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Senate health care bill to include public option

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ProRealDoc

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http://news.yahoo.com/s/ap/us_health_care_overhaul


WASHINGTON – Health care legislation heading for the Senate floor will give millions of Americans the option of purchasing government-run insurance coverage, Majority Leader Harry Reid announced Monday, although he stopped short of claiming the 60 votes needed to pass a plan steeped in controversy. Reid, D-Nev., said individual states would have the choice of opting out of the program.
His announcement was cheered by liberal lawmakers, greeted less effusively by the White House and noted with a noncommittal response by Democratic moderates whose votes will be pivotal.
Sen. Olympia Snowe of Maine, the only Republican to vote with Democrats on health care so far this year, issued a statement saying she was "deeply disappointed" in the approach the Democratic leader had chosen.
Reid said, "While the public option is not a silver bullet, I believe it's an important way to ensure competition and to level the playing field for patients with the insurance industry." He said a long-delayed Senate debate on President Barack Obama's call for an overhaul of the health care system would begin as soon as the Congressional Budget Office completes a mandatory assessment of the bill's cost and impact on coverage.
Changes on the public option — and numerous other provisions in the measure — are possible during a debate expected to last for weeks.
And officials said Reid had prepared several variations of key provisions so he could make adjustments in his bill at the last minute and still make sure he was within Obama's target of a $900 billion price tag over a decade.
Both the House and Senate are struggling to complete work by year's end on legislation extending coverage to millions who lack it, to ban insurance industry practices such as denying coverage because of pre-existing medical conditions and to slow the rise in medical costs nationally.
As in the Senate, attempts to complete drafting a measure in the House have been delayed by internal Democratic divisions on the details of a government-run option. Differences in bills passed by the House and Senate would have to be reconciled before any legislation reached Obama's desk.
In an appearance at a Florida senior center during the day, Speaker Nancy Pelosi suggested a new name for the same approach to ease the opposition. She suggested "the consumer option." Rep. Debbie Wasserman Schultz, D-Fla., appearing at Pelosi's side, used the term "competitive option."
Critics say that by any name, the approach amounts to a government takeover of the insurance industry.
In deference to moderates, Reid also said he was including a provision for nonprofit co-ops to sell insurance in competition with private companies.
Senate Democratic officials say the bill Reid envisions would require most individuals to purchase insurance, with exemptions for those unable to find affordable coverage. Large businesses would not be required to provide insurance to their workers, but would face penalties of as much as $750 per employee if any qualified for federal subsidies to afford coverage on their own.
The bill will also include a tax on high-cost insurance policies, despite opposition from organized labor, officials said. In a gesture to critics of the plan, Reid decided to apply the new tax to family plans with total premiums of $23,000 a year. The Senate Finance Committee approved a tax beginning at $21,000 in total premiums.
Nominally, the majority leader has spent the past two weeks melding bills passed earlier by the Senate's Finance Committee and Health, Education, Labor and Pensions Committee. But in reality, he has had a virtual free hand to craft a new measure in consultations with senior members of the two panels and top White House aides.
"I feel good about the consensus that was reached within our caucus and with the White House," he said at his news conference. And we're all optimistic about reform because of the unprecedented momentum that now exists."
Within minutes, the White House released a statement saying Obama was "pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out."
Obama has long voiced support for such a plan but has also signaled it is not a requirement for a health care bill he would sign. He has also said he would like bipartisan support for the legislation — and Snowe appears to be his last, best hope for that.

She favors a standby provision for government coverage if there is not enough competition in the private marketplace. Reid said that was not in his bill. "We hope that Olympia will come back. ... She's a very good legislator. I'm disappointed that the one issue, the public option, has been something that's frightened her."
Sen. Chuck Schumer, D-N.Y., who has long backed a government-run insurance option, said the approach "has a new life because as Americans have learned more about it, they have come to see it is the best way to reduce costs and increase competition in the health insurance industry."
Ben Nelson of Nebraska, the most conservative Democrat in the Senate, "is not committing how we will vote regarding any proposal Senator Reid is advancing," said spokesman Jake Thompson.
Sen. Blanche Lincoln, D-Ark., a moderate seeking a new term in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.
With the support of two independents, Democrats command 60 seats in the Senate, precisely the number needed to overcome any Republican filibuster.
Asked about the prospects for success, Reid answered, "We have 60 people in the caucus. ... We all hug together and see where we come out."
While the controversy over government-run insurance is the most intense, there are numerous other issues to be settled before legislation can win passage.
Obama has set a $900 billion, 10-year price tag for the legislation, and the program would be funded through cuts in future payments to Medicare providers and through higher taxes — an income surcharge on million-dollar earners in the House version and a new levy on high-cost insurance policies in the Senate.
Pelosi has said the House bill will strip the insurance industry of its exemption from antitrust laws, a provision that the Congressional Budget Office said during the day would have only a small impact on the cost of insurance to consumers.
The insurance industry was sharply critical of Reid's announcement.
"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs, and this plan doesn't do that," said Karen Ignagni, head of America's Health Insurance Plans.
___ Associated Press writers Julie Hirschfeld Davis, Ricardo Alonso-Zaldivar and Erica Werner in Washington, and Matt Sedensky in Sunrise, Fla., contributed to this story.
 

coprolalia

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http://news.yahoo.com/s/ap/us_health_care_overhaul


WASHINGTON – Health care legislation heading for the Senate floor will give millions of Americans the option of purchasing government-run insurance coverage, Majority Leader Harry Reid announced Monday, although he stopped short of claiming the 60 votes needed to pass a plan steeped in controversy. Reid, D-Nev., said individual states would have the choice of opting out of the program.
His announcement was cheered by liberal lawmakers, greeted less effusively by the White House and noted with a noncommittal response by Democratic moderates whose votes will be pivotal.
Sen. Olympia Snowe of Maine, the only Republican to vote with Democrats on health care so far this year, issued a statement saying she was "deeply disappointed" in the approach the Democratic leader had chosen.
Reid said, "While the public option is not a silver bullet, I believe it's an important way to ensure competition and to level the playing field for patients with the insurance industry." He said a long-delayed Senate debate on President Barack Obama's call for an overhaul of the health care system would begin as soon as the Congressional Budget Office completes a mandatory assessment of the bill's cost and impact on coverage.
Changes on the public option — and numerous other provisions in the measure — are possible during a debate expected to last for weeks.
And officials said Reid had prepared several variations of key provisions so he could make adjustments in his bill at the last minute and still make sure he was within Obama's target of a $900 billion price tag over a decade.
Both the House and Senate are struggling to complete work by year's end on legislation extending coverage to millions who lack it, to ban insurance industry practices such as denying coverage because of pre-existing medical conditions and to slow the rise in medical costs nationally.
As in the Senate, attempts to complete drafting a measure in the House have been delayed by internal Democratic divisions on the details of a government-run option. Differences in bills passed by the House and Senate would have to be reconciled before any legislation reached Obama's desk.
In an appearance at a Florida senior center during the day, Speaker Nancy Pelosi suggested a new name for the same approach to ease the opposition. She suggested "the consumer option." Rep. Debbie Wasserman Schultz, D-Fla., appearing at Pelosi's side, used the term "competitive option."
Critics say that by any name, the approach amounts to a government takeover of the insurance industry.
In deference to moderates, Reid also said he was including a provision for nonprofit co-ops to sell insurance in competition with private companies.
Senate Democratic officials say the bill Reid envisions would require most individuals to purchase insurance, with exemptions for those unable to find affordable coverage. Large businesses would not be required to provide insurance to their workers, but would face penalties of as much as $750 per employee if any qualified for federal subsidies to afford coverage on their own.
The bill will also include a tax on high-cost insurance policies, despite opposition from organized labor, officials said. In a gesture to critics of the plan, Reid decided to apply the new tax to family plans with total premiums of $23,000 a year. The Senate Finance Committee approved a tax beginning at $21,000 in total premiums.
Nominally, the majority leader has spent the past two weeks melding bills passed earlier by the Senate's Finance Committee and Health, Education, Labor and Pensions Committee. But in reality, he has had a virtual free hand to craft a new measure in consultations with senior members of the two panels and top White House aides.
"I feel good about the consensus that was reached within our caucus and with the White House," he said at his news conference. And we're all optimistic about reform because of the unprecedented momentum that now exists."
Within minutes, the White House released a statement saying Obama was "pleased that the Senate has decided to include a public option for health coverage, in this case with an allowance for states to opt out."
Obama has long voiced support for such a plan but has also signaled it is not a requirement for a health care bill he would sign. He has also said he would like bipartisan support for the legislation — and Snowe appears to be his last, best hope for that.

She favors a standby provision for government coverage if there is not enough competition in the private marketplace. Reid said that was not in his bill. "We hope that Olympia will come back. ... She's a very good legislator. I'm disappointed that the one issue, the public option, has been something that's frightened her."
Sen. Chuck Schumer, D-N.Y., who has long backed a government-run insurance option, said the approach "has a new life because as Americans have learned more about it, they have come to see it is the best way to reduce costs and increase competition in the health insurance industry."
Ben Nelson of Nebraska, the most conservative Democrat in the Senate, "is not committing how we will vote regarding any proposal Senator Reid is advancing," said spokesman Jake Thompson.
Sen. Blanche Lincoln, D-Ark., a moderate seeking a new term in 2010, said through a spokesman she intends to study the details and decide how to vote based on the impact on her home state.
With the support of two independents, Democrats command 60 seats in the Senate, precisely the number needed to overcome any Republican filibuster.
Asked about the prospects for success, Reid answered, "We have 60 people in the caucus. ... We all hug together and see where we come out."
While the controversy over government-run insurance is the most intense, there are numerous other issues to be settled before legislation can win passage.

Obama has set a $900 billion, 10-year price tag for the legislation
, and the program would be funded through cuts in future payments to Medicare providers and through higher taxes — an income surcharge on million-dollar earners in the House version and a new levy on high-cost insurance policies in the Senate.
Pelosi has said the House bill will strip the insurance industry of its exemption from antitrust laws, a provision that the Congressional Budget Office said during the day would have only a small impact on the cost of insurance to consumers.
The insurance industry was sharply critical of Reid's announcement.
"A new government-run plan would underpay doctors and hospitals rather than driving real reforms that bring down costs and improve quality. The American people want health care reform that will reduce costs, and this plan doesn't do that," said Karen Ignagni, head of America's Health Insurance Plans.
___ Associated Press writers Julie Hirschfeld Davis, Ricardo Alonso-Zaldivar and Erica Werner in Washington, and Matt Sedensky in Sunrise, Fla., contributed to this story.


This is money that will never be seen again/repaid. Mark my words.

BOONDOGGLE!

-copro
 

EternalMD

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From the thomas reuters report regarding waste of money in medicine

"Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year."

so i have to ask: Where the FU** is tort reform? oh right, lawyers are the ones at the helm of this HEALTHCARE overhaul. they MUST know what they're doing
:mad:
 

foxtrot

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From the thomas reuters report regarding waste of money in medicine

"Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year."

so i have to ask: Where the FU** is tort reform? oh right, lawyers are the ones at the helm of this HEALTHCARE overhaul. they MUST know what they're doing
:mad:

Bingo...the people who make our laws don't want to reform themselves. Hell, look at Obama's home state, Illinois, it has some of the worse malpractice problems in the country and many docs have fled the state left and right in the not so distant past. Everyone in congress should have to sign up for the public option plan, them I am sure we would all get paid because they are all used to having Cadillac health care plans.
 

flashgordon

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Maobama... worst... f'ing... president... ever...

He doesn't give a sh!t about physicians who are at the forefront of his healthcare plan. No tort reform? Now a public plan which will likely reimburse medicare rates? :boom:

Can't believe I voted for his stupid ass. Hell, I'd take Palin over this douchebag right now...
 

coprolalia

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I hope you all realize that this MOTHER F*CKER is going to completely ruin the medical profession.

You want to know how?

-copro
 

flashgordon

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What did you think he was going to do when you voted for him?

Definitely not win the Noble peace prize...

In actuality, my wife went to school in Illinois and drank the Maobama Kool-Aid. I didn't know any better and thought he would end the war and bring our soldiers back home.

You can be damn sure we won't be voting for him the next round.
 

coprolalia

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I hope you all realize that this MOTHER F*CKER is going to completely ruin the medical profession.

You want to know how?


-copro

Ask me. I'll tell you. I'm starting to see it already.

-copro
 

militarymd

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From the thomas reuters report regarding waste of money in medicine

"Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year."

so i have to ask: Where the FU** is tort reform? oh right, lawyers are the ones at the helm of this HEALTHCARE overhaul. they MUST know what they're doing
:mad:

although I agree with tort reform, I doubt that it will decrease cost of care by much....

We currently have an entire generation of physicians out there who practice "defensive" medicine....ie following strict protocols of ordering an endless list of tests because they were "told" to by "guidelines" and "standards of cares" that are generated by people who believe in "systems" of care.

Instead of thinking, and "practicing" medicine....we have been instructed to follow these rules...or risk being SUED.

It will take another whole generation of NEW docs before cost savings from tort reform will be realized....

at least that's my opinion.
 

Dirtball

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Reportedly 20% of Medicare dollars paid is for fraud(60 Minutes -Oct 2009), for bogus equiptment/drug claims......yet they disallow every PS 3 & 4 modifier on their sickest patients, while paying us $70/hr...I am solo and do my own billing--I see it in black and white . If they add 40 million Americans at MCR rates, it's game over for us. America will get anesthesia from many more physician extenders, when we all stop practicing. I will not work for RN pay.
 

flashgordon

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So let's say that the public option included in the new bill pays based on medicare rates (i.e. 33%).

How many attendings here would continue practicing?

How many med studs & residents here would switch to a different field?
 

EternalMD

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It will take another whole generation of NEW docs before cost savings from tort reform will be realized....

at least that's my opinion.


I agree completely. It won't happen within the next few years but the change needs to occur as we shed our old ways of defensive medicine
 

EternalMD

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So let's say that the public option included in the new bill pays based on medicare rates (i.e. 33%).

i just wonder with this new change, whether the emphasis will be more on a 4:1 system with an anesthesiologist covering more rooms
 

coprolalia

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:) Dude, he's going to tell us anyway, he's just workin' the crowd.

Man, some of you guys have me pegged... You know the saying, "Often wrong but never in doubt"? The only difference in how that applies to me is that I'm rarely wrong...

And, to add to MilMD's concerns (which are also right on track) and Dirtball's (which are equally spot on... except that he's going to be essentially forced to work for those wages, despite protestations).

That's precisely what's going to happen, and it will have a cascade effect.

Eventually, the added cost of providing "Universal care" will not be meted out by the money coming in (as is already happening). All this bill will do is add MORE cost. The result is going to be further cutting of reimbursements to offset the increased cost. They will have to do this. There will be no choice. That means lower pay for us all.

In the original wording of the bill, the government (as they do now with CMS to a large extent) will set all rates - and there will be no recourse to negotiate with those rate. This will include how much hospitals can charge for ancillary services as well. You will have to provide that care at that cost. You will not have a choice. And, you will not be able to refuse to provide care to patients.

Medical schools will not be able to support the cost of educating doctors. As a result, tuition will increase. And, unless the government is willing to offset the cost of medical education, the diminished reimbursement (resulting in lower income) will further dissuade the brightest college minds from entering the field.

Right now, like it or not, a full 25% of all practicing physicians in the U.S. are foreign-trained. This is a fact. If you remove the incentive for foreign doctors to come to the U.S., endure our rigorous testing, and then undergo additional graduate training to enter our workforce, you will further amplify the physician shortage already existent in this country.

These three things together, primarily, can be thusly summarized:
- Decreased reimbursement = decreased salary.
- Inability to negotiate reimbursement = loss of autonomy.
- Bleak prospects for meaningful career choice = less top-tier college students entering the field.
- No incentive to have "better life" by coming here from Europe/India = fewer doctors amplifying physician shortage.

This will necessarily propel midlevels into more and more advanced roles of integrated, protocol-driven care. Patients, like it or not, will not be able to see the even more-scarce physicians unless they present with truly catastrophic or "outside the norm" presentations. And, even then, it will be primarily in tertiary-type centers where physicians will exist.

You will continue to see the expansion of "scope of practice" in varying fields. The surgical specialties may be the only area spared, and even this won't be fully. The surgeons will become the primary specialist and will have to do more and more outside of the OR, as reimbursements for procedure-driven medicine will have gone down substantially.

The primary-care fields will become solely the domain of midlevel practitioners. Most medical specialties, except in the academic centers, will dwindle.

I expect, in about 30 years, the medical profession as we know it will completely change. There will still be doctors, but there will not be a vast increase in the numbers of them projected by the COGME and AAMC. The overall quality of candidates entering medical school will go down. The training will be focused, in large part, on systems management instead of actual care. It will be "theoretical" instead of "hands on", and the few doctors that are out there will learn mostly to manage the midlevels under their direction.

Don't believe me?

It's already happening.

The government plan is just going to accelerate this.

Having to choose all over again, there's no way in hell I would've gone to medical school. By the end of my career, I will be completely superfluous.

-copro
 

miamidc

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While I agree with most of this. I think the fact that we will be able to negotiate rates, as opossed to taking medicare rates, that will help us out alot. The fact that the new house bill has negotiated rates in it is huge, no way the senate includes that, if a public option even makes it to conferance. I think major changes will take 10+ years, so for those of us just getting a job, i think we will be OK, for those just starting med school. Good luck.
 

badasshairday

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Here is the latest, the bold is my emphasis:
http://news.yahoo.com/s/ap/20091030/ap_on_bi_ge/us_health_care_overhaul

WASHINGTON – Cheered by President Barack Obama, House Democrats rolled out landmark legislation Thursday to extend health care to tens of millions who lack coverage, impose sweeping new restrictions on the insurance industry and create a government-run option to compete with private insurers.
But even as party leaders pointed toward a vote next week, there were fresh questions that went to the heart of their ambitious drive to remake the nation's health care system.
Congressional budget experts predicted the controversial government insurance option would probably cost consumers somewhat more than private coverage. At the same time, rank-and-file conservative Democrats sought additional information about the bill's overall impact on federal health care spending.
There was no official estimate on the total cost of the legislation, which ran to 1,990 pages. The Congressional Budget Office said the cost of additional coverage alone was slightly more than $1 trillion over a decade. But that omitted other items, including billions for disease prevention programs.
Yet another $230 billion or more in higher fees for doctors treating Medicare patients, included in an earlier version of the bill, was stripped out and will be voted on separately.
The measure "covers 96 percent of all Americans, and it puts affordable coverage in reach for millions of uninsured and underinsured families, lowering health care costs for all of us," boasted Speaker Nancy Pelosi, D-Calif., at a ceremony attended by dozens of Democratic lawmakers. She spoke on the steps of the Capitol, not far from where Obama issued his inaugural summons for Congress to act more than nine months ago.
Pelosi said the legislation would reduce federal deficits over the next decade by $104 billion, and congressional budget experts said it would probably reduce them even further over the following 10 years.
While saying they expected a vote next week, Democratic leaders were careful not to claim they had yet rounded up enough votes to pass the legislation. Still, the day's events capped months of struggle and marked a major advance in their drive — and Obama's — to accomplish an overhaul of the health care system that has eluded presidents for a half-century.
Across the Capitol, the Democratic-controlled Senate is expected to begin debate within two weeks on a bill crafted by Majority Leader Harry Reid, D-Nev. It, too, envisions a government-run insurance option, although states could opt out, unlike in the bill the House will vote on. That portion of the Senate version appears likely to be weakened even further, as moderates press for a standby system that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
Obama called the House legislation "another critical milestone in the effort to reform our health care system."
Republican reaction was as swift as it was negative. "It will raise the cost of Americans' health insurance premiums; it will kill jobs with tax hikes and new mandates, and it will cut seniors' Medicare benefits," said the party's leader in the House, Rep. John Boehner of Ohio. He carried a copy of the 1,990-page measure into a news conference to underscore his claim it represented a government takeover of the health care system.
Republicans have already signaled their determination to make the health care debate a key issue in next year's congressional elections, when all 435 House seats will be on the ballot.
But their ability to block passage in the current House is nonexistent as long as Pelosi and her leadership can forge a consensus among the Democratic rank and file. The party holds 256 seats in the House, where 218 makes a majority.
Broad in scope, the House Democrats' bill attempts to build on the current system of employer-provided health care. It would require big companies to cover their employees and include federal subsidies to help small companies provide insurance for theirs, as well. Most individuals would be required to carry insurance, and much of the money in the legislation is dedicated to subsidies for those at lower incomes to help them afford coverage.
For those at even lower incomes, the bill provides for an expansion of Medicaid, the state-federal health program for the poor. Adults up to 150 percent of the poverty level — individuals making up to $16,245 and a family of four up to $33,075 — would be covered, a provision estimated to add 15 million to Medicaid.
One of the bill's major features is a new national insurance market, in which private companies could sell policies that meet federally mandated benefit levels, the government would offer competing coverage and consumers could shop for the policy that best met their needs.
In a bow to moderates, Democrats decided doctors, hospitals and other providers would be allowed to negotiate rates with the Health and Human Services Department for services provided in the government insurance option.
Liberals had favored a system in which fees would be dictated by the government, an approach that would have been less costly than what was settled on, and also would have moved closer to a purely government-run health care system than some Democrats favor.
The Congressional Budget Office said the result would be fees comparable to those doctors receive from private insurers. But for consumers, government-backed plans "would typically have premiums that are somewhat higher than the average premiums for private plans" sold in competition. As a result, it said enrollment would be only about 6 million.
Conservative Democrats known as Blue Dogs reacted to the overall CBO analysis by asking whether the bill would reduce the long-term rate of growth in federal spending. They noted the agency had said last summer that an earlier version would fail to do so, and they said they wanted updated answers "in order to make an informed decision."
Thursday's bill includes an array of new restrictions on the private insurance industry, in addition to forcing insurers to compete with the federal government for business.
Firms would be banned from denying coverage on the basis of pre-existing medical conditions and limited in their ability to charge higher premiums on the basis of age.
They would be required to spend 85 percent of their income from premiums on coverage, effectively limiting their ability to advertise or pay bonuses. Additionally, the industry would be stripped of immunity from antitrust regulations covering price fixing, bid rigging and market allocation. And in a late addition to the bill, 30-year-old restrictions on the Federal Trade Commission's ability to look into the insurance industry would be erased.
In response, the industry's top lobbyist, Karen Ignagni, issued a statement containing a somewhat milder version of criticism than recently unleashed against the Senate's version of the legislation. "We are concerned" the House bill will violate assurances that individuals would be able to keep their insurance if they like it, she said. She said it would be responsible for "increasing health care costs for families and employers across the country and significantly disrupting the quality coverage on which millions of Americans rely today."
Ignagni added that the presence of a government-run insurance plan "would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid and ultimately increase the federal deficit."
While Democrats touted new benefits for seniors, the bill relies on more than $400 billion in cuts from projected Medicare spending over the next decade. Much of the money would come from the part of the program in which private companies offer coverage to seniors.
The bill's other major new source of revenue is from a proposed income tax surcharge of 5.4 percent on wealthy earners, individuals making at least $500,000 a year and couples $1 million or more.
The legislation includes other taxes, such as a 2.5 percent excise tax on the makers of medical devices, expected to raise $20 billion over a decade.
 

notinkansas

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The problem is, this bill isn't about health care reform. This bill, and any health care bill supported by Pelosi/Obama, are about putting the infrastructure in place which will allow a single payer government run socialized medicine program. That it their goal. They really don't want to reduce costs. They don't want to limit malpractice. They just want to pass a bill that has provisions which can be used, over time, to allow the government to take over medicine 100%. These people's devotion to this as an ultimate goal is documented in audio and video. You have to look for it, because the mainstream media won't publicize it.
 

cfdavid

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although I agree with tort reform, I doubt that it will decrease cost of care by much....

We currently have an entire generation of physicians out there who practice "defensive" medicine....ie following strict protocols of ordering an endless list of tests because they were "told" to by "guidelines" and "standards of cares" that are generated by people who believe in "systems" of care.

Instead of thinking, and "practicing" medicine....we have been instructed to follow these rules...or risk being SUED.

It will take another whole generation of NEW docs before cost savings from tort reform will be realized....

at least that's my opinion.

I'd say I agree with this, in my limited relative experience. Just doing floor work, it becomes painfully obvious that these "practices" are not exclusively (or majorily) done as a result of liability concerns. We seem to, indeed, be training a whole generation of doctors that rarely think about cost/benefit ramifications.

But, for too long, "we've" practiced medicine in this country as if money just grows on trees. Somehow everyone gets a paycheck, so it must be alright. I think this is about to change.

Doing a swallow study (with subsequent EGD) on a 91 year old with dysphagia?? Do tell how that's going to change the treatment plan, regardless of diagnosis. No GI in his/her right mind will dilate the thing, and is she really going to start CHEMO in the case of cancer??? Come on. Yet I saw this during my Sub-I, and on many other occassions.

The only way I can tolerate our obvious overconsultation in medicine is to throw the fellows some "business" etc. which serves an educational purpose and provides them with necessary experience. But, otherwise? We need some checks in place.

I do, however, feel that tort reform would enable academic attendings to feel much more comfortable in helping to real in costs, and thus it's a step in the right direction.
 

Jeff05

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I'd say I agree with this, in my limited relative experience. Just doing floor work, it becomes painfully obvious that these "practices" are not exclusively (or majorily) done as a result of liability concerns. We seem to, indeed, be training a whole generation of doctors that rarely think about cost/benefit ramifications.

But, for too long, "we've" practiced medicine in this country as if money just grows on trees. Somehow everyone gets a paycheck, so it must be alright. I think this is about to change.

Doing a swallow study (with subsequent EGD) on a 91 year old with dysphagia?? Do tell how that's going to change the treatment plan, regardless of diagnosis. No GI in his/her right mind will dilate the thing, and is she really going to start CHEMO in the case of cancer??? Come on. Yet I saw this during my Sub-I, and on many other occassions.

The only way I can tolerate our obvious overconsultation in medicine is to throw the fellows some "business" etc. which serves an educational purpose and provides them with necessary experience. But, otherwise? We need some checks in place.

I do, however, feel that tort reform would enable academic attendings to feel much more comfortable in helping to real in costs, and thus it's a step in the right direction.

the problems is that those "checks" will be /are being imposed by administrators without any knowledge of medicine.

there are NO good answers. if you pay for procedures, people will likely perform TOO many procedures. if you don't pay for them, people will perform too few. in any case, we/patients lose.
 

modelslashactor

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I'd say I agree with this, in my limited relative experience. Just doing floor work, it becomes painfully obvious that these "practices" are not exclusively (or majorily) done as a result of liability concerns. We seem to, indeed, be training a whole generation of doctors that rarely think about cost/benefit ramifications.

But, for too long, "we've" practiced medicine in this country as if money just grows on trees. Somehow everyone gets a paycheck, so it must be alright. I think this is about to change.

Doing a swallow study (with subsequent EGD) on a 91 year old with dysphagia?? Do tell how that's going to change the treatment plan, regardless of diagnosis. No GI in his/her right mind will dilate the thing, and is she really going to start CHEMO in the case of cancer??? Come on. Yet I saw this during my Sub-I, and on many other occassions.

The only way I can tolerate our obvious overconsultation in medicine is to throw the fellows some "business" etc. which serves an educational purpose and provides them with necessary experience. But, otherwise? We need some checks in place.

I do, however, feel that tort reform would enable academic attendings to feel much more comfortable in helping to real in costs, and thus it's a step in the right direction.

good points. regarding tort reform, do you think the monetary value will substantially change behavior? personally i'm averse to the idea of getting sued period, whether it's for 50k or 50 million. what would the monetary threshold be where doctors would be willing to take the risk and not play cya?
 

cfdavid

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good points. regarding tort reform, do you think the monetary value will substantially change behavior? personally i'm averse to the idea of getting sued period, whether it's for 50k or 50 million. what would the monetary threshold be where doctors would be willing to take the risk and not play cya?

That's a fair and good question. My best guess would be to the extent that lawyers determined with increasing frequency that, either the case was more willing to be thrown out (thus becoming cost prohibitive to do the necessary due dilligence to begin with), as well as limitations on punitive damages that made such cases less and less appealing due to them taking on greater financial risk in general. And, in the best of circumstances, as the "market" for punitive damages "tightened", it could force lawyers to require patients themselves to anti up a bit to begin with, which we know would be very difficult for the vast majority of would-be claimants.....

This would also send a signal (I don't think it would take too long) to patients themselves after hearing from lawyers that would be less and less likely to even entertain their case due to the above. I think we'd see an entirely different attitude from many patients under such circumstances.
 

powermd

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although I agree with tort reform, I doubt that it will decrease cost of care by much....

We currently have an entire generation of physicians out there who practice "defensive" medicine....ie following strict protocols of ordering an endless list of tests because they were "told" to by "guidelines" and "standards of cares" that are generated by people who believe in "systems" of care.

Instead of thinking, and "practicing" medicine....we have been instructed to follow these rules...or risk being SUED.

It will take another whole generation of NEW docs before cost savings from tort reform will be realized....

at least that's my opinion.

http://www.factcheck.org/2009/10/malpractice-savings-reconsidered/
 
D

deleted50478

these studies do not reflect reality. they do not account for a basic underlying practice style that has developed as a result of the medicolegal environment.

they also ignore the massive expense of failure to convert from 'doing everything' to comfort care which may be significantly impacted by the fear of a lawsuit when deciding everything beyond comfort care is futile.
 

madarkhoob1

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I'm kind of tired of hearing anesthesia folks brag about 12 weeks' vacation and 500k salaries...

For all of you who talk of leaving the profession.... DO IT!!!!

Market forces will readjust...

And the overall economy will survive...

Currently, healthcare inflation is not sustainable, kills productivity and weakens our ability to compete w/ foreign nations...

= weaker dollar... Which, ironically, decreases the value of that 500k you make!!!

Oh, and fyi... Though I agree w/ need for tort reform, in reality, it comprises only 2-3% of last year's $2.3 trillion in health care costs...
 

2win

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I'm kind of tired of hearing anesthesia folks brag about 12 weeks' vacation and 500k salaries...

For all of you who talk of leaving the profession.... DO IT!!!!

Market forces will readjust...

And the overall economy will survive...

Currently, healthcare inflation is not sustainable, kills productivity and weakens our ability to compete w/ foreign nations...

= weaker dollar... Which, ironically, decreases the value of that 500k you make!!!

Oh, and fyi... Though I agree w/ need for tort reform, in reality, it comprises only 2-3% of last year's $2.3 trillion in health care costs...

Hey troll - please leave this board. You have nothing to do with anesthesia and you just try to irritate us. Again - please leave. Thx
 

nlfru

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Currently, healthcare inflation is not sustainable, kills productivity and weakens our ability to compete w/ foreign nations...

= weaker dollar... Which, ironically, decreases the value of that 500k you make!!!

It must healthcare, and not the printing/borrowing of TRILLIONS of dollars, that is weakening the dollar. If it weren't for fckuing idiots like you, maobama won't be in office and we wouldn't be in this MASSIVE mess.
 

nlfru

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It must healthcare, and not the printing/borrowing of TRILLIONS of dollars, that is weakening the dollar. If it weren't for fckuing idiots like you, maobama won't be in office and we wouldn't be in this MASSIVE mess.

This bill has NOTHING to do with healthcare. It is a power grab at 1/6 of the economy. Celebrate while you can because it will die in the senate.
 

WholeLottaGame7

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I'd say I agree with this, in my limited relative experience. Just doing floor work, it becomes painfully obvious that these "practices" are not exclusively (or majorily) done as a result of liability concerns. We seem to, indeed, be training a whole generation of doctors that rarely think about cost/benefit ramifications.

But, for too long, "we've" practiced medicine in this country as if money just grows on trees. Somehow everyone gets a paycheck, so it must be alright. I think this is about to change.

Doing a swallow study (with subsequent EGD) on a 91 year old with dysphagia?? Do tell how that's going to change the treatment plan, regardless of diagnosis. No GI in his/her right mind will dilate the thing, and is she really going to start CHEMO in the case of cancer??? Come on. Yet I saw this during my Sub-I, and on many other occassions.

The only way I can tolerate our obvious overconsultation in medicine is to throw the fellows some "business" etc. which serves an educational purpose and provides them with necessary experience. But, otherwise? We need some checks in place.

I do, however, feel that tort reform would enable academic attendings to feel much more comfortable in helping to real in costs, and thus it's a step in the right direction.

100% agree. Even in my 1+ years on rotation to date, I've seen far more tests ordered because no one knew the most efficient way to work something up than as a CYA mechanism.

The question is, are consultations a good or bad thing? I know on my urology rotation, the urologists claimed that specialists are actually more cost-effective because they actually know the proper way to work something up and don't have to shotgun it. Supposedly they had statistics to back them up. I can buy that. But I've also had the experience of consulting services where they ordered what appeared to be unnecessary tests just to make it look like they were doing something. So I can see it both ways.

I also agree that it's a product of our medical education, one in which medical students/residents operate in a vacuum and money is of no importance. If finances are even tangentially mentioned in determining patient care, the person bringing it up is crucified as a heartless [email protected]@rd who doesn't care about patients. Really? Money is of no object? Is that how the real world works?

Hell, if I'm 90 years old, I don't want some crazy test that is probably going to come back ambiguous anyway and is going to cost me (and secondarily my family) a couple thousand bucks. Maybe we should let patients know how much each test/procedure/visit will cost before they decide on anything, and give them a rough idea of how effective each test will be.

The problem with that is that it requires an involved patient, and let's be honest, a significant number of patients don't give enough of a crap.
 
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