AMERICAN CONSERVATISM IN 2008 AND BEYOND

@maporsche,

maporsche wrote:

48 billion is roughly half of what the plans in congress will cost us per year.

If you were to save that 2%, HALF of the health care proposal would be paid for.

Based on the track record of Congress/the Administration on providing accurate numbers on costs of various proposed programs--and that would include the numbers of what we were told by the previous administration vs the actual costs to the taxpayers--I think you would be smart to increase that $96 billion or whatever the number is fivefold or tenfold or more. All you have to do is look at what happened to Social Security, the war on poverty, Medicaid, Medicare, the Seniors Prescription Drug program, the war in Iraq, etc. etc. etc. to know that the government isn't going to come in anywhere close to budget on any big program they propose.

1 Reply

@Foxfyre,

If we didn't have the Iraq war, 100% of the cost would have been covered.

1 Reply

Another gleaning from today's e-mail that underscores the problem we have with a Congress who has less economic sense or accountability than a college freshman with a maxed out credit card:

Quote:

Congressional Budget Office Makes a $600 Million Mistake
Posted by Erick Erickson (Profile)
Thursday, September 24th at 9:13PM EDT

For those who have problems with John Cornyn personally, as opposed to the NRSC operation, I want you to take particular note of this story. He’s doing good work and we need to support him despite differences on the side.

Today the Senate voted, by voice vote, on an amendment by Senator Debbie Stabenow. Keep in mind that Senator Stabenow offered just one amendment to the healthcare legislation.

The Congressional Budget Office, rushing to keep up with the Senate’s aggressive schedule on passing health care legislation, scored the one amendment.

There was a voice vote. Senator Stabenow’s amendment passed.

Only after the amendment passed did the Congressional Budget Office realize it made a mistake in the scoring and under counted the one amendment to the tune of $600 million.

It took Senator John Cornyn (R-TX) to point it out. And now he is offering an amendment of his own to make sure this does not happen again. According to Senator Cornyn, his “amendment requires that before the Finance Committee votes on any amendment to America‘s Healthy Future Act of 2009, the Congressional Budget Office (CBO) and the Joint Tax Committee scoring estimates of such amendment must be publicly available and posted on their respective websites for at least 24 hours before any vote.”

We need to support him and the Senate should pass his amendment. $600 million may be chump change to the Democrats, but for the rest of us, it is real money.
http://www.redstate.com/erick/2009/09/24/congressional-budget-office-makes-a-600-million-mistake/

0 Replies

@Setanta,

Setanta wrote:

Overwhelmingly, health service providers are corporate entities. If you reduce the cost to the corporate entity, they are just going to keep the difference as a dividend. But more than that, health insurance providers negotiate fee schedules with health service providers--they (the service providers) are already accepting the lowest nominal rates the insurers were able to negotiate with them for their large group coverage, so the insurers aren't saving a damned thing when malpractice insurance rates are lowered--there is no savings for them to pass along to the customer. I know this both because i have worked on the hospital side of insurance benefits/payment, and because, more recently, as a small business manager, i would routinely deal both with the service providers and the insurers.

If one reduces the cost to those corporate entities of selling health insurance, AND each of these corporate entities have to compete with ALL other such corporate entities throughout the United States--currently they only have to compete with those located in their same state--then the price of health insurance will decrease, or will not increase as much as it has previously.

2 Replies

@ican711nm,

ican711nm wrote:

Setanta wrote:
Overwhelmingly, health service providers are corporate entities. If you reduce the cost to the corporate entity, they are just going to keep the difference as a dividend. But more than that, health insurance providers negotiate fee schedules with health service providers--they (the service providers) are already accepting the lowest nominal rates the insurers were able to negotiate with them for their large group coverage, so the insurers aren't saving a damned thing when malpractice insurance rates are lowered--there is no savings for them to pass along to the customer. I know this both because i have worked on the hospital side of insurance benefits/payment, and because, more recently, as a small business manager, i would routinely deal both with the service providers and the insurers.

If one reduces the cost to those corporate entities of selling health insurance, AND each of these corporate entities have to compete with ALL other such corporate entities throughout the United States--currently they only have to compete with those located in their same state--then the price of health insurance will decrease, or will not increase as much as it has previously.

The one thing that is so difficult to include and quantify in complicated national issues is the indirect side effects resulting from policy and legislation.

For instance, when capital gains taxes are reduced, it is fairly easy to compute the amount of taxes that are not being collected as capital gains. The simple notion is that the tax cuts therefore increase the deficit because the treasury isn't receiving as much money. Government tracking agencies can and do provide numbers showing that to be the case.

However, honest economists also look at the indirect effects of such tax cuts. The change in behavior of those who hold property subject to capital gains must also be considered as well as the effect on the overall national productivity and economic growth. Reducing tax revenues from Source A can result in a similar or greater tax revenues from Source B and honest accounting will acknowledge that fact. Likewise raising taxes to increased tax revenues from Source A could result in similar or greater reductions in tax revenues from Source B, and honest accounting will acknowledge that too.

It is a fact that healthcare costs have continued to rise in Texas after tort reform was enacted. But I want to see the numbers of where those healthcare costs have increased. I bet it has little or nothing to do with tort reform and, in fact, the increase would have been more without the tort reform. Certainly having more instead of fewer healthcare providers and insurers in the state has not increased healthcare costs there.

0 Replies

@ican711nm,

Which has nothing to do with a silly claim that tort reform will reduce health insurance premiums.

It is also apparent that you didn't understand a damned thing that i wrote. There is nothing in the reduction of malpractice insurance premiums which reduces the cost of the provision of health care to the health insurance industry. Try to pay attention, will ya?

1 Reply

@cicerone imposter,

Cicerone imposter wrote: If we didn't have the Iraq war, 100% of the cost would have been covered.

Ican writes: If we hadn't won the Iraq war, al-Qaeda would have murdered many more Americans than they did on 911.

If we don't win the Afghanistan war, al-Qaeda will murder many more Americans than they did on 911.

0 Replies

@Setanta,

Setanta, I read and understood, but did not believe, your dissertation on how health insurance providers generally operate.

I understand that if health insurance providers have little competition they will charge more than they would if they have much more competition. Do you?

1 Reply

@Foxfyre,

Foxfyre wrote:

Without thinking it all the way through, at first blush I would object to allowing a tax credit for this kind of charitable donation and not for other kinds of charitable donations as I think that would make it non-uniform and non-equal and would unnecessarily disadvantage many worthy charities. Also, you would have everybody from the YMCA (who already provides a form of healthcare for their programs such as Silver Sneakers and aquacize for rehab patients) to Planned Parenthood to ACORN claiming they are providing healthcare to needy persons and wanting in on that deal. I think it would become a bureaucratic nightmare deciding who qualified and who didn't. Better to treat all charities alike.

And why would providing healthcare be of more social value to merit extra tax relief than would giving a meal to a hungry person at a soup kitchen or a warm winter coat to the child who doesn't have one:?

Before your response, I was focused on proposing an alternative way to provide private health care insurance without any federal government participation or subsidies.

You raise a valid issue: why would it be fair to permit tax credits for contributions to a health care insurance charity, but no tax credits for contributions to other charities?

My answer: it wouldn't be fair; and it would not be an equalization of liberty. But on the otherhand, utilizing a way to keep the federal government from providing health care insurance will save the private economy trillions of dollars. That will benefit a great many people by reducing the number of people who would otherwise be unemployed because of high government taxes, or high inflation, or both.

I now recommend we start by implementing my original recommendation. Then we next we proceed to phase out the federal government contributing to any charity via tax credits, via income deductions, or via subsidies or gifts.

Quote:

ftp://ftp.bls.gov/pub/suppl/empsit.cpseea1.txt
Total Employed in USA..........Change
2000 136,891,000------------------
2001 136,933,000...............+42,000
2002 136,485,000.............-448,000
2003 137,736,000..........+1,251,000
2004 139,252,000..........+1,516,000
2005 141,730,000.........+2,478,000
2006 144,427,000.........+2.697,000
2007 146,047,000.........+1,620,000
2008 145,362,000............-685,000
2009 139,649,000..........-5,713,000 (as of August 31)

0 Replies

@ican711nm,

I understand that you don't know how health insurers and health services providers interact. Health insurers negotiate rates for services, and when they have arrived at a negotiated fee, that's what they pay, without regard for what may cause the providers' costs to rise or fall. If you had ever spent any time looking at health insurance plans and their provisions, you'd know that there is virtually no effective competition, despite there being literally hundreds of options to choose from. The most common package is 80-20 (sometimes 75-25) with a set deductible for outpatient services and for hospital admissions, and with a set co-pay for prescriptions and certain services. How much you pay in a premium will be determined by the risk factors of each individual--such as their age, gender and tobacco use--and the precise details of the plan, such as the size of the deductibles and the co-pay provisions. These vary by a matter of a less than a dollar per certificate per month from one company to another, which should not be surprising, since they are all working from the same actuarial tables. They're not trying to compete.

As is so often the case, your appeal to "common sense" simply displays your ignorance of how the world works. A final note: what you do or don't believe does not determine reality.

1 Reply

@Setanta,

Setanta wrote:

I understand that you don't know how health insurers and health services providers interact. Health insurers negotiate rates for services, and when they have arrived at a negotiated fee, that's what they pay, without regard for what may cause the providers' costs to rise or fall. If you had ever spent any time looking at health insurance plans and their provisions, you'd know that there is virtually no effective competition, despite there being literally hundreds of options to choose from. The most common package is 80-20 (sometimes 75-25) with a set deductible for outpatient services and for hospital admissions, and with a set co-pay for prescriptions and certain services. How much you pay in a premium will be determined by the risk factors of each individual--such as their age, gender and tobacco use--and the precise details of the plan, such as the size of the deductibles and the co-pay provisions. These vary by a matter of a less than a dollar per certificate per month from one company to another, which should not be surprising, since they are all working from the same actuarial tables. They're not trying to compete.

As is so often the case, your appeal to "common sense" simply displays your ignorance of how the world works. A final note: what you do or don't believe does not determine reality.

I grant you that what I do or do not believe does not determine reality.

You should grant me that what YOU do or do not believe does not determine reality.

You believe medical care insurers do not compete. You further believe that if the following two changes were made nationwide, they would continue to not compete:
(1) limit, in all 50 states, the size of tort awards for non-expenses, to the same amount;
(2) permit a resident of any of the 50 states to buy from any of the medical care insurers in any of the 50 states.

I believe that with only limiting tort awards for non-expenses, the pressure on medical care insurers to compete is small when their competition is only a small number within their state. Changing that and requiring states to permit such insurers to sell their insurance in any of the 50 states, would go a long way toward requiring them all to compete to survive.

LINKS TO PERTINENT COMMENTARIES

Quote:

http://www.altavista.com/web/results?itag=ody&q=power+corrupts&kgs=0&kls=0

ONE SUCH PERTINENT COMMENTARY

Quote:

http://www.phrases.org.uk/meanings/288200.html
Power corrupts; absolute power corrupts absolutely
Meaning

Literal meaning.

Origin

This arose as a quotation by John Emerich Edward Dalberg Acton, first Baron Acton (1834"1902). The historian and moralist, who was otherwise known simply as Lord Acton, expressed this opinion in a letter to Bishop Mandell Creighton in 1887:

"Power tends to corrupt, and absolute power corrupts absolutely. Great men are almost always bad men."

Another English politician with no shortage of names - William Pitt, the Elder, The Earl of Chatham and British Prime Minister from 1766 to 1778, is sometimes wrongly attributed as the source. He did say something similar, in a speech to the UK House of Lords in 1770:

"Unlimited power is apt to corrupt the minds of those who possess it"

1 Reply

Once again, you either fail to understand the relationship between health care insurers and health services providers, or are willfully being disingenuous--i suspect the former. Tort reform doesn't affect the relationship because they negotiate their rates, and the negotiations are based on actuarial tables and the latest reliable professional estimates on the cost of providing health care services at the time of negotiation. They don't care what the corporation has to pay doctors or nurses, nor what their insurance liabilities are, nor what their physical plant costs them, nor what their advertising and PR departments cost them. If the health care provider corporation does not accept a price at or below the highest nominal fee the insurer is willing to pay, they will simply drop them from their list of acceptable service providers, and then pay their lowest nominal rate to any certificate holder who uses their services, rather than paying the services provider directly, at which point the certificate holder is responsible for the balance.

These are not things i believe about the system, these are things i know from having worked in the system, and worked with the system, for many years.

So much for the fable about tort reform and health insurance premiums. As for buying insurance from other states, there is absolutely nothing which will stop you from buying insurance from any company you want to buy it from, as long as the insurer is not on a proscription list with your state's insurance regulators.

The last small business which i managed purchased it's liability insurance from a company in Michigan, its health insurance from a company in Wisconsin, it's auto insurance from a company in Ohio, and had its pension plan with a Canadian insurance company which maintains offices in Buffalo, New York to service its American customers. You clearly know nothing about business insurance.

0 Replies

@ican711nm,

Setanta wrote:

I understand that you don't know how health insurers and health services providers interact. Health insurers negotiate rates for services, and when they have arrived at a negotiated fee, that's what they pay, without regard for what may cause the providers' costs to rise or fall. If you had ever spent any time looking at health insurance plans and their provisions, you'd know that there is virtually no effective competition, despite there being literally hundreds of options to choose from. The most common package is 80-20 (sometimes 75-25) with a set deductible for outpatient services and for hospital admissions, and with a set co-pay for prescriptions and certain services. How much you pay in a premium will be determined by the risk factors of each individual--such as their age, gender and tobacco use--and the precise details of the plan, such as the size of the deductibles and the co-pay provisions. These vary by a matter of a less than a dollar per certificate per month from one company to another, which should not be surprising, since they are all working from the same actuarial tables. They're not trying to compete.

You apparently believe that since that is the way it has been, therefore that is the way it will be.

I believe you neglected a significant probability factor: the probability of a tort suit. In Texas, the probability of tort suits has decreased by more than a factor of ten, since 2003. Why? That is because in Texas the tort awards for non-expenses has been reduced significantly, and the price of tort insurance doctors buy has decreased. I believe that probability will decrease more. If it does decrease more, I believe the price of doctor's tort insurance will decrease more. If that happens, I believe doctor's fees for medical services will decrease as a result.

2 Replies

@ican711nm,

The data you provided from the Texas example showed that the cost to the consumer did not decrease after the implementation of tort reform.

0 Replies

Once again, what you believe is meaningless. Health insurers base their premiums on actuarial tables and their historic costs with large groups (or, as was the case with our insurer in Wisconsin, pools of small group coverage), and those are in turn conditioned by their negotiated rate schedules. They don't care what a doctor charges--they will state in the contract how much they will pay up front, and if you doctor charges more than that amount, it is up to you to pay the balance, or to convince your physician to accept the rate the insurer is willing to pay.

0 Replies

Here ya go, Ican, from the article which you linked:

"Doctors have seen their costs fall for liability insurance as malpractice insurance companies return to the state and to profitability. There is no evidence of savings to Texas consumers, however."

You do understand capitalism, don't you, Bubba? If i am charging you $25.00 for a service which it costs me $19.00 to provide, and my costs drop to $17.50--i'm still gonna charge you $25.00. The only difference will be that i used to pocket $6.00, and now i get to keep $7.50.

And, once again, health insurance premiums are based on the historical costs to the insurer, from which they negotiate the rates they will pay, and not on what the physician or health services provider corporations have to pay to provide the services.

1 Reply

@ican711nm,

Again the factors that are not included in the anti-tort-reform data should be considered when evaluating the benefits or lack thereof of the legislation. You have to look beyond the raw data and evaluate the change in behaviors as a result of the 'reform'. I have looked and have not found that tort reform increased anybody's costs--it did most likely cut into profits of certain trial attorneys who make their living filing lawsuits against people they perceive as having the deepest pockets.

But if an unnecessary diagnostic test is not ordered as result of tort reform, there is no rational way to say that there is no benefit in savings. Over the long term, I think honest data will show that overall, the consumer of health care has benefitted in various ways.

And as previously posted, even if only 2% of healthcare costs involve defensive medicine or malpractice suits, saving those costs is certainly not chicken feed. Who was it who said a billion here and a billion there and pretty soon you're talking about real money.

I doubt more than a tiny handful of Texans--that would include those opportunistic trial lawyers--would vote to rescind the reforms Texas enacted.

Quote:

Texas Can Demonstrate Success Of Tort Reform
Tyler Morning Telegraph
September 15, 2009

In his speech on health care reform, President Barack Obama expressed a willingness to consider tort reform as a part of the plan; he added he'll look to the states to see if it can make a difference.

"Many in this chamber -- particularly on the Republican side of the aisle -- have long insisted that reforming our medical malpractice laws can help bring down the cost of health care," Obama said on Wednesday night. "I don't believe malpractice reform is a silver bullet, but I have talked to enough doctors to know that defensive medicine may be contributing to unnecessary costs. So I am proposing that we move forward on a range of ideas about how to put patient safety first and let doctors focus on practicing medicine. I know that the Bush administration considered authorizing demonstration projects in individual states to test these issues. It's a good idea, and I am directing my Secretary of Health and Human Services to move forward on this initiative today."

We're way ahead on this one.

Texas has already demonstrated how malpractice reform can make life better for millions of people.

"Since 1995, no state has done more than Texas to restore the trust of citizens in their court system," notes the Texas Public Policy Foundation. "Tort reform has lowered liability costs for numerous occupations, reduced frivolous lawsuits, and reduced overall costs to businesses and consumers in Texas. Texas' efforts to reform its tort system have been successful in lowering medical malpractice premiums and attracting physicians to Texas."

Gov. Rick Perry declared medical malpractice lawsuits a statewide crisis in 2003.

"Doctors were caught between rising medical malpractice insurance costs and lower compensation from insurance-provided benefit contracts and low Medicare/Medicaid reimbursement levels," said former state Rep. Joe Nixon. "Combined with increasing hassles and demands to appear in court or in depositions, doctors were choosing to retire or leave Texas. In doctor-per-citizen ratio, Texas ranked 49th out of 50 states."

Of the state's 254 counties, more than 150 had no obstetrician in 2003, and more than 120 had no pediatrician.

But lawsuit reform was a driving force in the general elections of 2002. And when lawmakers gathered with a new Republican majority, lawsuit reform was a top priority -- culminating in the 96-page House Bill 4.
It worked.

"Tort reform has been responsible for the creation of 499,000 new Texas jobs according to economist Ray Perryman," notes Bill Hammond of the Texas Association of Business.

Adds Peggy Venable, Texas director of Americans for Prosperity, "Doctors and hospitals are using their liability insurance savings to expand services and initiate innovative programs; those savings have allowed Texas hospitals to expand charity care by 24 percent."

If Obama is serious about looking to the states for tort reform solutions, he need look no further. The Lone Star State stands out.
http://www.tortreform.com/node/545

1 Reply

@Foxfyre,

Foxfyre, your post deserves repeating in larger type:
Again the factors that are not included in the anti-tort-reform data should be considered when evaluating the benefits or lack thereof of the legislation. You have to look beyond the raw data and evaluate the change in behaviors as a result of the 'reform'. I have looked and have not found that tort reform increased anybody's costs--it did most likely cut into profits of certain trial attorneys who make their living filing lawsuits against people they perceive as having the deepest pockets.

But if an unnecessary diagnostic test is not ordered as result of tort reform, there is no rational way to say that there is no benefit in savings. Over the long term, I think honest data will show that overall, the consumer of health care has benefitted in various ways.

And as previously posted, even if only 2% of healthcare costs involve defensive medicine or malpractice suits, saving those costs is certainly not chicken feed. Who was it who said a billion here and a billion there and pretty soon you're talking about real money.

I doubt more than a tiny handful of Texans--that would include those opportunistic trial lawyers--would vote to rescind the reforms Texas enacted.

0 Replies

@ican711nm,

Here are some numbers.

Quote:

http://blogs.wsj.com/health/2008/05/19/doctors-flock-to-texas-after-tort-reform/?mod=WSJBlog
May 19, 2008, 7:44 AM ET Doctors Flock to Texas After Tort Reform

By Scott Hensley
In the last three years, 7,000 doctors have moved to Texas. So many doctors want to practice there that the state has had trouble keeping up with the requests for licenses.

Texas Capitol
How come the flood? A clampdown on damages in malpractice suits has made Texas a very attractive place to practice medicine, says an opinion piece in the WSJ.

The most significant change is a $250,000 cap on non-economic damages per defendant, such as pain and suffering and loss of companionship. “Before the caps, the average award was $1.21 million; it’s been $880,000 since,” the Dallas Morning News reported last year.

Malpractice suits have plummeted. In 2003, before the caps took effect, there were 1,108 medical liability suits filed in Dallas County, the Morning News reported. Only 142 cases were filed in 2004. Last year there were 184.

Proponents of malpractice reform point to Texas as a model. The surge of doctors has helped relieved shortages in some rural parts of the state.

0 Replies

Moving on from the ditto-heads of movement conservatism to the small but interesting minority of grown-up conservatives: Richard Posner, the Chicago law professor, legal mastermind of American conservatism, leader of the law-and-economics revolution, Reagan-appointed appeals court judge, and arguably Conservatism's most influential public intellectual ...

... has officially announced his conversion to Keynesian economics.

Might there be hope for American Conservatism yet?

4 Replies

AMERICAN CONSERVATISM IN 2008 AND BEYOND

Related Topics

Quick Links

My Account

able2know