Impeding changes to our Health Care system

[classicman]

Seemingly Partisan Op-ed opinion piece....

A study from the Medicare Payment Advisory Commission found that the average Advantage plan costs the government 13 to 17 percent more than conventional fee-for-service Medicare. That would seem to make the Advantage program a good target for cost-cutting.

Yet, much of that additional expense goes directly toward providing Advantage enrollees with better benefits, which results in better outcomes. A 2004 review conducted by America's Health Insurance Plans found that Advantage outperformed traditional Medicare in several key quality indicators, including annual flu vaccinations, diabetes testing, and breast cancer screenings. Researchers also found that Advantage enrollees were screened and diagnosed earlier for deadly diseases like cervical cancer, colon cancer, and melanoma.

Not only does Medicare Advantage deliver superior outcomes, it also helps keep health-care costs for other patients lower than they would be if all seniors were consigned to fee-for-service Medicare.

How so? Conventional Medicare reimburses health-care providers much less than it actually costs to treat a patient. In California, for instance, Medicare only pays about 74 cents for every dollar in hospital costs.

So providers often lose money on each Medicare patient they treat. To compensate, they charge privately insured patients more. In fact, Medicare underpayments cause privately insured Americans to pay $49 billion more each year than they would if Medicare paid private-market rates. This "hidden tax" is four times greater than the alleged over-payments to Medicare Advantage plans. By driving more seniors into traditional fee-for-service Medicare, the government will significantly increase this hidden tax.

It will also reduce seniors' access to care. Low reimbursement rates have already caused doctors to stop accepting Medicare patients. According to a 2008 survey, 36 percent of doctors report that Medicare payments do not cover the cost of providing care. A full 12 percent of those surveyed said that they'd closed their practices to new Medicare patients.

Link

This seems like a rational rationale though. I am curious - what happens if this trend continues? If it is a trend. Is there some way to curb the # of providers from not accepting medicare patients? Can we link the care provided through insurance to only those providers who also accept Medicare or something?

Again, I realize this is only a commentary on a certain aspect of the bill, but . . .

[SamIam]

I don't know about Doc's charging more to patients with regular health care than they do Medicare/Medicaid patients. I have heard of sliding scales based on what you are able to pay. I see this more in rural clinics whose purpose is to provide care for folks far away from any other medical care. I do know that if you are a M/M patient, its next to impossible to find a GP or an internist who will take you. Currently, I am forced to drive out of town to the nearest rural clinic to recieve care. It is almost my understanding that Medicare patients may be faced with a horrendous bill which is then reduced by some formula when the payment is made to Medicare.

Frankly, I'll trade you places. I'd much prefer to have an income that makes me shell out for private insurance costs, rather than be so poverty stricken that I must rely on the M/M.

[xoxoxoBruce]

Originally Posted by jinx

How long will it take? Takes 1/2 hour to get car insurance.

I don't know, that's why I said he was making an assumption. Like planning a trip without knowing what roads will be open/closed.

And where does the CAT fund come into play.

Fuck that... right here, this is my line in the sand... I ain't paying for anybodies cats.

Originally Posted by xoxoxoBruce

I don't know, that's why I said he was making an assumption. Like planning a trip without knowing what roads will be open/closed.
Fuck that... right here, this is my line in the sand... I ain't paying for anybodies cats.

It would certainly take more time than buying car insurance.

There is an enrollment process to determine eligibility for government subsidy and the level of that subsidy, which varies by income. At the very least, it would require submission of personal tax data for income verification.

[xoxoxoBruce]

But we're still speculating, the fact is we just don't know exactly how it'll all work out. When people ask specific questions about detailed situations, they are unanswerable at this stage of the game. Even after it's signed into law, it's only Congress's framework of intent. The various agencies that create specific rules of implementation is where the questions get answered... and the courts.

I don't think it will ever be repealed, but I'm sure we will see a lot of massaging, in the future, to iron out snags/unintended consequences, expand/contract coverage, and adjust for budgets.

edit:
There was a story about Switzerland on TV today. They addressed universal coverage by requiring everyone to buy health insurance, everyone. It turned out to be much more expensive than they had planed. In the range of 10 to 11 % of GNP, as opposed to the US's 15 to 16 %. But they do have the Rollex of health care systems.

[TheMercenary]

Well a Big Brother just got a little bigger. The IRS is going to be the stick to the Healthcare Reform. And it is going to cost the taxpayers more money to do it and that cost is not part of the estimates for the cost of healthcare reform. So add 10 billion to the cost of any plan that comes out of Congress.

Internal Revenue Service agents already try to catch tax cheats and moonshiners. Under the proposed health care legislation, they would get another assignment: checking to see whether Americans have health insurance.
The legislation would require most Americans to have health insurance and to prove it on their federal tax returns. Those who don't would pay a penalty to the IRS.

That's one of several key duties the IRS would assume under the bills that have been approved by the House of Representatives and Senate and will be merged by negotiators from both chambers.

The agency also would distribute as much as $140 billion a year in new government subsidies to help small employers and as many as 19 million lower-income people buy coverage.

In addition, the IRS would collect hundreds of billions of dollars in new fees on employers, drug companies and device makers, according to the non-partisan Congressional Budget Office (CBO).

Some critics of the health bill question whether the IRS, which has struggled in recent years with budget problems, staffing shortages and outdated computer systems, will be up to the job of enforcing the mandate and efficiently handling the subsidies.

The CBO estimated the IRS would need $5 billion to $10 billion in the first decade to cover the costs of its expanded role. The IRS' annual budget is currently $11.5 billion.

Neither the House nor Senate bill includes funding for the IRS, but money could be added by House and Senate negotiators.

The IRS already has trouble meeting its primary duty: collecting taxes. By the IRS's own estimates, it failed to collect about $290 billion in taxes in 2005, the latest year for which data are available.

Pete Sepp, spokesman for the National Taxpayers Union, an IRS watchdog group, says the IRS might be the "logical" agency to enforce the mandate, "but that doesn't mean things will go smoothly."

http://www.usatoday.com/news/washing...are-role_N.htm

[TheMercenary]

Why would this not surprise me. Hipocritical scumbags. Transparency my ass...

Democrats may side-step conference committee on health care

Washington Bureau - As Congressional Democrats attempt to arrive at a final healthcare bill, they appear increasingly likely to forego the formal conference committee process for merging House and Senate versions of legislation, instead opting for closely-held negotiations between leaders from the two chambers.

Under that scenario, aides said, the House would be likely to take up and amend the Senate bill before sending that bill back to the Senate for a vote.

In theory, the Senate could amend the new version and send it back to the House, triggering another round in a process sometimes called "ping-ponging.

But Democratic leaders will seek to draft a compromise version of the healthcare overhaul that would be acceptable to both the House and Senate, opening the way for final congressional action later this month or in early February.

House leaders will return to Washington this week to begin talks in earnest and to chart the path forward--and aides stressed Monday that no final decision had been made. The entire House Democratic caucus will meet Thursday before the House returns to business next week.

Typically, competing bills are reconciled by a conference committee composed of House and Senate chairmen of key committees. But Democrats on the Hill are free to fashion an alternative and more informal procedure because they aren't relying on Republican votes to pass the final bill.

For congressional Democrats and the White House, the advantages of the alternative process are numerous. Bypassing a conference committee would deny Senate Republicans--who have promised to use every procedural tactic available to delay the bill--an opportunity to filibuster motions in the Senate to appoint and instruct representatives to the committee.

And, forcing the House to vote on a Senate bill would prevent the House GOP from using a stalling maneuver known as a "Motion to Recommit" to hold up the bill there.

http://www.baltimoresun.com/health/s...,6833132.story

Originally Posted by TheMercenary

A parliamentary procedure that is really no different than the minority using other parliamentary procedures for the sole purpose of obstruction....or the use of reconciliation (requiring only a majority to avoid cloture/filibuster) for Bush's 01 and 03 tax cuts.

[classicman]

I really didn't read Mercs post, but are you implying that two wrongs make a right here? That whats good for the goose is good for the gander? That simply because it was done before it is ok to do it again?

[TheMercenary]

Ha. Why of course. Bush and the Republickins were very wrong when they did it and screwed everyone. But when the Savior and the Demoncrats do it is is ok. Freaking Hipocrites. It is because of attitudes like that....

Originally Posted by classicman

I really didn't read Mercs post, but are you implying that two wrongs make a right here? That whats good for the goose is good for the gander? That simply because it was done before it is ok to do it again?

I am saying that both parties work the system and often use every parliamentary procedure or rule they can to support their positions and achieve their goal.

Parliamentary procedures that one party may use to its advantage have been around as long as Congress itself. It is not "two wrong making a right" and the procedures are not illegal or unethical, but, IMO, simply represent the nature of the system at its best or worst to give voice to the minority party but to ensure that, in the end, the majority still rules.

Republicans have used cloture/filibuster procedures over the last three years more than twice as often as previous minority party in any given session of Congress in the last 50+ years. That is their right as the minority party.



I might find it frustrating, but I dont think it makes them scumbags.

The hypocrisy is the selective outrage....the in this case is the latest in the never-ending references to scumbags, whores and/or Nazis.....IMO, childish and more appropriately left to those at the level of the emmas and williamtalks.

added:
The follow-up reference to the "Savior".....more childish

[classicman]

Originally Posted by Redux

I am saying that both parties work the system and often use every parliamentary procedure or rule they can to support their positions and achieve their goal.

It is not "two wrong making a right" and the procedures are not illegal or unethical, but, IMO, simply represent the nature of the system at its best or worst to give voice to the minority party but to ensure that, in the end, the majority still rules.

Unfortunately I agree. I think it sucked when the R's did it and it sucks now that the D's are. I am still hoping for the time when they ALL represent us and work toward what is best for us instead of them and their "people." Yeh, I'm a dreamer. <shrug>

Originally Posted by classicman

Unfortunately I agree. I think it sucked when the R's did it and it sucks now that the D's are....

My point was the selective outrage. It is not just the D's doing it now unless you ignore the spike in cloture/filibuster procedures (see graph above for you ) by the Rs in the last 2-3 years, in many cases, to disrupt the process.

One can question whether the R filibusters spiked because of other procedures initiated by the Ds or the D's resorted to the procedures because of the spike in filibusters initiated by the R....chicken and egg...although the Rs said on numerous occasions that their goal, with respect to some bills, would be to disrupt the legislative process as much as possible using any procedures available.

And as the graph further indicates, the Ds (and earlier Rs) used the cloture/filibuster much less often when in the minority than the current R minority.

But I agree a return to more cordiality and respect for the process that provides both sides a voice is preferred...but not an equal voice or what is the point of being in the majority?

The process was much more respectful 25 years ago when I worked in the Senate during the early Reagan years.

[classicman]

Originally Posted by Redux

My point was the selective outrage.

By whom?

The process was much more respectful 25 years ago when I worked in the Senate during the early Reagan years.

Ahhh - another piece of the redux puzzle falls into place

Originally Posted by classicman

By whom?

THe spammer who consistently calls anyone who might disagree or challenge him either a hypocrite or a partisan and whose own opinion he expects to be treated as factual while he dismisses the facts of others as partisan opinions.

You know the one...who consistently refers to one side as scumbags and whores and/or Nazis but claims not to be a hypocrite or a partisan.