MSNBC: McConnell proposes giving Obama unilateral debt ceiling power

[Wrong Direction]

I think this touches on a fundamental problem, in that these politicians have got to stop promising pie-in-the-sky and start to tell people the reality of what they can, can't, and must do.

Maybe then people would begin to start to have realistic expectations, realistic outlooks, and stop being such ninnies who want fantasies to be true.

~Bang

You know this happens from all sides, at all levels, right?

Politics, unfortunately, is about giving people a break. It started with helping people who had a bad break, but it's so far beyond that now it's ridiculous.

Sort of...

[Bang]

You know this happens from all sides, at all levels, right?

Politics, unfortunately, is about giving people a break. It started with helping people who had a bad break, but it's so far beyond that now it's ridiculous.

Sort of...

Of course I do. And you're right.

I'm tired of it. Tired of bull****ters bull****ting about bull**** every day.

As it is we constantly expect something for nothing, and the sense of entitlement that pretty much EVERYONE has is ridiculous.

The old cliche of the lying politician is one thing when they aren't talking about the economic collapse of the country. But these are dark times, and we dseserve better, even if as a whole we're not smart enough to demand it.

This country is paralyzed, and no one wants it to be otherwise because people want to believe that the fantasies they're being spoonfed are true.

And fantasies in which there is no room for compromise aren't healthy.

I guess the sad thing is that I hear in your words (truthfully, I might add) that the politicians don't want to do anything painful because it may cost them their cushy job, regardless of the damage it may cause.

I'm one who would have a ton more respect for a lawmaker who did the right thing as opposed to just trying to perpetuate the fantasies to get re-elected all the damn time.

That is someone that would earn my vote... as opposed to the usual attempt to buy it.

~Bang

[twa]

Burgold....there is nothing stopping Obama or congresscritters from recommending tax increases or closing loopholes

not making it part of the bill simplifies it

[PeterMP]

It's the same math as Obamacare "bending the cost curve" downward and lowering costs to all. How is that one working out?

Larry Kudlow had a great article last week showing Obama's spending plan alongside Paul Ryan's. Both show spending moving strongly upward, one just less than the other. Right now the plan on the table slows it for 2012 and then it just rockets upwards again. We are so hosed at this point.

I don't believe that Ryan's plan "bends the curve" either really. I believe that it simply ties the federal component to inflation (and maybe even under inflation) and not true health care costs. The amount the federal government has to pay doesn't go up that fast, but there's no reason to believe (to my knowledge) that it'll really change the rate health care costs go up.

---------- Post added July-13th-2011 at 05:58 PM ----------

Burgold....there is nothing stopping Obama or congresscritters from recommending tax increases or closing loopholes

not making it part of the bill simplifies it

Yes, it simplifies it in a manner that is consistent with the Republican party wants.

I wonder why it simplify it by allowing only for tax increases?

[twa]

Yes, it simplifies it in a manner that is consistent with the Republican party wants.

I wonder why it simplify it by allowing only for tax increases?

The McConnel price for allowing the debt limit to rise is matching delayed cuts

if the Dems want to submit a alt plan raising taxes or increasing revenue they are free to do so....now or after the McConnel plan is implemented

We can simply remain deadlocked if you wish...it is fine by me,in fact I would prefer it.

[deejaydana]

You know this happens from all sides, at all levels, right?

Politics, unfortunately, is about giving people a break. It started with helping people who had a bad break, but it's so far beyond that now it's ridiculous.

Sort of...

This speaks to me. We have just a gigantic welfare state and people like Obama, Pelosi, et al want to expand what is already far beyond what we need and what is necessary in a country as free as ours. The people you find defending it most vigilantly on this board and elsewhere are already gov't worker bees and layabouts, that and people who just simply want to right every perceived wrong as they see it.

[Wrong Direction]

I'm one who would have a ton more respect for a lawmaker who did the right thing as opposed to just trying to perpetuate the fantasies to get re-elected all the damn time.

The problem with this line of thinking is many of us genuinely disagree on what the right thing to do is. I certainly don't want a tax increase, at least not a substantial net tax increase. I think you and others disagree, as you think the right thing to do is this grand compromise that involves real tax hikes and spending cuts.

[Larry]

Burgold....there is nothing stopping Obama or congresscritters from recommending tax increases or closing loopholes

not making it part of the bill simplifies it

There is nothing stopping Boehner from proposing Medicare cuts, either.

Wonder why he feels like he has to attach them to a bill that has to pass, or the nation is ****ed.

[Wrong Direction]

I don't believe that Ryan's plan "bends the curve" either really. I believe that it simply ties the federal component to inflation (and maybe even under inflation) and not true health care costs. The amount the federal government has to pay doesn't go up that fast, but there's no reason to believe (to my knowledge) that it'll really change the rate health care costs go up.

Aside from any CBO projections, the economic theory behind a Ryan plan is to allow the market to be more in touch with pricing, thus getting to more value and lowering costs. I doubt that's reflected in any government estimates.

---------- Post added July-13th-2011 at 06:32 PM ----------

There is nothing stopping Boehner from proposing Medicare cuts, either.

Wonder why he feels like he has to attach them to a bill that has to pass, or the nation is ****ed.

The house has already proposed and voted on major Medicare reform. Many thought/think that bill is the Dem path to victory in 2012. Republican balls are on the table on Medicare.

[twa]

There does not have to be a debt limit increase at all

http://www.weeklystandard.com/blogs/easy-abc_576796.html

First, they can pass legislation prioritizing federal spending in the case of limits imposed by the debt ceiling, protecting Social Security recipients, and the military, for starters.

Then they have three paths (which aren’t mutually exclusive, and could be approached all at once or sequentially).

[Larry]

I don't believe that Ryan's plan "bends the curve" either really. I believe that it simply ties the federal component to inflation (and maybe even under inflation) and not true health care costs. The amount the federal government has to pay doesn't go up that fast, but there's no reason to believe (to my knowledge) that it'll really change the rate health care costs go up.

That's the way I understand it, too.

His plan is that Medicare will end, and that instead, the government will pay part of the cost of purchasing private insurance. And then the amount that the government pays will go down (it will go up, but less than the rate of inflation) every year, forever.

He doesn't say that this will mean that the citizen will have to pay more, every single year, to buy insurance that will cover less, every single year.

But the only way his plan doesn't do that, is if some magical spell causes the price for private health insurance to go up less than the rate of inflation, every year, forever.

---------- Post added July-13th-2011 at 06:45 PM ----------

There does not have to be a debt limit increase at all

Yep. All Congress has to do, is to completely balance the federal budget. In the next two weeks.

But don't worry. I'm certain that the GOP will show up in the room, and then announce that showing up is all the bending that they're willing to do.

(Then they'll flee the room because someone mentioned something that wasn't on the Republican agenda, and announce that they demand that the President resign before they will again deign to set foot in the room.)

---------- Post added July-13th-2011 at 06:54 PM ----------

Aside from any CBO projections, the economic theory behind a Ryan plan is to allow the market to be more in touch with pricing, thus getting to more value and lowering costs. I doubt that's reflected in any government estimates.

Like I said. A magic wand which will mysteriously cause the price of private health insurance to go down, every single year, forever.

Odds of that happening in reality?

How about if Obama announces that effective immediately, he's going to assume tha the cost of Medicare is going to go down, every single year, forever, without any reduction in coverage? And then announced that he's made a serious proposal to cut the deficit.

You buy that one?

The house has already proposed and voted on major Medicare reform. Many thought/think that bill is the Dem path to victory in 2012. Republican balls are on the table on Medicare.

The house has already voted on a plan that none of them would have even voted for, if there had been a chance of it passing. A plan who's most famous component was to eliminate Medicare entirely, and replace it with private insurance which will cost more, every year, for less coverage. And which, even with that aspect, doesn't pay back the government giveaways to the corporations and the rich (all of which happen up front) for decades.

[PeterMP]

Aside from any CBO projections, the economic theory behind a Ryan plan is to allow the market to be more in touch with pricing, thus getting to more value and lowering costs. I doubt that's reflected in any government estimates.

Oh, I understand what he and others say the reasoning is. I just don't see any reason to believe it is true. Similar to the other thread, I just have never seen much to actually back it up, and there's any number of papers in good peered reviewed journals that explain and study why health care costs don't respond to normal market pressures and why this is a problem in essentially every nation in the world and not just the US.

I've never seen the fact that people aren't in touch with pricing as very high on the list.

[Wrong Direction]

Oh, I understand what he and others say the reasoning is. I just don't see any reason to believe it is true. Similar to the other thread, I just have never seen much to actually back it up, and there's any number of papers in good peered reviewed journals that explain and study why health care costs don't respond to normal market pressures and why this is a problem in essentially every nation in the world and not just the US.

I've never seen the fact that people aren't in touch with pricing as very high on the list.

Part D is 40% below projected costs. It's almost exactly the model Ryan is proposing.

[PeterMP]

Part D is 40% below projected costs. It's almost exactly the model Ryan is proposing.

Part D is a supplemental prescription drug benefit that started in 2006.

You know what else has happened since 2006, the rate at which prescription drugs have been increasing has decreased.

And of course that decrease is not at all related to Part D, but is tied to the move of drugs from patent protection to generics based on the productivity of the Pharma industry and the length of patents.

Are you claiming Ryan's plan is going to cause a long term decrease in the productivity, in terms of patents, of the medical industry?

**EDIT**

http://www.cbpp.org/files/5-6-11health.pdf

[Wrong Direction]

Oh, I understand what he and others say the reasoning is. I just don't see any reason to believe it is true. Similar to the other thread, I just have never seen much to actually back it up, and there's any number of papers in good peered reviewed journals that explain and study why health care costs don't respond to normal market pressures and why this is a problem in essentially every nation in the world and not just the US.

I've never seen the fact that people aren't in touch with pricing as very high on the list.

Maybe I can convince you of the problems inherent in Medicare, and how Private Insurance changes things. Larry, this is for you too. First, remember that the Medicare payment system is set by politicians who have every incentive to remain in office. Now, consider these examples:

1. Negative Pressure Wound Therapy (NPWT) is a service that is widely known as overpaid. NPWT companies regularly report 90%+ profits. Note, Medicare doesn't even track this. You know how Medicare determines what price it'll pay? It essentially takes the company's word for it. In this case, the ccompany said it'll cost in the neighborhood of $1,400 per treatment. Part two of this problem relates to beneficiaries and cost sharing. Since most beneficiaries have very little or zero cost sharing, there's no incentive to stick with less fancy solutions, like a simple wound dressing. In fact, because the margins are certainly higher, doctors have a much higher incentive to provide NPWT instead of simpler, much cheaper wound dressings. Note, NPWT is appropriate in some circumstances and is probably a fine service. However, it's overused and overpriced. For the money we're paying, we could dress dozens and dozens of wounds.

Here's the kicker. Once Medicare sets payment rates, new companies with the same service get paid the same rate, coded exactly the same by Medicare. Why is this important? Because companies aren't competing against each other. They're simply taking the way-over-paid payment rate and laughing all of the way to the bank.

How would this change under private insurance? Simple, private insurance companies would negotiate the lowest rate they could with NPWT companies and they'd add a prior authorization and/or incentives to use cheaper solutions as part of its benefit package. Private insurance wouldn't just lower the rate of cost increases, it would dramatically lower the actual cost of numerous services like this.

2. Provenge: This is a similar issue. In a nutshell, the Provenge people knew they had to be covered by Medicare, even at roughly $100,000 a pop and with little effectiveness data in the Medicare population. Every coverage guy in Medicare would have loved to deny coverage, but the politicians stepped in and said it needs to be covered.

A private insurance plan would achieve a dramatically lower price from the manufacturer and they'd have real access limits. This is another case of free healthcare costing millions.

3. Competitive Bidding: This is a politician's response to overpayments. In 2003, after years of knowing DME was overpaid in Medicare (reports from late 90's), Bush and Republicans passed the competitive bidding program. In 2011 it was implemented, and that was only because of our debt situation. It's original implementation dates were pushed back several years, it was only implemented originally in 9 regions and only for 9 product categories, not nearly all of DME.

How are they achieving savings? They're requiring companies to bid against each other. This is resulting in real savings and it's a good thing, however I have two significant nitpicks. First, it took years for Congress to pass anything to this effect. Second, it took 8 years to implement. Third, since Medicare is a single payer, it's actually too draconian in it's implementation. If you don't win a bid, you don't get Medicare business. In healthcare, if you don't get Medicare business, you are likely out of business.

In a private insurance world, they'd negotiate separately with DME companies and only contract with enough to cover their geographical area. DME companies would be able to negotiate back, and if they didn't get a contract they'd move on to another insurance company and still have some business.

4. Ambulance services: Here's one anecdote for you. My uncle needed to go from the hospital to a rehab facility, and back. It was a 1/4 mile trip and it cost $700 each way. Of course, my uncle didn't have to pay a dime. Would a man with a 4 inch incision have paid that to go 1/4 mile, even with an accompanying medical person? Would a more flexible system allow for non-emergent transportation system that costs much less? Would my uncle have ever agreed to pay $1,400 for 1/2 mile of transportation?

We could go on into hospice, hospital payments, home health, etc. This is Medicare, and I haven't even talked about fraud yet and how that could be diminished in private insurance. The bigger point here is this all happens because politicians are incapable of effectively managing something so complex. People in favor of a single payer system are clueless about what that actually means, IMO.

If it makes anyone feel better, ObamaCare isn't as bad as Medicare. In fact, it's much closer to what Ryan has proposed.

---------- Post added July-13th-2011 at 09:21 PM ----------

Part D is a supplemental prescription drug benefit that started in 2006.

No it's not. Part D is the primary insurer for about 30 million Americans.

You know what else has happened since 2006, the rate at which prescription drugs have been increasing has decreased.

And of course that decrease is not at all related to Part D, but is tied to the move of drugs from patent protection to generics based on the productivity of the Pharma industry and the length of patents.

I have personally reported to government officials about generic utilization rates in Part D compared to Medicaid. Even with generic mandates in states, Part D led in generic utilization rates and drove the trends in other sectors. To do this comparison, I had to look at OIG and CMS/Part D data. Why did this happen? The answer is two fold. First, Part D comes with a 25% statutory copayment. Since many customers had to worry about price, they CHOSE generic drugs instead. Second, Part D came with a donut hole. In this case, price sensitivity was even higher.

Are you claiming Ryan's plan is going to cause a long term decrease in the productivity, in terms of patents, of the medical industry?

Uh. No.

---------- Post added July-13th-2011 at 09:29 PM ----------

http://www.cbpp.org/files/5-6-11health.pdf

By the way, that paper was as partisan as they get. I already addressed the issue about generics. The issue about rebates is also misleading. Medicare rebate data isn't public, first of all, so any discussions to that effect are uninformed. Second, Medicare didn't achieve drug savings only through drug rebates. They also achieve savings - in fact, they primarily achieve savings - through negotiated prices with pharmacies. This is what is missing throughout Medicare!

Pharmacies, and all healthcare providers, have Usual and Customary prices (U&C). These prices are technically charged to uninsured patients and they're always much higher than the price they negotiate with insurance companies. I can go into more detail here if you have specific questions.

On their enrollment claim, I had never heard estimates were based on 93% enrollment. I'm not sure how they assumed that. As it stands, just over 90% of Medicare beneficiaries have qualified prescription drug coverage.

[PeterMP]

Maybe I can convince you of the problems inherent in Medicare, and how Private Insurance changes things. Larry, this is for you too. First, remember that the Medicare payment system is set by politicians who have every incentive to remain in office.

Nobody is claiming that medicaid and medicare don't have issues and don't need to be reformed. The question was will Ryan's plan bend the curve. The answer is there is no reason to believe it will and what has happened with part D isn't a reason to believe it will as laid out in the link I supplied.

Even for private insurance, the costs of health care are going up faster than inflation and have been for some time. I don't think there is even good evidence that the costs of private insurance is going up more slowly than Medicare costs (or that private insurance actually produces better health care results).

I have personally reported to government officials about generic utilization rates in Part D compared to Medicaid. Even with generic mandates in states, Part D led in generic utilization rates and drove the trends in other sectors. To do this comparison, I had to look at OIG and CMS/Part D data. Why did this happen? The answer is two fold. First, Part D comes with a 25% statutory copayment. Since many customers had to worry about price, they CHOSE generic drugs instead. Second, Part D came with a donut hole. In this case, price sensitivity was even higher.

Just wanted to pull out this one part because it is related to the link I added:

"As a result, the federal government is incurring considerably higher drug costs for the dual eligible beneficiaries than were previously paid under Medicaid. According to CBO, requiring drug

manufacturers to pay Medicaid-level rebates (or discounts) for drugs dispensed to the Medicare beneficiaries who receive Medicare’s “low-income subsidy” to help them afford the premiums for Medicare drug coverage (most of whom are dual eligibles) would reduce Medicare Part D costs by $112 billion over the next ten years.11 This is strong evidence that reliance on private insurance, has raised, rather than lowered, the government’s costs."

[Wrong Direction]

Nobody is claiming that medicaid and medicare don't have issues and don't need to be reformed. The question was will Ryan's plan bend the curve. The answer is there is no reason to believe it will and what has happened with part D isn't a reason to believe it will as laid out in the link I supplied.

Sure it does. Part D incents consumers to choose cheaper plans AND to get more value for $ spent. That's exactly what Ryan's trying to do with his reforms. How are they different?

Even for private insurance, the costs of health care are going up faster than inflation and have been for some time. I don't think there is even good evidence that the costs of private insurance is going up more slowly than Medicare costs (or that private insurance actually produces better health care results).

I'm glad you made this point. The problem with these statistics is they assume a free marketplace, with actual market efficiencies and dissimilar mandates. Unfortunately, our private insurance system has incredible limitations to markets. I just wrote a book about Medicare. We'll just have to agree to disagree on this one until I one day get the chance to go into more depth on this issue.

Just wanted to pull out this one part because it is related to the link I added:

"As a result, the federal government is incurring considerably higher drug costs for the dual eligible beneficiaries than were previously paid under Medicaid. According to CBO, requiring drug

manufacturers to pay Medicaid-level rebates (or discounts) for drugs dispensed to the Medicare beneficiaries who receive Medicare’s “low-income subsidy” to help them afford the premiums for Medicare drug coverage (most of whom are dual eligibles) would reduce Medicare Part D costs by $112 billion over the next ten years.11

You can't draw the conclusion below from the statement above.

This is strong evidence that reliance on private insurance, has raised, rather than lowered, the government’s costs."

All the first quote is saying is that if you require an unnatural (in market terms) rebate to be paid into an existing system with negotiated prices, that those rebates will add up. Well, if they're not getting cheaper prices that exact way now, of course implementing that system would add up in the CBO's eyes.

Here's the problem. That little nugget in my book above about Plans/Pharmacies negotiating prices and getting big discounts that way is incredibly important because they negotiation prices off of some cost benchmark (Average Wholesale Price (AWP), Wholesaler Acquisition Price (WAC), others). Every brand drug gets an AWP. So, the typical Pharmacy-Plan negotiated price for a drug is something like AWP-18%. If the Dems get this new rebate into their bill, all pharmaceutical manufacturers will do is raise the AWP, thus passing the cost of the rebate right into the negotiated price of the drug, and all Part D beneficiaries pay that price, not just the low income.

Now, how much will they raise AWP to compensate? I don't know. I do know that the answer is > 0.

[PeterMP]

Sure it does. Part D incents consumers to choose cheaper plans AND to get more value for $ spent. That's exactly what Ryan's trying to do with his reforms. How are they different?

They aren't, but what has happened for Part D that has allowed that to happen is that there has been a move of many of the most relevant drugs to generics so Part D consumers have been able to move to generics. Ten years ago, when more of the most used drugs weren't generics, then the Part D member wouldn't have had a choice.

This only works if you assume that the health care industry's output, in terms of important patents, will stay low. If there are no relevant generics, you can't pick generics.

And many states have generic requirements as part of their medicaid programs.

I'm glad you made this point. The problem with these statistics is they assume a free marketplace, with actual market efficiencies and dissimilar mandates. Unfortunately, our private insurance system has incredible limitations to markets. I just wrote a book about Medicare. We'll just have to agree to disagree on this one until I one day get the chance to go into more depth on this issue.

Well, they don't. They look at private insurance and compare them to Medicare. Now, if you want to claim that the health insurance industry isn't a free market and that affects what private insurance charges than you can do so, but private insurance as it is right now over the long term hasn't combated costs increases any better than Medicare to my knowledge.

You can't draw the conclusion below from the statement above.

All the first quote is saying is that if you require an unnatural (in market terms) rebate to be paid into an existing system with negotiated prices, that those rebates will add up. Well, if they're not getting cheaper prices that exact way now, of course implementing that system would add up in the CBO's eyes.

Here's the problem. That little nugget in my book above about Plans/Pharmacies negotiating prices and getting big discounts that way is incredibly important because they negotiation prices off of some cost benchmark (Average Wholesale Price (AWP), Wholesaler Acquisition Price (WAC), others). Every brand drug gets an AWP. So, the typical Pharmacy-Plan negotiated price for a drug is something like AWP-18%. If the Dems get this new rebate into their bill, all pharmaceutical manufacturers will do is raise the AWP, thus passing the cost of the rebate right into the negotiated price of the drug, and all Part D beneficiaries pay that price, not just the low income.

Now, how much will they raise AWP to compensate? I don't know. I do know that the answer is > 0.

And of course Pharma is being sued and losing for playing games with AWP as compared to the real market value of the drugs.

http://www.pharmalot.com/2008/04/glaxo-and-novartis-face-alabama-fraud-suit/

So that should curtail that game and simultaneously ameliorate your concern.

[Wrong Direction]

And of course Pharma is being sued and losing for playing games with AWP as compared to the real market value of the drugs.

http://www.pharmalot.com/2008/04/glaxo-and-novartis-face-alabama-fraud-suit/

So that should curtail that game.

That game is secondary, actually. AWP is being phased out (and may be by now) because of that corruption. Still, pharmacy-plan contracts are based off of a benchmark price.

In thinking about that CBO quote more, I'm actually really curious about what it's saying now.

The OIG has done reports about overall prices in Medicaid and Medicare. They were lower in Part D. Now I'm wondering about the rest of that quote. Is the CBO saying the total price for those drugs (less rebates) is that much lower in Medicaid or are they saying the difference in rebates is that much? I'd be really interested to know the analysis because I'm sure the original OIG studies to this effect said Medicare prices were lower than Medicaid prices.

Knowing the politics behind this, I worry we're not comparing apples to apples.

I deleted your first point, but in general, the fact is that consumers effect change as much as anything. If they have skin in the game, and if the government allows unique coding for services, competitive prices will be available through the marketplace and consumers will choose lower-priced items that do the trick. It's true of generic drugs just like it's true of wheelchairs or oxygen suppliers.

---------- Post added July-13th-2011 at 10:12 PM ----------

And of course Pharma is being sued and losing for playing games with AWP as compared to the real market value of the drugs.

http://www.pharmalot.com/2008/04/glaxo-and-novartis-face-alabama-fraud-suit/

By the way, I didn't address this but the AWP gaming happened only to the calculation of the price. Pharma manufacturers can raise AWP by actually raising prices as much as they want. Since the rebate is basically a tax, they're likely to do this. The cost offset won't be huge because it'll be spread through every consumer in America with insurance, since they're all paying rates negotiated off of AWP or it's successors. This is great for politicians. They're basically lowering federal spending by $100 billion on the backs of all Americans, but all Americans won't even know it because pharma prices are so volatile anyway. Brilliant!

I bet pharma profits don't suffer. Amazing how that works.

[PeterMP]

That game is secondary, actually. AWP is being phased out (and may be by now) because of that corruption. Still, pharmacy-plan contracts are based off of a benchmark price.

And as long as the benchmark price reflect a real world market price the deductions the government gets will be real savings for the government.

I deleted your first point, but in general, the fact is that consumers effect change as much as anything. If they have skin in the game, and if the government allows unique coding for services, competitive prices will be available through the marketplace and consumers will choose lower-priced items that do the trick. It's true of generic drugs just like it's true of wheelchairs or oxygen suppliers.

Yes, in general, that's the theory how it works, but health care markets aren't "general" or "normal" markets. Here's part of a much larger review of the literature:

http://www.rand.org/pubs/technical_reports/2005/RAND_TR105.pdf

"Economic markets function best when consumers know what they are buying and so

can find the product with the combination of qualities and cost that is best for them.

In health care, consumers lack information on what is wrong with them, whether treatments will work in general or for them and on the quality of their doctor or

hospital. To relieve these gaps and improve individual and market outcomes, there

have been some attempts to provide consumers with more information, especially in

the US. However, the current literature is not clear about the extent to which more

information actually influences consumer choices. We conclude that while in theory

information for consumers might improve market outcomes, there is currently little

empirical evidence for how that information has any effect in practice."

(Note, the italics THEIRS not mine).

Like I said, I understand the theory. I just haven't seen much evidence that the health care is a normal market and responds to pressure like a normal market.

And again, the government can mandate or strongly encourage costs saving measures, such as generic requirements, which is being done, and it can include things like co-pays w/o going to private insurance.

You need to make the argument that people making choices on information that it isn't at all clear they understand and are able to make good choices on are going to result in real savings as compared to general and basic government regulation.

That might happen, but I haven't seen a whole lot of evidence for it. There's a reason that Pharma spends a ton of money advertising, and I don't know how many of the ads you've seen, but it ain't to get consumers a lot of good information so they can make good choices.

And again, all we need to look at is private insurance. There many people have a skin in the game, and private insurance hasn't controlled costs.

By the way, I didn't address this but the AWP gaming happened only to the calculation of the price. Pharma manufacturers can raise AWP by actually raising prices as much as they want. Since the rebate is basically a tax, they're likely to do this. The cost offset won't be huge because it'll be spread through every consumer in America with insurance, since they're all paying rates negotiated off of AWP or it's successors. This is great for politicians. They're basically lowering federal spending by $100 billion on the backs of all Americans, but all Americans won't even know it because pharma prices are so volatile anyway. Brilliant!

I bet pharma profits don't suffer. Amazing how that works.

And the same is true for any other cost saving measure. More people buy generics, what are the name brand drug producers going to do, raise their prices on the name brands/drugs still under patent protection.

The "savings" are going to be spread across the many to protect Pharma profits. Using your logic, we might as well give up and just give Pharma how much ever money they want.

(And there are people on this board that will tell you I'm a Pharma "apologizer")

What do you think about Medicare Advantage and the job private insurers have done there?

http://democrats.energycommerce.house.gov/index.php?q=news/new-report-highlights-medicare-advantage-insurers-higher-administrative-spending

[mardi gras skin]

An interesting phenomenon is going on here. Peter is playing the part of twa in the Global Warming threads and Wrong Direction is playing the part of...Peter.

[DRSmith]

I was thinking about thos offer, over lunch. And I did experience a bit of a paradigm shift in my viewpoint, here.

The thought occurred to me that a lot of the focus in this thread is on the political theater aspect of the proposal.

(And I can understand that, because it is political theater. In fact, I think it's pretty obvious that it's primary intent is to permit the GOP to lie to their base. But I decided to try to pretend that those aspects of the thing weren't there.)

Basically, if were were to consider this offer to be presented in some fictional universe where politics didn't exist, what the offer says is:

• Obama can raise the limit when needed (at least until 2012).
  
• He has to ask for it. (But the request is automatically granted, unless overridden.)
  
• He has to propose deficit reductions (over 10 years) equal to the amount of debt limit increase (immediately).
  
• Congress must vote on those proposals. (And they only happen if Congress passes them.)
  
• And the deficit reduction proposals must come in the form of spending cuts. Deficit reduction through adjusting revenue cannot be proposed.
  

Now, if we could look at this law without the theater, is it really that bad a proposal?

Is the proposal that every dollar of DL increase (which happens immediately) must be matched by debt reduction (on paper, over 10 years) really that onerous?

I can understand why the GOP wanted the "must be spending, no tax changes" idea. But

1. Is that really that bad a restriction? And
   
2. If it's really that bad a restriction, then maybe Obama could counter-offer? "Make that "three dollars out of every four in debt reduction must be spending cuts, and you've got a deal"?
   

Now, granted, when I consider the political theater aspect of this proposal, then what I see is absolutely ugly. And not just a little bit.

But is that a good enough reason to reject the thing?

Except Republicans will only agree to cuts that come at the exspense of average Americans

Suggest cuts to nilitary or Israel and see if they say yes

[PeterMP]

An interesting phenomenon is going on here. Peter is playing the part of twa in the Global Warming threads and Wrong Direction is playing the part of...Peter.

Remind me when the last time in a global warming thread a skeptic quoted a large section from a review of the peer reviewed literature, or the last time I made a point and then in the very next post turned around and essentially said, 'wait, that point I just made is actually irrelevant.'

There's one person here that is citing the peer reviewed literature.

Here are the facts as I see them and they remain uncontested:

1. The public does a poor job of making decisions related to health care.

2. The major reason that D came in under budget is the move to generics.

3. The government can and does do various things to encourage use of generics such as requiring paper work for people to not use generics and having co-pays.

And lastly (and most important with respect to this discussion):

4. There is no evidence suggesting that private insurance has controlled costs better than medicare and medicaid.

And Wrong Direction will make various posts and arguments that those points aren't right and attempt to confuse the issues, but I doubt he will post a single study or real piece of information that contradicts them.

[mardi gras skin]

There is one person in this thread thinks he understands the issue because he reads peer reviewed articles. The other person works in the field and understands the peer reviewed articles from the inside out.

Which one are you?

[twa]

how many times have I pointed out the flaws in peer review?

http://www.ama-assn.org/public/peer/7_13_94/pv3089x.htm

add

damn I'm rooting against myself by proxie?