Corrections Appended: February 26 and March 12, 2013. Thank you! Allan, how many Canadians “hop” across the border for U.S. care at Canadian prices? Universal adoption of electronic medical records; shifting insurance risk to providers with payments for “bundled services” and “accountable care organizations” (ACOs) so that providers would have an incentive to offer fewer services; and. Health care in the United States is a racket. How could Orszag sign a report in December 2008 saying “comparative effectiveness research” would actually increase federal spending (see Option 45) when, as Brill reports, Orszag had announced at a health policy summit convened by Senators Baucus and Grassley on June 16, 2008 that “comparative effectiveness research” was one of the most effective methods of cutting health care costs? Peter, You made a very clear statement: “providers could have bolted” That requires an explanation. Some aspects of modernity make me quite happy. Columns. Regulation can’t occur when there is an opt out. Welcome to the Surfing Pizza 2020 Christmas Countdown! (Part Four: #20-#11), The 50 Greatest Sega CD Games of All-Time! By KIP SULLIVAN. Why would providers have bolted? Did Orszag not read that report? The closer to totally “free” enterprise a system gets, the higher the costs, with the U.S. the highest in the world (x2). For single-pay to work (lower costs) providers would have to accept negotiated less reimbursement. We’re all flaming hypocrites – to lesser or greater degrees. (p. 416), But two paragraphs later Brill offers this explanation for why the ACA won’t lower costs: “The battles and closed-door deals of 2009 and 2010 emasculated the efforts by the White House economic team to use reform to ‘bend the cost curve.’ Like its Romneycare predecessor, Obamacare was the product of a choice … to increase coverage first and deal with costs later, if ever.” (p. 416). Similarly, while Harvard liberal arts professors supported the idea of Obamacare and financial redistribution, they were not happy when a similar ledger was imposed upon them. America’s Bitter Pill is Steven Brill’s acclaimed book on how the Affordable Care Act, or Obamacare, was written, how it is being implemented, and, most important, how it is changing—and failing to change—the rampant abuses in the healthcare industry. Dean Baker at the blog Beat the Press is a rare pundit who constantly points this out. Explain yourself. Peter Orszag was the director of the CBO in 2008 when it did the research that it relied on to score the ACA legislation in 2009. While I do consider myself to be a part of the feminist/reproductive rights world, I picked this book up because I wanted a first look at the history of the pill. Why should any physician or provider break his butt trying to reduce costs when he doesn’t benefit from it? Op-eds. But his explanation for why that happened is wrong. At this point, the for-profit insurance industry would probably be glad to turn over the ACA to a Medicare public option. You don’t have to provide it, but you could have declined to provide it more civilly. Can the Government Mandate a Covid-19 Vaccine? This is a constant flaw of these 10 year projections that Congress is addicted to. Canada’s doctors have drooled over U.S. compensation (disregarding higher mal/med insurance) but going across country borders is harder than driving across state borders. It was in a perfect situation. Although largely considered a democratic ideal. We have to figure out ways of reducing the costs of healthcare while providing quality. Pessimistically, he states the federal measures to get more people purchasing health insurance  has actually done very little - if anything - to make health care in the U.S. any more affordable. Under intense lobbying pressure by the insurance industry, that option was not allowed into the arena, to mix the metaphor. This has to be a national solution – with state management. 2) Medicare is the closest thing to single payer. Celebrating the zaniest, goriest bouts of all time! Your email address will not be published. The competitive marketplace would have allowed the government to actually see if a single-payer option would have drawn enough subscribers to actually drive down the costs while providing comparable quality of care. Obama and “a chorus of frustrated congressional Democrats” (as ABC News put it) heaped abuse on the CBO for refusing to knuckle under to the conventional wisdom the Democrats had come to believe in. With premiums rising, on average, 8 percent from 2014 to 2015, approximately one-fifth of the U.S. gross domestic product is now tied up in medical costs. TIME Health . Steven Brill, the author of America’s Bitter Pill: Money, Politics, Backroom Deals, and the Fight to Fix Our Broken Healthcare System, doesn’t quite put it like that.. To give you an idea of just how gigantic this problem is, as of 2015, So with social security expenses reaching critical mass, it's not surprising the federales would have sought to yank more dough out of the public's pocket sooner than later. Hey You! It’s a fly-on-the-wall account of the titanic fight to pass a 961-page law aimed at fixing America’s largest, most dysfunctional industry. Apr 04, 2013. is a platform for academics to share research papers. For example, the New York Times reported, “Senators were shocked when the Congressional Budget Office said an earlier version of the legislation would cost $1.6 trillion over 10 years.” Brill reports that “one of Obama’s healthcare aides” interrupted a meeting at the White House on July 17 to report what the aide called “a bombshell”: “The CBO had just scored the House bill and declared that it would not result in any significant long-term health care savings.” (p. 139). (1)There was little evidence in 2009, and little today, to support the claims by Orszag et al. The only person with an illusion is you. - his ideas are just too pie-in-the-sky, even as Utopian conjecture. One sentence in the article stood out to me, which was the comment that Obama was impressed by projected savings of $300 billion over 10 years due to EMR and other reforms. Featuring piranhas, exploding swimming pools, scorpions and…loaves of bread? The ACA’s inability to cut costs was not caused by the watering down of tough, evidence-based proposals by Obama’s “economic team.” It was due, rather, to the ineffectiveness of the nostrums proposed by the “economic team.”, [1] Brill reports, for example, that Orszag was “obsessed” with the fee-for-service system, and that he thought “the best ways to cut costs would be to use information technology to judge and act on the comparative effectiveness of drugs, medical devices, and other treatments.” (p. 58) We learn that Emanuel and Kocher had developed a “spreadsheet” even before Obama’s inauguration which “projected savings [of] more than $300 billion over ten years [from] reforms ranging from requiring doctors to use electronic medical records … to penalizing hospitals that had high rates of patients who were discharged and then readmitted within 30 days.” (p. 84) Brill reports that Emanuel and Kocher thought that consolidating hospitals and doctors into entities that could accept “bundled payments” (i.e., ACOs) would be a “game changer.” (pp.


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