Austin Frakt suggests that some progressives — including this blog — may have been too quick to dismiss the Rivlin/Domenici “premium support” proposal that Republicans on the super committee are now advancing as a viable compromise to the Medicare privatization plan contained in the GOP budget. Rivlin/Domenici would provide seniors with “premium support” vouchers that they could spend on traditional fee-for-service Medicare or a private health insurance plan that would be required to offer Medicare benefits. Medicare and private health insurers would compete for beneficiaries by offering bids for a defined benefit, which the government would then convert into a “premium support” based on the second lowest bid in each geographic area. Seniors would enroll in a low-bid plan — whose costs can be fully covered by the premium support — or select a more expensive policy and pay the difference between the bid and the “premium support.”

Some progressives argue that Medicare would lose that competition because healthier beneficiaries would join private plans, causing costs to increase in the traditional fee-for-service program. Frakt disagrees:

With network adequacy in place and prices dropping below private plans to an increasing extent, traditional Medicare may perform well under competitive bidding. Why are so many seeming to lack confidence that the program can compete? After all, look at what’s going on today. Private plans are at a tremendous advantage and have been for many years. They receive per beneficiary subsidies way above the average cost of traditional Medicare. They offer many additional benefits and many plans offer lower premiums and cost sharing relative to traditional Medicare. Still, traditional Medicare retains 75% of the market. Competitive bidding would reduce the overpayments to Medicare Advantage plans, reducing the advantage they have in the market today.

Thus, I think there is a chance traditional Medicare would do just fine under competitive bidding. It might even thrive. This is, admittedly, speculative, and it depends, in part, on what Congress allows the plan to do, which depends on how any competitive bidding statute is written (if ever). The devil, as always, is in the details.

Setting aside the beneficiary cap in Rivlin/Domenici — the premium support grows at GDP plus 1 percent and does not keep up with actual health care spending — I would probably be more enthusiastic about competitive bidding between Medicare and private insurance if it was truly possible to limit adverse selection and both parties competed on an equal playing field (and were required to offer not just the same benefits, but also the same scope of benefits so as to prohibit insurers from dialing up healthy people benefits and dialing down those services that are used by the sick). But I have a sneaking suspicion that insurers and the lawmakers who they work with would oppose this kind of “pure” competitive bidding structure because they’re more interested in privatizing Medicare and lowering federal spending on the program than actually tackling national health care spending. And in that case, this would turn into a cost shift to seniors, rather than a sensible way to reform the program.

Michigan Republicans have seized on a bogus story about abandoned fetal remains to push through a bill that callously disregards the feelings of women who have to abort wanted pregnancies for medical reasons.

RH Reality Check explains that here was never any proof to support an anti-abortion activist’s claim of finding fetal remains in an abortion clinic’s dumpster, but the anti-abortion lobby has nevertheless used the story as an excuse to propose an unprecedented bill about the disposal of fetuses.

Laura Berman of the Detroit News reports that as a result of the bill, one of the first questions hospitals may ask women who have just miscarried or had still births is “what do you want to do with the fetus?”:

In the wake of an Eaton County abortion clinic’s Dumpster scandal, the state Senate passed a package of bills Oct. 20 to ensure the “dignified disposition of fetal remains.” But if the bills would treat fetuses with newfound dignity, they don’t extend the same compassion to those especially vulnerable women who have lost pregnancies in clinics and hospitals. [...]

“I think some women will be devastated,” says Joanne Mulhere, who counsels women undergoing loss of pregnancies at Beaumont Hospital in Royal Oak, where about 175 women lose pregnancies through miscarriage or stillbirth annually. Patients would be handed Kleenex, as well as a form to sign, requesting the remains be cremated, buried or interred. [...]

It’s a “choice” that effectively reframes the way women are supposed to think about early pregnancy, imposing new opportunities for grief where none might have existed.

State Sen. Rebekah Warren (D) of Ann Arbor notes that “This would be the first time in Michigan law that a fetus, or fetal remains, would be classified as a dead body at 10 weeks. That’s the most stunning piece of it.”

The bill is likely to pass, either this year or next. Anti-choicers may relish the idea of tormenting women who have had abortions with graphic reminders of their “crime,” but they have no problem traumatizing couples who have just lost pregnancies in the process.

Berman sums it up: “Unfortunately, Michigan legislators have crafted a bill that’s more sensitive to the needs of tissue that fits in a tablespoon than to grown women who, at vulnerable moments, will face a new form to sign, an unsought, disturbing decision to make.”

Michele Bachmann prides herself for pressing Republicans to repeal the Affordable Care Act, but during an appearance at Webster City, Iowa Wednesday night, the Minnesota congresswoman proved that she’s also leading the charge in developing outrageous new attacks against the legislation. At the town hall, Bachmann complained that undocumented immigrants are exempt from paying for the law, claimed that a seven-foot doctor told her the IRS had to approve medical procedures, and reiterated her long-standing view that doctors and hospitals would provide free care to the uninsured if they were shielded from malpractice claims:

– “Under Obamacare illegal aliens don’t have to pay for Obamacare. Only American citizens pay for Obamacare. [...] Illegal aliens have the possibility of getting the care, but they have no requirement to pay for the care. Only the citizens do.”

– “One man stood up, he was over 7-feet tall. He was a physician in the community. And he said, ‘I had a little lady in my office and because of Obamacare, I had to call the IRS and I had to get a number to put on a form before I could see her.’”

– “When I was a little girl…There were people who could not pay [for health care]. I mean they just did not have any money at all. And so the doctor would just write it off. [...] It’s very different today. Now, doctors don’t feel like they can do that…they worry about liability.”

Watch it:

It’s hard to make sense of any of Bachmann’s claims. Republicans successfully fought to keep undocumented immigrants from receiving tax credits through the exchanges and the ACA does nothing to change the existing Reagan-era law that requires hospitals to provide health care to everyone in need of emergency services. Undocumented immigrants also paid $11.2 billion in taxes in 2010, including $8.4 billion in sales taxes, $1.6 billion in property taxes, and $1.2 billion in personal income taxes.

The seven-foot doctor’s claims are similarly dubious, since the IRS does not begin enforcing the individual requirement to purchase health insurance until 2014 — and even then, the penalty is processed through personal income tax returns and would not require a medical provider to call the agency. Finally, Bachmann’s oft-repeated solution to reducing the number of uninsured — shield doctors from lawsuits and they’ll provide free health care to anyone who needs it — is a poor idea, to put it charitably, and hasn’t actually increased access to providers in states with existing “liability shield” regulations.

The new S&P Healthcare Economic Index shows that Medicare costs increased at an all time low of 1.97 percent, while commercial insurers saw growth of 8 percent over the 12-months ending September 2011:

“As we enter the fall, we continue to see the summer trends of a deceleration in the annual growth rates of Medicare costs, while those of commercial costs continue to moderately accelerate” says David M. Blitzer, Chairman of the Index Committee at S&P Indices. “The Composite Index posted an annual rate of +5.75%, the Commercial Index +8.03% and the Medicare Index +1.97%. With September’s data, both the Composite and Commercial Indices posted five consecutive months of accelerating annual growth rates. “The three Medicare and the Professional Services indices saw a deceleration in their annual growth rates in September 2011; all other headline indices saw their annual rates increase. The Professional Services Index rate was +5.78%, down 0.05 percentage points from its August rate. The Medicare index was up 1.97%, which is not only a new low in this series’ almost seven-year history, but is now less than one fourth the +8.02% high rate it posted in November 2009. The Economic Hospital Medicare index posted a new low annual growth rate of +0.71%, well below its August 2009 highest rate of +8.30%.

Look:

Last month, HHS announced that the annual increases in premiums for seniors in Medicare Part B will be somewhat lower than expected and attributed the change to “historically low healthcare utilization rates, due in part to the health reform law’s investment in prevention; and the 3.6 percent Social Security cost-of-living hike announced earlier this month.” Comparatively, premiums in employer-sponsored health insurance market increased more than expected — by 9 percent — despite the historically low utilization rates (a result of the recession). As Austin Frakt has explained, the causes of premium changes are somewhat complex, but it makes one wonder about the wisdom of the GOP’s plan to shift seniors from Medicare into private coverage. At the very least, this comparison isn’t very flattering for private insurers or their abilities to control health care spending.

Over at Mother Jones, David Corn discovers that like the Newt Gingrich of three years ago, the former speaker’s for-profit think tank, the Center for Health Transformation (CHT), also promotes the individual health insurance mandate:

Gingrich first backed the concept in 1993, “I am for people, individuals — exactly like automobile insurance — individuals having health insurance and being required to have health insurance,” he said on Meet the Press. He supported the idea in 2007 — writing in a Des Moines Register op-ed, “Personal responsibility extends to the purchase of health insurance. Citizens should not be able to cheat their neighbors by not buying insurance” — and again in 2008: “Finally, we should insist that everyone above a certain level buy coverage (or, if they are opposed to insurance, post a bond).”

Romney himself pointed this out in a debate, saying, “Actually Newt, we got the idea of the individual mandate from you…and the Heritage Foundation.” “I absolutely did work with the Heritage Foundation against Hillarycare,” Gingrich conceded.

CHT also works with business groups that may benefit from the mandate. As Lee Fang has reported, CHT serves approximately 94 health industry corporations and lobby groups, including health insurance (BlueCross BlueShield Association, WellPoint, AHIP, UnitedHealth), health IT (L-3 Enterprise, Microsoft, IBM), and pharmaceutical companies — with each paying up to $200,000 annually.

Health insurance premiums for employer-sponsored coverage increased by 50 percent from 2003 to 2010 and will “rise 72 percent by 2020, to nearly $24,000″ if Congress repeals the Affordable Care Act, a new report from the Commonwealth Fund concludes. Over the last seven years, premiums outpaced income growth in every state, as employees contributed an ever growing share towards coverage that became less protective over time with higher per-person deductibles and out of pocket expenses:

But several provisions in the Affordable Care Act — including new restrictions on insurer administrative costs, state and federal review of premium increases, payment incentives, and delivery reform changes — could reverse this tend and reduce national costs by “an average of 1 to 1.5 percentage points per year over the next decade,” Commonwealth projects, saving families between $2,161 and $3,173 annually by 2020: