Some bloggers are actually NOT writing about co-ops…

AEI’s Andrew Biggs does some number crunching and estimates that the average Medicare beneficiary can “expect to receive around $108,915 more in benefits than he paid in taxes.”  Biggs thinks this should be taken into consideration when discussing health reform because “conservatives should be careful not to cement in place the idea that Medicare benefits are sacred because they have been ‘paid for’ by seniors. The typical senior hasn’t come close to paying full freight for his Medicare benefits.”

Health PROSe (from the Association of Academic Health Centers) has a very specific call for reform: Medicare’s clinical trial policy:

Good science—and new cures and treatments for a host of diseases and illnesses–require that Medicare beneficiaries participate in clinical trials. That was the vision and purpose of the clinical trial policy, laid out in an executive memorandum signed by President Clinton in 2000. The goal was to provide increased access for Medicare beneficiaries to clinical trials—and that is not happening. During the Bush Administration, the policy was not fulfilling its intent and, in fact, was quite dismantled, creating a situation that discouraged participation of seniors in trials.

Daniel Palestrant on The Health Care Blog, the founder and CEO of a social networking site for physicians examines how web 2.0 offerings can capture physicians’ take on health reform.

Paul Hughes-Cromwick on the Altarum Institute blog plugs consumer-directed health care policies, saying, “Combining the science of medical effectiveness with the ’science’ of consumerism is the only way to break the shackles imposed by the third-party insurance system and move forward given our individualistic leanings and distrust of communal solutions in this nation.”

Paul Testa of the New Health Dialogue says President Obama has “refocused” his health reform message onto the examples of individuals.

Wonky bloggers are inspired by a letter (pdf) from a group of 13 health economists to President Obama, endorsing Office of Management and Budget Director Peter Orszag’s idea for a special agency to oversee Medicare. The Independent Medicare Advisory Council (IMAC) would be comprised of experts that would make reimbursement and policy decisions. IMAC gained media attention after the Congressional Budget Office found such an body could generate meager savings in a ten-year budget window.

The idea could make it into the Senate Finance Committee’s legislation: Congress Daily reports that the Committee is near a deal on a similar panel, which Chairman Max Baucus is referring to as the “Medicare Preservation Committee,”:

Baucus said Congress would have the power to reject the panel’s cost-cutting ideas in their entirety or let them go into effect. …The negotiators are attempting to balance the division of decision-making influence between Congress and the panel to hit a savings target that Baucus did not disclose.

Regarding the economists’ letter on IMAC, David Leonhardt of the New York Times’ Economix reports “They split the difference and agreed with both sides. …But the 13 economists also made clear that they support Mr. Orszag’s contention that IMAC has the potential to ‘bend the curve’ of rising health spending.”

The New Republic’s Noam Scheiber conjectures:

 I’m not sure how the letter came about, but it strikes me as a pretty shrewd way to suggest CBO’s original estimate may have lowballed the savings. At the very least, it gives the administration something credible to point to when it makes that point. (“CBOs own health care advisers say…”).

Orszag’s response?  He praised the letter on his blog, writing:

Their support of the IMAC proposal underscores what most serious health analysts have recognized for some time: that moving toward a health system emphasizing quality rather than quantity will require continual effort, and that a key objective of legislation should be to put in place structures (like the IMAC) that facilitate such change over time.”

However, the Atlantic’s Derek Thompson says he is “not as optimistic” about IMAC because of the potential political implications.  Thompson envisions intense lobbying pressure on Congress to reverse IMAC’s decisions, and that the agency could become ineffective in the long-run: 

How much popular pushback would IMAC withstand? I don’t know. But it’s not hard to imagine Americans, rightly or wrongly, feeling besieged by an un-democratic body of experts sticking their noses in the doctor-patient relationship. IMAC would begin to look less like a group of benevolent Delphic oracles and more like a wrathful god throwing lightening bolts into the health care system.

 Blogger Right Klik likens IMAC to a “Federal Health Board” and says, ” Rather than giving you health care freedom, the kleptocrats would prefer to give you IMAC.

Tired of analyzing policies in the Democrats’ health reform bills with words alone, commentators and activists have turned creative.

First, we have Health Care Harry from public interest advocacy group PIRG.

PIRG’s interactive patient, based on the board game Operation, is plagued by “endless red tape” and the “rug pulled out” from under him. Poor Harry.

Next there’s skeptical Andrew Malcolm of the Los Angeles Times’ Top of the Ticket with a script imagining President Obama as a door-to-door salesman for health reform:

(Doorbell) “Hello. You don’t have a vicious dog, do you? I’m selling healthcare reform on your street and I want to tell you a little about it.”

“Well, we already have healthcare insurance at work and we’re really quite happy with it.”

“Ah, yes, but you might not have it for long because costs are spiraling out of control and…”

“You know what? When did costs ever go down? I paid 27.9 cents a gallon for gas to the prom and $2,400 for a full year of private college.”

“Yes, but 47 million Americans don’t have health insurance and…”

“Well, I’m sorry for them. Truly. But right now our family is more worried about the economy and keeping our own paychecks. How’s that job jolt stimulus thing coming along that was so urgent last winter? Because we haven’t seen…”

“That’s another issue completely. This summer I’m selling healthcare reform. We don’t have all the particulars from Nancy Pelosi and Max Baucus yet, but I can guarantee you the reforms won’t add another dime to the federal deficit.”

“Yeah, right, and the Cubs are gonna win the World Series.”

“They are? Even with Reed Johnson out for a month?”

Uwe Reinhardt on the New York Times’ Economix blog is in a list-making mood: his “All-American Wish List for Health Reform,” is rife with conflicting desires, pointing to a graphic from another article:

Ron Barrett for the New York Times

But back to wordsmithing, The New Republic’s Jonathan Cohn analyzes yesterday’s events on Capitol Hill, noting “reform advocates both on and off Capitol Hill seem more than a little bit concerned.” After reviewing Thursday’s reported deals with Blue Dog dems and developments on the Senate Finance Committee, Cohn concludes:

What happens next? I’m not quite sure. While delays would seem to strengthen the opponents of reform, an August vote was already off the table anyway. It’s not clear this latest stoppage in Finance, at least, is a problem for its own sake. If anything, a little respite might do some good. It’s easy to forget, but congressional staff and the members themselves are human beings, prone to same behavior as anybody else when under stress. Everybody is tired and on edge. Tempers are flaring. This is not an environment conducive to progress of any sort. …  In an ideal world, one way or another this latest episode will shake things up in a way that produces better legislation.

Critical Condition’s Tevi Troy critiques Democratic political strategy demonizing insurance companies and rises to the defense:

No one is willing to pay all costs out of pocket because of the risks of catastrophic conditions, and the American people seem fairly exercised about the notion of a government-run public option. This leaves us with private insurers to pay for health coverage, and 70% of covered Americans rate their coverage either good or excellent. …In fact, much of the current debate is about how to get more people, not fewer, covered by private insurance.

Troy says the best way to get better care and insurance coverage is to “promote competition” among insurers by allowing the sale of insurance across state lines.

Wonk Room’s Igor Volksy, who advocates a totally different approach to refrom from Troy, goes after the newest Republican health reform alternative plan and concludes, “Like it’s predecessors, this legislation would break-up employer-based coverage, endanger the coverage of Americans with pre-existing conditions, and drive-up health care spending.”

Finally, the Washington Post’s Ceci Connolly looks at opposing positions of some business groups on health reform.

The New York Times’ Caucus blog leads with the headline, “The Early Word: Balking at Health Care Costs.”  Indeed, that’s the watch word of the last few days after Congressional Budget Office Director Douglas Elmendorf shook things up when he testified that the Democrats’ proposed legislation would add to, not reduce, the federal deficit.

The Atlantic’s Marc Ambinder reports on the logic behind the Obama Administration’s focus on costs, but points out:

The basic problem with the cost argument is that it elides over an important point, one that the White House wants to make publicly but cannot: in order to reduce costs in the short term, reform will cost something extra in the near-term. A deeper point they cannot make: it may take MORE money to build a better system. Only when that system produces better outcomes — this would be years off — can true cost-savings be realized.

And on the Robert Wood Johnson Foundation’s blog, the Urban Institute health policy director John Holahan says, “So is $1.6 trillion a lot of money?  In most contexts, it truly is. But in the context of the health reform debate the number needs to be better understood.” Then he elaborates.

The flip side of all that spending?  Cato’s Michael Cannon thinks “the docs are supporting the Democrats’ health care plans because the Democrats are buying them off.”

Finally, Michelle Malkin notes that administrative costs to the federal government are not included in CBO’s estimates and says, “The administrative costs and spillover spending effects will be astronomical. Look at existing federal programs.”

 Also from weekend, you might want to check out a new interactive health reform timeline from the New York Times (screen grab below.)

If you’re looking for an even more detailed timeline, you can find it on the Kaiser Family Foundation site. (note: KHN is a program of KFF).

The House Democrats’ Tri-Committee Bill is sparking a lot of reaction. Bloggers allied with the Dems had immediate and overwhelmingly positively reaction, while skeptics and opponents were much quieter. But first, the non-partisan view:

Congressional Budget Office Director Douglas Elmendorf points to an under-reported fact: “The figures released today do not represent a formal or complete cost estimate for the draft legislation. First, as noted above, these figures do not address the entire bill. Second, the analysis was based on specifications that were provided by staff of the three committees and that differ in important ways from the ‘discussion draft’ version of legislative language that was released in June.” I.E., these numbers could change — but will the commentary shift as well?

The Wall Street Journal’s Jacob Goldstein points out:

We were struck by one estimate in particular: “…total enrollment in the public plan would equal about 11 million or 12 million, counting both individually purchased policies and employer-sponsored enrollees.” That’s about 4% of the current U.S. population, and seems rather small in comparison to how much attention the debate over the public plan has drawn.

MSNBC’s First Read reports: “The measure would leave 17 million uninsured in 2020, according to CBO. Half of that number would be illegal immigrants, and much of the remainder would be people who opt to forgo coverage and pay a fine. Without the plan, the CBO says 54 million would be without insurance in 2020.”

The New York Times’ Caucus blog focused on the funding: “The tax would apply to modified adjusted gross income — total income minus certain “above the line” deductions, but before itemized deductions like those for charitable gifts or mortgage interest on a primary residence.”

The Liberals:

Jason Rosenbaum of the advocacy group Health Care for America Now offers up his org’s support: “It’s a good bill, and we’ll be supporting it. It’s a good bill because it does what it’s supposed to do.”

Paul Krugman on his NY Times blog calls the bill “a bargain” and says, “There is now absolutely no excuse for Congress to balk at doing the right thing.”

The Washington Post’s Ezra Klein, who says the bill “looks good,” is more impressed with the Congressmen themselves: “The Process Is the Message: Three separate committees — Energy and Commerce, Ways and Means, and Education and Labor — have come together on one bill. This is an incredible achievement.”

The New Republic’s Jonathan Cohn: “My immediate, admittedly tentative reaction is strongly positive. Once fully implemented, this reform plan will accomplish most of the goals on my mental checklist.”

Wonk Room’s Igor Volsky made a table of the bill’s provisions and their estimated savings (including “sexy facts”!).

The Conservatives:

Conn Carroll on The Heritage Foundation’s Foundry blog writes about “The House’s Hidden Train Wreck:” “the Congressional Budget Office (CBO) released a preliminary scoring of the bill putting a $1.3 trillion price tag on the effort. Weighing in at 1,018 pages, that comes to $1.264 billion per page. But even this analysis understates the true costs of the bill. The CBO only scores bills on a ten-year time frame, and House Democrats have designed their bill to obscure the catastrophic long-term fiscal path it places our country on.”

At the National Review’s The Corner Tevi Troy calls the bill “far to left” and adds: “This is not surprising, as the House Leadership’s strategy appears to be to pass a bill that is as far to the left as possible in order to have maximum leverage when negotiating with whatever compromise comes out of the Senate.”

The American Spectator’s Philip Klein looks at the Blue Dog Democrats’ reaction.

Keith Hennessey says the bill raises taxes on middle-income Americans and asks: “Does the House want to raise taxes on eight million uninsured people?”

The New Atlantis’ James Capretta turned his attention to President Obama last night:

“It’s now a clear pattern. When the president senses his position is vulnerable to a factual criticism, he asserts emphatically that the opposite is true — without ever providing evidence to back up his claim. Here’s the latest example. According to Politico, President Obama told skeptical Blue Dog Democrats last evening that they should support the health care bill emerging in the House because it would produce savings beyond the ten-year budget window.”

The focus is back on Obama today as the President delivered another presser focused on Iran and the economy. But according to the New Republic’s Jonathan Cohn, Obama’s most interesting answer was in response to a question from ABC News’ Jake Trapper on whether a public plan option would force some people to lose insurance options.  Obama replied:

So let’s assume that nothing happened. I can guarantee you that there’s the possibility for a whole lot of Americans out there that they’re not going to end up having the same health care they have. Because what’s going to happen is, as costs keep on going up, employers are going to start making decisions. We’ve got to raise premiums on our employees. In some cases, we can’t provide health insurance at all.

James Capretta of the National Review Online’s The Corner had a different interpretation of this exchange:

Faced with incontrovertible evidence that he and his allies have no intention or ability to fulfill their commitment to Americans regarding their current coverage, President Obama decided today at his press conference to try to redefine the promise. What he meant, he now says, is that the government wouldn’t force people out of their health-care plan. If tens of millions of people get pushed out of their current coverage, it would be because firms chose to drop their insurance plans — never mind the fact that they would do so based on the financial incentives the government put in place (his emphasis).

Other commentators are starting to predict the future of the bill itself. The Washington Post’s Ezra Klein predicts that health reform “is going to go the way of stimulus.”  He explains:

The stimulus was a historic legislative accomplishment that nevertheless left liberals frustrated because they made concessions they didn’t see any reason to make and ended up with a bill that they knew would not fully solve the problem…as the legislation winds its way through the Senate, there will be unpleasant compromises, and unconscionable omissions, and the constant knowledge that though this is progress, it is not sufficient.

Speaking of the stimulus, the Heritage Foundation’s Foundry latches onto a recent bit in a New York Times blog that argued the landmark bill’s COBRA subsidies and unemployment expansions are making it more expensive for some small businesses to hire employees.

Meanwhile, Leighton Ku on the Health Affairs Blog points out that although some reports media have focused on public plan squabbling, “a quieter debate is brewing over whether coverage for low-income people should be achieved through Medicaid expansions or subsidies to purchase insurance through an exchange.” Ku argues that a Medicaid expansion would cost less than extending private insurance to cover more low-income Americans, concluding:

No matter what the mechanism, the cost of providing adequate health insurance coverage to the millions of low-income uninsured Americans will be high, although some of the costs can be offset through savings in our health care system. Nonetheless, if our intentions are serious, Medicaid expansion is the most cost-effective and appropriate method available.

Ku summarizes some interesting research as we wait for the Senate Finance and HELP committees to finalize the subsidy and expansion portions of their overhaul bills.

Interesting Elsewhere:

The New York Times’ Economix has a new feature where they ask experts from around the nation “What should the priorities for health care reform be?”  Today there are posts on consumers, patients and workers; doctors, hospitals and the quality of care; insurers and insurance systems; and businesses, competition and innovation.

Lynn Sweet of Politics Daily reports that a visit from First Lady Michelle Obama indicated she is “wading, not diving, into the health care debate.”

Insure Blog’s Henry Stern says, “The underlying problem is that no one in Washington really understands the relationship between health care costs and health insurance costs, so no plan realistically addresses either one. The overarching motto is ‘throw more money at it.’ ”

John Geyman of Physicians for a National Health Program, a group that supports a single-payer plan, complains about the shape of the current health reform debate and says “Under these circumstances, no bill is better than a bad one that will not rein in costs and will set back health care reform for years to come.”