I'm feeling content with the Senate health-care bill.

My biggest problem with all the bills floating around was that I thought they had no plans for cutting health-care costs. Insuring everyone and creating stability for those already insured is nice - but those things do not really matter if the government defaults on its health-care obligations.

Now I’ve read an article that has me convinced that the Senate bill does have a plan to cut costs, and it’s a plan that might actually work. The article is by Atul Gawande of the New Yorker. For those that don’t know Gawande, I suggest reading some of his other articles. The man knows how to write about medicine.

So here is the breakdown. The Senate bill plans to cut costs with pilot programs. There is not much else. Every major suggestion from health-care experts for cutting costs (except malpractice reform) was put into a pilot program. The theory is that health-care costs are up because health-care providers do not want to try anything new that will lower costs. Unfettered capitalism does not work if businesses do not know the best choices to make. So the way to help them is to force some of them to try new things. The hope is that if one of the pilot programs starts to work, its methods will start being employed voluntarily by other health-care providers.

For a description of some of the programs you can read the article. Some of the programs for Medicare and Medicaid are just experiments that the government will monitor to see if any will work. Other programs make insurance companies or health-care providers try new things in order to gain evidence of what works or not.

Left to their own devices health-care providers have been too timid to cut costs. Most likely because their customers are insurance companies rather than patients. However, if they see something that works, like one of the Senate Bill’s pilot programs, then they won’t be shy to adopt it.

This is the grand plan to lower costs. There is little else, besides a possible public option that - if it ever makes its way into a bill - will not do a lot to lower costs. It still relies on a government insurance company to lower costs by negotiating with health-care providers, when neither medicare nor medicaid have been all that successful.

What does everyone else think? Will this work?

I’ve become fairly convinced that America’s high health costs are at least 70-80% due to using the newest technologies and helping with the R&D on them. Before, I had thought that this wasn’t the issue because people had only pointed out the price discrepancy of pharmaceuticals. But it looks like everything that’s an actual purchased item, medical equipment, pharmaceuticals, etc. we pay about double what they do elsewhere.

While we could certainly cut cost by simply not buying the newest and greatest, the problem with that is that we seem to be the -only- country that buys the newest and greatest. The rest of the world waits until things have become proven and affordable. If our buying habits change to match the rest of the world, then there’s no longer a client for cutting edge technology, which will end up harming the development of new technologies. We’re better off to force the rest of the world to help pay for that cost than to try and reduce our spending.

No opinions about this? There are like tens of threads discussing the public option and nothing about what Congress really wants to do to cut costs. Whether the public option is in or not will not matter unless the pilot programs in the bill work. The public option has become a purely political battle, with almost no effect on overall health-care costs.

Sage Rat, won’t that just mean that there won’t be a client for inefficient cutting edge technology? The efficient stuff will still be bought buy rich American hospitals. The point is to spend the money more wisely, but the oodles of money we do have will still be spent.

It’s an incremental improvement. I had hoped we could go directly to single payer and skip all of the death, destruction, wailing, and gnashing of the teeth that an incremental progression to single-payer would involve, but I guess some people are just gluttons for punishment.

I just hope the next increment is more substantial.

The cost cutting is all in the “maybe” territory. I think we need a standalone bill that cuts Medicare and Medicaid to prove that the government is serious. As with most bills going through congress, this one frontloads the benefits and backloads the pain. Which means that the pain will come when most Congressmen are out of office, or not at all.

The insurance companies will do every thing they can to sabotage the health care when it is implemented. They are not interested in the welfare of the people, only profits and bonuses.

So far, I’m not very optimistic. The bill looks like it is being watered down, special interests and religious groups seem successful so far in getting the anti-abortion limitations, lobbyists and pharmacies and everyone else will want to have their fingers in the till, or have “bad parts” taken out, and there is still all the usual nonsense and scare tactics from the politicians. I doubt whatever we end up with, will have much resemblance to what was origianlly intended, or what we thought we were getting.

I expect that in the end, it will be a bureaucratic and regulatory disaster that will not benefit anyone. I see it being “set up to fail”.

Cutting costs will give them profits.

It is just that right now they prefer to cut costs by giving people less for their money. But if a pilot program starts to work (and cut costs on the health-care side) then there is no reason that insurance companies won’t adopt it.

That sounds like pretty much everything that goes through Congress. I don’t doubt that Insurance and Pharmaceutical companies will score some provisions within the bill, but if ends up cutting rising costs and insuring a lot of people (it’s looking to be 94%) then I say it isn’t a total failure.

The fact that euthanasia and abortion was dragged into this really sucks. But that’s probably the result of the cable news crowd not understanding anything that is in this bill so they need familiar and simple topics to complain about.

and why is there any reason to think that insurance companies won’t continue to cut costs the old way?

they’ll have their cake and eat it too - they’re not going to magically be nicer to their policyholders because they’ve had reductions in their outlays.

Call me a cynic.

There will be 'annual caps", thanks to guys like Harry Reid and the CBO. There will be, in one form or another, some sort of “lifetime caps” eventually. The very things that “customers” need the insurance for, the catastrophic, life threatening, high dollar things, will be denied because that would push them over The Cap.

So, it looks like this new system may just be a corporate trough while the rest of us get screwed. That’s what I expect to happen.

UHC is/was a good idea. Our own “leaders” will turn it into garbage.

The bill does have reforms to restrict these practices. There is supposed to be a ban on denying coverage based on preexisting conditions, and cap on out of pocket expenses. I know that this is not guaranteed yet, and SteveG1 does have a right to be skeptical, but I’m going on what is promised at the moment. If I don’t get it, then I’ll start being upset.

But for now the bill has restrictions on insurance companies cutting costs the old fashion way and it has incentives for them to cut costs without hurting consumers. I’ll have to watch closely to see if any of this changes.

Will we be able to trade them? 'Cos that would be a twofer for the Obama Administration. Woohooo!