Seems to me we were sold a bill of goods by President Obama and others that the government could make a serious dent in controlling health care costs if they could just pass the health care overhaul bill. We needed to pass this bill so we could find out all the great things it contained. According to Medicare's office of the actuary, overall health care spending will increase from 17% to 20% of the total U.S. economy. These are projections nine years out and are bound to change, and I would assume not for the better.
On a comparative basis of how much they are saying the Obamacare mandates will increase the cost is small over (+ @ $300) what would happen with the costs otherwise (basically it would still increase almost as much w/o Obamacare). What is not happening is "bending down" the cost curve of health care. That was a central element which was pitched to us, and now the administration is having to admit perhaps they over-sold this just a tad.
"That's because the new law would have virtually no effect on the upward trajectory of health care spending, while bringing insurance coverage to an additional 32.5 million people and ending the worst insurance company abuses.
Put another way, the controversial reform measure has enough cost controls to deliver protections to more Americans for roughly the same money as would have been spent otherwise. What it doesn't have is enough controls to prevent health care from growing at unsustainable rates much higher than inflation. That's not a reason to repeal health reform, but it is reason to revisit it.
Health care spending continues to surge in part because, once deductibles and co-payments are satisfied, patients and providers are largely free to play with insurers' money. This creates incentives to overprescribe, overtest and overtreat — and to develop high-priced new drugs and other products that are only marginally better than existing ones. There is a lack of any real push toward efficiency. The price for all of this is passed along in the form of higher premiums and soaring outlays for government benefits.
" Bending the cost curve on health care is hard to do," President Obama conceded at Friday's news conference, something he downplayed while selling his plan to a skeptical public and Congress.
http://www.usatoday.com/news/opinion/editorials/2010-09-13-editorial13_ST_N.htm
Hmmm, there's that word unsustainable again...yikes!
WASHINGTON — The nation's health care tab will go up – not down – as a result of President Barack Obama's sweeping overhaul. That's the conclusion of a government forecast Thursday, which also predicts the increase will be modest.
The average annual growth in health care spending will be just two-tenths of 1 percentage point higher through 2019 with Obama's remake, said the analysis from Medicare's Office of the Actuary. And that's with more than 32 million uninsured gaining coverage because of the new law.
"The impact is moderate," said Andrea Sisko, an economist with the nonpartisan unit that prepared the report.
Factoring in the law, Americans will spend an average of $13,652 per person a year on health care in 2019, according to the actuary's office. Without the law, the corresponding number would be $13,387.
...."We really haven't trimmed health care spending," said Robert Bixby, executive director of the Concord Coalition, which advocates for reducing the federal deficit. "Even if we found a way to provide more people with coverage, we still have the same fiscal problem we always did. Frankly, it's a little bit more difficult to solve now because we have made a major new commitment."
Bixby's group raised concerns about the cost of the health care legislation, but did not oppose it."
http://www.huffingtonpost.com/2010/09/09/health-care-overhaul-will_n_710225.html
And here comes the Obama Apologist Choir with such hits as:
1) It's the insurance companies fault
2) Obama didn't say that
3) It's this way because the Republicans are blocking everything
4) A former Governor from Kansas knows medicine better than doctors
5) It's only XX% of GDP!
And that golden oldie:
6) It's all Bush's fault!
(http://janeheller.mlblogs.com/gospel.choir.jpg)
As for the choir, you left out:
7. You are a racist (I can't believe you forgot that one);
8. You are an Islamaphobe;
9. What Obama really meant to say was _________ .
Perhaps you could wait to start crowing until the meat of the bill actually takes effect. You know, the part that actually reduces insurance costs.
The biggest part of the problem here is that doctors order far more expensive procedures than are really necessary, in an attempt to head off malpractice suits (which is ineffective at its stated purpose) and when doctors don't do that, patients demand them because they think they really have to have that MRI for a headache. After all, they could have the brain cancerz!
None of this was addressed by the bill because that would be tantamount to DEATH PANELS!!one
There is some good stuff in the bill, but it does very little on the cost containment side.
Quote from: Conan71 on September 13, 2010, 09:09:41 AM
What it doesn't have is enough controls to prevent health care from growing at unsustainable rates much higher than inflation. That's not a reason to repeal health reform, but it is reason to revisit it.
Wow, I didn't think you were a communist.
Quote from: nathanm on September 13, 2010, 09:22:53 AM
Perhaps you could wait to start crowing until the meat of the bill actually takes effect. You know, the part that actually reduces insurance costs.
The biggest part of the problem here is that doctors order far more expensive procedures than are really necessary, in an attempt to head off malpractice suits (which is ineffective at its stated purpose) and when doctors don't do that, patients demand them because they think they really have to have that MRI for a headache. After all, they could have the brain cancerz!
None of this was addressed by the bill because that would be tantamount to DEATH PANELS TORT REFORM!!one...
FIFY
Quote from: nathanm on September 13, 2010, 09:22:53 AM
Perhaps you could wait to start crowing until the meat of the bill actually takes effect. You know, the part that actually reduces insurance costs.
Nathan, there is no part which reduces insurance costs. You simply cannot demand that insurance companies provide additional coverage without the costs going up. Insurance costs will never go down as a result of Obamacare. That's a fairy tale.
All you have now is Sebelius sending out Rahm Emanual-esque missives on her letterhead to companies who are increasing premiums to cover the cost of additional coverage mandates. The interwebs are lit up this morning calling her actions extortion and comparing them to the mob:
"We will not stand idly by as insurers blame their premium hikes . . . on the requirement that they provide consumers with basic protections," she wrote in a letter to the insurance industries' trade association.
At the very least, she noted "bad actors" could be excluded from new government-run health-insurance exchanges that will begin operation in 2014 under the law. That could cost insurers as many as 30 million customers nationwide. People also might not be able to use government subsidies to buy insurance from companies that don't toe the administration line. What's next? Only companies that write checks to the Democratic National Committee can participate? Have too many employees contribute to the wrong candidate, and you get a visit from the insurance commissioner?
Read more: http://www.nypost.com/p/news/opinion/opedcolumnists/obamacare_extortion_iQ5A2V2Nu2NoaBKQq2m9xK#ixzz0zQANP4Ii
'As a consequence of us getting 30 million additional people health care, at the margins that's going to increase our costs—we knew that," President Obama said at his press conference Friday in response to a question about rising health spending.
That wasn't how he sold the plan, but, anyway, that's a truism. Here's another: The White House was always going to blame insurance companies for any cost increases, even when its own policies cause them.
Witness Kathleen Sebelius's Thursday letter to America's Health Insurance Plans, the industry trade group—a thuggish message even by her standards. The Health and Human Services secretary wrote that some insurers have been attributing part of their 2011 premium increases to ObamaCare and warned that "there will be zero tolerance for this type of misinformation and unjustified rate increases."
Zero tolerance for expressing an opinion, or offering an explanation to policyholders? They're more subtle than this in Caracas.
What Ms. Sebelius really means is that the government will prohibit insurers from doing business if reality is not politically convenient for Democrats. ObamaCare includes a slew of mandated benefits for next year, such as allowing children to remain on their parents' plans until age 26 and "free" preventative care (i.e., no direct out-of-pocket cost sharing for consumers). The tone of Ms. Sebelius's letter suggests that she doesn't understand that money is exchanged for goods and services, and that if Congress mandates new benefits, premiums will rise.
The Administration estimates that these regulations should increase all premiums by 1% to 2% on average. Even if that turns out to be right—on average—that isn't what insurers are finding in practice in the local, price-sensitive individual and small business insurance markets, where coverage is typically less comprehensive to hold down costs. For some current policies in some states, the one-year increase jumps as much as 9%.
http://online.wsj.com/article/SB10001424052748703597204575483900330728436.html
Quote from: Trogdor on September 13, 2010, 09:46:17 AM
Wow, I didn't think you were a communist.
Huh? That's quoted material. What about that makes me a communist, Trog?
Have another cup of coffee and then re-read.
Oh and Guido, you are right I don't know how I forgot this one:
7. You are a racist (I can't believe you forgot that one);
My CD has a scratch on it and it keeps repeating.
Quote from: Conan71 on September 13, 2010, 09:53:47 AM
Huh? That's quoted material. What about that makes me a communist, Trog?
Have another cup of coffee and then re-read.
Oh and Guido, you are right I don't know how I forgot this one:
7. You are a racist (I can't believe you forgot that one);
My CD has a scratch on it and it keeps repeating.
You are pushing government controlled costs of health care.
Unless of course you disagree with the portions of your article that you bolded.
Quote from: Trogdor on September 13, 2010, 10:02:25 AM
You are pushing government controlled costs of health care.
Unless of course you disagree with the portions of your article that you bolded.
What? To deflect a flat-out lie we were fed on what HC reform would do, you are calling me a communist? Really? FWIW, I don't consider government regulation which impacts cost of anything as communism, it's not even close.
Were we not told during the sales pitch that Obamacare would reign in health care costs? I'm not making a value judgement on whether or not I think cost controls are good, I'm asking where are these cost controls which were going to "bend down the curve"? I highlighted this sentence because it identifies a shortfall in the program which we were assured was not there.
Add song #10 to the list:
10) You are a communist because my reading comprehension (and/or critical thinking skills) sucks.
Quote from: Conan71 on September 13, 2010, 09:51:30 AM
Nathan, there is no part which reduces insurance costs. You simply cannot demand that insurance companies provide additional coverage without the costs going up. Insurance costs will never go down as a result of Obamacare. That's a fairy tale.
Hmm, so bigger risk pools don't reduce premiums? That's a new one on me. Pull the other one.
The biggest failure in the HCR bill was that it didn't create one, very large, risk pool, and instead allowed us to continue with our balkanized insurance scheme.
Quote from: nathanm on September 13, 2010, 10:27:42 AM
Hmm, so bigger risk pools don't reduce premiums? That's a new one on me. Pull the other one.
Nope, not when you have a bunch of previously un-insured (or un-insurable) adverse risks suddenly introduced to the pool. It's increasing exposure.
Quote from: Conan71 on September 13, 2010, 10:25:23 AM
What? To deflect a flat-out lie we were fed on what HC reform would do, you are calling me a communist? Really? FWIW, I don't consider government regulation which impacts cost of anything as communism, it's not even close.
Were we not told during the sales pitch that Obamacare would reign in health care costs? I'm not making a value judgement on whether or not I think cost controls are good, I'm asking where are these cost controls which were going to "bend down the curve"? I highlighted this sentence because it identifies a shortfall in the program which we were assured was not there.
Add song #10 to the list:
10) You are a communist because my reading comprehension (and/or critical thinking skills) sucks.
"
controls to
prevent health care from
growing at unsustainable rates much higher than inflation."
The only for the government to "control" the cost of health care is for the government to limit profits or run it. This isn't about "impact". This statement is about controlling cost increases regardless of the actual cost to the insurance companies. That is how you control the costs from increasing at rates higher than inflation.
I never heard that this was going to force health care to not increase. I heard that the original public option would have done such a thing. But that isn't want the Republican's wanted. So now we just have more people covered and hopefully less in the emergency room. You must be talking about the original plan.
Quote from: Conan71 on September 13, 2010, 10:31:51 AM
Nope, not when you have a bunch of previously un-insured (or un-insurable) adverse risks suddenly introduced to the pool. It's increasing exposure.
At this point, yes. When the individual mandate kicks in, the healthy people will also be buying insurance. I think this is just as fair as me having to have liability insurance despite never having been involved in a collision.
My point was that the bill should help make health insurance less expensive relative to the cost of medical procedures. Unfortunately, it does nothing about the latter.
Also, the bill should have done for other particularly high cost diseases what was done for people with end stage renal disease, taken them out of the private system and made them eligible for Medicare. That one thing would reduce the cost of insurance dramatically. There are several not-so-rare lifelong conditions that cost millions of dollars a year to treat where, thanks to modern medicine, the person can live pretty much indefinitely.
I am sure it will make things less expensive. If there is anything I am convinced of it is that:
1. Government is excellent at containing costs.
2. All Government programs operate more efficiently than private sector programs.
3. The quality of care that government can require/provide always exceeds what can be purchased in the private sector.
4. Money taken by Government is always spent in accordance to its primary and original purpose.
I mean, have there ever been ANY exceptions to the above?
I certainly can't find any!
;)
Quote from: nathanm on September 13, 2010, 10:46:38 AM
At this point, yes. When the individual mandate kicks in, the healthy people will also be buying insurance. I think this is just as fair as me having to have liability insurance despite never having been involved in a collision.
My point was that the bill should help make health insurance less expensive relative to the cost of medical procedures. Unfortunately, it does nothing about the latter.
Also, the bill should have done for other particularly high cost diseases what was done for people with end stage renal disease, taken them out of the private system and made them eligible for Medicare. That one thing would reduce the cost of insurance dramatically. There are several not-so-rare lifelong conditions that cost millions of dollars a year to treat where, thanks to modern medicine, the person can live pretty much indefinitely.
As the Republican's pushed in the 1990's I agreew with the healthy and insurance. I would however agree to dropping the "penalty" if we try to get everybody insured. You can opt out and not face a penalty but all of your personal property can be taken to pay for your medical bills. If you are insured then if you can't pay your medical bills your home/etc. is not able to be taken.
Quote from: Gaspar on September 13, 2010, 10:51:21 AM
I am sure it will make things less expensive. If there is anything I am convinced of it is that:
1. Government is excellent at containing costs.
2. All Government programs operate more efficiently than private sector programs.
3. The quality of care that government can require/provide always exceeds what can be purchased in the private sector.
4. Money taken by Government is always spent in accordance to its primary and original purpose.
I mean, have there ever been ANY exceptions to the above?
I certainly can't find any!
;)
I would have liked a public option with 1) the cost to consumers required to be = to the cost incurred for the program. I could definitely see the public option running with 1) money going to other things and 2) the program running at a huge defecit. But as long as we keep voting republican #1-4 aren't a problem, right!
http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/ (http://www.visualeconomics.com/healthcare-costs-around-the-world_2010-03-01/)
Yes, health care costs are 17% of the GDP. Should we go with a plan where it is 9% of GDP? No, lets stick with this one!
Gaspar, your sarcasm is great, but Medicare wastes less money on overhead than private insurance, it was cheaper to have grunts doing KP duty in the Army rather than paying contractors to do it, and despite being snowjobbed with a vast sum of near-fraudulent mortgages in 2008 after the investment banks stopped packaging MBS for the mortgage companies, FHA has still managed to keep itself afloat without massive intervention (although they are having to make changes to shore up the balance sheet), unlike most of the banks.
So yeah, sometimes government does a better job than private industry. Often they don't.
Oh, and public universities are less expensive and are better in almost every measure than private (read: investor-owned) schools.
There are some things in this world where the profit motive does not force good results, often because it's difficult or impossible for consumers to be informed about their choices or have few to no choices.
Just as I figured excuses and obfuscation. Apologies essentially.
Quote from: Conan71 on September 13, 2010, 11:24:41 AM
Just as I figured excuses and obfuscation. Apologies essentially.
I think you may need to re-read the posts on this thread. You're wishing someone would defend the bill, but nobody is.
Quote from: nathanm on September 13, 2010, 11:27:04 AM
You're wishing someone would defend the bill, but nobody is.
Thank you for making that crystal clear.
The evolution of opinion is beautiful.
Quote from: Gaspar on September 13, 2010, 12:10:12 PM
Thank you for making that crystal clear.
The evolution of opinion is beautiful.
And you make the mistake of believing that all of us who aren't defending the bill are also against the bill. The closest I can get to defense of it is to say that it's better than what we had before. The closest that I can get to condemnation of it is saying that it didn't go nearly far enough.
So this is what "better than nothing" looks like, eh?
I have a hard time with this whole nonsense about Republicans watered down the bill. Democrats own this as they passed this using reconcilliation and had majorities in the House and Senate. I simply don't see the point if costs are not contained. This was going to make it more efficient, remember?
Quote from: nathanm on September 13, 2010, 12:16:28 PM
And you make the mistake of believing that all of us who aren't defending the bill are also against the bill. The closest I can get to defense of it is to say that it's better than what we had before. The closest that I can get to condemnation of it is saying that it didn't go nearly far enough.
No that's not bad. It's basically in line with the old "Anyone but Bush" bumper stickers.
Well. . .you got it on both counts! ;D
Quote from: Conan71 on September 13, 2010, 03:19:23 PM
So this is what "better than nothing" looks like, eh?
I have a hard time with this whole nonsense about Republicans watered down the bill. Democrats own this as they passed this using reconcilliation and had majorities in the House and Senate. I simply don't see the point if costs are not contained. This was going to make it more efficient, remember?
Sort of. It is better that kids with preexisting conditions can't be denied coverage and that lifetime caps on benefits were outlawed.
We haven't seen the effect of most of the bill yet, though. The complaints at this stage are utterly ridiculous. Most of the provisions aren't in force yet. I've said many times that I agree that the limited cost containment measures in the bill probably didn't go far enough. Of course, given that they're not in effect yet, who knows?
Republicans didn't water down the bill, the Senate did that on its own, in some misguided attempt at bipartisanship. There's no point in attempting that when the other side refuses to sit at the table, but try they did. Senate Democrats were idiots on that. If I wasn't aware of
how much worse Senate Republicans are, I'd be all for tossing the bastards out. As it is, I'm happy for every primary challenger to Harry Reid and his league of quitters.
We need a stronger left, not so this country can be shifted radically leftward, but to counterbalance the continuing descent into bats***insanity that has been gripping the Republican party of late. It's not as if you have to worry about someone marching in and implementing Communism. Even Fidel Castro has finally figured out that it doesn't work very well.
Edited to add: And what the heck is with this thread anyway? Of course it's going to cost more to insure 10% more of the population. If the modest cost controls do end up working, by 2019 or so we'll be better off than we were before the new law...
Nathan let me tell you what is stuck in my craw: we were told this would "fix" health care for everyone. They were finally going to put the screws to big pharma, ruthless health insurers, and major HC corps. They capitulated to their donors who helped get them elected- all of the above. They simply should have called this what it really will become: massive Medicaid expansion. However, that wasn't marketable as a lot of people have a strong distaste for entitlements. "Health care reform" sounds like a far better legacy than ultimately putting 31mm more Americans on our much maligned Medicare.
I see you've been reading the Heritage Foundation's blog. The more likely number is 16 million, not that that's really important. It was stated very clearly that part of the new law was subsidizing insurance for the poor. I don't know on what planet 133% of poverty isn't "poor."
Quote from: nathanm on September 13, 2010, 09:23:37 PM
I don't know on what planet 133% of poverty isn't "poor."
Remulak. It's not really a town in France.
Actually Nathan if you had fully read my first post on the topic you'd know that figure came from left-slanted op-eds in USA Today & HuffPo. Seems everyone besides you knows this, including the President and Secretary Sebelius. But maybe they've just been trolling Freep
Quote from: Conan71 on September 14, 2010, 07:58:46 AM
Actually Nathan if you had fully read my first post on the topic you'd know that figure came from left-slanted op-eds in USA Today & HuffPo. Seems everyone besides you knows this, including the President and Secretary Sebelius. But maybe they've just been trolling Freep
That phrase "massive Medicare expansion" is direct from their talking points.
Either way, if you look at the projections (http://content.healthaffairs.org/cgi/content/full/hlthaff.2010.0788v1), there is indeed a jump in spending, thanks to the greater number of people covered, but you'll see that toward the end of the period, projected growth in spending is lower under the current law than new law.
In almost all years, projections for out of pocket expenses are lower. Until 2014, growth in spending is lower under new law compared to old law. In 2014, there's that pesky one time jump. Whether you like it or not, the cost curve over the long term has been moved downwards. CBO's numbers from earlier this year show this more clearly, as they use a much longer horizon.
Edited to fix broken link..stupid bbcode being not like HTML
Quote from: nathanm on September 14, 2010, 08:26:09 AM
That phrase "massive Medicare expansion" is direct from their talking points.
Either way, if you look at the projections (http://"http://content.healthaffairs.org/cgi/content/full/hlthaff.2010.0788v1"), there is indeed a jump in spending, thanks to the greater number of people covered, but you'll see that toward the end of the period, projected growth in spending is lower under the current law than new law.
In almost all years, projections for out of pocket expenses are lower. Until 2014, growth in spending is lower under new law compared to old law. In 2014, there's that pesky one time jump. Whether you like it or not, the cost curve over the long term has been moved downwards. CBO's numbers from earlier this year show this more clearly, as they use a much longer horizon.
Even adding 16mm to the Medicare rolls would be considered massive, why dispute the point just because you have an issue with the Heritage Foundation? It's a valid description of what is going on.
Another issue I've got with this is the assumption that just because 31mm more people will have paid access to health care that they will use it, or that it won't become abused and over-used and costs won't be greater. It's like economic theory, it takes into account everything but human behavior which is less than predictable or reliable. There are simply some people, regardless of cost or their ability to pay, who will avoid seeing a doctor until they are in serious deep smile with their health.
See if you can fix your link, it's not working, I'd love to see what it says.
Quote from: Conan71 on September 14, 2010, 09:20:51 AM
Even adding 16mm to the Medicare rolls would be considered massive, why dispute the point just because you have an issue with the Heritage Foundation? It's a valid description of what is going on.
Another issue I've got with this is the assumption that just because 31mm more people will have paid access to health care that they will use it, or that it won't become abused and over-used and costs won't be greater. It's like economic theory, it takes into account everything but human behavior which is less than predictable or reliable. There are simply some people, regardless of cost or their ability to pay, who will avoid seeing a doctor until they are in serious deep smile with their health.
See if you can fix your link, it's not working, I'd love to see what it says.
Ok, but look. You're projecting behavior that is literally unmeasurable until it happens. Who really knows if the newly-insured will use the system too much, too little, or just right? We can make somewhat educated guesses, but until it actualizes, they're just that: guesses.
This is what galls me about the whole thread. I can accept a negative review of HCR -- like nathan, it's been obvious to me from pretty early on that the Administration let politics trump the amount of reform we needed -- but so much of this is just pissing into the wind until 2019 or whenever. Even though the reform was watered down (again, IMO), it's still has a jillion moving parts that won't fully come to bear for another decade. In an environment like that, a negative projection is a valid data point, but has to be taken as just that, another data point. And a mostly premature one at that.
But what a single negative projection
isn't is proof that 1) we don't need reform, 2) that the whole reform process was useless and 3) that the bill we got wasn't a net positive.
If you want to use this single news item as an entre into guido-style complaining about how misled you feel . . . well, that's your prerogative, but it doesn't prove very much about the actual product.
Where there's smoke there's fire, this is the tip of the iceberg, and any other useless cliche`s you can dredge up. ;) This bill is nothing but a legacy bill so they can say "we fixed health care". Probably 70% of Americans actually believe that the HC system was miraculously cured with passage (by reconcilliation mind you) of the bill. The pitch man will have been out of office between 3 to 7 years when we finally figure out what it contained and what the reality is and will be able to safely hide behind: "They modified my plan and that's why it sucks now."
This is bad business, pure and simple as it defies a whole lot of economic logic and necessarily requires a wealth shift. It also creates a shroud of mystery in terms of benefit requirements for employers and their record keeping and tax liabilities as a result. Creating doubt or questions in the minds of business people especially in a down economy is bad ju-ju.
"Nobody knows" is one reason companies are reluctant to hire right now. I heard a great comment somewhere on MSNBC last night: Keynesian economics may have worked during the Great Depression but isn't now because money is out there, people need confidence in the economy and the business climate.
You can say how health care and different tax policies shouldn't be continuing to keep unemployment so high. All it takes is the paradigm of those who run businesses to become that current actions of the government are not pro-business, right/wrong, or ill percieved. Those are the people who hire and even if the reality is the exact opposite of what they believe, it's their belief not reality which is governing their thinking. If they aren't hiring and saying current government actions are why they are not, we need to listen to them.
Here's a Time article on more people listening to the debunking of Keynes by Friedman.
A monetary theorist, the bald and somewhat cherubic University of Chicago professor maintains that the U.S. and many other major nations mismanage their economies. They do so, he argues, by manipulating taxes, federal spending and money supply—techniques that were formulated by Britain's John Maynard Keynes. "Keynesian economics doesn't work," says Friedman. "But nothing is harder for men than to face facts that threaten to undermine strongly held beliefs."
Those beliefs have grown stronger in the past eight years, while the U.S. economy has expanded under the vigorous application of neo-Keynesian principles. Today, when the economy is strained by inflation, Friedman's challenge commands serious attention and growing support, and is a topic of heated debate among economists, bankers and Government officials.
Read more: http://www.time.com/time/magazine/article/0,9171,839744,00.html#ixzz0zWAgnFTE
Just a bit Off Topic, but Obama wants a part of Obamacare (yes I said Obamacare just to tease Nate) repealed:
QuoteFacing a backlash from small businesses over a new tax-reporting requirement in the healthcare law the president signed in March, the Obama administration is embracing the first change to the landmark legislation.
In a letter to Senate leaders, Health and Human Services Secretary Kathleen Sebelius and Treasury Secretary Timothy F. Geithner urged the Senate to back a proposal to scale back the new reporting mandate.
http://www.latimes.com/health/la-na-health-reform-change-20100914,0,5055513.story
Pelosi was right I guess. We did need to pass the bill so we could see what's in it.
Quote from: we vs us on September 14, 2010, 10:04:05 AM
Ok, but look. You're projecting behavior that is literally unmeasurable until it happens. Who really knows if the newly-insured will use the system too much, too little, or just right? We can make somewhat educated guesses, but until it actualizes, they're just that: guesses.
Well, there is useful data (http://www.kff.org/uninsured/upload/8083.pdf) with which to predict this. The uninsured poor who will be newly covered by Medicaid are on average healthier than those who are presently on Medicaid. Among those who will be covered, most consider themselves very health to in perfect health.
My point about the phrase the Heritage Foundation chose to use is not that there isn't an expansion of Medicare going on, but that we have known since before the bill was passed that said expansion was one of the main purposes of the bill. It wasn't hidden, it was trumpeted as getting health care to more poor people.
Also Conan, as I'm sure you're aware, the legislation does not require that existing plans change one iota. If employers or insurance companies choose to change them, they don't change.
Quote from: nathanm on September 14, 2010, 12:50:49 PM
Well, there is useful data (http://www.kff.org/uninsured/upload/8083.pdf) with which to predict this. The uninsured poor who will be newly covered by Medicaid are on average healthier than those who are presently on Medicaid. Among those who will be covered, most consider themselves very health to in perfect health.
My point about the phrase the Heritage Foundation chose to use is not that there isn't an expansion of Medicare going on, but that we have known since before the bill was passed that said expansion was one of the main purposes of the bill. It wasn't hidden, it was trumpeted as getting health care to more poor people.
I'm not buying that. Typically poorer demographics don't pay close attention to nutrition, have sedentary or otherwise unhealthy lifestyles like smoking or addiction problems or risky sexual behavior as well as high pregnancy rates and riskier pregnancies because they won't seek out better pre-natal care even when it is available and paid for.
You can't cure indifference to proper use of the health system.
Quote from: Conan71 on September 14, 2010, 12:59:03 PM
I'm not buying that. Typically poorer demographics don't pay close attention to nutrition, have sedentary or otherwise unhealthy lifestyles like smoking or addiction problems or risky sexual behavior
I think you are confusing the people who are already eligible for Medicaid with those who are not presently but will be in 2014.
Quote from: nathanm on September 14, 2010, 01:13:17 PM
I think you are confusing the people who are already eligible for Medicaid with those who are not presently but will be in 2014.
No, simply stating what is already well known amongst poorer demographics.
Quote from: guido911 on September 14, 2010, 12:41:18 PM
Pelosi was right I guess. We did need to pass the bill so we could see what's in it.
Um, that particular provision was publicized prior to passage of the bill.
Honestly, I think they're being somewhat ridiculous about it. It would be trivial for any small business accounting package to generate the necessary 1099s. There would be a burden initially as companies obtained tax ID numbers from everyone they pay and enter the information in, but going forward, it's not really an issue, nor would it be for any new payees. And at this point, if you're not using QuickBooks or something similar and you have an accountant, you're probably paying more for the accountant's time every year than you would on a QB license.
Quote from: Conan71 on September 14, 2010, 01:17:45 PM
No, simply stating what is already well known amongst poorer demographics.
You say that, but you have no evidence for it, whereas I do have evidence for my contention. Among the people who will be added to Medicaid, they are on average healthier than those already on Medicaid.
Quote from: nathanm on September 14, 2010, 01:22:45 PM
You say that, but you have no evidence for it, whereas I do have evidence for my contention. Among the people who will be added to Medicaid, they are on average healthier than those already on Medicaid.
Post it then, I'd love to read it.
Quote from: Conan71 on September 14, 2010, 03:42:03 PM
Post it then, I'd love to read it.
I guess you didn't see my link earlier?
Quote from: nathanm on September 14, 2010, 03:46:23 PM
I guess you didn't see my link earlier?
Finally found it. Would you mind posting open links, my eyes have a hard time discerning an embedded hyperlink.
That's not necessary any more...
This relies on the idea that most people are great at self-diagnosis.
"Although close to 60% of these adults report being in excellent or very good physical health and a similar share report being in excellent or very good mental health, some of these adults may have health problems that have gone undiagnosed without medical care (Figure 5). Many of the approximately 42% who report being in good, fair or poor physical health may seek medical care for ongoing health problems once they become eligible for Medicaid."
I can see where you are drawing your conclusion from, however, the report doesn't take into consideration that out of those polled and said they are in good or very good health 50% might be smokers or use smokeless tobacco or drink to excess every day or engage in riskly sexual behavior. Also keep in mind that with insurance, now these individuals might be more likely to seek medical attention for common colds and flu instead of allowing nature to take it's course like they have in the past. Now physicians can get them in the system and start diagnosing conditions they never realized they had like depression, ADHD, incontinence, ED, high cholesterol, etc. and get them on the med train.
Sorry, I'm very cynical when it comes to the modern day pill pushers.
I admit to being cramped for time this afternoon and have not given the report my full attention. It's conclusions are drawn from self-reporting of patients or potential patients which I personally don't see as being very reliable.
Quote from: Conan71 on September 14, 2010, 04:10:24 PM
I admit to being cramped for time this afternoon and have not given the report my full attention. It's conclusions are drawn from self-reporting of patients or potential patients which I personally don't see as being very reliable.
Use of the medical system is by definition self reported (at least the vast majority of the time). People don't generally go to the doctor unless they have a problem. Next time you see your doctor, ask him what proportion of his patients come in for preventative care.
Quote from: nathanm on September 14, 2010, 01:21:03 PM
Um, that particular provision was publicized prior to passage of the bill.
Honestly, I think they're being somewhat ridiculous about it. It would be trivial for any small business accounting package to generate the necessary 1099s. There would be a burden initially as companies obtained tax ID numbers from everyone they pay and enter the information in, but going forward, it's not really an issue, nor would it be for any new payees. And at this point, if you're not using QuickBooks or something similar and you have an accountant, you're probably paying more for the accountant's time every year than you would on a QB license.
Amendment didn't pass. The story says Nelson claims the Johanns amendment would have "gutted the reform bill". With all the sausage-making on the Hill who knows what else was stuck in there.
"The Senate in a series of procedural votes chose not to move forward on two amendments that sought to completely or partially repeal a new tax reporting provision in the new health reform law.
Respective amendments offered by Sens. Mike Johanns (R-Neb.) and Bill Nelson (D-Fla.) each sought a different solution for paring down the reform law's 1099 provision, which in 2012 will require any business that purchases more than $600 worth of goods or services from another business to submit a 1099 tax form to the Internal Revenue Service.
The requirement is expected to save $17 billion over 10 years, but certain lawmakers and business trade groups have called for its repeal, claiming it would put a huge tax burden on small businesses. "Even the White House now admits they went too far and their mandate will hurt small businesses," said Senate Republican Leader Mitch McConnell (R-Ky.), who supported Johanns' amendment to completely repeal the reporting requirement.
Nelson, who had suggested exempting businesses with 25 or fewer employees from the requirement, argued that Johann's approach would "gut the reform bill" in order to pay for the repeal.
Neither amendment achieved the 60 votes necessary to proceed to a final vote for possible inclusion in the "Small Business Jobs and Credit Act of 2010," which is still under consideration in the Senate"
http://www.modernhealthcare.com/article/20100914/NEWS/309149984/0
Quote from: Conan71 on September 16, 2010, 11:36:29 AM
The requirement is expected to save $17 billion over 10 years, but certain lawmakers and business trade groups have called for its repeal, claiming it would put a huge tax burden on small businesses.
Wow, that's a new one on me. Small businesses will be hurt because
they have to pay the tax they owe. That's pretty ballsy, arguing that the new 1099 requirement will make ongoing tax fraud harder is a reason to repeal the requirement.
As I mentioned before, I don't really care either way. I can pretty easily make my "accounting" software tally my spending with each payee and generate the 1099s. What I don't know is how much the IRS will like having to sort through the mountain of paper that will be coming their way in early 2013.
Here's some better, or at least somewhat more detailed information on it:
"Two separate amendments introduced by Senate Democrats and Republicans to the Small Business Jobs Act were unable to reach the 60-vote threshold needed to cut off debate on Tuesday and be included in the final bill. One amendment, introduced by Sen. Mike Johanns, R-Neb., would have repealed the provision, but would have made more people exempt from having to buy health insurance by lowering the affordability exemption for the individual mandate. The amendment was defeated on a procedural vote of 46-52.
The Democratic alternative, introduced by Sen. Bill Nelson, D-Fla., would have increased the threshold for reporting the purchases on a 1099 from $600 to $5,000, and exempted businesses with 25 or fewer employees from the new reporting requirement. His amendment was defeated on a vote of 56-42, also failing to reach the 60-vote threshold.
The Senate may next try to pass the 1099 repeal as a separate piece of legislation. Earlier efforts to pass the 1099 repeal before lawmakers left for their August recess have also failed to pass in the House (see Small Business Tax Relief Act Fails to Pass in House).
The Obama administration is asking to scale back, but not repeal, the requirements. Treasury Secretary Timothy Geithner and Health and Human Services Secretary Kathleen Sebelius sent a letter Monday to Senate Majority Leader Harry Reid, D-Nev., and Senate Minority Leader Mitch McConnell, R-Ken., urging them to scale back the new 1099 requirements.
"We are committed to reducing the gap between taxes legally owed and taxes paid," they wrote, according to Politico.com. "However, the administration believes that the burden created on businesses by the new information reporting requirement on purchases of goods that exceed $600, as included in Section 6041 of the Internal Revenue Code as modified by Section 9006 of the Affordable Care Act, is too great." They said they opposed the Johanns amendment because it would withhold money from a new fund for wellness programs until 2018.
Johanns blamed Democrats for the defeat of his amendment. "Regulations, mandates and government spending simply will not create jobs," he said in a statement. "Today's vote signifies that Senate Democrats and the Obama administration would rather protect a section of their more than 2,400-page unpopular health care bill than stand up for small businesses. It is wrong to have paid for the president's health care plan on the backs of small businesses. My amendment would have truly helped small businesses and I am committed to continuing this fight until this provision is repealed."'
http://www.webcpa.com/news/Senate-Fails-Repeal-1099-Requirements-55560-1.html
Sounds like the party of "NO" (to small business) is at it again.
Quote from: guido911 on September 16, 2010, 12:23:11 PM
Sounds like the party of "NO" (to small business) is at it again.
You come up with that one yourself?
I can't believe Johanns is still claiming that reducing tax fraud is somehow punishing small businesses. I guess he thinks it's OK if you cheat on your taxes, as long as you're "running a small business?" The health care bill isn't paid for by new taxes on small businesses. In fact, Democrats have passed legislation to
reduce their tax burden. This entire controversy is ridiculous.
Quote from: nathanm on September 16, 2010, 01:42:03 PM
You come up with that one yourself?
I can't believe Johanns is still claiming that reducing tax fraud is somehow punishing small businesses. I guess he thinks it's OK if you cheat on your taxes, as long as you're "running a small business?" The health care bill isn't paid for by new taxes on small businesses. In fact, Democrats have passed legislation to reduce their tax burden. This entire controversy is ridiculous.
It's not registering with me where this cuts tax fraud, nor where they expect this will gain $1.7 bln in revenue every year. What's the cost of having the IRS compile and track all this new information? I can't imagine the net gain would be all that great. People who are dealing in cash to avoid paying taxes will continue to do so.
Quote from: Conan71 on September 16, 2010, 01:46:05 PM
It's not registering with me where this cuts tax fraud, nor where they expect this will gain $1.7 bln in revenue every year. What's the cost of having the IRS compile and track all this new information? I can't imagine the net gain would be all that great. People who are dealing in cash to avoid paying taxes will continue to do so.
With the 1099 being required, both sides of the covered transactions must be complicit in the tax fraud to pull it off, rather than only the recipient of the payments. It works in the same way that filing 1099s for contractors or banks reporting interest on 1099-INT or the W-2 does.
The limit seems a little intrusive to me because it's only $600, but the fundamental concept is sound.
Quote from: nathanm on September 16, 2010, 01:58:18 PM
With the 1099 being required, both sides of the covered transactions must be complicit in the tax fraud to pull it off, rather than only the recipient of the payments. It works in the same way that filing 1099s for contractors or banks reporting interest on 1099-INT or the W-2 does.
The limit seems a little intrusive to me because it's only $600, but the fundamental concept is sound.
We have clients clamoring to update their software because of changes to the 1099 and W-2s. Some are requesting custom programing for their existing software revisions, and others are updating to new revisions that handle the additional fields.
We have a group of clients that just left for an accounting convention in Springfield, MO. The main gist of the convention is changes in the tax code. The main frustration they all have is the "limbo" they are now facing when it comes to Q4 planning. Typically by now everyone knows most of the important changes and requirements for the upcoming year, but as I keep hearing from them, they are not yet sure what reporting will be necessary, or what has yet to be passed or repealed. Most don't know what they need to start reporting as part of the healthcare bill, because there is apparently differing opinions on tax stratagies.
I'm very interested to find out what they discover, because ultimately it will have an impact on my business since we have to make all of the changes to their systems and consult with their accounting departments.
It's job security for me, but ultimately it's a burden on the client that produces no return.
I don't know, but the new 1099 requirement may cost the government more from an audit standpoint than it is capable of returning. It certainly places a new tax burden on companies, and increases their overhead. Stupid in a stalled economy with almost 10% unemployment!
Quote from: Gaspar on September 16, 2010, 03:42:29 PM
It's job security for me, but ultimately it's a burden on the client that produces no return.
I don't know, but the new 1099 requirement may cost the government more from an audit standpoint than it is capable of returning. It certainly places a new tax burden on companies, and increases their overhead. Stupid in a stalled economy with almost 10% unemployment!
My understanding is that the new 1099 requirement doesn't kick in until 2012. That seems like plenty of time to me. Also, collecting taxes owed but not being paid is not a "new tax burden" by any reasonable definition of "new." It would be more accurate to say that they are subject to new enforcement efforts and new reporting requirements. If they've been paying tax correctly all along, their only worry is getting their accounting system updated.
I get your point, but how is the gov't calculating this as a $17bln windfall with such certainty? Other part is, what does a company like Office Depot do with hundreds of thousands of 1099's all the sudden?
Quote from: Conan71 on September 16, 2010, 09:26:54 PM
I get your point, but how is the gov't calculating this as a $17bln windfall with such certainty? Other part is, what does a company like Office Depot do with hundreds of thousands of 1099's all the sudden?
A company like Office Depot does what they do for everything else: outsource. I have a sneaking suspicion ADP will be expanding soon.
I don't know where they're getting the specific savings number. Without knowing more, I'd regard it as an educated guess by some IRS people. Various government agencies collect sales data for all sorts of goods and services, so I can envision there being at least some data on which to base their estimate.
Quote from: Conan71 on September 16, 2010, 09:26:54 PM
I get your point, but how is the gov't calculating this as a $17bln windfall with such certainty? Other part is, what does a company like Office Depot do with hundreds of thousands of 1099's all the sudden?
More like millions. ??? Most small retailers that will be responsible for hundreds of thousands. Office Depot will be in the millions. So will most billion dollar cap businesses that sell things.
Office Depot has millions of suppliers? Really?
Quote from: nathanm on September 17, 2010, 12:06:46 AM
A company like Office Depot does what they do for everything else: outsource. I have a sneaking suspicion ADP will be expanding soon.
I don't know where they're getting the specific savings number. Without knowing more, I'd regard it as an educated guess by some IRS people. Various government agencies collect sales data for all sorts of goods and services, so I can envision there being at least some data on which to base their estimate.
Basically, it would ride on the premise that companies chronically under-report their sales, especially cash transactions.
Here's what I don't like- this cavalier attitude that businesses should simply be able to shoulder the costs of more regulations and compliance just because the Feds want them to. Your solution is "ADT". That comes with a cost. I suspect compliance cost and enforcement cost will way out-strip the benefit of what will ultimately be collected.
I personally think this was a schlocky method to try and show in the accounting of the HC bill how it could be paid for. Companies under-reporting sales revenue is a different issue entirely and should be dealt with via separate legislation if this is such a problem. There's a whole secondary economy out there which is untaxed, this is but a very small part of it. A simplification in tax code (i.e. consumption-based tax like the "Fair Tax"...and before someone shouts "regressive" read up on it, it's not) would end a lot of the shenanigans people pull to avoid paying taxes. But that's a discussion we've beat to death on other threads and I don't care to dredge it back up here.
Quote from: nathanm on September 17, 2010, 09:11:13 AM
Office Depot has millions of suppliers? Really?
No Nathan, they are a supplier to millions, that means a 1099 coming in from every business which buys $600 worth of goods. Only $50 a month. They have to open, properly file, and store these 1099's.
Quote from: Conan71 on September 17, 2010, 09:18:44 AM
No Nathan, they are a supplier to millions, that means a 1099 coming in from every business which buys $600 worth of goods. Only $50 a month. They have to open, properly file, and store these 1099's.
I have a sneaking suspicion they will have a way to do the vast majority of this electronically.
Either way, we all pay the cost of tax cheats one way or another. When you have too many of them, you look like Greece. I find it hard to gin up outrage on behalf of said tax cheats. It sucks that enforcement increases costs for everybody, but that's what enforcement does. Unless you have an idea of how it can be done without more strict reporting requirements?
Quote from: nathanm on September 17, 2010, 09:27:38 AM
I have a sneaking suspicion they will have a way to do the vast majority of this electronically.
Either way, we all pay the cost of tax cheats one way or another. When you have too many of them, you look like Greece. I find it hard to gin up outrage on behalf of said tax cheats. It sucks that enforcement increases costs for everybody, but that's what enforcement does. Unless you have an idea of how it can be done without more strict reporting requirements?
Nathan, most businesses rely on their sales records and expense records to come up with their taxable income now. A business which operates honestly will always operate honestly, one which is intent on flaunting tax codes will find ways around it. With the new 1099 requirement, what's to keep a business owner from taking more clients to lunch or expensing some business trips? I seriously doubt a string of 1099's tightens the noose any tighter.
But I do love the selective outrage of liberals like yourself. Illegal immigration is considered harmless, yet pobably your best example of tax cheats would be those people who are doing day labor for cash, mowing lawns, cleaning gutters, painting houses, etc. all for cash under the table. By law, those people should be keeping records, preparing returns, and paying tax on that income. How do you feel about those tax cheats?
Quote from: Conan71 on September 17, 2010, 09:34:36 AM
But I do love the selective outrage of liberals like yourself. Illegal immigration is considered harmless, yet pobably your best example of tax cheats would be those people who are doing day labor for cash, mowing lawns, cleaning gutters, painting houses, etc. all for cash under the table. By law, those people should be keeping records, preparing returns, and paying tax on that income. How do you feel about those tax cheats?
I consider that we make it almost impossible for illegal immigrant day laborers paid under the table to pay taxes. Why do you think I'm fully in favor of making it easier for them to do so and have stated that repeatedly on this very forum?
My outrage isn't at all selective. I'm not going to get upset about people being forced to pay the tax they owe, no matter who it is. It's not as if I'm saying that the owners of businesses not paying their taxes should be deported, after all.