CBO: Government's Innovative Health Savings Programs Don't Work


No, not *that* kind of pilot program.

Back in March, Health and Human Services Secretary Kathleen Sebelius showed up in Politico touting a whole bunch of reasons why Americans should feel just dandy about last year's health care overhaul. None of them were terribly convincing, however, in particular her insistence that health care cost growth could be restrained through ever-better technocratic management of the health care sector. "As part of the health care law," she wrote, "we have invested in preventive care, and innovative programs aimed at slowing that growth of premiums. By testing and implementing new ideas to coordinate care, improve patient safety, and reduce waste, fraud and abuse, the law will create additional savings for decades to come."

As I wrote at the time, there's never been much reason to believe that those "innovative programs" she brags about would be very effective. Now there's even less reason: The Congressional Budget Office is readying a report essentially saying that all those fancy pilot programs Sebelius is so proud of don't work very well, 

From a joint Fiscal Times/Kaiser Health News report by Merrill Goozner:

A forthcoming report from the Congressional Budget Office shows that more than two dozen demonstrations projects launched by Medicare and Medicaid over the past decade have failed to stop the upward march of health care costs, CBO director Doug Elmendorf said Tuesday.

…Elmendorf defended CBO's projections that delivery system reforms like the accountable care organizations allowed under reform would only save a few billion dollars in the coming decade. "The demonstration projects that Medicare has done in this and other areas are often disappointing," he said. "It turns out to be pretty hard to take ideas that seem to work in certain contexts and proliferate that throughout the health care system. The results are discouraging."

There's already a fair amount of evidence that Medicare pilot programs haven't worked very well, with innovations frequently proving tougher to scale or replicate than expected. And the law's overly prescriptive approach to accountable care organizations—another of the law's frequently touted delivery system reforms—has turned out to be so off-putting that a number of the highly integrated providers who inspired the idea have said they won't participate in the program as it currently exists

Even still, this is a major blow to the foundation of ObamaCare's promises to rein in health spending and keep premium prices from rising as fast as otherwise projected. Those savings are largely premised on the notion than empowered, independent health policy experts can identify successful delivery-system innovations, then copy them throughout the system, thus saving lots of money without any sort of explicit rationing or reducing the quality of care. What the CBO is now confirming is that when the government has tried this approach in the past, it's rarely worked. 

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  1. Has anyone here ever been able to sit through all of Top Gun without reaching for a bottle of cyanide?

    That is all.

    1. Has anyone here ever been able to sit through any movie starring Tom Cruise without wanting to throw him in a volcano? Either whole or in chunks?

      1. I generally avoid Tom Cruise films but he was great in ‘Magnolia’ as Frank TJ Mackey.

        I give PT Anderson all the credit.

        1. Me too. Ever notice how much he looked like DeNiro in “Heat?” Same suit, same hair, same goatee, same shooting technique.

        2. Collateral was good, and Cruise was good in it. Ditto Tropic Thunder

        3. agreed – this was on just a couple weeks ago – well cast, and he didn’t “just show up”

          1. I think Cruise is only as good as his costars, as Tropic Thunder, A Few Good Men and Collateral all show.

      2. Re: Aresen,

        Has anyone here ever been able to sit through any movie starring Tom Cruise without wanting to throw him in a volcano?

        I was taken hostage and made to watch “Legend” once…

        1. I can sympathize with the horror of the situation, but did you or did you not want to throw Tom Cruise into a volcano. [Given his espousal of Scientology, it seems an appropriate way to dispose of him.]

        2. “I was taken hostage and made to watch “Legend” once…”

          You mean you woman made you watch it with her. NTTAWWT. I’ve watched some pretty bad flicks in the name of pussy myself.

    2. Dunno about the cyanide, but it’s definitely the most just-beneath-the-surface gay movie of all time.

    3. When I was eight.

    4. He wasn’t the problem in Minority Report.

      1. That was almost a decent movie.

        I thought he was okay in Valkyrie, and, of course, Risky Business was good, though I’d credit Curtis Armstrong and Rebecca De Mornay more than Tom Cruise.

        1. Yeah, I totes forgot about Valkyrie. Not enough Kenneth Branaugh or Eddie Izzard, but Tom Cruise was pretty good.

          1. More Kenneth Branagh is usually a good thing. Speaking of Branagh Nazis, ever see Conspiracy?

            1. I did. I have to confess that I don’t recall much beyond Stanley Tucci burning the guest book pages.

              1. Branagh got the Nazis to all agree to kill all the Jews.

    5. Thank you for participating in my sociological experiment.

      I go now.

  2. Obama and the Democrats have so thoroughly screwed up the economy (Team Red helped some too!) that there’s no way ObamaCare will last that long. Any reforms Congress makes to restrain spending and the deficit will have to include ObamaCare. The numbers are going to get worse and worse each year so there’s no way in hell there won’t be major reforms coming soon.

    1. “Reforms” = higher taxes.

  3. “to reign in” = to rule a place
    “to rein in” = to pull back or control
    “to rain in” = to experience precipitation

    /usage nazi.

    1. “to Ronin” – to be Robert DeNiro.

      1. …speaking of awesome movies.

        But who did the “driving the wrong way on the freeway” chase first. To Live and Die in LA ?

        1. “To Live and Die in LA”

          Now THERE’S an underrated movie. Skinny, young William Peterson, and Willem Dafoe is always good as a bad guy. When Peterson gets it in the face with the shotgun, that’s almost as surprising as DiCaprio getting it in “The Departed”

          1. one of my favorite flicks, but I also liked Friedkin’s Sorcerer.

            1. I agree, one of the most underappreciated movies of all time. Classic 80’s film. Full frontal of a young William Peterson and pretty impressive in that regard.

            2. And Sorcerer was great too. Had the misfortune of opening the same weekend as Star Wars. The Tangerine Dream score is classic.

        2. Oh, and “who did the “driving the wrong way on the freeway” chase first”?

          Charlie Chaplin

          1. Harold Lloyd?

            1. Buster Keaton?

          2. love to see a link

    2. “To Ring in” – to cast the Ring into Mount Doom instead of putting it on and challenging Sauron for rule over Middle Earth.

    3. The problem isn’t that there are too many homophones for “rain,” the problem is that there are too few!

  4. We are on the Highway to the Danger Zone

  5. Because we were inverted.

    1. *does that weird “Iceman” Val Kilmer chomping the teeth move toward OM*

      Really – what the fuck was that move with the teeth, Kilmer?

      1. He was trying to chew his way out of the script.

  6. Simply stated, we will not stand idly by as CBO and H&R blame their premium hikes …

    1. “OK. yer ugly, too.”

  7. Slow down, there, hoss.

    Are you telling me that a top-down micromanagement of a large, complex system is doomed to failure?

    1. Let me be clear.

      Bottoms up!

      1. AGAIN!?

        1. Let me be clear. (Hee-hee!)

          “Let’s move!”

    2. Fuck you!!! Is not!

  8. You can see program bloat at a smaller scale in the company I work for.

    Ten years ago, we had a small quality department. Now we have a large Lean and an even larger QA department, both which consume large amounts of resources and money.

    Every year we can continue to push to reduce scrap and cut overall costs, but it never quite works out as well as anticipated – especially since no department is truly held accountable if costs start to rise.

    Instead the solution involves yet more meetings and more QA hires. It’s a drag on production.

    One of our divisions makes heavy trucks and has a minimal quality department. Somehow they’ve managed to grow in size where their profit is greater than the other divisions combined. They fire people who don’t perform.

    1. “They fire people who don’t perform.”

      By which you mean you chase them down in homemade death racers and impale them with pneumatic crossbows?

      1. It would be good sport.

        1. There’s a reason that Death Race was the most popular sport in America, back in 2000, until steroids destroyed it.

      2. By which you mean you chase them down in homemade death racers and impale them with pneumatic crossbows?

        You know I had been considering a transfer to Human Resources…..

  9. I suppose that when the policies fail, the people will just start faking the results, like the Atlanta school system.

    1. The Bernank is figuring out how to fake good economix results. He’s finding it more difficult than faking schoolkids’ grades.

      Keep at it, The Bernank! Like Libertopia, success for you is “just around the next corner!”

  10. “Government’s Innovative Health Savings Programs Don’t Work”

    You shut up!

    1. Oh, yeah? Who’s gonna make m

  11. OH! Almost forgot – EXCELLENT alt text for the EXCELLENT picture selection, Suderman. The Gobbler must be proud right now!

    1. I don’t get what you are saying. All I remember about Gobby is “Hello Shit Facktory” and he has a gay sister (NTTAWWT).

      1. When they used to post the Top-5 most-read articles (or something) each week, Gobby lived and died with whether Suderman made it. It got to the point where I was afraid Gobbler would commit suicide if Peter didn’t make the list – he seemed so morose.

        If PS made the list, it was always, “Way to go, kiddo!” The Gobbler

  12. I have posted this already here before You guys should stop complaining because, one the health care we have now isn’t as good as it was supposed to be. also the law has just been signed so give it some time. so if u want to say u have the right to choose tell that to ur congress men or state official. If you do not have insurance and need one You can find full medical coverage at the lowest price check search online for “Penny Health Insurance” If you have health insurance and do not care about cost just be happy about it and believe me you are not going to loose anything!

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