Which hospital in the United States charges its patients the highest bills for common medical procedures? It turns out that the nation’s most expensive hospital is located in Bayonne, NJ, where you’ll pay nearly $100,000 dollars to treat your case of chronic lung disease — five times as much as what others hospitals charge for the same procedure.

Last week, the Center for Medicare and Medicaid Services (CMS) released first-of-its-kind data detailing the prices that hospitals charge for common procedures. The new numbers revealed that there’s a huge range of price fluctuations between different hospitals, with no good reason for why some places are charging so much more than others. Bayonne Medical Center topped the list, billing at a rate more than four times the national average for the 100 most common types of medical treatments.

Does that mean that, since patients at Bayonne are paying extremely well for their time in the hospital, they’re receiving particularly good care? Not really. The New York Times points out that Bayonne Medical Center ranks about average in terms of the quality of its care, no better or worse than most other hospitals in New Jersey. That fits into the broader national trends regarding health costs and health quality — spending more on care isn’t actually correlated with better treatment.

The Obama administration, which is encouraging greater price transparency in the health care industry as one of the central tenets of Obamacare, hopes that making hospital costs public could help encourage Americans to shop around. If New Jersey residents decide they’d rather not receive the particularly expensive care at Bayonne Medical, maybe they’ll decide to go to a different hospital in the area — and maybe that will force Bayonne to lower its prices to stay competitive.

But addressing the United States’ sky-high medical costs isn’t just about better educating patients. In fact, there’s evidence that teaching doctors more about the actual costs of the procedures they’re recommending can also help. Studies have shown that doctors are less likely to order unnecessary tests and procedures when they know how expensive they are. And, in order to further continue to cut down on wasteful medical spending, the U.S. needs to do more research on which specific types of health spending could be pared down without sacrificing the quality of Americans’ health care.

For the 37th time since 2011, House Republicans will hold a vote to repeal Obamacare on Thursday, bringing the total cost of all of their failed repeal votes to roughly $55 million in taxpayer money, according to one estimate.

Last year, CBS News calculated that the number of hours spent on 33 repeal votes — then roughly 80 hours, or two full work weeks — cost taxpayers an estimated $48 million. Since then, Republicans have held three more votes (another $4.5 million) and will add another $1.5 million with their latest.

At a time when lawmakers have implemented $85 billion in across-the-board cuts on top of $1.5 trillion in spending cuts over the next decade, no dollar can be spared. And the country has serious health-related needs that could use funding. Here are some better health care uses for the more than $50 million these symbolic votes against the Affordable Care Act have wasted:

1. Restore cuts from sequestration to Title X family planning programs and Title V maternal and child health services. The National Women’s Law Center calculates that a 5 percent cut to the budgets of each program will reduce them by $15 million and $32.5 million, respectively. Rather than voting to repeal a bill that expands women’s access to preventative services, the House could use the money to expand them.

2. Double the Department of Justice’s budget for sexual assault services, which has currently been authorized a $50 million budget. The program gives money to states so that they can support rape crisis centers and other nongovernmental organizations that provide direct intervention, core services, and other assistance to the victims of sexual assault. Current funding is inadequate, as some states receive less than $300,000 and many programs lack the resources to meet victims’ needs.

3. Grant a request for $50 million to train 5,000 new mental health professionals as part of a new initiative to expand mental health treatment and prevention services. This proposal came in the wake of the Sandy Hook shooting to address gaps in the mental health system.

4. Help states implement paid leave policies. President Obama included a $50 million State Paid Leave Fund in his 2011 budget to provide start-up support for states that want to enact paid leave for workers. More than 40 percent of workers don’t have access to paid sick leave, heading to work when they or their family members experience an illness, but this funding could help give them a better option.

The current Congress is on track to be the most unproductive since the 1940s, but still has time to hold votes that won’t result in actual legislative change. There are many other priorities lawmakers could focus on instead and better ways to spend taxpayer dollars.

Last week, House Majority Leader Eric Cantor (R-VA) promised to schedule the first full Obamacare repeal vote for this legislative session. That vote, which will likely come on Thursday, will give freshman Republicans in the 113th Congress the opportunity to cast their own purely symbolic vote against health care reform. It will also mark the 37th time that the GOP-controlled House has voted to get rid of the health law.

And, as the New York Times points out, House Republicans’ obsession with repealing Obamacare becomes even more apparent when the amount of time they’ve devoted to that issue is calculated as a percentage of the total time they’ve spent on the floor:

The repeal vote, which is likely to occur Thursday, will be at least the 43rd day since Republicans took over the House that they have devoted time to voting on the issue.

To put that in perspective, they have held votes on only 281 days since taking power in January 2011. (The House and Senate have pretty light legislative loads these days, typically voting only three or four days a week.)

That means that since 2011, Republicans have spent no less than 15 percent of their time on the House floor on repeal in some way. [...]

Michael Steel, [Speaker John Boehner's spokesman], said that spending 15 percent of their time on the issue was hardly a waste for Republicans. “Given that the bill amounts to a takeover of roughly 15 percent of the American economy,” he said, “that sounds about right.”

By some earlier estimations, Republicans in the 112th Congress wasted about 90 hours and $50 million dollars on their multiple failed efforts to get rid of the health reform law. This new Congress is shaping up to be no different. Even though Republicans have admitted they have lost on Obamacare, and are even acknowledging that their future repeal efforts will fail, they have continued to block legislative efforts to amend the health reform law in favor of stubbornly opposing it altogether.

The House conservatives who are focused on pushing the leadership further to the right have been particularly intent on scheduling a full Obamacare repeal vote this session. “It’s something that we wanted to move up on the list of priorities,” Rep. Steve Scalise (R-LA) told the New York Times. “And I’m glad they listened to us.”

Successfully repealing Obamacare would put more than 30 million Americans’ health coverage at risk, as well as increase the national deficit by billions. It would also ignore the opinion of the majority of the American public, who think that implementing Obamacare should be a top priority in their state. At this point, now that the bulk of the health law has already gone into place, most Americans aren’t interested in defunding it or repealing it altogether — they would rather tweak it to make it better.

One of the most important ongoing stories in the realm of budgets and health care economics is the remarkable drop in how much health care costs are projected to grow over the next decade. Back in March, David Cutler and Nikhil Sahni released some preliminary work arguing that, thanks to this slowdown, projections of government spending on health care for the next decade were overshooting by hundreds of billions of dollars. Now they’ve released a more complete paper (gated) with a specific number: if the lower growth rate continues, the federal government could save $770 billion by 2021. Furthermore, Cutler and Sahni concluded that as much as 55 percent of the slowdown has been driven by factors other than the recession.

That last point is especially important. If the slowdown in growth is due to the recession, then it’s temporary. Health care costs will once again rise at their previous rate once the economy recovers, driving health-related spending to ever greater heights and further straining the budgets of both the government and American families. But if the slowdown is due to deeper, structural changes in health care markets, then at least some portion of the slowdown may be long-term. And the government’s projections of future debt and deficits rely heavily on those previous assumptions of high health care cost growth. So if the slowdown sticks, the outlook for America’s fiscal future could improve radically, all without lawmakers cutting a dime.

Here’s Bloomberg with a nice summary:

Cutler’s research compared the U.S. government’s growth projections for health spending from 2004 to 2012 with actual increases in the period. It found that the real growth rate was about half of the government’s prediction, leading to a gap of more than $500 billion in 2012 between the projections and spending.

The paper calculates that the recession accounted for about 37 percent of the slowdown in health costs from 2003 to 2011. Declining private insurance coverage and cuts in payments byMedicare, (USBOMDCR)the government health plan for the elderly and disabled, accounted for another 8 percent and the remaining 55 percent is “unexplained,” Cutler wrote. That’s where the structural changes come in, he said.

If the current lower-than-expected rate of growth continues, the country may reap savings of as much as $770 billion through 2021, the research found.

As always, there’s a lot of uncertainty built in here. Another recent study by Kaiser, for instance, suggested that as much as 77 percent of the slowdown is a temporary result of the recession. Also, there’s a lot of complexity in the category of “structural” changes. Some of it’s improvements in the efficiency of health care delivery, quite possibly thanks to reforms in Obamacare that encourage providers to change the way they do business. Other parts of it may be one-time shifts in the market, such as the rise of generic drugs to replace more high-cost brand-name medicines.

The broader point, however, is that there are more ways to balance the budget than just slashing the aid and benefits Americans need to buy. A better-designed health care system could very well deliver lower and more efficient government spending than austerity ever could.

The Center for Medicare and Medicaid Services (CMS) released highly-anticipated data on Wednesday that outlines what hospitals across America charge for common inpatient medical services. The takeaway from the new numbers? There is no rhyme or reason to what different hospitals charge for the same procedures across geographic regions (or even within the same region), and prices can fluctuate by over $100,000 in the most extreme cases.

The CMS data is comprised of charge records from over 3,300 hospitals spanning 306 localities, and detail the costs of many of the most common inpatient procedures, such as treatments for heart failure, chest pain, respiratory infections, and lower limb replacements. The Huffington Post has a helpful graphic mapping the prices that hospitals throughout the New York and New Jersey areas charge patients for treating chronic obstructive pulmonary disease (COPD), which helps illustrate just how significant the disparities can be:

These numbers confirm a recent Time Magazine investigative report that found much of the same trend throughout the U.S. And the biggest victims of this rampant price variation — and apparent price-gouging — are the poor, the uninsured, and the underinsured. Public entitlements such as Medicare are relatively protected, since the government has the power to negotiate blanket prices and reimbursement rates for specific services. But private insurers — and, of course, the uninsured — don’t have that same capacity, making them subject to the whims of the hospitals they do business with. In essence, that means that poor people’s medical and financial stability are left up to pure luck, dependent on whether or not the hospital they visit charges reasonable rates.

As Obama Administration officials explained, there isn’t any feasible economic reason for this cost variation — and reformers are hoping that the publication of the data will shame hospitals into changing these practices and acting in good faith:

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Medicaid gets a bad rap from a lot of conservatives for poor access to health care and poor health outcomes. It’s one of the main arguments in favor of schemes to cut Medicaid funding and block grant it to the states, on the grounds it will promote efficiency and innovation in the program.

But a new study in the Journal of General Internal Medicine found that when you compare the proper groups, Medicaid actually does a better job delivering access and affordable coverage than either private coverage or Medicare.

As Aaron Carrol summed up at the Incidental Economist, the study focused on the underinsured — that is, people on insurance plans that just aren’t very good — rather than those who have no insurance. More importantly, it only looked at people at or below 125 percent of the poverty line. That’s important because the problem with the studies showing Medicaid delivering inferior results to private coverage is that it’s difficult for their comparisons to avoid the apples-to-oranges problem. Medicaid is meant for poorer Americans — you have to be below a certain income threshold to qualify for it — but private coverage is available to the poor and well-off alike. It’s a matter of basic economic logic that the private plans only the well-off can afford will will provide much better access and quality care then the plans the poor can afford as well. Products poor people can afford tend to be poor products.

That’s why safety net programs like Medicaid, which provide people more assistance than they could afford in a pure free market world, are so important. And why, when the proper apples-to-apples comparison is made between poor people on private insurance and poor people on Medicaid, the latter’s performance improves remarkably:

For the purposes of this study, underinsurance was defined as (1) having out-of-pocket expenses that were more than 5% of household income, (2) delaying or failing to get needed medical care because of cost, or (3) delaying or failing to get needed medications because of cost. This study specifically looked at adults who had full-year continuous coverage in some form, but had an income less than 125% of the poverty line. They specifically wanted to know how many of those people were still underinsured.

They found that more than a third of these adults were underinsured. What’s more is what kind of insurance left people underinsured. More than 65% of those people on Medicare were underinsured. More than 37% of people with private insurance were underinsured. But only 26% of people on Medicaid were underinsured. People who were underinsured were more likely to be White, in poor health, and unemployed. Even after adjusting for these factors, those on Medicaid were significantly less likely to be underinsured than those on private insurance (odds ratio 0.22).

The gap between Medicaid and Medicare, meanwhile, is most likely due to Medicare’s higher co-pays and other forms of cost-sharing. While this generally won’t be a problem for seniors in the middle class and up, it can be difficult for poor seniors to meet their share of the costs.

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Despite the fact that Obamacare has been in place for over three years at this point, a lot of Americans still remain confused about the specific nature of the health reform law. Last month, a Kaiser Health poll revealed that many Americans still can’t correctly identify Obamacare’s provisions. Now, Kaiser’s most recent polling finds that 42 percent of Americans aren’t sure about whether Obamacare is law at all. Seven percent of survey respondents believed the Supreme Court overturned it, and 12 percent thought Congress had repealed it:

Of course, now that Obamacare has survived a Supreme Court challenge, dozens of repeal efforts, and a presidential election, even Speaker John Boehner (R-OH) has admitted that it’s the “law of the land.” Nonetheless, as administration officials prepare for the full implementation of the law and ready the state-level insurance markets to open in 2014, they still have a long way to go when it comes to fully educating the American public about it.

Kaiser found that Americans’ education gaps fall along class lines, as wealthier Americans are more likely to have heard something about health care reform from newspapers, radio, or online sources. Just 30 percent of those with lower incomes reported that they had received information about Obamacare from those sources. That’s especially problematic because many low-income Americans stand to significantly benefit from the health law, as they will become eligible for federal assistance to help them afford insurance coverage on the state marketplaces. Still, 58 percent of uninsured Americans and 56 percent of low-income Americans told Kaiser that they don’t know how Obamacare will impact their lives.

The good news, as Wonkblog’s Sarah Kliff points out, is that there’s still some time to change the tide. Obamacare’s new health care options still won’t be available for another seven months, and some health care advocates point out that it might be confusing to tout a product that isn’t accessible yet. This summer, the nonprofit Enroll America — which hopes to increase public awareness about the impending health reform benefits — will ramp up its campaign to try to reach those four in ten Americans who still remain confused.

As Obamacare continues to take effect, and states across the country prepare to launch their health insurance marketplaces by 2014, Americans will soon be able to receive tax subsidies to help them afford their health care plans. That represents one of the health law’s most important initiatives to help ensure that everyone has access to insurance. And, according to a new study from the health care advocacy group Families USA, it’s a provision that will mainly help America’s working poor and middle class.

The Americans whose annual incomes fall between 138 percent and 400 percent of the federal poverty level — which translates to single adults earning less than $46,000 and families of four earning less than $94,000 — will be eligible for Obamacare’s subsidies. Families USA crunched the numbers to find that means about 25.7 million people will soon be able to better afford the high cost of health care. And the vast majority of those people are working Americans, who have tended to struggle to get by in the face of growing income inequality since the Great Recession:

“This reaches deeply into the middle class, as well as moderate-income families,” said Ron Pollack, founding executive director of Families USA, which released the national report. “This is a group that’s really deserving of priority help.” [...]

Most Americans, Pollack said, don’t know how the exchanges will work or that they are eligible for financial help to pay for insurance. That’s why Families USA released the report, he said.

The report shows that families that make between $47,000 and $94,000 will receive half the money, that 88% of the credits will go to working families, and that those up to the age of 36 are most likely to be eligible. Families USA did not include people who fall below 138% of the poverty line because, in the states that will expand Medicaid, they will not need subsidies.

As everyday Americans have struggled to get back on their feet after the economic downturn, the American Recovery and Reinvestment Act — colloquially known as the stimulus — went a long way toward helping lower- and middle-class families regain stability. As Families USA’s new report illustrates, the health care reform law is another federal policy that holds promise for that sector of the population as the country continues to slowly make its way toward recovery.

That’s especially true considering that the cost of health insurance plans has skyrocketed at the same time as American workers’ wages have stagnated. That means low-income Americans are increasingly delaying the health care they need because they can’t afford it. For example, poorer Americans are twice as likely as the people at higher income levels to skip out on their medication to save money. Thanks to Obamacare, many of those Americans will no longer be forced to prioritize their other bills over their health care.

But, as Pollack points out, the majority of the general public still doesn’t realize exactly how the state-level marketplaces will work or how this particular Obamacare provision will directly benefit their families. That fits into the larger national trend about Americans’ persistent misperpections about the benefits of health care reform. Health care advocates point out that there’s still a long way to go when it comes to educating Americans about what the Affordable Care Act actually does for them — thanks, in large part, to the politicized misinformation campaign that has been waged against it over the past three years.

As medical costs continue to soar, the prices for health care services have been rising across the entire industry. That’s especially true for hospital care, where an average trip to the ER costs 40 percent more than what most Americans spend on their monthly rent. Partly because doctors often don’t know the cost of the tests and procedures they’re recommending, hospitals can rack up massive profits for the services they provide — even, as it turns out, when they end up going wrong.

Even when hospitals make surgical mistakes, they still profit off of those botched surgeries, according to the results from a new study published in the Journal of the American Medical Association (JAMA). The researchers, who analyzed over 30,000 surgical procedures that took place at a 12-hospital chain in the South, found that hospitals actually profit even more off of their mistakes than they do when their surgeries go smoothly. Hospitals make about $30,000 more from the patients whose procedures result in at least one complication than they do from patients who don’t have any issues. Their profit margins tripled for privately insured people who experienced surgical complications, and doubled for Medicare patients.

“Policy makers talk about pay-for-performance, but instead Medicare and private payers are rewarding hospitals for complications,” Barry Rosenberg, one of the study’s co-authors, pointed out. “The U.S. healthcare system is paying for harm.”

How could our health care system possibly be rewarding errors so handsomely? It’s because complications resulting from surgery often necessitate follow-up care and a longer hospital stay. Of the more than more than the ones that resulted in complications forced those patients to stay in the hospital for triple the amount of time. So, when hospitals have to provide additional services resulting from one of their own mistakes, they end up being able to collect more from private insurers and the Medicare program.

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The Senate plans to begin considering the Democratic-sponsored budget resolution on Friday or Saturday, including the slew of amendments that Republican senators have tacked onto the legislation. Since budget amendments only need a simple majority to pass, GOP lawmakers have seized the opportunity to push their agenda by rushing to file hundreds of them — including several that would dismantle Obamacare.

Here are just some of the amendments that seek to undermine the implementation of the law, just as advocates prepare to celebrate its third anniversary:

REPEAL OBAMACARE: Tea Party favorite Sen. Ted Cruz (R-TX) cuts to the chase with Amendment #202, which would “establish a deficit-neutral reserve fund to provide for the repeal of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.”

PREVENT ANY NEW OBAMACARE SPENDING: Amendment #285, introduced by Sen. Robert Wicker (R-MS), wouldn’t repeal the health law outright — but it would “provide for the repeal of new spending under the Patient Protection and Affordable Care Act.”

REPEAL OBAMACARE’S FUNDING SOURCES: Several amendments seek to undermine Obamacare by preventing it from being able to use new revenue to carry out its health reform provisions. Sen. Mike Crapo (R-ID)’s Amendment #222 would “repeal the tax increases enacted under the Patient Protection and Affordable Care Act that were imposed on low- and middle-income Americans,” and Sen. Dan Coats (R-ID)’s Amendment #194 would “repeal the 3.8 percent tax on investment income imposed by the Patient Protection and Affordable Care Act.”

DELAY OBAMACARE’S IMPLEMENTATION: The health reform law’s implementation is marching forward across the country, but Sen. Richard Burr (R-NC) wants to halt that progress. His Amendment #357 seeks to “delay implementation of the President’s health care law for 2 years.”

INHIBIT MEDICAID EXPANSION: Sen. Tom Coburn (R-OK)’s Amendment #408 would “reduce the federal matching rate for Medicaid expansions,” which could threaten funding for the provision and dissuade states from opting to expand their Medicaid pools. Even though federal funding for Obamacare’s optional Medicaid expansion is not currently in question, Coburn also wants to “prevent the federal government from making an unrealistic promise to States to fund any State’s expansion of the Medicaid program at a higher level of federal reimbursement.”

ELIMINATE HEALTH INSURANCE SUBSIDIES: Two different amendments — #326 from Sen. Lindsay Graham (R-SC) and #417 from Sen. Coburn — seek to eliminate some of the subsidies that help ensure Americans can afford to purchase health care on the state-wide insurance marketplaces. Obamacare allows Americans with incomes up to 400 percent of the federal poverty level to receive some assistance to buy health insurance, but Graham and Coburn want to lower that cut-off to 300 percent.

UNDERMINE PUBLIC EDUCATION ABOUT HEALTH REFORM: Many Americans still have significant misperceptions about what’s included in Obamacare, but Sen. Pat Roberts (R-KS) doesn’t want those to be cleared up anytime soon. Roberts introduced Amendment #187 to “prohibit the use of funds for promotional or marketing materials promoting the Patient Protection and Affordable Care Act.”

Republicans have tried to repeal all or parts of the Affordable Care Act at least 54 times since its enactment.