. Flog a populist message about helping the little-guy and the helpless by taxing the wealthy. This is a numbers game - there are more voters that are poor than there are that are rich. All the better if your program creates a dependency of these voters on government hand-outs.
3. Find external “experts” with lots of degrees from major Universities, where you can cite their research and reports that support the position you want to promote.
4. Pay said “experts” (that already agree with your position, or that are just academic prostitutes) to do more supportive research, and speak publicly on behalf of the policies you want to promote. The zealot-experts would do it for free, but are happy to take the money as a perceived reward. The useful-idiot-experts (like Krugman) know they can’t make money in the real world, so become dependent on what is just another government handout or bribe.
5. Enlist the compliant media to (a) promote the message and (b) attack any detractors and (c) hide the truth.
If it blows up, like this one is doing, you blame the experts. Afterall, they were duped just like everyone else.
What’s surprising to me is that conservative commentators haven’t yet linked this methodology, on stark display here, to climate-change scientists and debate. It’s the exact same thing - find and exploit the works of “name” scientists from “name” universities to promote a socialist wealth redistribution scheme for pay.
Can it be that an unintended (or perhaps intended) consequence of GruberGate is to quash all of the talk about ressurecting Mitt Romnmey for another run at the republican presidential nomination in 2016?
That certainly is a big side benefit.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.
