Quinnipiac National Poll: Health Care By Their Numbers



Crunching the Numbers . . .




Over 3000 polled nationwide for a margin of error of +/- 1.8%

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Quinnipiac University Polling Institute> National (US)> Release Detail


July 1, 2009 - U.S. Voters Back Public Insurance 2-1, But Won't Use It, Quinnipiac University National Poll Finds; 72% Won't Pay More Than $500 A Year To Fix Health Care


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Although 69 percent of voters nationwide say Americans should have the option of government- run health insurance, only 28 percent would choose to be covered by it, according to a Quinnipiac University national poll released today. Voters say 49 - 45 percent they would pay more to reform health care, but a total of 72 percent don't want to pay more than $500 a year.

Of the 88 percent of American voters who have some form of health insurance, 49 percent are "very satisfied" with their plan and 36 percent are "somewhat satisfied." Among voters with Medicare or Medicaid 54 percent are very satisfied, compared to 45 percent of voters with private insurance. Voters say 52 - 34 percent that most Americans do not get good value in the cost and quality of health care. But these same voters say 70 - 25 percent that they personally get good value in the cost and quality of their health care, the independent Quinnipiac (KWIN-uh-pe-ack) University poll of more than 3,000 voters nationwide finds.

Only 15 percent of voters would be willing to pay $500 to $1,000 more in taxes each year for a health care plan that reduces costs and covers those who don't have health insurance. Another 27 percent would pay less than $500 per year, with 3 percent who would pay $1,000 to $3,000 and 45 percent who don't want to pay additional taxes.

While 54 percent of voters think the primary goal of any health care legislation should be to lower costs, 38 percent believe providing health coverage for everyone is most important.

"American voters want their fellow countrymen to have the option of a public plan, but don't want a public plan for themselves because they are satisfied personally with their health care," said Peter Brown, assistant director of the Quinnipiac University Polling Institute. "That presents a challenge to those who want Americans to pay more to reform the system."

"In addition, seven out of ten voters aren't willing to chip in what amounts to the price of a cheese pizza per week - without extra toppings - in order to finance an overhaul," Brown added. "Opposition to paying any additional taxes ranges from 40 percent among lower paid voters to 52 percent among those making more than $100,000 per year."

Voters trust President Obama more than Republicans in Congress 53 - 33 percent to handle health care.

By an overwhelming 63 - 30 percent margin, voters oppose a new tax on health care benefits workers receive from their employer.

The Quinnipiac University poll of American voters also finds:

  • 55 - 40 percent support for limiting tax deductions for those earning more than $250,000 to finance a health-care program;
  • By 46 - 38 percent, they don't believe the government can raise enough to finance health- care reform just by taxing those who earn $250,000 or more;
  • Reject 51 - 44 percent requiring everyone to have health insurance;
  • Support 73 - 24 percent requiring employers to help pay health insurance for workers;
  • Believe 52 - 42 percent that a public plan will "keep private insurance companies honest;
  • Split 46 - 49 percent on whether a public plan would put private insurers out of business;
  • Believe 58 - 32 percent that government-run health care would be a "bad thing."
Americans agree 53 - 44 percent it is the government's responsibility to make sure everyone in the United States has adequate health care. This compares to a 64 - 31 percent margin in a February, 2007, Quinnipiac University poll and 61 - 35 percent in May, 2008.

"Americans say they want the government more involved in health care, but not in the health care received by themselves or their families. Seven in ten say they are getting good value for the health care they receive, but only a third think their friends, neighbors and countrymen are faring as well," said Brown.

"There seems to be a disconnect between the projected price tag that is being thrown around to overhaul the health care system and how much the vast majority of Americans are willing to pay for it. They don't mind the rich or business financing it, but they don't seem all that eager to do it themselves. It does raise questions about whether the American people understand the financial enormity of what is under consideration."

From June 23 - 29, Quinnipiac University surveyed 3,063 registered voters nationwide with a margin of error of +/- 1.8 percentage points.

The Quinnipiac University Poll, directed by Douglas Schwartz, Ph.D., conducts public opinion surveys in Pennsylvania, New York, New Jersey, Connecticut, Florida, Ohio and the nation as a public service and for research. For more data or RSS feed - http://www.quinnipiac.edu/polling.xml, or call (203) 582-5201.

8. Do you approve or disapprove of the way Barack Obama is handling - health care?

 Tot Rep Dem Ind Men Wom Wht Blk His



Approve 46% 17% 76% 37% 43% 48% 39% 85% 56%
Disapprove 42 72 13 48 45 39 47 8 34
DK/NA 13 11 11 15 12 13 14 7 10



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Approve 54% 42% 45% 49% 43% 44% 72% 51% 23%
Disapprove 35 47 40 37 47 48 17 33 68
DK/NA 10 12 15 14 10 8 11 15 8



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Approve 58% 50% 43% 45% 47% 26% 33% 40% 60%
Disapprove 33 34 45 42 43 62 53 50 24
DK/NA 9 15 12 14 10 13 14 10 16






19. Who do you trust to do a better job handling health care - President Obama or the Republicans in Congress?

 Tot Rep Dem Ind Men Wom Wht Blk His



President Obama 53% 15% 88% 46% 50% 55% 46% 89% 70%
Republicans in Con 33 70 5 36 38 30 39 2 22
DK/NA 14 15 7 19 12 15 15 9 8



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



President Obama 61% 49% 52% 58% 50% 48% 85% 61% 24%
Republicans in Con 29 37 32 27 37 42 7 23 62
DK/NA 10 15 16 14 13 10 8 15 14



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



President Obama 66% 58% 49% 52% 55% 31% 37% 47% 69%
Republicans in Con 24 28 36 33 34 54 47 37 22
DK/NA 10 14 14 15 11 15 15 15 9






20. Which do you think is the more important goal for health care legislation - reducing health care costs or covering those who don't have health insurance?

 Tot Rep Dem Ind Men Wom Wht Blk His



Reducing costs 54% 75% 36% 58% 58% 51% 59% 35% 44%
Covering uninsured 38 18 56 34 34 41 33 59 50
DK/NA 8 7 7 8 9 8 8 6 5



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Reducing costs 52% 58% 52% 48% 63% 62% 35% 56% 66%
Covering uninsured 42 36 38 44 32 33 59 36 26
DK/NA 6 6 11 8 6 5 6 8 8



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Reducing costs 36% 43% 61% 55% 54% 64% 62% 63% 43%
Covering uninsured 58 48 32 37 38 28 29 30 51
DK/NA 6 9 7 8 8 8 9 7 7






21. Do you think it's the government's responsibility to make sure that everyone in the United States has adequate health care, or don't you think so?

 Tot Rep Dem Ind Men Wom Wht Blk His



Yes 53% 25% 77% 49% 47% 57% 47% 86% 67%
No 44 72 18 48 50 38 50 9 32
DK/NA 4 3 4 4 2 5 4 6 1



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Yes 62% 50% 50% 61% 43% 47% 79% 57% 31%
No 37 46 45 35 54 50 18 38 66
DK/NA 2 4 5 4 3 3 3 5 3



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Yes 69% 70% 48% 53% 52% 36% 36% 50% 63%
No 26 28 49 43 45 59 59 48 34
DK/NA 5 2 3 4 3 4 4 3 3



TREND: Do you think it's the government's responsibility to make sure that everyone in the United States has adequate health care, or don't you think so?

 July 1 Nov 12 May 15 Nov 1 Feb 22
2009 2008 2008 2007 2007



Yes 53 60 61 57 64
No 44 36 35 38 31
DK/NA 4 4 4 5 4






22. Would you be willing or unwilling to pay more in taxes for a health care overhaul plan that reduces health care costs and covers those who don't have health insurance?

 Tot Rep Dem Ind Men Wom Wht Blk His



Willing 49% 23% 71% 48% 47% 50% 45% 73% 53%
Unwilling 45 72 22 47 49 43 49 20 41
DK/NA 6 5 6 5 4 7 5 7 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Willing 61% 44% 48% 54% 48% 46% 76% 54% 27%
Unwilling 37 52 43 40 49 52 20 39 68
DK/NA 3 4 9 6 3 2 4 7 5



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Willing 58% 51% 47% 46% 55% 38% 36% 43% 73%
Unwilling 35 41 49 47 42 57 58 53 18
DK/NA 7 8 4 7 3 5 6 4 8






23. (If Willing q22) How much more would you be willing to pay in taxes each year - less than 500 dollars, between 500 and 1,000 dollars, between 1,000 and 3,000 dollars, or over 3,000 dollars?

 WILLING TO PAY MORE IN TAXES Q22...........................
Tot Rep Dem Ind Men Wom Wht Blk His



Less than $500 54% 65% 53% 51% 48% 59% 55% 57% 57%
$500 - $1,000 30 20 32 31 32 28 30 26 27
$1,000 - $3,000 7 8 7 8 10 5 8 5 6
Over $3,000 3 2 3 3 4 2 3 6 3
DK/NA 6 5 5 7 5 6 5 7 7



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Less than $500 62% 48% 54% 63% 52% 33% 49% 53% 66%
$500 - $1,000 27 35 27 24 32 45 34 31 22
$1,000 - $3,000 5 10 6 5 10 13 7 8 6
Over $3,000 4 3 3 2 2 7 6 1 3
DK/NA 2 5 9 6 3 3 5 6 4



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Less than $500 57% 52% 51% 61% 41% 68% 59% 58% 37%
$500 - $1,000 30 31 32 24 41 23 27 26 32
$1,000 - $3,000 6 6 8 6 10 5 7 9 18
Over $3,000 1 6 4 3 4 - 2 3 7
DK/NA 6 5 5 6 4 4 5 4 7






22. & 23 COMBINED . Would you be willing or unwilling to pay more in taxes for a health care overhaul plan that reduces health care costs and covers those who don't have health insurance? . (If Willing q22) How much more would you be willing to pay in taxes each year dollars, or over 3,000 dollars?

 Tot Rep Dem Ind Men Wom Wht Blk His



No more in taxes 45% 72% 22% 47% 49% 43% 49% 20% 41%
Less than $500 27 15 38 24 23 30 25 41 30
$500 - $1,000 15 5 23 15 15 14 13 19 14
$1,000 - $3,000 3 2 5 4 5 2 3 4 3
Over $3,000 2 1 2 1 2 1 1 4 2
DK/NA 8 6 10 8 7 10 7 12 10



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



No more in taxes 37% 52% 43% 40% 49% 52% 20% 39% 68%
Less than $500 37 21 26 34 25 15 37 29 18
$500 - $1,000 17 15 13 13 15 21 26 17 6
$1,000 - $3,000 3 4 3 2 5 6 5 5 1
Over $3,000 2 1 1 1 1 3 4 1 1
DK/NA 4 7 13 10 5 4 8 10 6



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



No more in taxes 35% 41% 49% 47% 42% 57% 58% 53% 18%
Less than $500 33 27 24 28 23 25 21 25 27
$500 - $1,000 17 16 15 11 22 8 10 11 23
$1,000 - $3,000 3 3 4 3 5 2 3 4 13
Over $3,000 1 3 2 1 2 - 1 1 5
DK/NA 10 11 6 10 6 7 8 6 13






24. Would you support or oppose a new tax on employees for the health care benefits that they receive from their employers?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 30% 23% 41% 25% 28% 32% 27% 42% 47%
Oppose 63 73 50 68 68 59 66 48 47
DK/NA 7 4 9 6 4 9 7 10 7



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 34% 29% 30% 37% 22% 28% 42% 32% 22%
Oppose 61 68 59 56 73 70 53 61 73
DK/NA 5 4 11 7 5 2 5 7 5



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 43% 42% 26% 31% 26% 27% 23% 28% 27%
Oppose 50 47 69 61 69 66 70 66 63
DK/NA 7 12 5 8 5 7 6 6 10






25. Would you support or oppose limiting tax deductions for families earning over 250,000 dollars a year?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 55% 44% 64% 54% 53% 56% 55% 50% 55%
Oppose 40 50 32 40 42 38 40 41 38
DK/NA 5 5 4 6 4 6 5 9 7



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 58% 55% 54% 55% 58% 53% 68% 60% 41%
Oppose 38 42 39 38 41 45 30 35 53
DK/NA 4 3 8 7 1 2 2 5 6



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 49% 53% 56% 53% 58% 50% 49% 57% 65%
Oppose 45 37 40 40 39 46 46 39 34
DK/NA 6 9 3 7 2 4 5 4 1






26. Some people say that raising taxes on families who earn more than 250,000 dollars would not raise enough money to pay for a health care overhaul plan. Do you agree or disagree?

 Tot Rep Dem Ind Men Wom Wht Blk His



Agree 46% 61% 32% 49% 52% 41% 47% 35% 43%
Disagree 38 29 51 34 34 42 36 56 46
DK/NA 16 11 17 17 14 17 17 9 11



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Agree 46% 50% 42% 42% 46% 57% 33% 42% 58%
Disagree 41 39 37 45 37 28 49 41 30
DK/NA 13 12 21 13 16 14 18 17 11



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Agree 41% 41% 50% 44% 51% 50% 49% 49% 40%
Disagree 46 42 36 42 30 37 35 37 41
DK/NA 13 17 15 14 19 12 16 15 20






27. Do you support or oppose requiring people to have health insurance?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 44% 29% 60% 39% 41% 47% 39% 67% 60%
Oppose 51 66 33 56 56 46 56 26 34
DK/NA 5 4 7 4 4 7 5 7 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 50% 38% 47% 47% 40% 40% 58% 48% 31%
Oppose 46 58 46 47 56 54 36 46 65
DK/NA 4 4 7 5 4 5 6 6 4



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 44% 58% 40% 44% 43% 32% 34% 42% 53%
Oppose 51 36 55 50 53 63 61 53 40
DK/NA 5 6 5 6 4 5 5 5 7






28. Do you support or oppose requiring businesses to help pay the cost of health insurance for their employees?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 73% 62% 86% 69% 66% 79% 70% 88% 82%
Oppose 24 35 11 28 31 18 27 10 17
DK/NA 3 3 3 3 3 4 3 2 1



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 79% 70% 72% 79% 72% 63% 84% 79% 60%
Oppose 20 27 22 18 25 36 14 17 38
DK/NA 1 2 5 3 3 1 2 4 3



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 80% 77% 70% 75% 68% 68% 66% 74% 65%
Oppose 19 19 27 22 29 29 31 23 31
DK/NA - 4 3 3 3 3 3 3 4






29. Do you support or oppose giving people the option of being covered by a government health insurance plan that would compete with private plans?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 69% 50% 86% 66% 64% 73% 66% 83% 80%
Oppose 26 44 10 29 33 21 29 9 17
DK/NA 5 6 4 5 4 7 5 8 3



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 79% 67% 64% 75% 66% 63% 88% 75% 51%
Oppose 19 29 28 20 32 33 9 20 44
DK/NA 2 4 8 5 2 4 3 5 5



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 77% 69% 68% 68% 70% 59% 60% 66% 70%
Oppose 17 24 28 26 27 36 34 31 29
DK/NA 6 7 4 6 3 5 6 3 1






30. Would you rather purchase health insurance from a private sector company or from a government program?

 Tot Rep Dem Ind Men Wom Wht Blk His



Private sector 53% 79% 33% 55% 58% 49% 58% 28% 41%
Gov't program 28 10 44 25 26 29 23 50 50
DK/NA 19 11 23 20 15 22 19 21 9



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Private sector 47% 57% 53% 43% 63% 65% 28% 51% 73%
Gov't program 38 24 26 38 19 20 46 29 16
DK/NA 15 18 21 19 18 15 26 20 12



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Private sector 32% 40% 61% 51% 59% 66% 65% 62% 50%
Gov't program 49 44 21 30 22 18 19 21 27
DK/NA 19 16 18 19 19 15 16 17 22






31. Some people say that giving people the option of being covered by a government insurance plan will keep private insurance companies honest. Do you agree or disagree?

 Tot Rep Dem Ind Men Wom Wht Blk His



Agree 52% 36% 71% 48% 49% 55% 50% 73% 55%
Disagree 42 58 22 46 46 38 44 23 39
DK/NA 6 5 7 6 5 7 6 4 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Agree 61% 51% 49% 55% 54% 50% 71% 60% 34%
Disagree 36 45 41 39 42 47 24 33 61
DK/NA 3 4 10 7 4 3 5 7 4



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Agree 55% 53% 53% 52% 54% 42% 43% 50% 63%
Disagree 40 37 43 41 42 53 51 44 29
DK/NA 5 10 4 7 4 5 7 6 8






32. Some people say that giving people the option of being covered by a government insurance plan would ultimately lead to the end of private health insurance and the government would end up running the health care system. Do you agree or disagree?

 Tot Rep Dem Ind Men Wom Wht Blk His



Agree 46% 67% 28% 46% 48% 44% 48% 29% 45%
Disagree 49 29 66 48 49 49 46 65 49
DK/NA 6 4 6 6 4 7 6 7 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Agree 41% 46% 48% 44% 46% 46% 27% 39% 65%
Disagree 55 50 44 50 50 50 69 56 29
DK/NA 5 5 8 6 4 3 5 5 6



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Agree 46% 46% 45% 48% 40% 56% 53% 50% 29%
Disagree 47 44 51 46 56 37 40 47 65
DK/NA 7 10 4 7 4 7 7 2 6






33. If the government ran the health care system, do you think that would be a good thing or a bad thing?

 Tot Rep Dem Ind Men Wom Wht Blk His



Good thing 32% 11% 53% 27% 30% 34% 27% 54% 59%
Bad thing 58 84 34 63 62 54 64 32 35
DK/NA 10 6 13 10 7 12 9 15 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Good thing 42% 29% 30% 39% 25% 28% 55% 34% 16%
Bad thing 49 63 58 50 66 67 33 55 78
DK/NA 9 9 12 11 9 5 12 11 6



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Good thing 55% 44% 26% 34% 27% 21% 21% 25% 43%
Bad thing 35 47 65 56 64 70 69 68 47
DK/NA 10 9 9 10 9 9 10 7 10






34. If a health care overhaul plan lowered your health care costs and insured all Americans, -- but limited your choice of doctor, hospital or treatment, would you support or oppose such a plan?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 30% 17% 43% 25% 31% 29% 29% 32% 41%
Oppose 66 81 52 71 65 67 67 65 53
DK/NA 4 2 5 4 4 4 4 3 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 39% 28% 26% 32% 32% 28% 45% 33% 16%
Oppose 58 70 67 63 65 70 50 63 81
DK/NA 3 3 7 5 3 3 5 3 3



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 44% 35% 28% 29% 30% 22% 24% 24% 36%
Oppose 52 59 69 66 66 74 72 72 57
DK/NA 4 6 3 4 4 4 4 4 7






35. If a health care overhaul plan lowered your health care costs and allowed your choice of any doctor, hospital or treatment you wanted, -- but did not insure all Americans, would you support or oppose such a plan?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 44% 52% 34% 48% 48% 40% 47% 33% 41%
Oppose 48 41 58 44 46 50 46 57 53
DK/NA 8 7 8 8 6 10 8 10 6



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 47% 47% 38% 39% 52% 50% 35% 46% 48%
Oppose 49 47 50 53 42 46 58 46 46
DK/NA 4 6 12 8 6 4 6 8 6



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 36% 35% 49% 43% 46% 45% 47% 53% 49%
Oppose 56 57 45 49 47 47 45 40 41
DK/NA 9 8 6 8 8 8 9 7 10






36. If a health care overhaul plan allowed your choice of any doctor, hospital or treatment you wanted and insured all Americans, -- but did not lower your health care costs, would you support or oppose such a plan?

 Tot Rep Dem Ind Men Wom Wht Blk His



Support 59% 46% 70% 61% 56% 61% 60% 61% 49%
Oppose 35 48 26 33 39 32 35 33 46
DK/NA 6 6 4 7 5 6 5 6 5



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Support 58% 61% 59% 57% 65% 60% 72% 66% 45%
Oppose 39 35 32 37 32 36 25 29 49
DK/NA 3 4 9 6 3 5 4 5 6



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Support 56% 54% 61% 56% 67% 54% 56% 62% 72%
Oppose 40 37 35 38 28 38 37 34 21
DK/NA 5 9 4 6 5 7 7 4 7






37. Are you now covered by any form of health insurance or health plan?

 Tot Rep Dem Ind Men Wom Wht Blk His



Yes 88% 90% 86% 90% 89% 87% 91% 78% 74%
No 11 9 13 10 10 12 9 22 26
DK/NA - - - - - - - - -



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Yes 79% 88% 96% 81% 96% 96% 84% 90% 90%
No 20 12 4 19 4 4 16 10 9
DK/NA 1 - - - - - 1 - -



WHITE.............
NoColl Coll BrnAgn
Degree Degree Evngl Prot Cath Jew

Yes 85% 96% 90% 93% 93% 89%
No 14 4 10 7 7 11
DK/NA - - - - - -






38. (If Covered q37) Is your health insurance plan Medicare, Medicaid, or a private health insurance plan?

 IF COVERED Q37.............................................
Tot Rep Dem Ind Men Wom Wht Blk His



Medicare 10% 10% 11% 10% 10% 11% 10% 13% 9%
Medicaid 3 2 5 3 3 4 2 4 12
Private plan 68 69 64 71 70 65 68 63 61
COMB OF PLANS(VOL) 16 17 17 14 15 17 17 15 11
DK/NA 2 3 3 2 2 3 2 5 7



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Medicare 5% 5% 19% 16% 4% 3% 8% 10% 12%
Medicaid 6 2 2 6 - 1 5 3 3
Private plan 84 87 39 52 85 87 71 68 67
COMB OF PLANS(VOL) 2 3 39 23 9 7 13 16 17
DK/NA 4 2 1 2 2 2 3 3 2



WHITE.............
NoColl Coll BrnAgn
Degree Degree Evngl Prot Cath Jew



Medicare 12% 6% 10% 11% 13% 12%
Medicaid 4 - 3 2 3 1
Private plan 62 80 64 64 64 72
COMB OF PLANS(VOL) 19 11 20 21 19 14
DK/NA 3 2 3 2 2 -






39. (If Covered q37) How satisfied are you with your health insurance plan - very satisfied, somewhat satisfied, somewhat dissatisfied, or very dissatisfied?

 IF COVERED Q37.............................................
Tot Rep Dem Ind Men Wom Wht Blk His



Very satisfied 49% 55% 47% 46% 49% 49% 50% 45% 44%
Smwht satisfied 36 35 36 38 37 36 35 41 41
Smwht dissatisfied 10 7 11 11 9 10 10 8 10
Very dissatisfied 4 2 5 5 4 4 4 4 5
DK/NA 1 1 1 1 1 1 1 1 1



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Very satisfied 46% 43% 57% 46% 49% 52% 44% 47% 53%
Smwht satisfied 35 41 33 39 37 37 33 39 37
Smwht dissatisfied 13 11 6 10 9 8 17 9 7
Very dissatisfied 5 5 2 4 4 3 5 4 3
DK/NA 1 - 1 1 1 - - 2 1



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Very satisfied - 54% 45% 49% 49% 51% 51% 53% 47%
Smwht satisfied - 34 38 36 38 35 35 34 48
Smwht dissatisfied - 7 11 10 9 9 9 10 4
Very dissatisfied - 3 5 4 3 4 5 1 1
DK/NA - 1 - 1 1 1 1 2 1






40. Thinking about both the cost and quality of the health care that you receive, do you think that you get good value for the money that you spend on health care?

 Tot Rep Dem Ind Men Wom Wht Blk His



Yes 70% 78% 67% 68% 69% 71% 72% 60% 64%
No 25 18 27 28 25 24 24 30 24
DK/NA 5 4 6 4 6 5 4 10 11



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Yes 59% 70% 79% 68% 71% 79% 63% 69% 76%
No 32 27 16 24 28 20 31 26 20
DK/NA 9 3 4 8 2 1 6 5 4



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Yes 43% 82% 70% 69% 73% 72% 73% 79% 75%
No 36 14 28 25 25 24 23 19 23
DK/NA 21 4 2 6 3 5 4 2 2






41. Thinking about both the cost and quality of the health care that most Americans receive, do you think most Americans get good value for the money that they spend on health care?

 Tot Rep Dem Ind Men Wom Wht Blk His



Yes 34% 45% 25% 35% 36% 33% 35% 31% 30%
No 52 38 61 54 52 51 51 49 61
DK/NA 14 17 14 11 12 16 14 20 9



AGE IN YRS....... INCOME............. POL PHIL.........
18-34 35-54 55+ <50 50-100 >100K Lib Mod Con



Yes 26% 35% 39% 34% 32% 41% 22% 31% 47%
No 65 52 43 52 57 48 70 55 38
DK/NA 8 13 18 14 11 11 8 14 15



INSURANCE TYPE Q38.. WHITE.............
NoHlth M'care/ NoColl Coll BrnAgn
Insure M'caid Prvate Degree Degree Evngl Prot Cath Jew



Yes 31% 37% 33% 35% 34% 43% 39% 40% 34%
No 61 42 55 50 55 45 46 49 55
DK/NA 8 21 12 15 11 12 15 11 11









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Contact us with your questions and comments. Copyright 1999-document.write(getYear())Script for writing out current year for copyright Quinnipiac University. Statement of liability and copyrights. CallAnalytics('');Script for Google Analytics

~OGD~

Cold Hard Facts: Health Care Reform and the Federal Budget




This was released June 16, 2009.



Has anyone else seen this reported in the news?

Please help others who may not have seen this info by promulgating this by recommending this post. Thanks in advance if you do.

- - - - - - - - - - - - - - - - - - - - - - - - - - -


The following is a cover letter from the Congressional Budget Office to Sen. Kent Conrad that details the relationship of the Health Care Reform effort and the federal budget.

After reading this cover letter you may wish to read the report in it's entirety that can be found here at the Cafe in my blog. The link is below the cover letter.


CBO Logo


CONGRESSIONAL BUDGET OFFICE

Douglas W. Elmendorf, Director

U.S. Congress

Washington, DC 20515

June 16, 2009

 

Honorable Kent Conrad
Chairman
Committee on the Budget
United States Senate
Washington, DC 20510

Dear Mr. Chairman:

In the absence of significant changes in policy, rising costs for health care will cause federal spending to grow much faster than the economy, putting the federal budget on an unsustainable path. This letter responds to your request for information about the features of reform proposals that would affect federal spending on health care over the long term.

As you noted, many experts believe that a substantial share of spending on health care contributes little if anything to the overall health of the nation. Therefore, changes in government policy have the potential to yield large reductions in both national health expenditures and federal health care spending without harming health. Moreover, many experts agree on some general directions in which the government's health policies should move--typically involving changes in the information and incentives that doctors and patients have when making decisions about health care.

However, large reductions in spending will not actually be achieved without fundamental changes in the financing and delivery of health care. The government can spur those changes by transforming payment policies in federal health care programs and by significantly limiting the current tax subsidy for health insurance. Those approaches could directly lower federal spending on health care and indirectly lower private spending on it as well. Yet, many of the specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning. Modest versions of such efforts--which would have the desirable effect of allowing policymakers to gauge their impact--would probably yield only modest results in the short term.

Therefore, one broad long-range approach for reform that has drawn interest recently would combine specific policy actions--to generate near-term savings and provide experience that would lay the groundwork for future savings--with a mechanism or framework to impose ongoing pressure for achieving efficiencies in the delivery of health care. The effectiveness of that path would depend ultimately on the willingness of federal policy to maintain significant and systematic pressure over time and would require tough choices to be made. Without meaningful reforms, the substantial costs of many current proposals to expand federal subsidies for health insurance would be much more likely to worsen the long-run budget outlook than to improve it.

CBO does not provide formal cost estimates beyond the 10-year budget window because the uncertainties are simply too great. However, in evaluating proposals to reform health care, the agency will endeavor to offer a qualitative indication of whether they would be more likely to increase or decrease the budget deficit over the long term.

The attached analysis elaborates on these points. Please contact me at (202) XXX-XXXX if you have any questions.

Sincerely,

Douglas W. Elmendorf
Director

Attachment

Identical letter sent to the Honorable Judd Gregg.


Again: The entire report is located in the Cafe here at my blog:


There is no doubt that it is a long read. Although, to place the ongoing health reform effort in it's full context it is a must read.


~OGD~






How About Some K-Y With Your Health Insurance Coverage ... (..if you can afford insurance that is...)




For your general information . . .




 

Testimony of Wendell Potter Philadelphia, PA

 

Before the U.S. Senate Committee on Commerce, Science and Transportation

 

June 24, 2009



Mr. Chairman, thank you for the opportunity to be here this afternoon.


My name is Wendell Potter and for 20 years, I worked as a senior executive at health insurance companies, and I saw how they confuse their customers and dump the sick - all so they can satisfy their Wall Street investors.

 

I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand--or even to obtain--information we need. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.

 

When I left my job as head of corporate communications for one of the country's largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry's charm offensive--which is the most visible part of duplicitous and well-financed PR and lobbying campaigns--may well shape reform in a way that benefits Wall Street far more than average Americans.

 

A few months after I joined the health insurer CIGNA Corp. in 1993, just as the last national health care reform debate was underway, the president of CIGNA's health care division was one of three industry executives who came here to assure members of Congress that they would help lawmakers pass meaningful reform. While they expressed concerns about some of President Clinton's proposals, they said they enthusiastically supported several specific goals.

 

Those goals included covering all Americans; eliminating underwriting practices like pre-existing condition exclusions and cherry-picking; the use of community rating; and the creation of a standard benefit plan. Had the industry followed through on its commitment to those goals, I wouldn't be here today.

 

Today we are hearing industry executives saying the same things and making the same assurances. This time, though, the industry is bigger, richer and stronger, and it has a much tighter grip on our health care system than ever before. In the 15 years since insurance companies killed the Clinton plan, the industry has consolidated to the point that it is now dominated by a cartel of large for-profit insurers.

 

The average family doesn't understand how Wall Street's dictates determine whether they will be offered coverage, whether they can keep it, and how much they'll be charged for it. But, in fact, Wall Street plays a powerful role. The top priority of for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street looks investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical ―benefit‖ ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.

 

To win the favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've failed to trim medical costs. I have seen an insurer's stock price fall 20 percent or more in a single day after executives disclosed that the company had to spend a slightly higher percentage of premiums on medical claims during the quarter than it did during a previous period. The smoking gun was the company's first-quarter medical loss ratio, which had increased from 77.9% to 79.4% a year later

.

To help meet Wall Street's relentless profit expectations, insurers routinely dump policyholders who are less profitable or who get sick. Insurers have several ways to cull the sick from their rolls. One is policy rescission. They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment. Asked directly about this practice just last week in the House Energy and Commerce Committee, executives of three of the nation's largest health insurers refused to end the practice of cancelling policies for sick enrollees. Why? Because dumping a small number of enrollees can have a big effect on the bottom line. Ten percent of the population accounts for two-thirds of all health care spending.(1) The Energy and Commerce Committee's investigation into three insurers found that they canceled the coverage of roughly 20,000 people in a five-year period, allowing the companies to avoid paying $300 million in claims.

 


They also dump small businesses whose employees' medical claims exceed what insurance underwriters expected. All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year's premiums so high that the employer has to cut benefits, shop for another carrier, or stop offering coverage altogether - leaving workers uninsured. The practice is known in the industry as ―purging. The purging of less profitable accounts through intentionally unrealistic rate increases helps explain why the number of small businesses offering coverage to their employees has fallen from 61 percent to 38 percent since 1993, according to the National Small Business Association. Once an insurer purges a business, there are often no other viable choices in the health insurance market because of rampant industry consolidation.

 

An account purge so eye-popping that it caught the attention of reporters occurred in October 2006 when CIGNA notified the Entertainment Industry Group Insurance Trust that many of the Trust's members in California and New Jersey would have to pay more than some of them earned in a year if they wanted to continue their coverage. The rate increase CIGNA planned to implement, according to USA Today, would have meant that some family-plan premiums would exceed $44,000 a year. CIGNA gave the enrollees less than three months to pay the new premiums or go elsewhere.

 

Purging through pricing games is not limited to letting go of an isolated number of unprofitable accounts. It is endemic in the industry. For instance, between 1996 and 1999, Aetna initiated a series of company acquisitions and became the nation's largest health insurer with 21 million members. The company spent more than $20 million that it received in fees and premiums from customers to revamp its computer systems, enabling the company to ―identify and dump unprofitable corporate accounts, as The Wall Street Journal reported in 2004.(2)


Armed with a stockpile of new information on policyholders, new management and a shift in strategy, in 2000, Aetna sharply raised premiums on less profitable accounts. Within a few years, Aetna lost 8 million covered lives due to strategic and other factors.


While strategically initiating these cost hikes, insurers have professed to be the victims of rising health costs while taking no responsibility for their share of America's health care affordability crisis. Yet, all the while, health-plan operating margins have increased as sick people are forced to scramble for insurance.

 

Unless required by state law, insurers often refuse to tell customers how much of their premiums are actually being paid out in claims. A Houston employer could not get that information until the Texas legislature passed a law a few years ago requiring insurers to disclose it. That Houston employer discovered that its insurer was demanding a 22 percent rate increase in 2006 even though it had paid out only 9 percent of the employer's premium dollars for care the year before.

 

It's little wonder that insurers try to hide information like that from its customers. Many people fall victim to these industry tactics, but the Houston employer might have known better - it was the Harris County Medical Society, the county doctors' association.

 

A study conducted last year by Pricewaterhouse Coopers revealed just how successful the insurers' expense management and purging actions have been over the last decade in meeting Wall Street's expectations. The accounting firm found that the collective medical-loss ratios of the seven largest for-profit insurers fell from an average of 85.3 percent in 1998 to 81.6 percent in 2008. That translates into a difference of several billion dollars in favor of insurance company shareholders and executives and at the expense of health care providers and their patients.


There are many ways insurers keep their customers in the dark and purposely mislead them - especially now that insurers have started to aggressively market health plans that charge relatively low premiums for a new brand of policies that often offer only the illusion of comprehensive coverage.


An estimated 25 million Americans are now underinsured for two principle reasons. First, the high deductible plans many of them have been forced to accept - like I was forced to accept at CIGNA - require them to pay more out of their own pockets for medical care, whether they can afford it or not. The trend toward these high-deductible plans alarms many health care experts and state insurance commissioners. As California Lieutenant Governor John Garamendi told the Associated Press in 2005 when he was serving as the state's insurance commissioner, the movement toward consumer-driven coverage will eventually result in a ―death spiral‖ for managed care plans. This will happen, he said, as consumer-driven plans ―cherry-pick‖ the youngest, healthiest and richest customers while forcing managed care plans to charge more to cover the sickest patients. The result, he predicted, will be more uninsured people.


In selling consumer-driven plans, insurers often try to persuade employers to go ―full replacement,‖ which means forcing all of their employees out of their current plans and into a consumer-driven plan. At least two of the biggest insurers have done just that, to the dismay of many employees who would have preferred to stay in their HMOs and PPOs. Those options were abruptly taken away from them.


Secondly, the number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance. The industry is insistent on being able to retain so-called ―benefit design flexibility so they can continue to market these kinds of often worthless policies. The big insurers have spent millions acquiring companies that specialize in what they call ―limited-benefit‖ plans. An example of such a plan is marketed by one of the big insurers under the name of Starbridge Select. Not only are the benefits extremely limited but the underwriting criteria established by the insurer essentially guarantee big profits. Pre-existing conditions are not covered during the first six months, and the employer must have an annual employee turnover rate of 70 percent or more, so most of the workers don't even stay on the payroll long enough to use their benefits. The average age of employees must not be higher than 40, and no more than 65 percent of the workforce can be female. Employers don't pay any of the premiums--the employees pay for everything. As Consumer Reports noted in May, many people who buy limited-benefit policies, which often provide little or no hospitalization, are misled by marketing materials and think they are buying more comprehensive care. In many cases it is not until they actually try to use the policies that they find out they will get little help from the insurer in paying the bills.

 

The lack of candor and transparency is not limited to sales and marketing. Notices that insurers are required to send to policyholders--those explanation-of-benefit documents that are supposed to explain how the insurance company calculated its payments to providers and how much is left for the policyholder to pay--are notoriously incomprehensible. Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away. And that's exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.

 

Thank you, Mr. Chairman, for beginning this conversation on transparency and for making this such a priority. S. 1050, your legislation to require insurance companies to be more honest and transparent in how they communicate with consumers, is essential. So, too, is S. 1278, the Consumers Choice Health Plan, which would create a strong public health insurance option as a benchmark in transparency and quality. Americans need and overwhelmingly support the option of obtaining coverage from a public plan. The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent, publicly-accountable health care option as a ―government-run system. But what we have today, Mr. Chairman, is a Wall Street-run system that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care, and to the state and federal governments that attempt to regulate it.


_____________________


1 Samuel Zuvekas and Joel Cohen, "Prescription Drugs And The Changing Concentration Of Health Care Expenditures," Health Affairs, 26 (1) (January/February 2007): 249-257.


2 "Behind Aetna's Turnaround: Small Steps to Pare Cost of Care," Wall Street Journal, August 13, 2004.




-----end----


ezra-klein/Potter_Commerce_Committee_written_testimony_2020090624-FINAL.pdf


~OGD~


Health Care for All Report : Increase in cost of insurance as share of median income from 2006 to 2016


For your general information . . .



From: Health Care For America Now!


June 23rd, 2009

Skyrocketing premiums and out-of-pocket medical costs are battering family budgets, eroding U.S. competitiveness in the global economy and threatening the American standard of living, once the envy of the world. As President Barack Obama and his economic advisers have repeatedly said, health costs are increasing at an unsustainable rate, and the national economy will not thrive unless they are reined in. Health care reform that guarantees quality, affordable care for everyone in the United States -- and offers the choice of a public health insurance plan -- can do what our private health insurance system has failed to do: provide economic security for families and the nation. read more



Health Insurance: Unaffordable Now, And Destined To Get Much Worse

Mouse over each state to see the percentage of median income absorbed by employer-sponsored insurance in 2006, and what that percentage would be in 2016 without a change in policy.

Click a state and the document icon to get the full report.

Increase in cost of insurance
as share of median income,
from 2006 to 2016

     70% and lower (turquoise)
     71% to 85%
     86% to 100%
     101% to 115%
     115% or higher (black)



~OGD~

Open Thread for Discussion: Why hasn't TPM dedicated a page to Health Reform Discussions?



Your thoughts?


On the front page of TPM there has been added a "Health Care Overhaul" column that is linking to Brian Beutler who has now started ramping up coverage on the ongoing debate over in TPMDC here, here, here. and here.

But with this issue being the prime issue to be debated through the summer into the fall shouldn't there be a more organized way here at TPM for nesting this discussion.

How about something along the line of a dedicated page, say, TPM Health Reform Debate?

Hey Josh ... I know you're listening . . .

What do others 'round here think?

Let's get it on.

~OGD~

Health Reform Deniers: Logic? We Don't need No Stinkin' Logic . . .


   Let's try and get real here . . .


Here is the President's response to a question during the press conference yesterday about private insurers and their arguments against the competition from a public option plan:


Q Won't that drive private insurers out of business?

THE PRESIDENT: Why would it drive private insurers out of business? If private insurers say that the marketplace provides the best quality health care, if they tell us that they're offering a good deal, then why is it that the government -- which they say can't run anything -- suddenly is going to drive them out of business? That's not logical.

whitehouse.gov/.../Press-Conference-by-the-President-6-23-09/



Logic doesn't put fear in the hearts of the unsuspecting public. (see video here at the Cafe)

Anyone here have any thoughts on the President's push back (if even ever so slightly) on this issue?

~OGD~

A DOSE OF REALITY: MYTH VS. FACT ON HEALTH REFORM


   For your general information . . .





MYTH VS. FACT ON HEALTH REFORM


GOP MYTH: Health reform means fewer choices for Americans.
FACT: The House proposal will increase choice among an array of high‐quality private and public health insurance options. Most importantly, if you like what you have, you can keep it. More Americans will have access to greater choices in doctors and plans by taking away the insurance industry's ability to deny coverage and care.

GOP MYTH: Health reform means bureaucrats will ration health care.
FACT: The House proposal will expand and improve the availability of quality health care for all Americans, not ration it. Under this proposal, doctors, nurses and patients will make medical decisions, not big insurance companies or the government. Republicans content with the status quo want to leave patients at the mercy of big insurance companies that make decisions to protect profits not patients.

GOP MYTH: Health reform means raising taxes, or making coverage more expensive.
FACT: Under the status quo, middle‐class families pay an enormous "hidden tax" of nearly $1,100 per year to provide care for the uninsured and underinsured. The House proposal will end this tax by containing overall costs and expanding access to affordable care for all Americans. Additionally, the House proposal invests in reforms to contain the costs of health insurance overburdening businesses, families and the federal deficit. Republicans can either continue to be the "Party of No" and defend the status quo that is costing American families and businesses more every year, or they can be part of the solution.

GOP MYTH: Health reform means Americans will be forced out of their current plans.
FACT: The House proposal builds on what works - the employer‐based system - while giving every American the peace of mind of knowing that their health needs will be covered by insurance. No one will have to worry about being denied insurance based on a pre‐existing condition, or being without coverage if their employer drops coverage, they lose their job, or change employers. Republicans make this claim based on a study of a proposal that is nothing like the House proposal.

GOP MYTH: Health reform means individuals will be forced to buy insurance they can't afford.
FACT: Millions of Americans cannot afford insurance today or are locked out of the system because of a preexisting condition. The House proposal emphasizes shared responsibility among individuals, businesses and the government and helps make coverage affordable and available to all. Affordability credits will be available to help low‐ and moderate‐ income working families afford coverage, regardless of the plan they choose.

GOP MYTH: Health reform will force businesses to cut jobs and squeeze small businesses.
FACT: All businesses will benefit from insurance market reforms and a high performing health system that will reduce costs of health care. The status quo is unsustainable for businesses. Under the House proposal, employers will continue to offer their employees health care or contribute towards coverage. Certain very small businesses would be exempt from this requirement. With tax credits and a reformed market that ensures access to affordable coverage, small business owners and their employees will have new options to purchase affordable health insurance that are not available to them now.

GOP MYTH: Health reform that builds on Medicare and Medicaid will only hurt the programs' long‐term sustainability, and cost state and federal governments more.
FACT: Health reform is a critical first step toward containing health care costs for business, individuals, and the federal government in Medicare and Medicaid. By eliminating wasteful overpayments to private plans under Medicare, reforming how doctors are reimbursed, and creating new incentives for coordinated, high quality care we will extend Trust Fund solvency and improve Medicare for generations to come.

Myths vs. Fact (pdf)

PREPARED BY HOUSE DEMOCRATIC LEADERSHIP AND COMMITTEE STAFF

JUNE 19, 2009


~OGD~

From 538.com: Public Support for the Public Option



From Nate Silver at 538 discussing the
various polling data on the public option plan.


6.20.2009

Public Support for the Public Option

by Nate Silver @ 3:52 PM


UPDATED at 5:45 PM to include Lake/HCAN poll

A major, though by no means the only, substantive point of debate regarding health care reform is whether the plan considered by Congress will include a "public option" -- a government-run insurance program that would compete with private plans. Barack Obama's plan on the campaign trail included a public option: "any American will have the opportunity to enroll in the new public plan or an approved private plan," it said.



Inclusion of a public option is a sine qua non for many progressives, who believe it would lower costs by increasing competition, or who may have an objection to the notion of requiring that people (since health care would have an individual mandate) purchase something through a private, for-profit entity. On the other hand, the public option has drawn the ire of conservatives and industry groups, who believe that it would gobble up profit margins from private industry and that it might have unfair competitive advantages. Both liberals and conservatives seem to acknowledge some possibility that a public option might gradually evolve into a version of a single-payer system; for liberals this is a big plus and for conservatives a big minus. The revised plan released by Max Baucus's Senate Finance Committee on Thursday did not include a public option, although the House's latest version does.

It is worth evaluating polling on the public option, which has begun to be widely cited in the blogosphere, particularly by liberals who believe most of the polling favors them. The balance of this post contains a summary of the five six polls that I am aware of on the public option, which produce widely disparate results and all of which require careful interpretation.

1. Kaiser Family Foundation Tracking Poll

Who They Are / What's Their Angle: A California based non-profit founded in 1948 by Henry J. Kaiser. The Foundation no longer has any association with Kaiser Permanente, which operates hospitals and insurance programs mostly in the South and the West. KFF released numerous materials on the candidates' positions on health care in advance of the 2008 election which generally took a neutral tone. KFF itself has not given money to political candidates, although its employees collectively donated $11,700 in 2008 and $9,550 in 2006 to Judith Feder, a public policy expert who is an adviser to KFF and ran unsuccessfully for Congress as a Democrat in Virginia's 10th Congressional District.

Specifications: 1,205 American adults, including cellphone and Spanish-language samples, conducted from June 1-June 8. The sample was split in half, however, for the two formulations of the public option question as expressed below, and so sample sizes for each one are closer to 600.

Question Wording and Results:

"Now I'm going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it [...]

"Creating a public health insurance option similar to Medicare to compete with private health insurance plans."

Favor: 68% (40% strongly favor)
Oppose: 28% (17% strongly oppose)


"Creating a public health insurance option to compete with private health insurance plans."

Favor: 65% (32% strongly favor)
Oppose: 29% (17% strongly oppose)


Discussion: One suspects that KFF is pro-reform, but they seem to have taken care to frame their materials in ways that avoid partisan scrutiny. Their question wording is fairly straightforward but does not include the phrase "government", which might provide more clarity to the respondent about exactly what the public option is. Note, however, that they phrase the question in two different ways: to half their sample they include the phrase "similar to Medicare" and to the other half they don't. Responses were about the same between the two question wordings, although the half that had the Medicare language included were notably more likely to strongly favor the public option. Including a sample of cellphones and Spanish-language interviewers are nice perks. Although the sample sizes are not huge, particularly since the sample was split into halves, KFF found nearly identical results in their April tracking poll.

Non-partisanship rating:
Question wording:
Sample size, sample selection and disclosure:
Overall informativeness:

2. Employee Benefits Research Institute (EBRI)

Who They Are / What's Their Angle: A Washington, D.C. - based nonprofit, which is focused -- as their name implies -- on research on employee benefit programs. I can find no evidence of lobbying activities or campaign contributions by ERBI. They are funded by a largely corporate set of donors such as American Express, Chevron, IBM, Shell Oil and Towers Perrin, although they also receive financing from noncorporate groups like AARP and Blue Cross Blue Shield. An issue brief that EBRI prepared on the public option was neutral to slightly skeptical about it. The poll was conducted in conjunction with Mathew Greenwald & Associates.

Specifications: 1,000 American adults aged 21 and over. Interviews conducted from May 8th through June 2nd.

Question Wording and Results:

"Creating a new public health insurance plan that anyone can purchase."

Support: 83% (53% strongly support)
Oppose: 14% (9% strongly oppose)


Discussion: Information about this poll was a little bit harder to come by than it probably should be. For example, I had to look in a separate press release to find details about its sample size. Nor is it clear that the entire battery of questions was released in ERBI's summary brief. The selection of adults 21+, rather than 18+, is also unorthodox, and is a strange enough choice that I wonder about the other decisions ERBI made in constructing its sample. EBRI's poll was also the only one which did not specify that the public option would be designed to compete with private plans.

Non-partisanship rating:
Question wording:
Sample size, sample selection and disclosure:
Overall informativeness:

3. Consumers Union

Who They Are / What's Their Angle: Not a labor union; Consumers' Union is instead a Yonkers, NY-based non-profit group and the publisher of Consumer Reports. They take a somewhat unabashedly liberal view on health care reform and the poll was released in conjunction with Democratic Senator Chuck Schumer. The Consumers Union' generally spends several hundred thousand dollars on lobbying activities each year.

Specifications: 2,009 American adults aged 18 and over. Interviews conducted from April 2nd to April 6th, 2009.

Question Wording and Results:

"Congress is discussing several ideas to address healthcare reform. One proposal provides everyone, whether insured or uninsured, an additional choice: the option of a public health plan that people can count on to cover what they need at more affordable rates. This option would allow people with good insurance that they like to keep it. Those without good insurance can gain access to reliable healthcare, regardless of preexisting medical conditions, and obtain a consistent menu of benefits. This public plan would be paid for by enrollees. Those that cannot afford to pay the full premiums would be subsidized based on their income.

Please rate your level of support for this proposal."

Support: 66% (33% strongly support)
Oppose: 16% (8% strongly oppose)


Discussion: This is more or less an explicitly partisan poll, both in terms of the organization backing it and in its question wording, which is leading and highly favorable to the public option. The large sample size is nice, but Consumers Union' should have picked more neutral phrasing.

Non-partisanship rating:
Question wording:
Sample size, sample selection and disclosure:
Overall informativeness:

4. Rasmussen Reports

Who They Are / What's Their Angle: Regular readers of this website will be very familiar with Rasmussen Reports, a standalone polling firm that releases a prolific amount of polling data on elections and public policy issues. Past FiveThirtyEight.com analyses have generally found Rasmussen's electoral polling to be quite reliable. However, some observers have questioned its issue-based polling, which frequently tends to elicit responses that are more conservative than those found on other national surveys. Rasmussen Reports' founder, Scott Rasmussen, is a Republican, although neither he nor Rasmussen Reports have appear to have contributed to political candidates in recent years. Nor to my awareness does Rasmussen Reports conduct a significant amount of polling directly on behalf of political candidates.

Specifications: 1,000 American adults on June 12th and 13th. Assuming that procedures here were the same as for other Rasmussen polling, surveys were conducted via the IVR ("robocall") method and were weighted for partisan identification and other factors.

Question Wording and Results:

"Would it be a good idea to set up a government health insurance company to compete with private health insurance companies?"

Yes: 41%
No: 41%


Discussion: I am not particularly fond of this question wording. For one thing, unlike the other polls, it focuses on the action of setting up the "government health insurance company" rather than the choice of insurance plans this ultimately presents to the consumer. For another, it is not clear that a new program would have to be "set up" in order to provide for a public option (i.e. an existing program like Medicare could be expanded), nor that any such entity would properly be described as a "company". The poll seems designed to juxtapose the terms "government" and "company" in a way that might elicit a negative response. (Note that I actually like the inclusion of the term "government" in conjunction with, or perhaps instead of, the term "public". The problem is not with the term "government" itself but instead with the overall way that the question is phrased.)

Non-partisanship rating:
Question wording:
Sample size, sample selection and disclosure:
Overall informativeness:

5. NBC / Wall Street Journal

Who They Are / What's Their Angle: Presumably you are familiar with NBC News and the Wall Street Journal. The NBC/WSJ polls themselves are conducted by Hart/McInturff, a pairing of Democratic pollster Peter Hart and Republican pollster Bill McInturff. Likewise, the NBC/WSJ pairing itself is a collaboration between a somewhat left-leaning and somewhat right-leaning news organization. This is an excellent model to avoid partisanship, both in appearance and in practice.

Specifications: 1,008 American adults on June 12th-15th, including a cellphone sample.

Question Wording and Results:

"In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government and a private plan for their health insurance--extremely important, quite important, not that important, or not at all important?

Extremely Important: 41%
Quite Important: 35% (76% Extremely or Quite Important)
Not That Important: 12%
Not At All Important: 8% (20% Not That or Not At All Important)


Discussion: I have no problem with the formulation of the question; in fact, I particularly like the wording "a public plan administered by the federal government" which makes clear that the public plan is in fact government-run. But I have a big problem with the choice of answers. "Importance" is a notoriously vague concept in public opinion polling and may be separate and distinct from asking someone whether or not they support a particular policy. How might someone respond to this question, for instance, if they had particularly strong feelings against a public option? Would they say that it was "not at all important", or would they say that it was "extremely important"? Conversely, how would someone respond if they had a weak preference for a public option, but didn't consider it an especially important component of health care reform? The 1,008 random adults that NBC/WSJ surveyed are going to interpret these dilemmas in a variety of different ways. In addition, the particular category of "quite important" is somewhat ambiguous and probably falls somewhere in between a favorable response and a neutral one.

Non-partisanship rating:
Question wording:
Sample size, sample selection and disclosure:
Overall informativeness:

6. Lake Research / HCAN

Who They Are / What's Their Angle: Lake Research Partners is a Democratic polling firm. Their poll was conducted on behalf of Health Care for America Now! (HCAN), an advocacy group that wants comprehensive health care reform and strongly favors the public option.

Specifications: Sample of 800 likely voters from January 8-13th, 2009.

Question Wording and Results:

"Which of the following three approaches to health care reform do you prefer: one, everyone getting health insurance through private health insurance plans; two, everyone getting health insurance through a public health insurance plan; or three, everyone having a choice of private health insurance or a public health insurance plan?"

73% choice of public or private
15% private only
9% public only


Discussion: Celinda Lake is an excellent pollster, but she is a Democratic pollster and this is a Democratic poll. I don't hate the question wording, but it really emphasizes the option part of the public option and somewhat de-emphasizes the public part; in this sense, it is sort of the alter ego to the Rasmussen poll. As in some of these other polls, it also may not be immediately obvious to the respondent that "public" means administered by the government. A couple of additional points of critique: the use of a likely voter model (as opposed to all adults or registered voters) is a bit unusual this far out of an election cycle, particularly when it regards how the public feels about a particular policy rather than how they want their elected officials to vote on it. And the poll is now a bit outdated, having been conducted in January.

Non-partisanship rating:
Question wording:
Sample size, sample selection and disclosure:
Overall informativeness:


Summary: The only poll I have a particularly high degree of confidence in is the Kaiser Family Foundation poll, which finds that between 65 and 68 percent of the public support a public option depending on how the question is phrased. The only thing I would change about their poll is to specify, as NBC/WSJ does, that the public plan would be administered by the government.

The other polls have one or more characteristics that give me pause about them. The question wording in the Consumers Union' poll is push-y and explicitly partisan; the question wording in the Rasmussen and Lake/HCAN polls is strange and probably implicitly partisan. The NBC/WSJ poll is otherwise terrific, but very difficult to interpret because they ask people about the importance of a public option, and not necessarily their support for one. I might be more comfortable with the ERBI poll if I learned more about it, but the comparative lack of disclosure coupled with the unusual choice to exclude adults 18-20 from the sample and a result that appears to be a mild outlier gives me some concerns about it.

Overall, polling points toward the public option being at least mildly popular and indeed perhaps quite popular. But more polling is required on this question, particularly by the news organizations and other unaffiliated groups like Pew and Gallup, and more care should be taken to frame both questions and answers in a neutral and informative way.

 

...see also health care, methodology, question wording, rasmussen



Health Care Bill: Initial House "Discussion Draft" . . .



   Have fun . . .


If you're interested . . . It's only 850 pages in length:

energycommerce.house.gov/Press_111/20090619/ .... discussiondraft.pdf



Or ... If you wish to read a fairly quick overview -- find it below at the LATimes:

latimes.com/features/health/la-na-healthcare20-2009jun20



~OGD~

CBO Report June 16, 2009: Health Care Reform and the Federal Budget




Did anyone else see this on the evening news?




CBO Logo


CONGRESSIONAL BUDGET OFFICE

Douglas W. Elmendorf, Director

U.S. Congress

Washington, DC 20515

June 16, 2009

 

Honorable Kent Conrad
Chairman
Committee on the Budget
United States Senate
Washington, DC 20510

Dear Mr. Chairman:

In the absence of significant changes in policy, rising costs for health care will cause federal spending to grow much faster than the economy, putting the federal budget on an unsustainable path. This letter responds to your request for information about the features of reform proposals that would affect federal spending on health care over the long term.

As you noted, many experts believe that a substantial share of spending on health care contributes little if anything to the overall health of the nation. Therefore, changes in government policy have the potential to yield large reductions in both national health expenditures and federal health care spending without harming health. Moreover, many experts agree on some general directions in which the government's health policies should move--typically involving changes in the information and incentives that doctors and patients have when making decisions about health care.

However, large reductions in spending will not actually be achieved without fundamental changes in the financing and delivery of health care. The government can spur those changes by transforming payment policies in federal health care programs and by significantly limiting the current tax subsidy for health insurance. Those approaches could directly lower federal spending on health care and indirectly lower private spending on it as well. Yet, many of the specific changes that might ultimately prove most important cannot be foreseen today and could be developed only over time through experimentation and learning. Modest versions of such efforts--which would have the desirable effect of allowing policymakers to gauge their impact--would probably yield only modest results in the short term.

Therefore, one broad long-range approach for reform that has drawn interest recently would combine specific policy actions--to generate near-term savings and provide experience that would lay the groundwork for future savings--with a mechanism or framework to impose ongoing pressure for achieving efficiencies in the delivery of health care. The effectiveness of that path would depend ultimately on the willingness of federal policy to maintain significant and systematic pressure over time and would require tough choices to be made. Without meaningful reforms, the substantial costs of many current proposals to expand federal subsidies for health insurance would be much more likely to worsen the long-run budget outlook than to improve it.

CBO does not provide formal cost estimates beyond the 10-year budget window because the uncertainties are simply too great. However, in evaluating proposals to reform health care, the agency will endeavor to offer a qualitative indication of whether they would be more likely to increase or decrease the budget deficit over the long term.

The attached analysis elaborates on these points. Please contact me at (202) XXX-XXXX if you have any questions.

Sincerely,

Douglas W. Elmendorf
Director

Attachment

Identical letter sent to the Honorable Judd Gregg.


Health Care Reform and the Federal Budget

June 16, 2009

 

Because the Congress is now considering major legislation affecting health care and health insurance, the possible effects on the federal budget have received significant attention. To elucidate those effects, this analysis examines the budget outlook under current law; the likely budgetary effect of efforts to expand the scope of insurance coverage; the potential for reducing health care spending; the likely impact of specific changes in the health system; and mechanisms for engendering efficiency gains in health care over time.

The Federal Budget Outlook

The federal budget is on an unsustainable path, primarily because of rapidly rising spending on health care. Federal outlays for Medicare and Medicaid have increased from 1 percent of gross domestic product (GDP) in 1970 to more than 5 percent in 2009; and the Congressional Budget Office (CBO) projects that under current policy, they will exceed 6 percent of GDP in 2019 and about 8 percent in 2029. Most of that increase will result from rising costs per capita, rather than from the aging of the population. As a result, the country faces difficult and fundamental trade-offs between limiting the growth of Medicare and Medicaid relative to GDP, accepting a continuing increase in taxes relative to GDP, and reducing other spending relative to GDP, possibly to levels not experienced in this country in more than 40 years.1

Moreover, serious fiscal imbalances are not a far-off problem. Under current law, CBO projects, Medicare's Part A trust fund--which pays for inpatient services, post-acute care, and hospice services and receives revenues principally from the payroll tax--will have insufficient funds to pay for all covered services starting in 2017. More broadly, federal debt held by the public is set to jump from 41 percent of GDP at the end of 2008 to more than 60  percent by the end of 2010, the highest level since the mid-1950s. Under CBO's March baseline projection, the debt would fall back below 60 percent of GDP in the second half of the decade, but the baseline assumes that currently scheduled increases in tax rates will be allowed to occur, even though policymakers seem intent on extending at least some of the 2001 and 2003 tax cuts. If those and all other expiring provisions were extended and the alternative minimum tax was indexed for inflation, the debt would continue to rise relative to GDP throughout the next decade, reaching 86 percent by 2019. Debt held by the public has not been that high since the years immediately following World War II.

For many observers and policymakers, that grim outlook for the federal budget during the next decade and beyond is an important motivation for crafting health care reform and making other policy choices in a manner that significantly reduces future deficits.

The Potential Impact of Expanding Health Insurance Coverage on the Budget Outlook

The federal government's financing of health care will total more than $1 trillion in 2009, all told. Federal outlays for Medicare and Medicaid are about $700 billion; tax preferences for health care (especially the exclusion of premiums for employment-based health insurance from income and payroll taxes) amount to more than $250 billion; and the federal government also pays for veterans' health care, public health initiatives, and other health programs. Already, those direct and indirect payments for health care account for nearly 60 percent of total health expenditures for the nation.

Many proposals to significantly expand insurance coverage would add to federal costs by providing large subsidies to help lower-income individuals and families purchase insurance. Those proposals would take several years to implement, but it is useful to consider the budgetary implications if they were up and running now so as to compare those costs to existing obligations. Depending on the specific policies selected, the added cost could be on the order of $100 billion. In the absence of specific constraints on growth, the new spending (or revenue losses, if tax credits were used to provide subsidies) would probably increase over time roughly with the underlying costs of health care and, thus, would grow about as fast as spending on other federal health care programs.2

From that perspective, a large-scale expansion of insurance coverage would represent a permanent increase of roughly 10 percent in the federal budgetary commitment to health care. Improving the budget outlook therefore would require that other aspects of an initiative on health care reduce the federal resources devoted to it by more than that amount (or that other federal spending or revenues be adjusted to accomplish the same end).

By themselves, insurance expansions would also cause national spending on health care to increase, in part because insured people generally receive somewhat more medical care than do uninsured people--notwithstanding the fact that some newly insured people would avoid expensive treatments by getting care sooner, before their illness progressed.3 However, the rise in national spending on health care would be less than the increase for the federal government because some costs that are now paid by others would be shifted to the government (via the subsidies provided by the proposal).

Expanding insurance coverage would make it modestly easier to achieve some other reductions in national and federal spending on health care, but it would not alter the fundamental nature of these challenges. Several issues are relevant:

  • Broader insurance coverage might lead to less cost shifting in the health care system, but that effect would probably be relatively small and would not directly produce net savings in national or federal spending on health care.

    If more people had insurance, then the amount of uncompensated care would decline. Some government payments designed to pay for part of that care (such as "disproportionate share" payments to hospitals that treat many poor patients) could be trimmed accordingly. And, to the extent that costs of uncompensated care are currently shifted to private payers, some offsetting savings could arise. However, undoing any current shifts of spending among different payers would not change the growth rate of federal spending beyond the first few years.

    Moreover, uncompensated care is less significant than many people assume. According to one study, hospitals provided about $35 billion in uncompensated care nationwide in 2008--less than 2 percent of national health expenditures--and the estimates are much smaller for other providers.4 The extent to which such costs are shifted to other payers is also uncertain; well-structured studies have found modest effects.5 Further, some proposed expansions of insurance coverage would broaden eligibility for Medicaid, which might lead to additional cost shifting given Medicaid's low payments to providers.
  • In terms of the trajectory of spending, policymakers might be more willing to slow the growth in payments to health care providers--and providers might be more willing to accept slower growth--if they were not worried about the possible impact of slower payment growth on access to medical care for uninsured or underinsured people. (That effect could arise if cutbacks in payment rates for insured patients led doctors or hospitals to limit their provision of such care.) But budgetary savings from reducing payments to providers would not occur automatically with broader insurance coverage; they would arise only to the extent that legislation explicitly trimmed payment rates relative to levels under current law.
  • Health care providers currently use resources looking for ways to receive payments for treating uninsured people. In addition, insurers currently use resources trying to determine the health of prospective customers and to avoid paying for treatments that address preexisting conditions. Expanded insurance coverage, together with the requirement that insurers provide coverage to all applicants and the elimination of restrictions on preexisting conditions (two features of many current insurance-market reform proposals), would save such resources.
  • Currently, a significant share of the population moves in and out of insurance coverage during a year, which complicates efforts to provide effective prevention and wellness services. As discussed later, though, those services are less broadly effective at reducing health care spending than might be expected, and in any event, expansion proposals would not eliminate all of the churning that makes it harder to maintain continuity of care.
  • Most expansions of insurance coverage that are under consideration would leave a moderate number of people uninsured, in part because some people would be ineligible for subsidies or would choose not to buy insurance even with large subsidies. Therefore, any current problems arising from the lack of insurance could be reduced but not eliminated.

It also bears emphasizing that if a reform package achieved "budget neutrality" during its first 10 years, budgetary savings in the long run would not be guaranteed--even if the package included initial steps toward transforming the delivery and financing of health care that would gain momentum over time. Different reform plans would have different effects, of course, but two general phenomena could make the long-run budgetary impact less favorable than the short-run impact:

  • First, an expansion of insurance coverage would be phased in over time to allow for the creation of new administrative structures such as insurance exchanges. As a result, the cost of an expansion during the 2010-2019 period could be a poor indicator of its ultimate cost.
  • Second, savings generated by policy actions outside of the health care system would probably not grow as fast as health care spending. Such would be the case for revenues stemming from the Administration's proposal to limit the tax rate applied to itemized deductions and from proposals to tax sugar-sweetened soda or alcohol, for example.

Some policy options under consideration would yield savings that grew in tandem with health care spending--reducing the level of federal spending on health care but not affecting the measured rate of spending growth after the first few years. For example, the largest savings proposed in the President's budget would arise from a decrease in payments to private health insurance plans operating under the Medicare Advantage program. If enacted, that change would permanently lower the level of Medicare spending, but it would probably not offset a noticeably larger share of the cost of an expansion of insurance coverage in the second 10 years than in the first.

Moreover, any savings in existing federal programs that were used to finance a significant expansion of health insurance would not be available to reduce future budget deficits. In light of the unsustainable path of the federal budget under current law, using savings to finance new programs instead of reducing the deficit would necessitate even stronger policy actions in other areas of the budget.

Potential Savings in Health Care

Given those challenges, a health care reform package would need to incorporate very significant and fundamental changes in health care to truly improve the long-run budget outlook. Of course, projecting the effect of health policy changes into the distant future is very difficult, partly because predicting how the practice of medicine would evolve in the absence of those changes is difficult. Therefore, experts generally focus on ways to reduce the growth of health care spending over the next decade or two rather than over the very long run.

Policy changes that reaped significant savings quickly would lessen the medium-term impact on the deficit that a large-scale expansion of insurance coverage would have and could lay the groundwork for greater savings later. For example, if the growth rate of federal health care spending was trimmed by 1 percent per year during the next 20 years, the savings would roughly match the cost of an expansion of insurance coverage by the end of the decade and would exceed that cost in the next decade.

Significant savings seem possible because the available evidence implies that a substantial share of spending on health care contributes little if anything to the overall health of the nation. Therefore, experts generally agree that changes in government policy have the potential to produce substantial savings in both national and federal spending on health care without harming health. However, turning that potential into reality in a sector that accounts for one-sixth of the U.S. economy is likely to be a prolonged and difficult process.

Perhaps the most compelling evidence about the extent of inefficiency in the health sector is that Medicare spending varies widely across different regions of the country, but the variation is not correlated with available measures of the quality of care or health outcomes. Researchers affiliated with the Dartmouth Atlas of Health Care have compared the Medicare spending for enrollees across the nation, controlling for demographic characteristics such as age, sex, and race. According to those researchers' calculations, Medicare spending could be reduced by almost 30 percent if outlays in medium- and high-spending regions were reduced to the average level in the lowest-spending decile.6

Comparisons of that sort are sensitive to the method of calculation. Some studies have expressed skepticism about the Dartmouth researchers' estimate.7 CBO's own informal comparison of per capita Medicare spending in metropolitan areas, controlling for both the health status of individuals and the prices of health care inputs, implies that the savings from turning medium- and high-spending areas into low-spending areas might be roughly half of the estimate by the Dartmouth researchers. In addition, much less is known about regional comparisons of spending for and the health of patients outside the Medicare program. Still, most experts conclude that both formal analysis and extensive anecdotal evidence of regional differences in medical care and costs imply that a significant portion of spending on health care is not serving its intended purpose. Moreover, the delivery of health care in low-cost regions is not completely efficient now, so further savings might be achievable even in those areas.

Many experts think that transformational changes in health care financing and delivery could reduce the federal budgetary commitment to health by more than the 10 percent increase that would result from a large-scale expansion of insurance coverage. Achieving substantial and lasting savings, however, would require fundamental changes in the organization and delivery of health care. Examples of efficient care certainly exist today, with many individual health care providers and groups of providers offering both high quality and relatively low cost. Yet applying the methods of those efficient providers throughout the health care system cannot be accomplished through fiat or good intentions. Instead, the government controls two powerful policy levers for encouraging changes in medical practice:

  • Changes in Medicare could directly affect the efficiency of health care delivered to older and disabled Americans. Changes in payment rules could induce providers to offer higher-quality and lower-cost care (while ensuring that efficiency gains were shared by the government), and changes in the structure of benefits could give program beneficiaries stronger incentives to choose less costly care. Improved efficiency within Medicare is likely to have spillover effects on the efficiency of health care outside of the program.
  • Changes in the tax exclusion for employer-sponsored health insurance can affect the efficiency of health care financed by the private sector, by giving workers stronger incentives to seek lower-cost health insurance plans. Those steps could well have spillover effects on Medicare.

Considerable consensus exists among experts about some types of changes that are likely to make the health sector more efficient: move away from a fee-for-service system toward paying providers for value, perhaps through fixed payments per patient, bonuses based on performance, or penalties for substandard care; provide stronger incentives for both providers and patients to control costs, through higher cost-sharing requirements or tighter management of benefits; and facilitate good decisionmaking by providers and patients by equipping them with more information about the effectiveness of different treatments and the quality of care delivered by different providers. Those changes in the flow of money and information would spur and facilitate other changes in the organization and delivery of health care.

Unfortunately, little reliable evidence exists about exactly how to implement those types of changes--especially at the level of specificity required for legislation. A recent letter to the President from a group of stakeholders in the health care industry reveals both the promise and the difficulty of achieving substantial savings through health care reform: Those stakeholders see increased efficiency as a critical goal of their organizations, and they agree that significant savings can be obtained. At the same time, many of the group's proposals offer little detail about the specific changes necessary to achieve those objectives or the obstacles to their making the changes.8

Policy Options That Could Produce Budgetary Savings in the Long Run

A number of specific reforms show great promise for reducing federal spending on health care over time without harming people's health. However, at this point, experts do not know exactly how best to structure those reforms to achieve that goal. They will need to learn through experimentation. In the meantime, any particular approach to implementing such ideas might well yield less savings than hoped for or might raise concerns about the impact on the quality of care and on patients and providers.

CBO has analyzed a number of reform options in its recent publications, including creating so-called accountable care organizations, bundling payments to hospitals and other providers, providing additional information about effective medical treatments, expanding the use of preventive and wellness services and primary care, increasing cost sharing by patients, and modifying the tax treatment of employment-based health insurance.9 When CBO evaluates policies, the agency aims to reflect the middle of the range of expert opinion about likely outcomes. For any particular policy option, CBO carefully reviews the relevant empirical evidence and examines the incentives that would be created to control costs and the factors that might limit the success of those incentives--as illustrated in the following discussion.10

One general point worth emphasizing is that reform options may have different effects on health and on the federal budget. Some policies, such as the increased use of preventive services and the coordination of care, would have clearer positive effects on health than on the federal budget balance. Other policies, such as certain changes in Medicare's payment methods, would have a direct impact on federal spending, but their effect on health outcomes would be less clear. In part, that uncertainty reflects the difficulty of measuring the quality of health care--a situation that is likely to improve but which will take time to do so.

Create Accountable Care Organizations

In Medicare's traditional fee-for-service program, providers have little or no financial incentive to coordinate the care their patients receive across different treatment settings or to be accountable for the costs and quality of that care. One prominent example of a structure that may function better would be accountable care organizations formed by physicians and other health care providers. Under this model, providers would receive bonuses if they held down the total cost of the services their patients received during a year while also meeting requirements for the quality of the care; some versions would also impose penalties on doctors who did not meet those targets.

Proponents contend that such groups would coordinate care more effectively, which would improve patients' health. In addition, the financial incentives would reduce the unnecessary use of specialists and expensive tests and procedures. Other initiatives, such as establishing "medical homes" for patients and implementing care coordination or disease management, could also be pursued more easily in this environment. Models of efficient health care today--including the Mayo Clinic, Kaiser Permanente, and Geisinger--are integrated delivery systems, and accountable care organizations have some of the same features.

A current demonstration project in Medicare (known as the Physician Group Practice demonstration) is testing similar approaches for providing care, using some of the integrated health systems noted above. However, the evidence for cost savings is mixed. Moreover, expanding this approach to physicians who are not already in an integrated system and may be reluctant to join one raises further issues. For example, challenges arise when trying to design programs that are voluntary for both enrollees and physicians, because both parties would generally need to expect some gain in order to participate--often at the government's expense. Making such mechanisms mandatory, though, raises understandable concerns.

Given the novelty of these organizations, a number of questions remain unanswered about the structure and environment of them: How tightly would the groups need to be integrated in order to achieve cost savings? How should bonuses and penalties be set? Should payments to providers in the regular fee-for-service system be restrained in order to encourage them to join accountable care organizations? Although many experts agree that this approach should be vigorously pursued, several rounds of successive and significant changes and refinements in Medicare's rules would probably be necessary to yield substantial budgetary savings.

Bundle Payments to Hospitals and Other Providers

A number of experts have proposed bundling Medicare's payments for hospitals and related services. (Payments are referred to as bundled when they cover multiple individual services.) These proposals illustrate a common issue in evaluating the budgetary effects of health care reform: Options that sound alike may have quite different cost consequences if they employ different degrees of aggressiveness in pursuing cost-saving goals.

CBO's Budget Options volume included an option that would have hospitals receive a single bundled payment from Medicare for both the hospital services they provide and the care that their patients receive in a post-acute setting in the 30 days following their discharge. Hospitals already receive a fixed payment per admission, but this arrangement would provide hospitals with a new incentive to coordinate the care their patients receive after they are discharged and to economize in the use of post-acute care. The payment amount would be adjusted over time to capture part of the anticipated reduction in costs. CBO estimated that this option would save about $19 billion over the 2010-2019 period.

The Commonwealth Fund also recently analyzed an option for bundling, one considerably more aggressive in reducing spending and altering incentives for providers.11 Under that option, successively more inclusive bundling would be phased in: Initially, Medicare would bundle together payments for a hospital stay and any readmissions within 30 days; after three years, the bundling would be expanded to include post-acute care services as well; and after three more years, the bundling would also include payments for physicians in the inpatient setting and emergency room. Payment amounts would be reduced immediately upon implementation and then would continue to be restrained over time to reflect anticipated increases in efficiency from coordination among providers. The Commonwealth Fund estimated that this proposal would reduce federal spending by over $200 billion between 2010 and 2020.

Provide Additional Information About Treatments' Effectiveness

Concerns about the limited evidence that is available to determine which treatments are most effective for which patients has generated considerable interest in expanding the supply and use of information that compares the effectiveness of treatment options. (Limited evidence may help explain why the use of certain treatments and the types of care provided vary widely from one area of the country to another.) Many analysts believe that, because of the broad benefits that additional information could provide, the federal government should fund research on the effectiveness of treatments and should help disseminate the results to doctors and patients.12

Merely conducting and disseminating additional research is unlikely to have major effects on patterns of clinical practice or health care spending, however. For new research to have a significant impact, providers' financial incentives would need to be aligned with the results. For example, legislation could allow the Medicare program to limit or deny coverage for treatments that were found to be less clinically effective or less cost-effective than other interventions. Alternatively, Medicare could tie its payments to providers to the cost of the most effective treatment, or patients could be required to pay for at least a portion of the additional cost of less effective treatments. In all of these approaches, patients and physicians could still choose the course of treatment they preferred, but Medicare's payments would depend on the broad results of research.

Further challenges in reaping net savings from comparative effectiveness research arise from the cost of the research itself and from the lags in getting research under way, developing results (particularly if they depend on new clinical trials), and disseminating the findings. Although those challenges do not undermine experts' support for additional research, they explain why such research might not yield net budgetary savings within a 10-year budget window.

Expand the Use of Preventive and Wellness Services and Primary Care

Many proposals to modify the health insurance system include provisions to expand the use of preventive and wellness services and the use of primary care. Those changes could improve people's health and the quality of care they receive. For example, vaccines can prevent the spread of diseases; screening tests may be able to detect illnesses at earlier and more treatable stages; and greater focus on primary care can foster healthier behavior and better coordination of care.

Although those policies could also lead to less spending on health care, the impact of specific preventive and wellness services on spending varies, depending on the disease being targeted and the population receiving the services. Evidence indicates that some preventive services (such as certain vaccines) reduce costs--that is, the savings for those who avoid getting sick exceed the costs of providing the intervention broadly. However, that outcome is far from universal: One study of the health and economic effects of preventive services found that only 20 percent of the services that were assessed yielded net financial savings.13

Several factors make preventive care less broadly effective at reducing health care spending than might be expected. For some preventive services, clinical evidence on effectiveness is lacking: In its 2006 review of such evidence, the U.S. Preventive Services Task Force was neutral toward--neither recommending nor discouraging the use of--approximately 40  percent of the services it reviewed because of a lack of evidence. For other preventive services, clinical evidence shows benefits, but the cost of the intervention for the many people who might receive it would exceed the likely savings for the relative few who would avoid the disease as a result. In addition, a decision by the federal government to subsidize preventive care might shift some costs to the government that would otherwise be borne by the private sector.

A related issue is the ability of the federal government to reduce its spending on health care by fostering healthier behavior and lifestyles. Reducing risk factors for chronic diseases that afflict older Americans can reduce the prevalence of those diseases and thereby the Medicare spending that goes to treat them. However, the overall budgetary effect also depends on the cost to the government of the policies that reduce risk, other health care costs that are incurred by people who live longer, and additional Social Security benefits that are paid to people who live longer. The relative magnitude of those effects varies for different diseases, and research on the topic is limited. One recent study that incorporated the interactions of different medical conditions and the cost of treating them--but did not address Social Security outlays or the cost of risk-reducing policies--found that controlling diabetes would increase medical costs and that controlling obesity would reduce costs substantially.14 Unfortunately, the design and costs of effective programs to reduce obesity are very unclear.

As with prevention, the budgetary impact of greater use of primary care would depend on the combination of increases and decreases in spending occurred. One study of the relationship between Medicare spending and the composition of the workforce of physicians found that, with the total number of physicians held constant, states with more general practitioners had lower spending.15 Achieving that outcome, however, involves reducing the number of specialists in line with increasing the number of primary care physicians, and the mechanism for accomplishing that change (for example, the appropriate adjustments in payment policies) is unclear. Savings would be less likely if the number of specialists remained the same while the number of primary care physicians increased.

Increase Cost Sharing by Patients

Increasing the cost-sharing obligations that individuals face in government health programs and private insurance would strengthen the incentives for them to use medical care prudently. Research has shown that patients are responsive to the price they pay for many aspects of care.16 To be sure, the rationale for insurance is to limit patients' out-of-pocket costs, so people with significant health problems or with low income and few assets could not pay a large share of their health costs themselves; cost sharing could be designed to maintain appropriate financial protection while still creating some sensitivity to cost. In addition, maintaining lower cost sharing for certain preventive services, medications to treat chronic conditions, and other care that would reduce future spending (which falls under the rubric of "value-based insurance design") may make sense. Still, ensuring that patients have some financial stake in decisions about treatment methods would lead them to ask their doctors more questions about the effectiveness of different tests and treatments and to make better-informed and more cost-sensitive decisions about their care.

CBO's Budget Options volume includes a number of approaches to modifying cost sharing in the Medicare program. One option to increase cost-sharing liabilities for most patients but place an upper cap on a patient's total annual liability was estimated to save $26 billion over 10 years. Making those changes and simultaneously restricting the amount of cost sharing that could be covered by individually purchased supplemental (medigap) insurance nearly tripled the estimated amount of budgetary savings. In addition, changing the tax treatment of employment-based health insurance (discussed next) would encourage a higher degree of cost sharing in private insurance, along with other effects.

Modify the Tax Treatment of Employment-Based Health Insurance

Nearly all analysts agree that the current tax treatment of employment-based health insurance--which exempts most payments for such insurance from both income and payroll taxes--dampens incentives for cost control because it is open-ended. Those incentives could be changed by restructuring the tax exclusion to encourage workers to join health plans with lower premiums; those lower premiums would arise through a combination of higher cost-sharing requirements and tighter management of benefits.

CBO's Budget Options volume discusses a number of such changes. One option would replace the current tax exclusion with a refundable but more limited tax credit. Another option would limit the amount of health insurance premiums that could be excluded from income and payroll taxes to specific dollar amounts that represented the 75th  percentile of premiums paid by or through employers.17 These approaches would change workers' incentives about how much insurance to purchase and how much care to demand, and they would increase federal revenues by several hundred billion dollars over 10 years.

Imposing Ongoing Pressure to Increase Efficiency in the Health Care System

Vigorous implementation of specific reforms discussed in the preceding section could save money for the federal government in the medium term; they could also lay the groundwork for long-term savings. However, many of the reforms would only reach fruition with substantial changes in how medicine is practiced. Therefore, the largest savings would be reaped slowly, as experts learn more from experience with innovative approaches to financing and delivering care and as payment rules are adjusted to shift behavior further and capture savings for the federal government.

To ensure that current legislation puts the federal budget on a more sustainable path will probably require creating a framework for federal health care spending that imposes ongoing pressure to increase efficiency over time--particularly but not exclusively in the case of providers. Such pressure could be imposed in several ways, including reducing Medicare's payment updates automatically to take account of expected productivity gains; reducing Medicare payments in higher-spending areas of the country; giving the Secretary of Health and Human Services broad discretion to change Medicare to produce savings, but imposing an across-the-board reduction in payments to providers if savings are not achieved in other ways; and limiting the growth of Medicare's implicit subsidy of premiums.

Yet for any of those approaches to work over time, the Congress would need to let the legislated changes to payments take effect--even in the face of concerns from providers and patients. If, instead, the Congress ended up relieving the pressure by boosting payments, then the anticipated savings would prove to be illusory. The repeated deferral of the cutbacks in payments to physicians called for by Medicare's sustainable growth rate mechanism is a cautionary example.

Reduce Annual Updates in Medicare's Payments to Reflect Expected Productivity Gains

Under current law, Medicare's fee-for-service payments to caregivers in a variety of facilities (including acute care and long-term care hospitals, outpatient facilities, skilled nursing facilities, and home health agencies) are determined according to preset fee schedules. The basic payment rates are updated annually to reflect changes in the prices of various inputs (such as labor and equipment) that are used to provide medical services. Those prices are measured by market-basket indexes, which combine various price increases into a single update factor for each type of provider. Each index is designed to approximate the changes in costs that providers incur as a result of changes in input prices--under an assumption that the quantity, quality, and mix of those inputs remain constant. To the extent that providers increase their productivity over time--for example, by using fewer inputs or a less expensive mix of inputs to produce the same or greater output--the payment updates overstate the actual increases in costs. Indeed, the Medicare Payment Advisory Commission (MedPAC) often recommends that updates be set equal to changes in market-basket indexes less overall productivity growth in the economy (as long as access to care and other measures meet appropriate standards).

Some experts maintain that increased use of information technology and a new focus on efficiency will yield substantial productivity gains in the health sector.18 Some of those gains may appear as reductions in the quantity of services and thus yield savings automatically for the government. However, most of the gains are likely to take the form of reduced costs per service, which would cut government spending only if the government cut the prices it pays (and otherwise would end up boosting providers' profit margins).19 Imposing slower growth in payments would create ongoing pressure on providers to identify and adopt efficiencies; it would also, however, create risks for providers and patients if the efficiency gains were not achieved.

More generally, reducing payment updates in the fee-for-service Medicare system could also prove to be a powerful mechanism for shifting providers into new payment schemes and organizational arrangements. Anticipated large reductions in payments to physicians under the sustainable growth rate mechanism, for example, could provide an impetus to physicians to join accountable care organizations, where they might receive bonuses for low-cost high-quality care. However, the fact that the Congress has intervened to prevent past cuts in payment rates that the mechanism would have caused makes it less likely that physicians will believe that scheduled future reductions will actually occur.

Reduce Medicare Payments in Higher-Spending Areas

Another tack for applying ongoing pressure to restrain spending would be to reduce Medicare payments, or the growth in those payments, in higher-spending areas of the country. CBO recently examined several variants of this approach in its Budget Options volume: reducing Medicare fees for physicians in high-spending areas, reducing Medicare payments across the board in high-spending areas, reducing Medicare's payments to hospitals in areas with a high volume of elective admissions, and imposing a surcharge on cost sharing by Medicare beneficiaries in high-spending areas.

This approach would focus directly on reducing the geographical disparities that currently exist in health care spending, although it would not target specific medical providers or types of services that might be most responsible for the differences in spending. As with reductions in payment updates, this approach would create risks for providers and patients in higher-spending areas if the efficiency gains were not achieved. The overall challenge in reducing the use of care that seems to be wasteful is trying to distinguish that care from necessary care, and that task is made only somewhat easier by focusing attention on geographic areas where wasteful spending is more likely to be occurring.

Combine Increased Discretion to Change Medicare With a Fallback If Savings Were Not Obtained

Another way to ensure significant savings in Medicare would be to give the Secretary of Health and Human Services, the Administrator of the Centers for Medicare and Medicaid Services, or some governmental entity broad discretion to make changes in Medicare to produce savings--but also to impose an across-the-board reduction in payments to providers if sufficient savings were not achieved in other ways.20

Many experts think that broader discretion for the administrators of Medicare would help to encourage innovation and enhance efficiency in any event. However, the fallback reductions in payments to providers would be crucial in encouraging providers to accept other changes in the program instead. Moreover, as noted above, this mechanism and others in this section would only be effective in the end if the Congress let the legislated reductions in payments take effect.

Limit the Growth of Medicare's Subsidy of Premiums

One other mechanism for imposing ongoing pressure to achieve efficiencies in Medicare would be to limit the growth of the program's implicit subsidy of premiums. If increases in medical costs beyond some threshold were borne at least partly by Medicare beneficiaries rather than the government, the government's financial burden could be reduced. In addition, beneficiaries would then face strong incentives to make informed, cost-sensitive decisions about their medical care. Such changes could be designed to maintain greater protection for older beneficiaries or beneficiaries with lower income.

 

1. The rapid growth of Medicare and Medicaid relative to the economy during the past four decades has been, in a sense, "financed" by a significant reduction in defense spending relative to GDP. Meanwhile, federal revenues and nondefense spending on other programs have grown about in line with the economy, on average. However, with health care spending continuing to shoot up and defense spending down to about 4 percent of GDP, the historical pattern cannot be repeated.

2. Spending growth in some other federal health programs depends on the aging of the population as well as the increase in age-adjusted health care costs. At the same time, the growth rate of spending on insurance subsidies would depend on the design of the programs. If lower-income households' costs for insurance were capped at a fixed share of income, then federal spending would rise faster than health care costs. Alternatively, subsidies for health insurance could be set to increase more slowly than health care costs, although that approach would make insurance more difficult for some households to afford over time. A reasonable assumption would therefore seem to be that, absent structural reforms, costs in all of the federal health programs would grow at roughly the same rate.

3. See Congressional Budget Office, Key Issues in Analyzing Major Health Insurance Proposals (December 2008), pp. 71-76.

4. Jack Hadley and others, "Covering the Uninsured in 2008: Current Costs, Sources of Payment, and Incremental Costs," Health Affairs, Web Exclusive (August 25, 2008), pp. W399-W415.

5. See Congressional Budget Office, Key Issues, pp.112-116.

6. See John E. Wennberg and others, "Geography and the Debate Over Medicare Reform," Health Affairs, Web Exclusive (February 13, 2002), pp.W96-W114.

7. See, for example, Jack Hadley and others, Variations in Medical Care Spending per Medicare Beneficiary: The First Stage of an Instrumental Variable Analysis (report submitted to the Changes in Health Care Financing and Organization Program, Robert Wood Johnson Foundation, May 2006).

8. In particular, many of the proposals could be implemented without legislation, so they would not affect the budgetary scoring of a reform proposal, although they might affect CBO's baseline projections of the costs of federal programs. See Congressional Budget Office, Response to Questions About Health Care Industry Stakeholders' Proposals, letter to the Honorable Dave Camp (June 16, 2009).

9. See Congressional Budget Office, Budget Options, Volume 1: Health Care (December 2008) and Key Issues.

10. See, for example, Congressional Budget Office, An Analysis of the Literature on Disease Management Programs, letter to the Honorable Don Nickles (October 13, 2004).

11. See Stuart Guterman and others, Reforming Provider Payment: Essential Building Block for Health Reform, The Commonwealth Fund, Commission on a High Performance Health System (March 2009).

12. See Congressional Budget Office, Research on the Comparative Effectiveness of Medical Treatments: Issues and Options for an Expanded Federal Role (December 2007). In addition to evaluating medical treatments and procedures, such analysis could examine processes for delivering care.

13. Joshua T. Cohen and others, "Does Preventive Care Save Money? Health Economics and the Presidential Candidates," New England Journal of Medicine, vol. 358, no. 7 (February 14, 2008), pp. 661-663.

14. Dana P. Goldman and others, "The Value of Elderly Disease Prevention," Forum for Health Economics & Policy, vol. 9, no. 2 (2006).

15. Katherine Baicker and Amitabh Chandra, "Medicare Spending, the Physician Workforce, and Beneficiaries' Quality of Care," Health Affairs, Web Exclusive (April 7, 2004), pp. W184-W197.

16. See Joseph P. Newhouse and the Insurance Experiment Group, Free for All: Lessons from the RAND Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1993); and Congressional Budget Office, Key Issues, pp. 73-74.

17. The dollar amounts in 2010 would be about $17,300 a year for family coverage and about $6,800 a year for individual coverage.

18.  See, for example, David Cutler, "Health System Modernization Will Reduce the Deficit," (May 11, 2009), available at www.americanprogressaction.org/issues/2009/05/pdf/health_ modernization.pdf.

19. For an illustration of that approach, see Option 54 in CBO's December 2008 Budget Options volume.

20. For an illustration of that approach, see Option 114 in CBO's December 2008 Budget Options volume.




-----------------------------------------------------------


cbo.gov/ftpdocs/103xx/doc10311/06-16-ConradLetter.htm


~OGD~

Obama: "Americans should have the choice of a public health insurance option operating alongside private plans." (re-posted)




   Which way will Congress go?


I've re-posted this due to the previous posting having been dropped from the queue.


WASHINGTON - Laying out in the clearest terms yet what he wants in a healthcare overhaul, President Obama told Congress yesterday that he strongly believes Americans should have the choice of a new public health insurance plan that would compete against private insurers.

Obama said he is also "open" to requiring individuals to obtain insurance coverage - which he opposed during his campaign - as long as there is a hardship exemption for those who cannot afford it, an approach similar to the system in Massachusetts. He said he supports forcing employers to contribute to their employees' insurance but that there should be exemptions for small businesses.

In a detailed two-page letter to key senators released yesterday, the president wrote that he wants to "fully offset the cost of healthcare reform" by cutting an additional $200 billion to $300 billion from Medicare and Medicaid over the next decade, on top of the $309 billion reduction he has already proposed in the government's two main healthcare programs for the poor, elderly, and disabled.

boston.com/news/... /2009/06/04/obama_lays_out_healthcare_overhaul/


And here is the Obama letter. . .

June 2, 2009
The Honorable Edward M. Kennedy
The Honorable Max Baucus
United States Senate
Washington, D.C. 20510

Dear Senator Kennedy and Senator Baucus:

The meeting that we held today was very productive and I want to commend you for your leadership -- and the hard work your Committees are doing on health care reform, one of the most urgent and important challenges confronting us as a Nation.

In 2009, health care reform is not a luxury. It's a necessity we cannot defer. Soaring health care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need. It is unsustainable for businesses, forcing more and more of them to choose between keeping their doors open or covering their workers. And the ever-increasing cost of Medicare and Medicaid are among the main drivers of enormous budget deficits that are threatening our economic future.

In short, the status quo is broken, and pouring money into a broken system only perpetuates its inefficiencies. Doing nothing would only put our entire health care system at risk. Without meaningful reform, one fifth of our economy is projected to be tied up in our health care system in 10 years; millions more Americans are expected to go without insurance; and outside of what they are receiving for health care, workers are projected to see their take-home pay actually fall over time.

We simply cannot afford to postpone health care reform any longer. This recognition has led an unprecedented coalition to emerge on behalf of reform -- hospitals, physicians, and health insurers, labor and business, Democrats and Republicans. These groups, adversaries in past efforts, are now standing as partners on the same side of this debate.

At this historic juncture, we share the goal of quality, affordable health care for all Americans. But I want to stress that reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach. So we must attack the root causes of the inflation in health care. That means promoting the best practices, not simply the most expensive. We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country. That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.

The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold. But for those who don't have such options, I agree that we should create a health insurance exchange -- a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs.

I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.

I understand the Committees are moving towards a principle of shared responsibility -- making every American responsible for having health insurance coverage, and asking that employers share in the cost. I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone's costs, and I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it. In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.

Health care reform must not add to our deficits over the next 10 years -- it must be at least deficit neutral and put America on a path to reducing its deficit over time. To fulfill this promise, I have set aside $635 billion in a health reserve fund as a down payment on reform. This reserve fund includes a number of proposals to cut spending by $309 billion over 10 years --reducing overpayments to Medicare Advantage private insurers; strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud and abuse; improving care for Medicare patients after hospitalizations; and encouraging physicians to form "accountable care organizations" to improve the quality of care for Medicare patients. The reserve fund also includes a proposal to limit the tax rate at which high-income taxpayers can take itemized deductions to 28 percent, which, together with other steps to close loopholes, would raise $326 billion over 10 years.

I am committed to working with the Congress to fully offset the cost of health care reform by reducing Medicare and Medicaid spending by another $200 to $300 billion over the next 10 years, and by enacting appropriate proposals to generate additional revenues. These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.

To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.
These are some of the issues I look forward to discussing with you in greater detail in the weeks and months ahead. But this year, we must do more than discuss. We must act. The American people and America's future demand it.

I know that you have reached out to Republican colleagues, as I have, and that you have worked hard to reach a bipartisan consensus about many of these issues. I remain hopeful that many Republicans will join us in enacting this historic legislation that will lower health care costs for families, businesses, and governments, and improve the lives of millions of Americans. So, I appreciate your efforts, and look forward to working with you so that the Congress can complete health care reform by October.


Sincerely,

BARACK OBAMA


~OGD~


Obama: Strongly believes Americans should have the choice of a new public health insurance plan that would compete against private insurers



   Which way will Congress go?



WASHINGTON - Laying out in the clearest terms yet what he wants in a healthcare overhaul, President Obama told Congress yesterday that he strongly believes Americans should have the choice of a new public health insurance plan that would compete against private insurers.

Obama said he is also "open" to requiring individuals to obtain insurance coverage - which he opposed during his campaign - as long as there is a hardship exemption for those who cannot afford it, an approach similar to the system in Massachusetts. He said he supports forcing employers to contribute to their employees' insurance but that there should be exemptions for small businesses.

In a detailed two-page letter to key senators released yesterday, the president wrote that he wants to "fully offset the cost of healthcare reform" by cutting an additional $200 billion to $300 billion from Medicare and Medicaid over the next decade, on top of the $309 billion reduction he has already proposed in the government's two main healthcare programs for the poor, elderly, and disabled.

boston.com/news/... /2009/06/04/obama_lays_out_healthcare_overhaul/


And here is the Obama letter. . .

June 2, 2009
The Honorable Edward M. Kennedy
The Honorable Max Baucus
United States Senate
Washington, D.C. 20510

Dear Senator Kennedy and Senator Baucus:

The meeting that we held today was very productive and I want to commend you for your leadership -- and the hard work your Committees are doing on health care reform, one of the most urgent and important challenges confronting us as a Nation.

In 2009, health care reform is not a luxury. It's a necessity we cannot defer. Soaring health care costs make our current course unsustainable. It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need. It is unsustainable for businesses, forcing more and more of them to choose between keeping their doors open or covering their workers. And the ever-increasing cost of Medicare and Medicaid are among the main drivers of enormous budget deficits that are threatening our economic future.

In short, the status quo is broken, and pouring money into a broken system only perpetuates its inefficiencies. Doing nothing would only put our entire health care system at risk. Without meaningful reform, one fifth of our economy is projected to be tied up in our health care system in 10 years; millions more Americans are expected to go without insurance; and outside of what they are receiving for health care, workers are projected to see their take-home pay actually fall over time.

We simply cannot afford to postpone health care reform any longer. This recognition has led an unprecedented coalition to emerge on behalf of reform -- hospitals, physicians, and health insurers, labor and business, Democrats and Republicans. These groups, adversaries in past efforts, are now standing as partners on the same side of this debate.

At this historic juncture, we share the goal of quality, affordable health care for all Americans. But I want to stress that reform cannot mean focusing on expanded coverage alone. Indeed, without a serious, sustained effort to reduce the growth rate of health care costs, affordable health care coverage will remain out of reach. So we must attack the root causes of the inflation in health care. That means promoting the best practices, not simply the most expensive. We should ask why places like the Mayo Clinic in Minnesota, the Cleveland Clinic in Ohio, and other institutions can offer the highest quality care at costs well below the national norm. We need to learn from their successes and replicate those best practices across our country. That's how we can achieve reform that preserves and strengthens what's best about our health care system, while fixing what is broken.

The plans you are discussing embody my core belief that Americans should have better choices for health insurance, building on the principle that if they like the coverage they have now, they can keep it, while seeing their costs lowered as our reforms take hold. But for those who don't have such options, I agree that we should create a health insurance exchange -- a market where Americans can one-stop shop for a health care plan, compare benefits and prices, and choose the plan that's best for them, in the same way that Members of Congress and their families can. None of these plans should deny coverage on the basis of a preexisting condition, and all of these plans should include an affordable basic benefit package that includes prevention, and protection against catastrophic costs.

I strongly believe that Americans should have the choice of a public health insurance option operating alongside private plans. This will give them a better range of choices, make the health care market more competitive, and keep insurance companies honest.

I understand the Committees are moving towards a principle of shared responsibility -- making every American responsible for having health insurance coverage, and asking that employers share in the cost. I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone's costs, and I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it. In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.

Health care reform must not add to our deficits over the next 10 years -- it must be at least deficit neutral and put America on a path to reducing its deficit over time. To fulfill this promise, I have set aside $635 billion in a health reserve fund as a down payment on reform. This reserve fund includes a number of proposals to cut spending by $309 billion over 10 years --reducing overpayments to Medicare Advantage private insurers; strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud and abuse; improving care for Medicare patients after hospitalizations; and encouraging physicians to form "accountable care organizations" to improve the quality of care for Medicare patients. The reserve fund also includes a proposal to limit the tax rate at which high-income taxpayers can take itemized deductions to 28 percent, which, together with other steps to close loopholes, would raise $326 billion over 10 years.

I am committed to working with the Congress to fully offset the cost of health care reform by reducing Medicare and Medicaid spending by another $200 to $300 billion over the next 10 years, and by enacting appropriate proposals to generate additional revenues. These savings will come not only by adopting new technologies and addressing the vastly different costs of care, but from going after the key drivers of skyrocketing health care costs, including unmanaged chronic diseases, duplicated tests, and unnecessary hospital readmissions.

To identify and achieve additional savings, I am also open to your ideas about giving special consideration to the recommendations of the Medicare Payment Advisory Commission (MedPAC), a commission created by a Republican Congress. Under this approach, MedPAC's recommendations on cost reductions would be adopted unless opposed by a joint resolution of the Congress. This is similar to a process that has been used effectively by a commission charged with closing military bases, and could be a valuable tool to help achieve health care reform in a fiscally responsible way.
These are some of the issues I look forward to discussing with you in greater detail in the weeks and months ahead. But this year, we must do more than discuss. We must act. The American people and America's future demand it.

I know that you have reached out to Republican colleagues, as I have, and that you have worked hard to reach a bipartisan consensus about many of these issues. I remain hopeful that many Republicans will join us in enacting this historic legislation that will lower health care costs for families, businesses, and governments, and improve the lives of millions of Americans. So, I appreciate your efforts, and look forward to working with you so that the Congress can complete health care reform by October.


Sincerely,

BARACK OBAMA


~OGD~


Ted Kennedy: "Americans want the choice of enrolling in a health insurance program backed by the government for the public good, not private profit."



   And . . .

He also stated:

"So that option will be available."
nytimes.com/2009/05/30/health/policy/30health.html


Also ... At Bloomberg News Kennedy is quoted as saying:

"An important foundation of our legislation is the following principle: If you like the coverage you have now, you keep it," Kennedy wrote. "But if you don't have health insurance or don't like the insurance you have, our bill will give you new, more affordable options."
bloomberg.com/apps/news



~OGD~

Health Care Plan: Did ya' hear what the fox said to the weasels?



    Uh . . .


"You've got the lemmings. I've got the henhouse."

Did ya' hear what the industry groups said to the congress?

Take a guess...

~OGD~

This Saturday: May 30th National Day of Action on Health Care



   Heads-up . . .


If you wish to get involved here's some info from Healthcare Now

May 30th: National Day of Action

healthcare-now.org/campaigns/may-30th-day-of-action/

You will find direct links at that page on the left side of the window that will assist you in finding the actual locations and times in your particular area or region.

~OGD~

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