Hopefully this doesn’t 404. Go down and click on “Chart: How the Bill Effects You” on the left sidebar.
Cyberhwk, I think you’re going to lose your existing coverage – doesn’t the bill prohibit bare-bones policies in the individual market? If I understand the law correctly, you will be obliged to buy a comprehensive policy, and if the LA Times graphic is correct, it looks like your out-of-pocket is going to be about $2,180.
I’m not sure this is true - there seems to be a ‘grandfathering’ provision in the bill which allows people to keep their current policy beyond 2014, even if it doesn’t meet the minimum standards. I can’t find any conclusive information for this in the bill text though, I’m going off what PolitiFact implies.
I also don’t think that’s how much Cyberhwk will be paying. This is a good site to help you work out how much you’ll be paying in premiums if you purchase a new plan from 2014. For your details, it says that you’ll get a $944 government subsidy, making your own premiums $1,693. And yes, that’ll be for a plan with comprehensive health coverage.
There we are either going to have to agree to disagree or at least admit that this really does qualify as a Great Debate. Late last year (October 2009?) the figure the CBO was tossing around was at least $54 Billion over 10 years and basic tort actions being 2% of total costs. That looks to be the cost of the actions themselves (judgments) and not the total costs (unnecessary tests being run basically for the prevention or defense of actions) but I can live with it as a starting point. Some figures run quite a bit higher but even if Elmerdorf and those following the “low ball” are right, it still strikes me as pretty darn important. Maybe not to Bill Gates but to me, paying my own insurance and medical bills, it looks quite important.
I can basically agree with a lot of what you just said. The CBO did predict that tort reform would save about $54 billion over the next 10 years. But the problem with talking about healthcare spending is we’re not used to dealing with these kind of numbers. $54 billion sure sounds like a lot of money - I’d be happy if I won that much on the lottery - but in the context of medical spending and the US budget deficit, it’s not that much. The current budget deficit is more than $1 trillion, much of which stems from healthcare spending, and in 70 years time it will be nearly 50% of GDP. (With today’s GDP figures that would be about $6 trillion.) Almost all of that increase in the deficit would be down to healthcare spending, particularly Medicare.
In that context, the savings made by tort reform ($54 billion) or even the savings made by Obama’s plan ($143 billion over the first ten years, $1.2 trillion in the next ten) are not nearly enough. Obama’s plan saves more than twice as much as tort reform would over the next 10 years, yet even that has been heavily criticized by the GOP for being fiscally irresponsible, and by a lot of healthcare experts for not doing enough to cut the deficit. And they’re right, a lot more needs to be done. Like I said, fixing the tort system is probably something worth doing, but in the context of healthcare spending it’s not that important, because it just doesn’t save that much.
Perhaps more importantly given you mentioned how tort reform relates to you “paying your insurance and medical bills”, numerous studies have shown that tort reform makes little, if any, difference to premiums. This study, this study and this study, to name but three, found there was no correlation between tort reform and premium levels. McAllen in Texas has become infamous for having implemented some of the toughest tort reform in the country, and yet still having some of the highest premiums.
Tort reform would not save enough money to be that important for the deficit; studies show it wouldn’t reduce premiums significantly; and besides, Democratic leadership and Obama himself repeatedly and publicly expressed their willingness to include it in their bill as part of a compromise with Republicans - but Mitch McConnell himself said no Republican would be compromising on anything of that sort. For those reasons I don’t think it’s a valid criticism of the bill. 
Would it be possible to expand on these points a bit? Is the $143 Billion over 10 years in deficit reduction (I think that’s the CBO number) including only the costs of the pilot programs, or is the CBO also trying to estimate the benefits of these pilot programs as well over the 10 years?
Per the Polifact article linked, national health care spending in 2019 is expected to increase by “only” 6.9% instead of the 7.2% that is projected to occur if the reforms are not implemented. Is this 0.3% decline in the spending growth assuming some contribution from the pilot programs, or is this decline solely attributable to the reforms as listed? Is the hope that the pilots will yield results to bring health care inflation more in line with other income or cost metrics (say, inflation, GDP growth, personal income growth, etc…), or are the long-term goals not really defined in these terms?
While the short- and medium-term goals of gettting everyone covered is certainly worthwhile, I’m actually more interested in any attempts to achieve long-term sustainability of health care programs, hence the above questions about the pilot programs. (I wish the mainstream media outlets would talk about the pilot programs more…)
Most of the cost controls aren’t literally ‘pilot programs’, that was a bit of a rhetorical device. They’re just programs started out at a relatively modest level, with the idea being that they can be built upon later if they work well. So in terms of whether the CBO has included the results of these cost controls in their predictions, the answer is yes: they take the bill in front of them, with everything in it, and they try to calculate what will happen. They don’t take into account any future expansions of those programs, because those aren’t in the bill. In the past the CBO has tended to err on the conservative side, so hopefully the bill could save more than the CBO estimate (Bush’s Medicare Part D bill didn’t add to the deficit as much as the CBO predicted, for instance).
This is a good article here by Ezra Klein briefly explaining five of the major cost controls in the bill: bundled payments, prudent purchasing, the Medicare Commission, the excise tax and the individual mandate.
However, as Klein notes, while this bill reduces the deficit slightly and provides a better base to work from, it’s not going to do nearly enough as it stands. Even once it passes, and even if it works better than expected, programs like Medicare are unsustainable and they will bankrupt the country in the next 70 years unless they’re reformed. Given the ferocity of criticism against Obama for the Medicare savings he has proposed in this bill, which are fairly mild, the country is going to have some very difficult choices pretty soon.
The senate bill is already law, having passed both houses and been signed by Obama.
The reconcilliation bill is a series of fixes (remove pork, tidy up some options) which some members are relying on to fix stuff they seriously disagreed with in the original bill.
It escapes senate filibuster because the Dems are claiming it is budgetary - budget measures cannot be filibustered. Since almost everything the congress does except passing laws is likely dealing with money, it’s an interesting argument. The strategists hav been over the bill with a fine-toothed comb, looking for precedents and removed anything that could be interpreted as “not budget”. Now they hope to use this loophole to escape the 60% rule.
The senate parliamentarian will look at the bill and decide if it meets the rules for budget requirements. If he believes it does, he will say so. If he thinks it doesn’t then I think I heard the news say that Biden (senate “president”?) has the ultimate say. If some senators disagree with that, there’s always the Supreme Court. The danger is that the court will say that picky house rules are legislative not judicial problems and toss that part of the case.
I’m surprised, common wisdom here in Canada is that one major reason for high US health care costs is that some doctors pay up to half their income to malpractice insurance. I would expect that tort reform, and eliminating many petty wrangles about who should pay medical bills, will reduce the case laod significantly; this would drop premiums for doctors’ malpratice.
In Canada, ultimately, the gvernment pays all medical bills so there’s no incentive to sue for medical costs. In the USA, if you or your insurance company is going to have to pay $100,000 due to some other careless bozo, there’s a real incentive to sue.
Budget reconciliation can only be used for measures that reduce the deficit, not just anything that ‘deals with money’. Congress does a whole bunch of stuff that doesn’t fit that criteria: one pertinent example in this case being restrictions on federally-funded abortion.
If the Senate Parliamentarian rules that a provision in the reconciliation package is not acceptable, then the package goes back to Senate Democrats, who will remove the offending provision and send it to the Parliamentarian again (this would require the House to vote on their reconciliation package again, because they need to be the same, but that wouldn’t be a problem). Biden gets involved if the Senate vote on the reconciliation package ends up 50-50 - as Senate President he gets the deciding vote in that scenario. That’s what happened with Dick Cheney for Bush’s second round of tax cuts back in 2003.
Sounds reasonable, but the evidence just doesn’t bear it out. According to the CBO tort reform would only cut about $5.6 billion a year off the $1.2 trillion deficit over the next decade, and according to numerous studies it wouldn’t have much effect on premiums.
I suppose the discussion of how the bill will affect the deficit is an answer to the question of what it entails, so I’ll write it here.
As I said, the CBO’s report predicts that the legislation will reduce the deficit by $143 billion in the first 10 years, and by $1.2 trillion in the second 10 years. This is because of a number of cost controls in the bill including the excise tax, the Medicare Commission and bundled payments, among others.
While Republicans have not questioned the CBO’s scoring of the bill, what they have claimed is that Democrats have sneakily taken certain costs out of the bill to make it look cheaper. This case has been championed by Rep. Paul Ryan: this link has a video to Ryan’s original criticisms at the healthcare summit, with Ezra Klein’s responses to each one, and this is a subsequent interview between Paul Ryan and Ezra Klein where they go back and forth debating his criticisms. It’s an excellent debate and I’d recommend both links.
The basic summary is that Ryan makes three points:
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Double counting: The first accusation is that Democrats have double-counted money by using trust funds, which will eventually have to pay out for Social Security, as collateral for health care payments. I have to admit this discussion went over my head - you can read it in the links yourself - but Ezra Klein seems to disagree that this is a genuine criticism of the bill’s fiscal responsibility.
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The Doc Fix: The second is the “doc fix”: a bipartisan law passed in 1997 indexed doctor’s payments against GDP. But since then GDP has fallen and doctor’s payments have risen, so to avoid having to slash doctor’s payments by 20% or more, every few years Congress implements a “doctor fix” which temporarily overrides this law. This has to be fixed permanently at some point. Democrats originally planned to fix it in this bill, but realized it would cost too much, so they took it out and said “we can do it separately”. Paul Ryan thinks the doc fix should be included as part of the cost of the bill, while Ezra Klein and Obama himself argue that it’s a problem which has existed for the last 10 years and which will exist anyway regardless of the bill, so it’s not fair to consider part of the bill’s costs. Personally I think that’s clearly right.
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Future implementations: The third is that the bill proposes cost controls in the future. The excise tax kicks in in 2017 for instance, and the Medicare Commission will implement savings in Medicare in the future. Ryan argues that future congresses will probably scrap these changes, so they can’t be considered as saving any costs. Klein says that if we can’t trust future congresses to not change the law, that implies we can’t do anything to cut the deficit at all, and we’ll go bankrupt. Ryan just agrees.
Personally I don’t find any of those criticisms convincing, but there’s that debate for you. Finally Republicans have simply questioned our ability to predict the future: CBO may have given us the most thorough estimate possible, and it shows a reduction in the deficit (it also shows that even in the worst case scenario, the bill will just be deficit-neutral), but we’re talking about 10 or 20 years in the future, and they can’t be certain. I think this is just unfounded scepticism really, and I’m sure the GOP will have no qualms about our ability to predict the future next time a CBO estimate goes their way.
That ain’t a problem. Believe me.
I’d gladly pay the increased amount for the increased coverage. That’ll be great.
Thank you guys.
Back up the stream somewhere you said “The bill is projected by the respected, non-partisan CBO to cut the deficit by more than $100 billion over the first ten years”. In light of that statement I would think the $54 Billion saved by tort reform, projected by the same CBO, again becomes VERY significant. And something worthy of attention when proposed by such a respected organization.
Studies and math are always things we can trade back and forth. That’s what makes this fun. In one place $100 billion can be something to celebrate and in another place half that doesn’t mean a thing. 
The Republican objections were not to tort reform as your statement seems to imply; it was to other provisions of this bill. Some would say most of the provisions but that is a different debate. Some of points that troubled the Republicans in this bill our fellow Democrats in Washington found impossible to swallow as well.
I have a feeling if a “tort reform act” was actually proposed outside of this bill you would find Republicans tripping over themselves to cross the aisle and stand beside President Obama in support of it. Now THAT would be something to celebrate!
I think this would be a very interesting figure to see, actually. I have no clue right now what my company pays for my insurance.
Absolutely, the $143 billion saved by Obama’s bill in the first ten years isn’t very important either. It’s just not that much. The bill saves $1.2 trillion in the second ten years, which is a much more significant amount, but still nowhere near enough. That’s the context in which you need to view the $54 billion tort reform would save.
I never celebrated the $143 billion Obama’s bill saves. It’s not very much. I said it’s an impressive achievement that it saves anything at all, because of what else the bill does, but the savings it makes in the first ten years are insignificant, and the savings it makes in the second ten years are still not enough.
I implied the opposite! You said that, “one of the bones (Republicans) wave the most around here is that nothing in this includes any real tort reform; something many in all the various parties feel is needed to really make any difference in health care costs. So I may not agree with them in general or about this particular bill but I can see where they are coming from in not supporting it.”
My argument is firstly that lack of tort reform is not the reason Republicans didn’t support the bill, because Democrats offered them tort reform and they said it wasn’t enough. And secondly that tort reform is not necessary to ‘really make any difference in health care costs’, because the savings it would make in health care costs are not that significant.
I will stand corrected in part; between us we had three streams of thought with two on my part - and they didn’t quite meet as I had thought. The differences in the “flow” aren’t great enough to pursue.
I wonder what tort reform could do for health care the second 10 years as it filters down to the various levels? That could exceed even the $1.2 trillion of this current bill. Especially since it would effect all aspects of “modern” life and save actual costs for many things; not just health care. The $54 billion of health care on the surface level being just part of the iceberg, not the whole. (at least that seems like the over-all consensus from the CBO)
I’m one of those who question the $1.2 Trillion projection. If this bill stood alone with no other health care measures passing; sure. But we can have many things influence the cost up as this tries to influence them down. All assuming, of course, most of the current package survives the various challenges.
So chances are we’ve arrived about the same place; this bill is nothing really important. Our main difference is what could be important. That’s not a bad place to be, all in all.
No, that’s not the consensus from the CBO (you can read their letter here). They say that tort reform would reduce national healthcare spending by 0.2%, and that would save $54 billion over the next ten years. They make no predictions at all about the ten years after that and they make no reference to it being ‘the tip of the iceberg’ or anything of that sort. If you want to believe tort reform would make dramatically higher savings in the second ten years that’s fine, but I’ve seen no evidence for that claim whatsoever. The CBO certainly doesn’t support it.
I’m not quite sure what this means - I think you’re questioning the $1.2 trillion projection because some of the savings this bill makes might be stripped out by future congresses (they might strip out the excise tax that’s due to come in in 2017, for instance). That’s a valid concern, and it’s possible. But personally I don’t think it’s a criticism of the bill. The bill signs it into law that an excise tax will kick in in 2017. If a future congress tries to strip that out then we should be criticizing that future congress when we come to it - it’s not the fault of this bill. This bill, as it has been passed into law, is estimated to save $1.2 trillion, possibly a lot more.
No, we haven’t agreed “the bill is nothing really important”. We’ve agreed the savings the bill makes in the first ten years are nothing important. (Which, incidentally, are much higher than any savings projected for tort reform). The savings it is projected to make in the second ten years are important, and the bill provides a platform which will make it easier to implement further cost controls in the future - the Medicare Commission and the insurance exchanges are two examples. And, of course, we’re only talking about the cost control side of the bill here: the bill does a lot of other things which I think are very important, making it illegal to discriminate based on pre-existing conditions to name just one.