QUOTE(rla @ Oct 12 2009, 03:53 PM)

IH, I think you put your finger on a very important distinction that is not given sufficient open and honest consideration.
What are the relative merrits of a system of Entitlements and a system of Charity?
Charity expands services in that internships and foreign doctors can work toward residency and
provide very close to equal services for less money. There is more waiting at charity hospitals
(we have a regional one in our parish) which can be as much as three to five hours. Private
hospitals usually get you into triage (without major howling) in an hour or so. But treatments
and facility safety (infections during or after stays) are very close to equal. In fact, "Big Charity"
in New Orleans (closed by Katrina, with negotiations almost complete to restore) had the best
reputation of trama (vehicle accidents and gun shots) treatment in The South.
In fact, no state has an equal system...it is considered the best such system in the US...I just talked
with a friend who recently reffered a woman who couldn't afford an MRI to the Bogalusa Medical Center
(a charity system branch - in a majority black city BTW) which took just what her insurance would pay...
which was hundreds less than the actually quoted price at a private hospital.
The way our charity system works is that anyone on food stamps, welfare, medicare, medicaid of CHIP gets
treatment for whatever can be recovered from said program(s) while people with insurance
or without that are above welfare recipient income pay. During recent years budget cuts have endangered
our regional charity hospital (actually named Lallie Kemp Regional Medical Center), but all residents and
thus our representatives have fought off closures and even maintained the cardiac unit, which is a very good unit.
Such treatment localizes support under the state (whith support of federal programs) and thus
maintains support from all sections, local employees, suppliers, maintenance staff etc.
--------------
On the Baucus Bill:
It appears to me that the Senate Finance Committee Bill is by far the best to have come out of
committee (I fully expect it to pass today) in the Congress to date. I say that after reading the
CBO letter of review which is posted at:http://cbo.gov/ftpdocs/106xx/doc10642/10-7-Baucus_letter.pdfI offer the following highlights:(In Introduction)
CBO and JCT’s analysis is preliminary in
large part because the Chairman’s mark, as amended, has not yet been embodied in legislative language.
...
(In the body of the letter)
The net cost of the coverage expansions would be more than offset by the combination of other spending changes that CBO estimates would save
$404 billion over the 10 years and other provisions that JCT and CBO estimate would increase federal revenues by $196 billion over the same
period.1
...
On a preliminary basis, CBO and JCT estimate that the proposal’s specifications affecting health insurance coverage would result in a net
increase in federal deficits of $518 billion over fiscal years 2010 through 2019. That estimate primarily reflects $345 billion in additional federal outlays for Medicaid and CHIP and $461 billion in federal subsidies that would be provided to purchase coverage through the new insurance exchanges and related spending.2 The other main element of the coverage provisions that would increase federal deficits is the tax credit for small employers who offer health insurance, which is estimated to reduce revenues by $23 billion over 10 years.
Those costs would be partly offset by receipts or savings, totaling $311 billion over the 10-year budget window, from four sources: net revenues from the excise tax on highpremium insurance plans, totaling $201 billion; penalty payments by uninsured individuals, which would amount to $4 billion; penalty payments by employers whose workers received subsidies via the exchanges, which would total $23 billion; and other budgetary effects, mostly on tax revenues, associated with the expansion of federally subsidized insurance, which would reduce deficits by $83 billion.
...
Reducing Medicare and Medicaid payments to hospitals that serve a large number of low-income patients, known as disproportionate share (DSH) hospitals, by almost $45 billion—composed of roughly $22 billion each from Medicaid and Medicare DSH payments.
The proposal also would establish a Medicare Commission, which would be required, under certain circumstances, to recommend changes to the Medicare program to limit the rate of growth in that program’s spending. Those recommendations would go into effect automatically unless blocked by subsequent legislative action.
...
The proposal would place a number of limitations on the actions available to the commission, including a prohibition against modifying eligibility or benefits, so its recommendations probably would focus on:
Reductions in subsidies for non-Medicare benefits offered by Medicare Advantage plans;
Reductions in subsidies of premiums charged by Part D plans; and
Changes to payment rates or methodologies for services furnished in the fee-for-service sector by providers other than hospitals, physicians, hospices, and suppliers of durable medical equipment
that is offered through competitive bidding.
...
An amendment adopted by the committee would require that, beginning in 2012, the Director of the Office of Management and Budget (OMB) certify annually whether or not the provisions of the legislation are projected to increase the budget deficit in the coming year. If the Director determined that they were projected to increase the deficit, he or she would be required to notify the Congress, and exchange subsidies would be automatically adjusted to avoid the estimated increase in the deficit for that year.
The estimates presented in this preliminary analysis do not incorporate the potential effects of using this proposed failsafe mechanism, although CBO
and JCT estimate that the amended mark would increase the deficit in fiscal years 2015 through 2018. Many of the budgetary effects of this proposal
would appear as part of larger aggregates in the budget and would not be readily observable. Consequently, its overall budgetary impact could not be identified, and OMB’s estimating assumptions and procedures would determine whether and how this failsafe procedure was implemented. It is therefore difficult to predict whether the proposed failsafe mechanism would result in a budget-neutral impact in each year. If the mechanism was implemented to reduce exchange subsidy rates in some years, it would probably result in significant reductions to the dollar volume of such subsidies and associated reductions in coverage. Under CBO and JCT’s estimates of the deficit impact for the proposal, the failsafe provisions would require a reduction in exchange subsidies averaging about 15 percent during the years 2015 through 2018.
Important Caveats Regarding This Preliminary AnalysisThere are a number of key reasons why the preliminary analysis that is provided in this letter and the enclosures does not constitute a final cost
estimate for the proposal:
The Chairman’s mark, as amended, has not yet been converted into legislative language. The review of such language could lead to significant changes in the estimates of the proposal’s effects on the
federal budget and insurance coverage.
The budgetary information shown in the above and enclosed tables reflects many of the major cash flows that would affect the federal budget as a result of implementing the specified policies and
provides a preliminary assessment of the net effects on the federal budget deficit. However, some cash flows (such as risk adjustment payments) would appear in the budget but would net to zero and thus would not affect the deficit; CBO and JCT have not yet estimated all of those cash flows. Furthermore, CBO and JCT have not yet divided all of the estimated cash flows into spending and revenue
components.
Federal spending that would be funded by future appropriations is not reflected in these estimates. For example, implementation costs for operations of the Internal Revenue Service and the Centers for
Medicare and Medicaid Services are not included. Those discretionary costs could total several billion dollars over the 10-year period, but CBO has not yet completed an estimate of the appropriations that would be necessary. (In contrast, administrative costs for establishing and operating the exchanges, largely funded through a premium surcharge, are included in Table 1.)
...
All told, the proposal would reduce the federal deficit by $12 billion in 2019, CBO and JCT estimate. After that, the added revenues and cost
savings are projected to grow more rapidly than the cost of the coverage expansion. Consequently, CBO expects that the proposal, if enacted, would
reduce federal budget deficits over the ensuing decade relative to those projected under current law—with a total effect during that decade that is in a broad range between one-quarter percent and one-half percent of GDP.
The imprecision of that calculation reflects the even greater degree of uncertainty that attends to it, compared with CBO’s 10-year budget estimates.
(There are an additional 14 pages of charts in support of the CBO letter.)
---------------------------
So, there are still problems (not the least of which is exact legislative language), but it doesn't scare me,
as the public option does. I will not request a vote against it by Senator Mary Landrieu's office.
Now, if Democrats can support Baucus...we will be farther down the road...if not...then Blue Dog bets are off, IMO.