Anyway - back on topic.
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These longer-term calculations assume that the provisions are enacted and remain unchanged throughout the next two decades.
However, the legislation would maintain and put into effect a number of procedures that might be difficult to sustain over a long period of time.
(1)
Under current law and under the proposal, payment rates for physicians’ services in Medicare would be reduced by about 21 percent in 2010 and then decline further in subsequent years. At the same time, the legislation includes a number of provisions that would constrain payment rates for other providers of Medicare services. In particular, increases in payment rates for many providers would be held below the rate of inflation. The projected longer-term savings for the legislation also assume that the Independent Payment Advisory Board is fairly effective in reducing costs beyond the reductions that would be achieved by other aspects of the legislation.
(2)
Based on the longer-term extrapolation, CBO expects that inflation-adjusted Medicare spending per beneficiary would increase at an average annual rate of less than 2 percent during the next two decades under the legislation—about half of the roughly 4 percent annual growth rate of the past two decades. It is unclear whether such a reduction in the growth rate could be achieved, and if so, whether it would be accomplished through greater efficiencies in the delivery of health care or would reduce access to care or diminish the quality of care.(3)
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(1) I recognize that assumptions must be made in order to give some sort of guesstimations.
But assuming that the legislation remain untouched for 20 years is not going to happen. Therefore virtually all of the opinions contained herein regarding any budgetary cost increases or reductions are, to me, worthless. However, we must make these assumptions in porder to have some sort of discussion.
(2) So initially they make an assumption that the "Independent Payment Advisory Board"
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which would hold sway over Medicare payment formulas. Under the legislation, the board would make annual recommendations to the president, Congress and private entities on actions they can take to improve quality and constrain the rate of cost growth in the private sector. Its Medicare recommendations are non-binding in years where Medicare growth is below the targeted growth rate. The board will develop its first recommendations in 2013 for implementation two year later.
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Who constitutes this board, and if their recommendations are in some cases non-binding then how are there going to be savings?
Furthermore, reducing physician payments will further reduce the number of providers accepting medicare as a payment form. Medicare is already reimbursing providers at a rate of approx. 20 -35% less than standard insurance carriers. Let me put it this way, Do you support a 20%+ pay cut to physicians who see Medicare patients? How many of you would take that? What alternatives are available to these doctors - retirement or not accepting Medicare patients.
If you are not willing to pay them what they are currently receiving now and instead reduce that amount by 21% in the future, there will obviously be less providers accepting medicare as a form of payment. That is simply basic econ101.
(3) Now I know that this is from the CBO, and apparently there are provisions in the bill somewhere that specify all this quite clearly, but I couldn't find it. This is one of the troubling parts that the left says isn't rationing care, and the right refers to as the "Death Panel." I don't know how else to look at it other than as it is written. "It is unclear whether such a reduction in the growth rate could be achieved, reduce access to care or diminish the quality of care." There is no guarantee, but it seems pretty clear that that the reduction of benefits is an option according to the CBO. Even taking that the care won't be rationed, it isn't clear to the CBO whether the cost reductions are even a viability.
Lastly, What steps are being taken to ensure that there will be enough primary care physicians, medical supplies and facilities to handle the increase in demand even though a shortage already exists today? Fewer physicians are currently accepting Medicare patients, and not all of the baby-boomers have retired?
Cue the partisan talking points.