The health care overhauls released to date would increase, not reduce, the burgeoning long-term health costs facing the government, Congressional Budget Office Director Douglas Elmendorf said Thursday.

That is not a message likely to sit well with congressional Democrats or the Obama administration, and House Speaker Nancy Pelosi, D-Calif., said Thursday she thinks lawmakers can find ways to wring more costs out of the health system as they continue work on their bills.

...

“In the legislation that has been reported, we do not see the sort of fundamental changes that would be necessary to reduce the trajectory of federal health spending by a significant amount and, on the contrary, the legislation significantly expands the federal responsibility for health care costs,” he (Elmendrf) said.

...

Russell Branyan [ View Trade ] Carl Crawford

Comments from Building 7:
I need to throw in something else. Not sure if you're even interested. Branyan is better than you would think. Check back on those other two players in nine years. They may be available then.

...

Factors Underlying Historical
Growth in Health Care Spending

From 1965 to 2005, real health care expenditures per
capita increased nearly sixfold in the United States. That
large increase was the combined result of many factors,
and accounting precisely for all of them is difficult.
Nonetheless, the general consensus among health economists
is that growth in real health care spending was principally
the result of the emergence of new medical technologies
and services and their adoption and widespread
diffusion by the U.S. health care system.5

Challenges in Measuring the Contribution of
Technological Change to Rising Costs

Directly measuring the effects of advancing technology
on total spending on health care is extremely difficult, for
several reasons. One reason is the sheer complexity of
medical science and its unusually rapid pace of change.
Also, technological change occurs simultaneously with
changes in other factors that affect health care spending,
such as personal income and third-party payment. And
those factors themselves influence the pace of technological
development, making it difficult to identify exactly
how technological change itself affects spending growth.
One way to examine how a specific technological development—
and the associated changes in clinical practice—
affected spending on specific types of patients is to
use a case-study approach. That approach, however, does
not allow a comprehensive analysis of how total spending
on health care changes with advances in technology.
Another way to approximate the effect of technological
change is to do so indirectly, using the “residual” method.
Certain demographic and economic factors, such as the
aging of the population and rising personal income, are
determinants of health care spending; using estimates of
the relationships between those factors and spending levels,
analysts can estimate how changes in those factors
contributed to changes in spending, assuming no changes
in medical technology. After accounting for the contributions
of as many measurable factors as possible, analysts
attribute the unexplained portion of spending growth, or
the residual, to technological change and the changes in
clinical practice associated with it. This approach yields
findings that can be sensitive to assumptions concerning
the effects of the various factors. In addition, studies
using this approach generally do not account for dynamic
interactions between growth of personal income, health
insurance coverage, and technology development. Nonetheless,
this approach can yield a reasonable approximation
of how technological change relates to long-term
growth in total health care spending.6


(5. This conclusion has been reached by Schwartz, “The Inevitable
Failure of Current Cost-Containment Strategies” (1987); Weisbrod,
“The Health Care Quadrilemma” (1991); Newhouse,
“Medical Care Costs” (1992); and Cutler, “Technology, Health
Costs, and the NIH” (1995). See Fuchs, “Economics, Values,
and Health Care Reform” (1996), for a discussion of the views of
economists on technological change and growth in health care
spending.)


(6. Another indirect way to measure the effect of technological
change on spending is to identify a measurable factor that can
serve as a proxy for technological change. For example, some analysts
use spending on research and development as a representation
of technological change. Each of the various approaches has
advantages and disadvantages. Generally, analyses using all of
these methods support the finding that most of the long-term rise
in health care spending is associated with the use of new medical
technologies. For analyses that employ an approach that differs
from the one used in this discussion, see Albert A. Okunade and
Vasudeva N.R. Murthy, “Technology as a Major Driver of Health
Care Costs: A Cointegration Analysis of the Newhouse Conjecture,”
Journal of Health Economics, vol. 21 (2002), pp. 147–159;
and Livio di Matteo, “The Macro Determinants of Health Expenditure
in the United States and Canada: Assessing the Impact of
Income, Age Distribution and Time,” Health Policy, vol. 71
(January 2005), pp. 23–42.)
...

[House version of the bill]

• Page 22: Mandates audits of all employers that self-insure!

• Page 29: Admission: your health care will be rationed!

• Page 30: A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process)

• Page 42: The “Health Choices Commissioner” will decide health benefits for you. You will have no choice. None.

• Page 50: All non-US citizens, illegal or not, will be provided with free healthcare services.

• Page 58: Every person will be issued a National ID Healthcard.

• Page 59: The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.

• Page 65: Taxpayers will subsidize all union retiree and community organizer health plans (read: SEIU, UAW and ACORN)

• Page 72: All private healthcare plans must conform to government rules to participate in a Healthcare Exchange.

• Page 84: All private healthcare plans must participate in the Healthcare Exchange (i.e., total government control of private plans)

• Page 91: Government mandates linguistic infrastructure for services; translation: illegal aliens

• Page 95: The Government will pay ACORN and Americorps to sign up individuals for Government-run Health Care plan.

• Page 102: Those eligible for Medicaid will be automatically enrolled: you have no choice in the matter.

• Page 124: No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed.

• Page 127: The AMA sold doctors out: the government will set wages.

• Page 145: An employer MUST auto-enroll employees into the government-run public plan. No alternatives.

• Page 126: Employers MUST pay healthcare bills for part-time employees AND their families.

• Page 149: Any employer with a payroll of $400K or more, who does not offer the public option, pays an 8% tax on payroll

• Page 150: Any employer with a payroll of $250K-400K or more, who does not offer the public option, pays a 2 to 6% tax on payroll

• Page 167: Any individual who doesnt’ have acceptable healthcare (according to the government) will be taxed 2.5% of income.

• Page 170: Any NON-RESIDENT alien is exempt from individual taxes (Americans will pay for them).

• Page 195: Officers and employees of Government Healthcare Bureaucracy will have access to ALL American financial and personal records.

• Page 203: “The tax imposed under this section shall not be treated as tax.” Yes, it really says that.• Page 239: Bill will reduce physician services for Medicaid. Seniors and the poor most affected.”

• Page 241: Doctors: no matter what speciality you have, you’ll all be paid the same (thanks, AMA!)

• Page 253: Government sets value of doctors’ time, their professional judgment, etc.

• Page 265: Government mandates and controls productivity for private healthcare industries.

• Page 268: Government regulates rental and purchase of power-driven wheelchairs.

• Page 272: Cancer patients: welcome to the wonderful world of rationing!

• Page 280: Hospitals will be penalized for what the government deems preventable re-admissions.

• Page 298: Doctors: if you treat a patient during an initial admission that results in a readmission, you will be penalized by the government.

• Page 317: Doctors: you are now prohibited for owning and investing in healthcare companies!

• Page 318: Prohibition on hospital expansion. Hospitals cannot expand without government approval.

• Page 321: Hospital expansion hinges on “community” input: in other words, yet another payoff for ACORN.

• Page 335: Government mandates establishment of outcome-based measures: i.e., rationing.

• Page 341: Government has authority to disqualify Medicare Advantage Plans, HMOs, etc.

• Page 354: Government will restrict enrollment of SPECIAL NEEDS individuals.

• Page 379: More bureaucracy: Telehealth Advisory Committee (healthcare by phone).

• Page 425: More bureaucracy: Advance Care Planning Consult: Senior Citizens, assisted suicide, euthanasia?

• Page 425: Government will instruct and consult regarding living wills, durable powers of attorney, etc. Mandatory. Appears to lock in estate taxes ahead of time.

• Page 425: Goverment provides approved list of end-of-life resources, guiding you in death.

• Page 427: Government mandates program that orders end-of-life treatment; government dictates how your life ends.

• Page 429: Advance Care Planning Consult will be used to dictate treatment as patient’s health deteriorates. This can include an ORDER for end-of-life plans. An ORDER from the GOVERNMENT.

• Page 430: Government will decide what level of treatments you may have at end-of-life.

• Page 469: Community-based Home Medical Services: more payoffs for ACORN.

• Page 472: Payments to Community-based organizations: more payoffs for ACORN.

• Page 489: Government will cover marriage and family therapy. Government intervenes in your marriage.

• Page 494: Government will cover mental health services: defining, creating and rationing those services.

Section 246 of the House health care plan, or HR 3200, states:

NO FEDERAL PAYMENT FOR UNDOCUMENTED ALIENS.
Nothing in this subtitle shall allow Federal payments for affordability credits on behalf of individuals who are not lawfully present in the United States.
But Stuart Bybee, spokesman for Rep. Dean Heller, R-Nev., told WND restrictions on illegal alien enrollment are not clearly enforced under the House bill.

"Essentially, it's just a very vague provision, and it really doesn't have any enforcement capability to it," Bybee said. "It just says if you go in and claim that you are a citizen, that's good enough."

Heller offered an amendment to HR 3200 during the House Ways and Means Committee markup that would have ensured that illegal aliens would not qualify for health care benefits under the bill.

Heller's amendment would have required the federal government use the same database it currently uses to determine eligibility for welfare recipients to ensure illegal aliens do not enroll in the government health care plan. Applicants would have to show eligibility through the Income and Eligibility Verification System and the Systematic Alien Verification for Entitlements system.

When Heller offered the amendment to H.R. 3200, he issued a statement saying Section 246 does not require the tools necessary to ensure illegal aliens don't access taxpayer-funded health care benefits.

The House Ways and Means Committee rejected Heller amendment July 17 in a straight party-line vote.

Bybee said, "If the intention was to make sure that only citizens had access to this care, then the congressman's amendment should have passed."

(b) IMPLEMENTATION.—To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, 11censing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services.

I disagree with you on your last 2 points.

5) I think the ability to cite malpractice is important. I realize it can be abused but it is an important part of the 'checks and balances'. Drugs should not be pushed by Pharma & Doctors when the risks are still in play. Basically, the threat of malpractice keeps them honest vice rushing drugs to market (sidebar: I used to work with the Pharma industry and I'm glad they had to jump through hurdles before drugs were brought to market...I have seen the side effects of the wrong drug on the wrong patient in clinical trials).

I choose to believe that most doctors are dedicated professionals doing the best they can
and who really care about their patients well being - Valk

237 Perm Dude
ID: 154552311
Thu, Jul 30, 2009, 18:42 I hope you were telling people that you want to keep all your money for your retirement rather than spend a dime on social services for others in need, Baldwin.

238 Boldwin
ID: 376192015
Thu, Jul 30, 2009, 19:30 You'd be surprised how little people who believe in an imminent armageddon spend dwelling on their retirement bankroll.
239 tree on the treo
ID: 515451613
Thu, Jul 30, 2009, 20:00 not surprised at all baldwin...people who are foolish tend to be foolish all around...
240 Boldwin
ID: 376192015
Thu, Jul 30, 2009, 20:07 Well I'm either too focussed on wealth or not focussed enuff on wealth. You two marxist cheerleaders put your wee heads together and get your jeering straight.
241 Perm Dude
ID: 154552311
Thu, Jul 30, 2009, 20:11 My point is that you don't have yours straight, Baldwin. You whine about the social net keeping you from retiring a "millionaire" (your word). Yet you claim that you don't worry about retirement.

Sounds like you are following two masters.

7 Yet what things were gains to me, these I have considered loss on account of the Christ. 8 Why, for that matter, I do indeed also consider all things to be loss on account of the excelling value of the knowledge of Christ Jesus my Lord. On account of him I have taken the loss of all things and I consider them as a lot of refuse, that I may gain Christ 9 and be found in union with him...

OBAMA: Well, first of all, I want to meet your mom.

(LAUGHTER)

OBAMA: And I want to find out what's she's eating.

(LAUGHTER)

OBAMA: But, look, the first thing for all of us to understand is

that we actually have some -- some choices to make about how we want to

deal with our own end-of-life care.

And that's one of the things I think that we can all promote, and

this is not a big government program. This is something that each of us

individually can do, is to draft and sign a living will so that we're

very clear with our doctors about how we want to approach the end of life.

I don't think that we can make judgments based on peoples' spirit.

That would be a pretty subjective decision to be making. I think we

have to have rules that say that we are going to provide good, quality

care for all people.

GIBSON: But the money may not have been there for her pacemaker or

for your grandmother's hip replacement.

OBAMA: Well, and -- and that's absolutely true. And end-of-life

care is one of the most difficult sets of decisions that we're going to

have to make.

I don't want bureaucracies making those decisions, but understand

that those decisions are already being made in one way or another. If

they're not being made under Medicare and Medicaid, they're being made

by private insurers.

We don't always make those decisions explicitly. We often make

those decisions by just letting people run out of money or making the

deductibles so high or the out-of-pocket expenses so onerous that they

just can't afford the care.

And all we're suggesting -- and we're not going to solve every

difficult problem in terms of end-of-life care. A lot of that is going

to have to be, we as a culture and as a society starting to make better

decisions within our own families and for ourselves.

Meanwhile, a Pew Research Center poll says there were "major declines" in Obama's job approval rating. Overall, his rating fell from 61 percent in June to 54 percent. On the economy, Obama lost 22 points, from 60 percent in April to 38 percent.

On health care, 42 percent approve of his work, down from 51 percent. But perhaps more telling, disapproval of his performance has risen 17 points, to 43 percent.

...

Obama, speaking at SEIU's New Leadership Health Care Forum on March 24, 2007, said, "My commitment is to make sure that we have universal healthcare for all Americans by the end of my first term as President."

...

"As I indicated before, I think that we're going to have to have some system where people can buy into a larger pool. Right now their pool typically is the employer, but there are other ways of doing it. I would like to -- I would hope that we could set up a system that allows those who can go through their employer to access a federal system or a state pool of some sort. But I don't think we're going to be able to eliminate employer coverage immediately. There's going to be potentially some transition process. I can envision a decade out or 15 years out or 20 years out where we've got a much more portable system. Employers still have the option of providing coverage, but many people may find that they get better coverage, or at least coverage that gives them more for health care dollars than they spend outside of their employer. And I think we've got to facilitate that and let individuals make that choice to transition out of employer coverage."

...

In his speech to the American Medical Association, President Obama said what White House health advisor Ezekiel Emanuel and Office of Management and Budget Director Peter Orszag have said in print some time ago. The only way to control health care costs is to get doctors to provide less care — fewer tests, fewer procedures, fewer everything. Of course, the Administration wants to eliminate only that care that is "unnecessary." But HMOs say the same thing.

Clearly the Administration does not consider doctors the best judge of what people need. The obvious end game: Washington will tell doctors how to practice medicine.

One method they have in mind: the power of the purse. The Administration is asking for independent authority to set reimbursement fees for all providers under Medicare. The easiest way to discourage "unnecessary care" is not to pay for it in the first place.

An example of what can be done is actually in legislation being written on Capitol Hill. Buried somewhere in the 1,000 plus pages is a provision to severely limit what Medicare pays for CT and MRI scans performed in doctors' offices. This would force elderly patients, for example, to go to the hospital for their radiology — where there are often lengthy waits. Patients in rural areas who must travel long distances to get to hospital-based testing facilities may be discouraged from getting the tests done at all.

To assist in this effort, the Administration is proposing a new federal health board to decide whether health care services are "effective" or "appropriate." When he first advanced this idea in Critical, Obama health care guru, Tom Daschle, pointed to the British National Institute for Health and Clinical Excellence (NICE) as the model. NICE has adopted a rule of thumb that health expenditures are inappropriate if they involve spending more than $22,000 to save six months of life. As a result, British cancer patients do not have access to drugs that are routinely available in the United States. The World Health Organization (WHO) estimates that 25,000 British cancer patients die prematurely every year because of these restrictions.

If health care is to be rationed, what's the right way to do it? Zeke Emanuel (who is also the brother of White House Chief of Staff Rahm Emanuel) wrote an entire article on this subject in the Lancet on January 31, 2009. Emanuel advocated allocating health resources in order to maximize collective life years. Suppose a 25-year-old and a 65-year-old have a life threatening disease. Since the 25-year-old has many more potential years of life ahead of him, he should receive preferential treatment, says Emanuel. He justifies denying care to elderly patients in the following way:

The complete lives system discriminates against older people…. Unlike allocation by sex or race, allocation by age is not invidious discrimination; every person lives through different life stages rather than being a single age. Even if 25-year-olds receive priority over 65-year-olds, everyone who is 65 years now was previously 25 years.

There's more. In a different article written more than 10 years ago for the Hastings Center Report, Emanuel said health services should not be guaranteed to "individuals who are irreversibly prevented from being or becoming participating citizens." He continues, "An obvious example is not guaranteeing health services to patients with dementia."