Congressional Budget Office Director Douglas Elmendorf gives an overview of the “projected net cost of $894 billion over 10 years,” which includes sentences like this: “That net cost itself reflects a gross total of $1,055 billion in subsidies provided through the exchanges (and related spending), increased net outlays for Medicaid and the Children’s Health Insurance Program (CHIP), and tax credits for small employers; those costs are partly offset by $167 billion in collections of penalties paid by individuals and employers.”

The New York Times’ Robert Pear and David Herszenhorn think journalists should be using a different number to discuss the bill’s price tag: “But a closer look at the budget office report suggests that the number everyone should have reported was $1.055 trillion – which is the gross cost of the insurance coverage provisions in the bill before taking account of certain new revenues, including penalties by individuals and employers who fail to meet new insurance requirements in the bill.”

Economist Uwe Reinhardt on the New York Times’ Economix compares analyzing the cost with buying a suit. He writes about uncertainties in the CBO estimates: “How the C.B.O. would score a bill that might ultimately be approved by both the Senate and the House of Representatives, after endless log-rolling and winning the votes of individual legislators by promising added spending for their pet ideas, is anybody’s guess.”

James Capretta of The New Atlantis attacks how lawmakers wrote the spending provisions, saying, “To create the impression of fiscal responsibility, the bill is jury-rigged with budget gimmicks, implausible eligibility rules, and arbitrary, government-dictated price controls — that have been tried repeatedly without success — to make it look like it costs ‘only’ $900 billion over a decade.”

TPMDC’s Brian Beutler notes deficit hawk  Sen. Kent Conrad, D-N.D., is pleased: “It’s now paid for, has deficit reduction over the first 10, and savings over the second 10…that’s a big improvement. I commend the House. They’ve made significant strides and they deserve credit for it.”

Happy Halloween!

As bloggers work to digest the newly released House health overhaul bill (more on that later today), let’s take a look at other items circling the Web.

First, there’s a new Health Wonk Review, the bi-weekly roundup of health policy blogging.  Boston Health News’ Tinker Ready hosts the Halloween-themed edition.

Director Douglas Elmendorf blogs on the Congressional Budget Office’s new brief examining the state of drug research and development.  The report found that pharmaceutical companies spent $50 billion on R&D in 2008, up from the year before, but the number of new drug introductions has fallen since 2000.

Elmendorf writes: “Slower revenue growth for drugmakers does not mean that consumers are using fewer prescription drugs. In fact, the total number of prescriptions continues to increase, albeit more slowly since 2004. But generic drugs, which cost less than their brand-name counterparts, comprise a greater share of prescriptions, having risen from 42 percent in 2000 to 58 percent in 2007.”

The New Health Dialogue’s Meredith Hughes discusses preventing fraud and abuse in federal health programs.

AHCJ’s Andrew Van Dam points to a newReuters profile of the controversial founders of the Medical Tourism Association.

Jaan Sidorov reports that a key Medicare demonstration project — on a “medical home” model — in lieu of a larger House ‘pilot program.’  Vince Kuraitis has more.

The WSJ’s Jacob Goldstein reports that a billionaire physician is offering a $100 million line of credit to help reopen a perpetually struggling Los Angeles public hospital.

Health Populi’s Jane Sarasohn-Kahn looks at a new study that showed calorie displays in New York City led consumers who saw them to order food with an average of 106 fewer calories.

And physician Roy Poses of Health Care Renewal writes about why he thinks comparative effectiveness research is “a good idea.”

Bloggers are reacting to yesterday’s Senate vote on “fixing” future Medicare payments to docs, along with more commentary on everyone’s (apparent) favorite topic to cheer or jeer: the public option.    

Bob Laszewski says a vote that rejected increasing Medicare payments to physicians and hospitals in the face of looming cuts “was easy to predict,” but notes, “In a town steeped in the cynical traditions of politics a bunch of Senators and some career federal health care experts both chose to do the right thing during the last 24-hours. If they keep this up we just might find our way to real health care reform some day!”

Heritage’s Conn Carroll says that the failed Medicare ‘doc fix’ vote “marks a significant failure of the Left’s special interest approach to passing Obamacare. From the beginning, the White House thought that if it bought off all of the business interests involved (the American Medical Association, the drug industry, health insurers, hospitals, etc.) opposition to the plan would wither.”

Wonk Room’s Igor Volsky says Republicans’ vote against the bill was “hypocritical” because “[Senate Minority Leader Mitch] McConnell supported paying for the SGR patch (the payment fix) with deficit spending before he opposed it. Since Congress began fixing the formula in 1999, he — and the majority of the Republican party — rarely objected to barrowing “another cent to pay for it.” McConnell has voted to patch the SGR five different times, three of his votes resulted in increased deficits”

On the public option, Slate’s Timothy Noah argues that there are three “likely” reasons that a new Washington Post/ABC poll was framed as “ some miraculous resurgence…1) Majority support for the public option has been ignored in Washington. … 2) Political reporters are momentum junkies, forever plotting out momentary trends to infinity. … 3) The insurance lobby goofed.”

Meanwhile, The Washington Post’s Ezra Klein discusses three “public option compromises:”  There are three ‘compromise’ public options currently being considered in the U.S. Senate (and yes, I know many argue that the public option is itself a compromise, and there’s something to that). Ben Nelson is advocating one. Olympia Snowe is behind another. Jay Rockefeller is talking up a third. Herewith, a guide for the perplexed.”

And Cato’s Michael Cannon has a new paper on “Yes, Mr. President, A Free Market Can Fix Health Care (pdf).”  He lists options for Congress to incorporate more free-market principles, including allowing the sale of insurance across state lines and reforming the tax treatment of health insurance.  Cannon concludes, “Would a free market be nirvana?  Of course not.  But fewer Americans would fall through the cracks than under the status quo or the government takeover advancing through Congress.”

Some entertaining skits for you this morning – one promoting the “public option” and another sponosored by an insurance company.

First, Heather Graham stars as “the public option” in a new Moveon.org spot, first reported by the Huffington Post:

 

Then there’s a video from Northwest Regence Blue Cross Blue Shield that asks, “What if everything worked like health care?” (Via Disruptive Women in Health Care)  The ad is part of a campaign, What’s the Real Cost?

There’s more (again) on the public plan today as health overhaul efforts move forward, while other writers are looking at charges of propaganda the AMA, health insurance exchanges and conflicts of interest.

The Hill reported Tuesday that Speaker Nancy Pelosi, D-Calif., plans to ask the Democratic House caucus to unite behind a “strong public plan option” today.  The New Republic’s Jonathan Cohn examines the news and says “Pelosi’s actions have provoked two very different reactions from within the [pro] reform community: Glee and fear.”

FiveThiryEight’s Nate Silver, a longtime poll watcher, gives 1o reasons he thinks an “impure” public option will is gaining momentum “(probably)”, including “the fact that the CBO thinks it will save money,” along with “Polls in myriad swing states and swing districts showing the public option is reasonably popular in these region.”

Critical Condition’s Kellyanne Conwaycalls Washington Post/ABC poll highlighting support for a public plan option “agenda-driven polling,” arguing: “Our side has not done enough to discredit and expose the positive-sounding “public option” for what it truly is: a government grab of one of the most intimate matters people face, and one about which most of them are presently content. Additionally, “private” is the opposite of public, and privacy is an important word in the overall health-care lexicon. We should message this aspect of “public option” as well.”

Perhaps illustrating Conway’s point, the Washington Post’s Ezra Klein thinks Sen. Ben Nelson’s shiffting comments, from “’states can opt out of the public option’ rather than ‘no public option at all’ suggests the goal posts on this are moving, and rapidly.”

Elsewhere, Hot Air’s Ed Morrissey is outraged by the fact that “One official government website now includes a form to express support of Dear Leader President Obama’s effort to overhaul the American medical system, a clear violation of laws against executive-branch propaganda through public channels.” (cross-out his).  Morrissey notes: “Senator Chuck Grassley, R-Iowa, sent a letter to Secretary Kathleen Sebelius requesting an explanation because of concerns that the button could violate rules governing executive-branch promotion through public channels.    

Morrissey concludes, “it’s impossible to read this as anything but propaganda for the White House.  And what happens to the contact information entered in the form?  Does that get used by Barack Obama for his re-election campaign?”

The New York Times’ Katharine Seelye reports that protestors are planning on showing up at the health insurance industry’s (AHIP) conference later this week.

The Heritage Foundation interviews conservative commentator Bill Kristol who believes “Obamacare will … fail.”

Linda Gorman on John Goodman’s Health Policy Blog asks “who does the [American Medical Association] really represent?”

Bill Kramer on the Health Care Blog says now is the “last chance to fix” health insurance exchanges.

 And Louise Norris of Colorado Health Insurance Insider, jumping off an Oct. 5th post about conflicts of interest among hospital boards, examines one in Colorado and says, “In order to make health insurance premiums (the direct cost that consumers tend to notice) more affordable, we have to make health care more affordable.  Perhaps filling our hospital board of director rosters with a Who’s Who of the richest people in the city isn’t the best way to go about that mission.”