randombetch

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http://www.nytimes.com/2010/03/19/us/19score.html?hp

1. Excise tax, $32 bill
2. 3.8% tax on unearned income
3. Higher taxes on income >$200k
4. Cuts in Medicare (privatization of Medicare Advantage plan), $16 billion

... No savings from increased efficiency? No s*** it'll reduce the budget deficit - they're just adding tons of taxes and making huge cuts in doctor reimbursement.
 
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http://www.nytimes.com/2010/03/19/us/19score.html?hp

1. Excise tax, $32 bill
2. 3.8% tax on unearned income
3. Higher taxes on income >$200k
4. Cuts in Medicare (privatization of Medicare Advantage plan), $16 billion

... No savings from increased efficiency? No s*** it'll reduce the budget deficit - they're just adding tons of taxes and making huge cuts in doctor reimbursement.
How else are you supposed to do it? By eliminating wasteful spending? :laugh:

But seriously, there are too many people (oil companies, agribusiness, etc.) with their hands out to make that a reality.
 

Bacchus

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Cuts in Medicare will directly affect physician salaries. That's a no no.
 

Parts Unknown

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... No savings from increased efficiency? No s*** it'll reduce the budget deficit - they're just adding tons of taxes and making huge cuts in doctor reimbursement.
Funny, you guys clearly know how to use computers, yet you always seem to stop just short of answering your own questions.

The CBO report (from December) on the Senate bill showed that over 2010-2019 the projected changes were thus:

Cost of coverage expansion: $624 billion
Increased revenue: $264 billion
Decreased outlays: $478 billion (i.e. spending cuts; I'm assuming this is what you mean by "increased efficiency")

624 - 264 - 478 = 118 ($118 billion in deficit reduction)

If you would like nice summary of various portions of the Senate bill, try Timothy Jost's blog at Health Affairs.
 
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How else are you supposed to do it? By eliminating wasteful spending? :laugh:

But seriously, there are too many people (oil companies, agribusiness, etc.) with their hands out to make that a reality.
u dont do it, thats how.

this is GG.
 

SoulinNeed

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http://www.nytimes.com/2010/03/19/us/19score.html?hp

1. Excise tax, $32 bill
2. 3.8% tax on unearned income
3. Higher taxes on income >$200k
4. Cuts in Medicare (privatization of Medicare Advantage plan), $16 billion

... No savings from increased efficiency? No s*** it'll reduce the budget deficit - they're just adding tons of taxes and making huge cuts in doctor reimbursement.
Where exactly are the cuts in doctor reimbursements? http://www.politico.com/livepulse/0310/BREAKING__Reconciliation_bill_posted_.html

These are the changes made to the bill. According to it, doctors must be reimbursed for all new new Medicaid patients at a rate of 100%. But where are the cuts to doctors reimbursement rates? It's not in this bill, the only cuts in medicare are to medicare advantage. The other cuts will be to hospital acquired infections, and preventable hospital admissions. Are these cuts really that bad? I mean, I want to see some hard facts for all this fear.
 
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rofl i just watched bunch of videos of senators expressing this point i have not heard before. for some if not all people. government will designate a healthcare plan that you must buy, and some how this plan still leaves out few hundred thousand people not having insurance, permenantly. and if you do not comply, with ur purchase of ur designated insurance by government, you will be fined, or spend 5 years in prison. prison, not jai, so apparently if you do not do what government tells you to do, or buy what they tell you to buy, ur commiting a federal felony.

i cant find the video now that i just watched a couple more. so tell me people of SDN, who would have seen this coming when obama promised healthcare for all.
 

randombetch

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Funny, you guys clearly know how to use computers, yet you always seem to stop just short of answering your own questions.

The CBO report (from December) on the Senate bill showed that over 2010-2019 the projected changes were thus:

Cost of coverage expansion: $624 billion
Increased revenue: $264 billion
Decreased outlays: $478 billion (i.e. spending cuts; I'm assuming this is what you mean by "increased efficiency")

624 - 264 - 478 = 118 ($118 billion in deficit reduction)

If you would like nice summary of various portions of the Senate bill, try Timothy Jost's blog at Health Affairs.
So you're saying "spending cuts" = "increased efficiency"? :laugh:

http://www.msnbc.msn.com/id/34258944/

The senate bill proposes $460 billion in Medicare cuts. Add $16 billion from cuts in Medicare Advantage, and you get $476 billion. Shockingly, that's right about the same amount of "decreased outlays" that the CBO predicts.

Cutting doctor reimbursements is not much of an efficiency gain. In the long run, it's probably an efficiency barrier.

Thanks for "answering my questions" about the efficiency gain. There is none.
 

illegallysmooth

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rofl i just watched bunch of videos of senators expressing this point i have not heard before. for some if not all people. government will designate a healthcare plan that you must buy, and some how this plan still leaves out few hundred thousand people not having insurance, permenantly. and if you do not comply, with ur purchase of ur designated insurance by government, you will be fined, or spend 5 years in prison. prison, not jai, so apparently if you do not do what government tells you to do, or buy what they tell you to buy, ur commiting a federal felony.

i cant find the video now that i just watched a couple more. so tell me people of SDN, who would have seen this coming when obama promised healthcare for all.

well I heard that Obama himself will knock on ur door and shove a pineapple up ur ass. no kidding.

In all seriousness, I suspect you may have misunderstood or are listening to right-wing nut jobs still convinced of Palin's DEATH PANELS. It would be helpful to post links or quotes.
 

morning

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rofl i just watched bunch of videos of senators expressing this point i have not heard before. for some if not all people. government will designate a healthcare plan that you must buy, and some how this plan still leaves out few hundred thousand people not having insurance, permenantly. and if you do not comply, with ur purchase of ur designated insurance by government, you will be fined, or spend 5 years in prison. prison, not jai, so apparently if you do not do what government tells you to do, or buy what they tell you to buy, ur commiting a federal felony.

i cant find the video now that i just watched a couple more. so tell me people of SDN, who would have seen this coming when obama promised healthcare for all.

Many prisons have become for-profit ventures, so there are actually plenty of people who would benefit if you got thrown into prison for some ridiculous reason (self-interest, woot! Just...not your self-interest.) but no, prison is NOT part of the penalties for ignoring a health insurance mandate.
 

SoulinNeed

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So you're saying "spending cuts" = "increased efficiency"? :laugh:

Cutting doctor reimbursements is not much of an efficiency gain. In the long run, it's probably an efficiency barrier.
What cuts to doctor reimbursement rates? Are you talking about the 21% Medicare reimbursement rate drops? If so, there is nothing in this bill about it. The fix will be in a separate bill.
 

Wolfman89

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Where exactly are the cuts in doctor reimbursements? http://www.politico.com/livepulse/0310/BREAKING__Reconciliation_bill_posted_.html

These are the changes made to the bill. According to it, doctors must be reimbursed for all new new Medicaid patients at a rate of 100%. But where are the cuts to doctors reimbursement rates? It's not in this bill, the only cuts in medicare are to medicare advantage. The other cuts will be to hospital acquired infections, and preventable hospital admissions. Are these cuts really that bad? I mean, I want to see some hard facts for all this fear.
Now this makes sense. Where exactly are these cuts coming from?
 

illegallysmooth

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So you're saying "spending cuts" = "increased efficiency"? :laugh:

Cutting doctor reimbursements is not much of an efficiency gain. In the long run, it's probably an efficiency barrier.
Well, it's that sort of true? If you define efficiency as maximizing results with minimum investment, that is. It completely depends what the cuts affect. If they are cuts to programs that are costly and not productive or effective, then yes - those cuts would increase efficiency.

For the record, I do not agree with cutting physician reimbursement. But I believe in spending cuts on Medicaid that have nothing to do with physician reimbursement.
 

randombetch

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Where exactly are the cuts in doctor reimbursements? http://www.politico.com/livepulse/0310/BREAKING__Reconciliation_bill_posted_.html

These are the changes made to the bill. According to it, doctors must be reimbursed for all new new Medicaid patients at a rate of 100%. But where are the cuts to doctors reimbursement rates? It's not in this bill, the only cuts in medicare are to medicare advantage. The other cuts will be to hospital acquired infections, and preventable hospital admissions. Are these cuts really that bad? I mean, I want to see some hard facts for all this fear.
Are you kidding me? The senate bill plans on cutting $460 billion from Medicare. What do you think that means?

http://www.cnn.com/2009/POLITICS/12/24/health.care/index.html

"The Senate bill also cuts Medicare by roughly $500 billion."
 

Wolfman89

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Are you kidding me? The senate bill plans on cutting $460 billion from Medicare. What do you think that means?
Like I said it depends on where they are cutting funding. If it is from a program that is both costly and inefficient then this is a good thing.
 

illegallysmooth

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Are you kidding me? The senate bill plans on cutting $460 billion from Medicare. What do you think that means?

http://www.cnn.com/2009/POLITICS/12/24/health.care/index.html

"The Senate bill also cuts Medicare by roughly $500 billion."

-Requires that doctors that care for Medicaid patients be reimbursed at the full rate.

--Spends $250 million to fight waste, fraud and abuse.


Subtitle B – Medicare

Sec. 1101. Closing the Medicare prescription drug "donut hole". Provides a $250 rebate for all Medicare Part D enrollees who enter the donut hole in 2010. Builds on pharmaceutical manufacturers' 50% discount on brand-name drugs beginning in 2011 to completely close the donut hole with 75% discounts on brand-name and generic drugs by 2020.

Sec. 1102. Medicare Advantage payments. Freezes Medicare Advantage payments in 2011. Beginning in 2012, the provision reduces Medicare Advantage benchmarks relative to current levels. Benchmarks will vary from 95% of Medicare spending in high-cost areas to 115% of Medicare spending in low-cost areas. The changes will be phased-in over 3, 5 or 7 years, depending on the level of payment reductions. The provision creates an incentive system to increase payments to high-quality plans by at least 5%. It also extends CMS authority to adjust risk scores in Medicare Advantage for observed differences in coding patterns relative to fee-for?service.

Sec. 1103. Savings from limits on MA plan administrative costs. Ensures Medicare Advantage plans spend at least 85% of revenue on medical costs or activities that improve quality of care, rather than profit and overhead.

Sec. 1104. Disproportionate share hospital (DSH) payments. Advances Medicare disproportionate share hospital cuts to begin in fiscal year 2014 but lowers the ten-year reduction by $3 billion.

Sec. 1105. Market basket updates. Revises the hospital market basket reduction that is in addition to the productivity adjustment as follows: -0.3 in FY14 and -0.75 in FY17, FY18 and FY19. Removes Senate provision that eliminates the additional market basket for hospitals based on coverage levels. Providers affected are inpatient hospitals, long-term care hospitals, inpatient rehabilitation facilities, psychiatric hospitals and outpatient hospitals.

Sec. 1106. Physician ownership-referral. Changes to December 31, 2010 the date after which physician ownership of hospitals to which they self refer is prohibited and provides a limited exception to the growth restrictions for grandfathered physician owned hospitals that treat the highest percentage of Medicaid patients in their county (and are not the sole hospital in a county).

Sec. 1107. Payment for Imaging Services. Sets the assumed utilization rate at 75 percent for the practice expense portion of advanced diagnostic imaging services.
 

randombetch

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Like I said it depends on where they are cutting funding. If it is from a program that is both costly and inefficient then this is a good thing.

-Requires that doctors that care for Medicaid patients be reimbursed at the full rate.

--Spends $250 million to fight waste, fraud and abuse.
Medicaid =/= medicare. Spending $250 million =/= cutting $460 billion.

All Medicare does is reimburse doctors for their services. You cut Medicare, you're cutting doctor reimbursement. Am I wrong somewhere?

http://seniorliving.about.com/od/medicarebenefitsf2/f/medicarefaq3.htm
 

SoulinNeed

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randombetch

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Yeah, from Medicare advantage. Medicare Advantage are subsidies that go to private health insurance companies to pick up people who don't want to be apart of traditional Medicare.
NO, not from Medicare Advantage. Medicare Advantage is a really small part of Medicare, and cuts from that will only amount to $16 billion.
 

morning

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Funny, you guys clearly know how to use computers, yet you always seem to stop just short of answering your own questions.
I totally agree with Señor Parts Unknown here. You guys do not use your computers to their full potential.

This is why Medicare cuts are up to 21.3%: http://en.wikipedia.org/wiki/Medicare_Sustainable_Growth_Rate

This information is available for your perusal and has been for ages.


http://www.govtrack.us/congress/vote.xpd?vote=h1997-345

Whoa dude, look at all those Republicans!
 

SoulinNeed

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NO, not from Medicare Advantage. Medicare Advantage is a really small part of Medicare, and cuts from that will only amount to $16 billion.
No offense, but can you please give me some links that state that this $520 billion in cuts will come from doctor's pay, or hospitals? Something concrete that actually states where in the bill it says that.
 

illegallysmooth

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morning

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No offense, but can you please give me some links that state that this $520 billion in cuts will come from doctor's pay, or hospitals? Something concrete that actually states where in the bill it says that.
It's because he thinks that the 21% Medicare cuts are part of this health bill, and not something separate.
 

randombetch

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It's because he thinks that the 21% Medicare cuts are part of this health bill, and not something separate.
No, not really. I just can't imagine how they're planning on saving $460 billion from Medicare without lowering doctor reimbursement. What would they cut the spending of then? Pay less to hospitals to upgrade their equipment?

Okay: if you don't believe doctor salaries will drop, then that's fine. That wasn't the main point of my OP. The point is, the health care bill only reduces deficits by increasing taxes and decreases Medicare expenditure. Whether or not it increases any efficiency at all is debatable, yet we might go ahead and approve this $940 billion bill.
 
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illegallysmooth

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Some things that haven't been mentioned (because we all strive for a well-balanced viewpoint...):

Section 2214. Income-Based Repayment. The section amends the Income-Based Repayment program to cap student loan payments for new borrowers after July 1, 2014 to 10% of adjusted income, from 15% percent, and to forgive remaining balances after 20 years of repayment, from 25 years.

Sec. 2301. Insurance Reforms. Extends the prohibition of lifetime limits, prohibition on rescissions, limitations on excessive waiting periods, and a requirement to provide coverage for non-dependent children up to age 26 to all existing health insurance plans starting six months after enactment. For group health plans, prohibits pre-existing condition exclusions in 2014, restricts annual limits beginning six months after enactment, and prohibits them starting in 2014. For coverage of non-dependent children prior to 2014, the requirement on group health plans is limited to those adult children without an employer offer of coverage.

Section 2102. Student Financial Assistance. This section provides $13.5 billion in mandatory appropriations to the Federal Pell Grant program.

Sec. 1501. TAA for communities. Appropriates $500 Million a year for fiscal years 2010 through 2014 in the Community College and Career Training Grant program for community colleges to develop and improve educational or career training programs. Ensures that each state receives at least 0.5 percent of the total funds appropriated.

Sec. 1302. Medicare prepayment medical review limitations. Streamlines procedures to conduct Medicare prepayment reviews to facilitate additional reviews designed to reduce fraud and abuse.

Sec. 1103. Savings from limits on MA plan administrative costs. Ensures Medicare Advantage plans spend at least 85% of revenue on medical costs or activities that improve quality of care, rather than profit and overhead.
 

randombetch

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Doesn't IBR exist already?

Increasing costs of running a health insurance company will increase the cost of health insurance.

Student financial assistance seems pretty irrelevant - Pell Grant is for undergrads too.

What the hell does community college and career training grants have to do with health care?

We already discussed MA cuts - they're there but not that significant.
 

SoulinNeed

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Doesn't IBR exist already?

Increasing costs of running a health insurance company will increase the cost of health insurance.

Student financial assistance seems pretty irrelevant - Pell Grant is for undergrads too.

What the hell does community college and career training grants have to do with health care?

We already discussed MA cuts - they're there but not that significant.
Student loan reform was also thrown into the bill, has nothing to do with health care.
 

thamsenman

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Cuts in Medicare will directly affect physician salaries. That's a no no.

Right, if there will be any doctors left who willl take medicare.
 

illegallysmooth

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Doesn't IBR exist already?

Increasing costs of running a health insurance company will increase the cost of health insurance.

Student financial assistance seems pretty irrelevant - Pell Grant is for undergrads too.

What the hell does community college and career training grants have to do with health care?

We already discussed MA cuts - they're there but not that significant.
IBR exists, but did you read the paragraph? It's about positive CHANGES to IBR.

1. Please identify what you are specifically referring to by "increasing costs of running a health insurance company."

2. Student financial assistance is not irrelevant, especially when student loans are frequently quoted as evidence of the financial burden on young doctors and opposition to the bill.

3. Community college and career training - consider the number of people supporting families with no post-high school education. Most are on welfare/medicaid/other forms of government assistance. This is a major health care burden. There SHOULD be some effort into relieving some of this problem from the bottom-up - a.k.a. - ENABLING people rather than just giving them money.

IMO, people really need to be more open-minded about this entire issue and consider the many factors that affect health care, education and the economy. Is it a vast interconnected network.
 

JaggerPlate

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Right, if there will be any doctors left who willl take medicare.
Doesn't matter ... medicare controls the market. Medicare drops reimbursement rates, everyone else follows suit. I also agree with Betch ... I don't see how cutting medicare won't lead to lower reimbursements and won't lower doc salaries. Remember that no one gives a **** about doctors though. The American public thinks we are all greedy bastards who remove healthy organs for 30k personal profit and drive Ferraris ... docs are easy to vilify.
 
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Congress wanted to pass a bill on student loans, it was foundering, they were going to use reconciliation but only one bill per year can pass via reconciliation (or some similar technicality) and so they're lumping the two into one bill here.

despite illegallysmooth's best efforts, "has nothing to do with healthcare" is correct. Being open minded is one thing. Being so open minded your brain leaks out is another.
 

SoulinNeed

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Guys I may have found something to ease your fears (not about 21% medicare cuts), but rather the cuts in Market Based rates of reimbursement for hospitals. The plan is to cut those rates, and that will give about $210 Billion in medicare savings, but this is not a new practice, Congress does this every year.

"The Medicare law is written to assume that per-service payments to hospitals will increase each year by an index called the market basket. If payments were to actually increase at the market basket rate each year, they’d grow about 4 percent per year.

Instead, every 3-5 years Congress “cuts” payments to hospitals. They change the law to pay hospitals “market basket minus X” for, say, the next five years. “We’ll pay you market-basket minus 1 for the next five years,” Congress says. That’s roughly +3 percent more per service per year.

“Look!” Congress says to themselves. “We just saved billions of dollars! Let’s go spend it!” In the same law, they spend some of the “savings” CBO scored them with from “cutting” the hospital payment growth rate from 4% per year to 3% per year. They claim deficit reduction for the rest."

They just included those cuts into this bill, so as to make it look like the bill will save money over the next 10 years, which it won't when you include the doctor reimbursement rate fixes. This is a great article that you guys should read. http://blogs.ajc.com/kyle-wingfield/2010/03/05/how-government-lies-about-cost-savings/?cxntfid=blogs_kyle_wingfield
 

randombetch

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IBR exists, but did you read the paragraph? It's about positive CHANGES to IBR.

1. Please identify what you are specifically referring to by "increasing costs of running a health insurance company."

2. Student financial assistance is not irrelevant, especially when student loans are frequently quoted as evidence of the financial burden on young doctors and opposition to the bill.

3. Community college and career training - consider the number of people supporting families with no post-high school education. Most are on welfare/medicaid/other forms of government assistance. This is a major health care burden. There SHOULD be some effort into relieving some of this problem from the bottom-up - a.k.a. - ENABLING people rather than just giving them money.

IMO, people really need to be more open-minded about this entire issue and consider the many factors that affect health care, education and the economy. Is it a vast interconnected network.
Ohh, I see. But if a typical doctor makes $200k, and pays 10% for 20 years, he would have paid $400k. Doesn't really help much.

1. "Extends the prohibition of lifetime limits, prohibition on rescissions, limitations on excessive waiting periods, and a requirement to provide coverage for non-dependent children up to age 26 to all existing health insurance plans starting six months after enactment. For group health plans, prohibits pre-existing condition exclusions in 2014, restricts annual limits beginning six months after enactment, and prohibits them starting in 2014. For coverage of non-dependent children prior to 2014, the requirement on group health plans is limited to those adult children without an employer offer of coverage."
These policies will make it costlier to maintain an insurance company. Of course, since the elasticity of demand for health insurance is very high, these costs will be reflected in the price of health insurance.

2/3. Increasing pell grants and increasing community college grants is great, but it can be (and IMO, should be) done separately from this health care bill. Obviously they're connected, but the same could be said about anything. Might as well put policies limiting the power of the Federal Reserve because their impact on the economy also affects health care costs.
 

randombetch

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Guys I may have found something to ease your fears (not about 21% medicare cuts), but rather the cuts in Market Based rates of reimbursement for hospitals. The plan is to cut those rates, and that will give about $210 Billion in medicare savings, but this is not a new practice, Congress does this every year.

"The Medicare law is written to assume that per-service payments to hospitals will increase each year by an index called the market basket. If payments were to actually increase at the market basket rate each year, they’d grow about 4 percent per year.

Instead, every 3-5 years Congress “cuts” payments to hospitals. They change the law to pay hospitals “market basket minus X” for, say, the next five years. “We’ll pay you market-basket minus 1 for the next five years,” Congress says. That’s roughly +3 percent more per service per year.

“Look!” Congress says to themselves. “We just saved billions of dollars! Let’s go spend it!” In the same law, they spend some of the “savings” CBO scored them with from “cutting” the hospital payment growth rate from 4% per year to 3% per year. They claim deficit reduction for the rest."

They just included those cuts into this bill, so as to make it look like the bill will save money over the next 10 years, which it won't when you include the doctor reimbursement rate fixes. This is a great article that you guys should read. http://blogs.ajc.com/kyle-wingfield/2010/03/05/how-government-lies-about-cost-savings/?cxntfid=blogs_kyle_wingfield
... Increasing payments at a lower rate than inflation is the same thing as cutting payments.
 

Perrotfish

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Sec. 1103. Savings from limits on MA plan administrative costs. Ensures Medicare Advantage plans spend at least 85% of revenue on medical costs or activities that improve quality of care, rather than profit and overhead.
I would love to know how you legally seperate 'overhead' from 'costs or activities that improve quality of care'.
 

illegallysmooth

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Ohh, I see. But if a typical doctor makes $200k, and pays 10% for 20 years, he would have paid $400k. Doesn't really help much.

1. "Extends the prohibition of lifetime limits, prohibition on rescissions, limitations on excessive waiting periods, and a requirement to provide coverage for non-dependent children up to age 26 to all existing health insurance plans starting six months after enactment. For group health plans, prohibits pre-existing condition exclusions in 2014, restricts annual limits beginning six months after enactment, and prohibits them starting in 2014. For coverage of non-dependent children prior to 2014, the requirement on group health plans is limited to those adult children without an employer offer of coverage."
These policies will make it costlier to maintain an insurance company. Of course, since the elasticity of demand for health insurance is very high, these costs will be reflected in the price of health insurance.

2/3. Increasing pell grants and increasing community college grants is great, but it can be (and IMO, should be) done separately from this health care bill. Obviously they're connected, but the same could be said about anything. Might as well put policies limiting the power of the Federal Reserve because their impact on the economy also affects health care costs.
In regard to your comment about IBR - obviously that is not the best payment route for THAT doctor. It is an improvement for those who benefit from IBR.

In regard to the health insurance reform measures - do you not agree these are positive reforms? Or does everything boil down to dollars and cents, whether or not it increases quality of life for many people?

You can say it isn't related enough, but if you're talking about the effect of this bill on physicians then you must consider the effect on education. There is too much "after-the-fact" legislation these days and it is where I disagree with many liberal policies.
 

illegallysmooth

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The important issue of Medicare reimbursement is addressed in the accompanying bill, HR 3961, which will permanently replace the outdated Sustained Growth Rate (SGR) for determining doctors' payments through Medicare and military TRICARE. When the SGR was implemented, projections failed to anticipate the steeper rise in health costs relative to growth in per capita Gross Domestic Product (GDP). As a result of a flawed formula, every year physicians face cuts to their reimbursement. For six years Congress has kicked the can down the road, preventing cuts one year at a time but failing to address a problem that continues to grow. The result is a looming 21% cut in 2010 that threatens doctors' practices and could force them to limit their services to seniors and military families. This bill will finally address the problem by rebasing expenditure targets on a rolling five year average to prevent the kind of cuts we've witnessed since the plan was first implemented.


Yeah, not really a great system from any angle. We as a nation simply cannot support the growing costs of healthcare. For the record, I'm not arguing in this thread FOR the bill. There are issues with it, obviously. It's not anywhere near perfect.
 
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Parts Unknown

Fork tender
Jun 26, 2009
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So you're saying "spending cuts" = "increased efficiency"? :laugh:
Not at all, I was just trying to figure out what the Hell you were talking about. "Increased efficiency" isn't parlance that I have come across in this debate.

randombetch said:
Cutting doctor reimbursements is not much of an efficiency gain. In the long run, it's probably an efficiency barrier.

Thanks for "answering my questions" about the efficiency gain. There is none.
Tsk tsk, I can see you haven't read or digested anything from the Health Affairs site I linked earlier. Rather than explain all this myself, here is but one example of the reimbursement experiments that have been ongoing for years (and which are included in the Senate bill in spades).

For the love of God, please move the cursor, click, and read.

It's important to remember that the goal of all this isn't to screw doctors, but to control spending while maintaining quality. As long as we remain shackled to a fee-for-service model we are vulnerable to having our bottom lines impacted by reimbursement cuts. Personally, I think we have reached a place where we would be better served by uncoupling our income from FFS, and instead opting for salaries +/- productivity incentives. If we are smart, we could end up getting paid the same to do less, which would make everyone happy.

Oh, one more thing. I'm 3.5 months from starting my first job as an attending and making some real money. I'm in my mid-30's, I have no retirement savings, 150K in med school debt, and no equity to speak of. If you think that I have any interest in advocating reforms that are deleterious to physician income, I can assure you that nothing is farther from the truth.
 

JaggerPlate

10+ Year Member
May 28, 2007
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Not at all, I was just trying to figure out what the Hell you were talking about. "Increased efficiency" isn't parlance that I have come across in this debate.



Tsk tsk, I can see you haven't read or digested anything from the Health Affairs site I linked earlier. Rather than explain all this myself, here is but one example of the reimbursement experiments that have been ongoing for years (and which are included in the Senate bill in spades).

For the love of God, please move the cursor, click, and read.

It's important to remember that the goal of all this isn't to screw doctors, but to control spending while maintaining quality. As long as we remain shackled to a fee-for-service model we are vulnerable to having our bottom lines impacted by reimbursement cuts. Personally, I think we have reached a place where we would be better served by uncoupling our income from FFS, and instead opting for salaries +/- productivity incentives. If we are smart, we could end up getting paid the same to do less, which would make everyone happy.

Oh, one more thing. I'm 3.5 months from starting my first job as an attending and making some real money. I'm in my mid-30's, I have no retirement savings, 150K in med school debt, and no equity to speak of. If you think that I have any interest in advocating reforms that are deleterious to physician income, I can assure you that nothing is farther from the truth.
So you recommend moving away from the FFS model into more ... managed care? PGP? Or some kind of hybrid HMO/PGP + incentives basis?

Honestly, as much as it kills me to say it, a. This seriously could be more lucrative in the face of the HC bill, especially when it will probably lead to most docs being roped into huge groups that cover mal-practice, offer some insurance, and probably chip into the 401k. b. I think this is where the government would like to see things go.

I don't think my opinions on this are unknown to you ... but I wouldn't be surprised if this happens in the future. However, I worry about phrasing like an incentive basis ... because it makes me think of uber managed care, where groups essentially want to incur no additional costs and encourage quick stays and little testing (though most of the research makes this seem like the quality of care doesn't suffer - I still have some issues with it).

I'd be interested to hear your input.
 

randombetch

Removed
Sep 22, 2009
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Not at all, I was just trying to figure out what the Hell you were talking about. "Increased efficiency" isn't parlance that I have come across in this debate.



Tsk tsk, I can see you haven't read or digested anything from the Health Affairs site I linked earlier. Rather than explain all this myself, here is but one example of the reimbursement experiments that have been ongoing for years (and which are included in the Senate bill in spades).

For the love of God, please move the cursor, click, and read.

It's important to remember that the goal of all this isn't to screw doctors, but to control spending while maintaining quality. As long as we remain shackled to a fee-for-service model we are vulnerable to having our bottom lines impacted by reimbursement cuts. Personally, I think we have reached a place where we would be better served by uncoupling our income from FFS, and instead opting for salaries +/- productivity incentives. If we are smart, we could end up getting paid the same to do less, which would make everyone happy.

Oh, one more thing. I'm 3.5 months from starting my first job as an attending and making some real money. I'm in my mid-30's, I have no retirement savings, 150K in med school debt, and no equity to speak of. If you think that I have any interest in advocating reforms that are deleterious to physician income, I can assure you that nothing is farther from the truth.
Interesting link! Not sure if that model would work very effectively, but it's nice to know some experiments with reimbursement are being done.
 

Perrotfish

Has an MD in Horribleness
10+ Year Member
May 26, 2007
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Attending Physician
As long as we remain shackled to a fee-for-service model we are vulnerable to having our bottom lines impacted by reimbursement cuts. Personally, I think we have reached a place where we would be better served by uncoupling our income from FFS, and instead opting for salaries +/- productivity incentives. If we are smart, we could end up getting paid the same to do less, which would make everyone happy.
What you've just described is military medicine. If this is what you want maybe you should consider it. If you don't want to risk the wars and uniforms and such, contract work at a military medical center work on more or less the same model.

BTW, I'm feeling better and better about the financial side of my decision to join. Worst case scenario with this reform really doesn't put me in that bad of a position.
 

JaggerPlate

10+ Year Member
May 28, 2007
8,458
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What you've just described is military medicine. If this is what you want maybe you should consider it. If you don't want to risk the wars and uniforms and such, contract work at a military medical center work on more or less the same model.

BTW, I'm feeling better and better about the financial side of my decision to join. Worst case scenario with this reform really doesn't put me in that bad of a position.
I'm struggling to see how it's not just another name/face on managed care?

Physicians are put under a big organization -> patients/businesses pay this organization a set amount of money in agreement that the organization covers all costs up to this point and eats any overages -> the big group gives physicians a salary and an incentive to move patients quickly, be more precise with tests, and shorten hospital stays to not incur these costs -> these costs don't occur and most patients don't use up that dollar amount paid per month/year, the company makes money and physicians are given a small reward for helping the company not go in into the red on x number of patients???

Maybe my understanding of managed care is off or something, but to me ... that is it, and this system seems like a new face on the same product.

HOWEVER, in the new system, this may be a more lucrative/efficient model all around. It wouldn't be my choice ... but we may not have one.