Health Care Must Reads
And if they’re not “must reads,” then they’re at least “worthy reads.” Both from today’s NYT.
Up first: David Leonhardt, who riffs on “real choice” (i.e., the lack thereof) among health insurance options. From his conclusion:
… the defenders of the employer system have some legitimate arguments. An insurance exchange may end up having some of the same pitfalls as 401(k) plans, in which some workers make poor choices. Having employers navigate the complex landscape of insurance, the defenders say, may be better for employees.
Here’s what I would ask those defenders, however: Given all the problems with health care — the high costs and decidedly mixed results — how comfortable are you defending the status quo? Why force people into a system you think is better for them?
Batting second: Jon Gabel, who writes that the integrity of the CBO is “beyond questioning.” But its cost-estimating methodologies (especially on health care reform) … not so much. From his conclusion:
… the record shows that [the CBO] has substantially overestimated the cost of health care reform three times out of three. As Congress now works on its greatest push for reform in generations, the budget office needs to revise the methods it uses to make predictions about costs.
17 Responses to “Health Care Must Reads”
What is never included in these cost discussions are a factoring in of the costs of just keeping the system for x amount of years.
Re: the Gabel article…The 3 out of 3 seems contrived to me, to give the impression that the CBO always underestimates cost savings. Surely there have been more than three instances over the past couple of decades when the CBO scored a healthcare initiative which was then passed, so we can compare their estimates with the reality. The author chose three examples where the costs ended up coming in lower than they predicted- but let's see a larger sampling of their cost predictions to see if that pattern holds true.
They're worth reviewing, certainly. My, they're stooping to try to recover from their failures so far. “We can't afford _not_ to do something” fools the easily fooled few (and diminishing few who still blindly insist on passing whatever they're told should be passed), but not the growing wary many.
And we see bad argumentation here, among the quotes. My, they're stooping to try to recover.
“[H]ow comfortable are you defending the status quo?”
Bogus statement. Almost nobody has been “comfortable with” or has been defending the status quo. A desire for “reform” is shared by nearly everyone (in effect, everyone who is involved currently).
“Why force people into a system you think is better for them?”
Bogus. There is no forcing, of course, and no superiority (or desireability) claimed for the current system; reform is obviously desired — the question is what kind and how. The subject always has been what is being sought as the replacement (the “reform[s]“), about which there are numerous concerns, and the burden of proof of course which rests on its proponents and real “defenders” here.
The flailing and bad behavior need to end, the Dems need to STOP, and first THINK about what they want, and then proceed purposefully, even if they don't negotiate with, but bypass, the Republicans.
“first THINK about what they want, and then proceed purposefully”
I might add….think then AGREE.
They need one plan and they need everyone in the party on board.
“They need one plan and they need everyone in the party on board.”
Yep. It's a Dem year and it'll be Dem legislation like everything else this year. But they've been worse and worse on each issue, not only with quality of legislation (we can't avoid that), but in how inept they have been (and how childishly they've rushed). Their overreach includes an over-extension even among themselves on this issue; the Dems are fractured even within the House. More mature and intelligent people already know that it's no blow their shattered little egos if they are delayed this year or even into next year. They have routinely sought what's not right (and badly wrong), but they can at least do it in the right way, and possibly pass less-bad legislation as a bonus as a result. We'll see in September.
CS
You may well find the evidence you suspect exists, but the article does seem explain an analytical failing when more than one variable is changed in a known cost model. That is a quite fair assessment. If you do happen to find those times where CBO did not overestimate, you still don't know if their methodology is sufficiently strong in modeling cost systems with unknown values or changes to multiple variables. If they do hit one right under those circumstances, it's as much luck as good economic analysis.
Here is the important healthcare read
24% Say Democrats Should Pass Health Care Reform Without GOP Votes
http://www.rasmussenreports.com/public_content/…
I just cant conceive of the democrats going it alone with a mere 24% support. Reconciliation would be political suicide.
The thing is that none of the concessions the GOP wants in order to vote are actually based on anything constructive. Why should any changes be made to sate purely ideological and emotional impulses? Even the few who have deigned to sit at the table, like Enzi or Grassley, are being nagged on by their own party and are generally just there to block the democrats. The criteria for bipartisanship have been abused to the point of comedy, and the belated democrat bird-flipping is understandable. The GOP has almost entirely (with the exception of some wonks) abandoned the privilege of being regarded as a meaningful contributor and critic to the whole affair. Most of the people on the other side have apparently never wanted any good faith, so why spend any on them?
“how childishly they've rushed”
This is lame. We've been talking about and considering health care reform for at least 20 years. What will change in the next one or two that we need to debate further?
I agree that there are some good points made- in particular, a subtopic of the multifactoral one that you mention was the political implication. If CBO isn't able to predict how those multiple factors might work in a synergistic way to reduce costs, then there's too much political inertia for the legislators to pass the cuts which might be unpopular.
I'm just saying that the part about them getting it wrong- in that particular direction- three out of three times, could just as easily be due to the examples being cherry picked as a true pattern. Maybe it does hold true overall, as the analysts do seem 'conservative' in their estimates of cost savings which can't be proven by past data. I've seen another blogger or journalist talking about this as a weakness, since a lot of proposed cost cutting strategies are ideas that haven't been tried before- so if they're routinely biased against scoring significant cost savings without historical data to support it, then they're going to tend to always underestimate a lot of these projections.
So, maybe his conclusion would be borne out by a larger sampling, but there's also the possibility that he stacked the deck.
CS
“I'm just saying that the part about them getting it wrong- in that particular direction- three out of three times, could just as easily be due to the examples being cherry picked as a true pattern.”
If you have a link that shows a larger sampling shows him wrong, I'll be happy to concur. Suspicion implies politics, but doesn't really prove that suspicion. All I'm saying is that CBO has tried to stay non-political in estimates requested. In fact, they certainly have not helped Obama with tailored numbers to fit his plans. I know you're not saying that the CBO is some kind of republican mole.
He used three examples, not a particularly important number of instances to prove a mathematical model, but it certainly is enough for a citation as long as no one can demonstrate the cherries being picked.
@ Hemm- I'm actually not implying that the CBO is political or partisan, but that people who are currently critiquing it often are. I have no idea if that holds true for the author of this piece, but basically I read everything that has political implications with a jaundiced eye, and his conclusion about the problems with the CBO projections on cost savings happens to be in support of a talking point of the advocates of the Obama/Congressional health insurance reform plan. So, the skeptic in me says, perhaps this guy is raising a legitimate point that supports those arguments, or perhaps he's trying to persuade people with some arguments that sound reasonable but might not be true across the board.
He used three examples, not a particularly important number of instances to prove a mathematical model, but it certainly is enough for a citation as long as no one can demonstrate the cherries being picked.
The insufficient number itself is the reason for my skepticism, and the fact that this small sample supports his hypothesis but we're not given enough information to know if other data would support the same conclusion. If, hypothetically, the CBO had scored those three proposals with lower cost savings than they ultimately produced, but in nine other cases had scored greater cost savings than the legislation actually produced, then his conclusion would be completely inaccurate.
As for finding the other data, the problem is that I have no idea how to do that and wouldn't be able to devote the time to searching for it. I'm just pointing out one particular reason that I find his argument insufficient to convince me- yes, I could try to prove him wrong but it's his assertion and he provides the evidence to back it, and I judge that evidence to be insufficient.
“This is lame.”
No, it isn't. The childish rushing has been blatant from the start of the year, with bailouts and stimulus shenanigans, and getting worse as the year has “progressed,” with health care being the latest, worst, and most blatant example (as reflected in the childish arguments in support of it, as well).
The only question (which I've raised all year) is to what extent the rushing is also (for the childish nature of so much of the rushing and insistence on passing whatever is offered is incontrovertible) due to other reasons, be it neurosis or political calculation underlying a specific objective of passing certain items before next year (though January, 2010 is hardly a magic moment insofar as state of affairs and prospects for re-election of the Dems are concerned).
“What will change in the next one or two that we need to debate further?”
Aside from what we can't predict about the current state of health care affairs (they could actually get better; they could well get worse in some noteworthy way), what's more important is that the public, if nobody among the Dems themselves*, could force the Dems to grow up and act more thoughtfully.
* although Blue Dogs already are something of a welcome brake, and other, wiser Dems like Joe Lieberman realize that the rush, especially before economic recovery, is a bad thing.
Again — they need to STOP, THINK, (and AGREE on what they want to do, as someone else added), and then proceed in a more safe and sane manner that would match overdue planning of the same kind. There is nothing wrong with admitting failure before restarting, and of course nothing wrong with it taking into next year for the Dems to decide on something and try to get it passed in a decent way.
[stripped from among false statements]
“Why should any changes be made to sate purely ideological and emotional impulses? “
That describes the Dems, all year, even if other impulusive and emotional people may not understand or accept it.
It's failing now, they've gotten so bad.
* * *
“Reconciliation would be political suicide.”
As bad as it is, it appears they may actually be seriously considering this, though.
CS
“
As for finding the other data, the problem is that I have no idea how to do that and wouldn't be able to devote the time to searching for it. I'm just pointing out one particular reason that I find his argument insufficient to convince me-”
I didn't mean to infer it was your job to do the data mining to prove or disprove a suspicion.
That's the problem we kind of have across the board in the health care debate. It's like the “facts” cited from the Lewin Group. Repubs cite this group regularly to prove their talking point du jour.
The realistic debate only starts with realistic and unbiased numbers.
Actually, the CBO itself admitted that they don't have the kind of experience examining health care as they do congressional budgets.
The CBO's ability to estimate the cost of legislation isn't as important as the CBO's ability to estimate the cost of *health* legislation. Medicaid and Medicare costs have far outstripped their estimates, because no one expected the cost of health care to rise so quickly. Fostering efficiency would be good, but it has its limits. At some point, all systems (private insurance, public insurance, and all universal coverage systems) have to have ways of determining when to not cover a medicine or procedure. Unfortunately, I haven't heard any politician seriously address this issue.
As far as bipartisanship: a group of Democrats quickly hammered out HR3200 by excluding Republicans and blue dog Democrats from the discussion until after it was presented. It shouldn't come as a surprise that both of these groups aren't on board with their plan.