Ezra Klein: The latest on health-care reform

Ezra Klein
Washington Post Business Blogger
Thursday, February 11, 2010; 12:00 PM

Trying to understand health-care reform, but getting lost in the weeds? Don't worry, Washington Post blogger Ezra Klein can help. From individual mandates to health care exchanges, Klein explains it all. He took your questions on health-care reform, economic and domestic policy and pretty much anything you can attach a chart to.

A transcript follows.

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Brooklyn, NY: Snowpocalypse: good or bad for Health Care Reform?

Ezra Klein: On the bright side, it's given Washington something else to talk about for a few days. On the not-so-bright side, it's given Washington something else to talk about for a few days. Right now, what would be good for health-care reform would be for Democrats to decide to pass it. Until that happens, no amount of snow or summits or polls will make a difference. it's up to them, even if they don't want to admit it.

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Oregon City, OR: I understand that you get paid to provide the details on legislation and arguments for or against, but when it all seems to continually come to naught on the hill, don't you get frustrated?

Ezra Klein: Yes.

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New York, NY: I keep hearing the Repubiclans say we should start from scratch. Given what the President said are his parameters, what would that accomplish, or is it just grandstanding to kill it?

Ezra Klein: There's no such thing as starting from scratch. It's just an applause line. Here's the deal: Republicans have done a lot of polling on this and have learned two things. 1) Americans want reform. 2) If Americans like the reform Democrats have proposed, and it gets enacted, Democrats will benefit electorally. So what Republicans are trying to do is make Americans dislike the reform Democrats have proposed while not positioning themselves against the general concept. That's led to a lot of this stuff about starting from scratch, but given that Republican leadership has nothing serious on the table, scratch is where we'd stay.

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Saving money: What part of the health care reform bill will save me money? My understanding is that health care tort reform would lower costs but this is not in the bill. I understand if the Government lowers Medicare payments by $500M, then this may save me money. I also understand that if the Government increases competition across state lines, this may save me money.

Ezra Klein: 1) Tort reform will do virtually nothing. 2) The Medicare payments might save you a bit in taxes down the road, but not much. 3) State lines will do nothing. What might save you money is competition between insurers in the exchange, payment reforms like bundling payments to hospitals, increased transparency that leads to better competition on price, and so forth. But this health-care bill does a lot more for bad luck than it does for ordinary consumers. So if you lose your job and you get sick and you need to get insurance, this bill will save you a ton of money, while if you keep getting good insurance through their job, your situation might improve a bit, but the difference will be slight.

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Frisco, Texas: To what extent in the health care bill are free market policies being employed to reform the health care industry? It seems we could go two ways with this bill and the Dems want to go the way of government control when perhaps just having everyone pay for their own medical expenses would be the driver to get costs down, as it has with lasik eye surgery.

Ezra Klein: The Lasik concept is a bit misleading, for a few reason. First, Lasik is a refusable good. It isn't like a heart bypass. Second, don't compare the trends of one good to ne sector. It isn't necessarily the case that individual treatments -- bypasses, for instance -- aren't getting better and cheaper as time goes on, just like Lasik. But they're developing more and more stuff they can do to us, and we're getting sicker, and so overall costs are going up.

To put this another way, spending on laser eye surgery is way higher than it was 30 years ago. But individual laser eye surgeries are improving and becoming cheaper. That makes it seem like Lasik is a model for the system, but Lasik is really a model for a good. if health-care spending increased as much as eye surgery spending, the country would be bankrupt already.

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Boston, MA: Given the endless debate over what the Senate Parliamentarian will or will not strike from a reconciliation bill, why hasn't anyone bothered to interview the Parliamentarian to ask him what he'd strike out of the bill? Not that he'd necessarily give a reporter a straight answer, but it seems worth it to try to get some idea on his perspective, given how much power over the Democratic agenda he holds. How hard can it be to get an interview with Alan Frumin?

Ezra Klein: The parliamentarian's rules are that he won't even tell senators that in advance of actual legislative language. Reporters have no chance.

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Ending Medicare as We Know It: So why aren't the seniors who protested against the modest cuts to Medicare, mainly not paying insurance companies to provide Medicare Parts B and C (I think), protesting against Congressman Paul Ryan's plan to end Medicare and provide vouchers instead? It seems that the more irresponsible Obama's loyal opposition becomes, the less accountability they have and then they become favored to make gains in November elections. This country sometimes confuses me.

Ezra Klein: Because as of now, it has no chance of becoming law. If that changed and the press focused on it and AARP mobilized, it'd be a very different situation.

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19th and R: In 2008 it seemed like President Obama was most in his element when he was speaking in front of SEIU or AFSCME or other union crowds. He really seemed to connect and enjoy speaking in front of them.

Now picture its 2012. EFCA has not been passed. Obama's labor nominees have been filibustered (see Becker, Craig) and Obama needs labors support and organizing to win. What does he say to those disappointed audiences? For all his campaign talk of supporting labor, can anyone name one area in which he has fought, actually fought, for an issue important to labor? I know it's only been a year but its been a pretty startling betrayal. Having worked for a union during and after the campaign I can certainly tell you labor thought things were going to be different. Your thoughts?

Ezra Klein: I think it's a good question. Obama should give them Becker as a recess appointment. he needs to do something for them.

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Austin, TX: Good morning, Ezra. Could you expand on the "tort reform will do virtually nothing" answer from above? I have read that, among states who have enacted tort reform, medical costs have not gone down, so I do think the studies bear out your point.

My question is more along the lines of, with the evidence that reform does do so little, why does it continue to be a GOP talking point? What do they hope to gain by passing tort reform?

Ezra Klein: Politically, the idea is that it harms trial lawyers, who are a big Democratic constituency. But more broadly, people just get into talking points. The public option was a lot more important than tort reform, but it also wasn't as big a deal as supporters implied. Policy debate is a lot messire thn CBO projections would suggest.

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New York NY: It seems that the House would give itself more leverage if it first passed the Senate HCR bill. I can't imagine the Nelsons and Landrieus of the world are going to want to keep their backroom deals in tact. You would think they would be highly motivated to pass a reconciliation bill to remove what has become a serious political liability. Based on your conversations, has House leaders even considered this in their political calculations?

Ezra Klein: Nope. I'm also not sure it's true. For Nelson and Landrieu, the damage has been done.

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Redmond, WA: If competition between insurers in the exchange would save some money, wouldn't it be better if more of us were in the exchange? I can't help but think so many people are against this bill because it does almost squat for people who get insurance through their jobs. Looking back at it now, should the Healthy Americans Act have been dismissed almost out of hand? I would have preferred single-payer, but I could go for Wyden-Bennett, too, because I think it does so much more. (I realize I'm way too late on this, though.)

Ezra Klein: Well, I certainly don't think Wyden-Bennett should have been dismissed out of hand. As for whether the bill would've received a better reception if it did more for most people, it's hard to say. On the one hand, a potent talking point was that it didn't change your basic insurance. The more changes you made, the more there was to scare people with.

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Madison, WI: I noticed from a previous post that you believe tort reform and elimination of state line barriers to purchasing health care will do little to control costs. Could you explain further? Also, why shouldn't Democrats incorporate these ideas in the health care bill? It would at least give the appearance of bipartisan efforts on the part of the Democrats would it not?

Ezra Klein: Not much to explain: Neither is a big factor in health-care costs. There is no evidence -- zero, non, zilch -- that even aggressive tort reform dramatically changes spending. The national savings would be a couple billion a year which is minimal in the context of our spending.

As for the bipartisan point, these pieces are already in the bills. They're compromised -- the state markets are opened to compacts between states and the tort reform is based around state pilot projects -- but they're there.

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competition between insurers in the exchange would save some money: Has this worked in MA with the connector?

Ezra Klein: Yep. The policies governed by the Connector have become far cheaper than pre-reform trends suggested.

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Houston, Texas: Hello Ezra. Have you considered that our health care system worked very well with lower costs before it became an insurance scam? Why don't we all cancel our health insurance policies and go back to dealing directly with our doctors? Now we have no idea how much medical procedures really cost. We need to eliminate the costly "middle man" to bring back capitalism to our broken system.

Ezra Klein: I think it's very difficult to compare the health-care system of 1904 or whatever with the health-care system of 2010. What costs money is not insurance or lawsuits. It's medical technology. It's stuff that we buy. And the central problem in the system, the one nobody knows how to solve, is it will eventually be the case that doctors have more things they can do to us to keep us healthy and alive than we can afford. So what do you do then?

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New York, NY: Ezra, you had a post in which you described the "6 Republican ideas" in the health care legislation. For each point, of course, there are qualifications that it is a compromise, making clear that none of these ideas meet the GOP ideal for what should be in a health care bill. Yet, in Rachel Maddow's show, she basically quoted Republicans verbatim and said those ideas are "in the bill!" Don't you think it is somewhat intellectually dishonest to make the leap that those things you mentioned are sufficiently similar to what conservative intellectuals have called for?

Ezra Klein: As I understand it, conservatives have some ideas and they want their ideas listened to and they understand that success in that process will be some form of compromise. That's what they've gotten. I think you could say, on tort reform, that that compromise is weak. But on purchasing across state lines and state innovation waivers and pooling and, for that matter, on the total victory of private insurance, those compromises are strong. Now, maybe conservatives don't want compromises at all, but then, they should have won the presidency and the Congress in the last two elections.

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Princeton, NJ: Wyden - Bennet preserves competitive private insurance companies. Most other countries had such a system, but could not get it to work just as competitive private fire depts failed in colonial America. They all switched to a universal government run system which works much better.

Can you show me any place where competitive private health insurance as been as efficient as what other countries have?

Ezra Klein: Actually, that's not quite right. A number of countries have, for lack of a better term, national private systems. The Netherlands and Switzerland both operate this way, and Germany uses a variant.

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Ezra Klein: Gotta end a bit early today, folks. Thanks!

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