Impeding changes to our Health Care system

[TheMercenary]

What Health Law Didn't Fix: Medicare Doctor Pay

Call it Medicare's version of Groundhog Day.

For the third time this year, Congress has just days to avert a scheduled 21 percent cut in pay to doctors who treat seniors and others on the Medicare program. And while just about everyone agrees a cut of that magnitude would be devastating for Medicare and the patients it serves, no one seems to be able to figure out how to solve the problem in anything except a stopgap way.

How It Began

The trouble actually dates back to 1997, when Congress passed a balanced budget law that put the current formula in place determining how doctors will be paid. The idea was that if doctors as a group cost Medicare too much, their pay would be docked to make up the difference in future years.

But James Rohack, president of the American Medical Association, says it was clear from the start that the "sustainable growth rate" would be anything but.

"We want to keep people healthy, and this formula penalizes [doctors] for doing the quality care you want," Rohack says.

For example, he says, "by keeping people's blood sugars under control, or helping them stay out of the hospital when they have heart failure," doctors may save Medicare money overall, but run up overall physician spending that then triggers future physician pay cuts.

Finding Physicians Who Take Medicare

And if those cuts get big enough, people worry that over time there will be more patients like Janice Jessup, a Medicare beneficiary in Virginia Beach, Va.

The last time Jessup needed to find a new primary care doctor a couple of years ago, she says she called as many as 40 doctors all over town. And what did they tell her?

"They weren't taking Medicare patients anymore," she says.

Jessup, who had severely cut her leg and ended up needing substantial follow-up care, eventually went to a walk-in clinic where she did get the care she needed. But it wasn't the care she wanted.

"It isn't the full medical attention you need with a primary physician. No lab tests or anything," she says.

'Chaos' For Doctors

From the doctors' point of view, however, it's not hard to see why they're getting more reluctant to take on new Medicare patients.

"We haven't had a raise in seven years," says Joseph Stubbs, the immediate past president of the American College of Physicians, which represents more than 100,000 internists.

Stubbs says as professionals, doctors feel a strong sense of duty to continue to care for their Medicare patients, even when profits erode. But at some point the balance will tip, he says, including for his own group of nine doctors in Georgia.

"We're having to face, well, if those cuts go into effect, we need to cut personnel," he says. "It will cost us, instead of reimburse us, to take care of Medicare beneficiaries."

And Congress has now made matters even worse, Stubbs says, by delaying the cuts not a year at a time, but — because of complicated federal budget rules — only by a month or two.

That's because making the cuts disappear entirely would add to the federal deficit at eye-popping amounts. An estimate issued last week by the Congressional Budget Office said merely canceling projected cuts in Medicare pay for doctors over the next decade — without giving them any increases — could cost $276 billion over the next decade.

But the short-term fixes have left physicians wondering what their income might be, and what to tell patients.

"It is absolute chaos for us as business people," Stubbs says. "What business could deal with not knowing whether your price is going to be up in the next month, or the same, or be cut by 21 percent? It's no way to be able to plan."

Searching For A New System Isn't Easy

Groups representing patients want to ensure that there are enough doctors to serve Medicare beneficiaries. But they're wary about the doctors' prescription for fixing the problem, which calls for repealing the current formula in its entirety.

"We don't just want to just remove all limits on what doctors can charge. That's a good way to get to bankruptcy," says John Rother of the senior group AARP.

Still, Rother agrees with the physician groups that Congress has not been fair about its handling of their Medicare payments.

"No one would defend a month at a time. Even a year at a time is problematic. So we certainly believe if it can't be permanent, it ought to be a multiyear fix," he says.

Physicians, not surprisingly, are a bit more emphatic about what they want from Congress, particularly after the issue got punted from the recently enacted health overhaul bill because of its price tag.

"From a fiscal standpoint, when they say they, 'Well gee, we can't do it because it will add to the deficit,' well, the reality is every one of these temporary patches has grown the deficit," says Rohack. "They could have fixed this three years ago for less than $50 billion."

Now the number is rapidly approaching $300 billion.

So the search continues for a new system that would pay doctors on Medicare fairly, but neither too much nor too little. That search has, so far, been elusive.

And the latest delay in the cut expires on May 31.

http://www.npr.org/templates/story/s...ryId=126535110

[TheMercenary]

The ink was barely dry on President Obama's signature before the RAND Corporation released a report concluding that not only would the hard-won health care package fail to curb premium increases, but the bill would drive premiums up as much as 17 percent for young people.

This should not have been a surprise: the Congressional Budget Office had already warned that the bill would do almost nothing to reduce future premium hikes. And when New York implemented the same time of insurance reforms in the 1980s, it led to a nearly $500-per-year increase in premiums for young people. But somehow, the media didn't pay much attention.

And of course, back during the health care debate, no presidential speech was complete without a promise that "if you have health insurance today and you like it, you can keep it." But the Congressional Budget Office now says that as many as 10 million workers will lose their current insurance under the bill. Some of those will have to buy new insurance through the government-run exchanges. Millions more will be thrown onto Medicaid.

In addition, the Center for Medicare and Medicaid Studies reports that half of seniors enrolled in the Medicare Advantage program will lose their coverage under that program and be forced back into traditional Medicare.

And how many times did President Obama criticize the United States for having the highest health care spending in the world? Well, the government's chief actuary released his report on the bill recently, showing that the bill will actually increase health care spending by $311 billion over the next 10 years.

At the same time, the actuary warns that promised future spending cuts, particularly those for Medicare, are unlikely to occur.

"The longer-term viability of the Medicare reductions is doubtful," wrote Richard Foster, chief actuary of the Medicare and Medicaid systems. What cuts do occur could have a severe impact on the quality of health care. As many as 15 percent of hospitals and other institutions could be forced out of business, according to the report, "possibly jeopardizing access to care" for millions of Americans.

Continues:
http://www.realclearpolitics.com/art...ed_105494.html

[xoxoxoBruce]

That's why they should have passed a single payer system.

[TheMercenary]

As I said before, I wish if they were going to go in they at least added the GOBBERMENT option. But no... the fucks would rather appease and screw our children and grand children for generations on end and never fix the problems...

Just like the failed Bail-out programs...

Where are the jobs Dems???

You guys are about to eat a big shit sandwhich.

[TheMercenary]

As I stated earlier in this debate, they bullshitted all of us with the numbers and how much it was going to cost. Now here we are..

May 12, 2010
um...about those budget savings we were going to get from Obamacare...
Ethel C. Fenig

Whoops! There goes the Congressional Budget office again--proving with hard facts and figures that Obamacare will cost more, as a matter of fact, much, much more, $115 billion more over ten years than President Barack Hussein Obama (D) estimated.

But...but...but Obama claimed his bill would reduce costs. Ah, but as the first ever female Speaker of the House, Rep Nancy Pelosi (D-CA) stated while pushing it through, "we have to pass the bill so that you can find out what is in it."

Well ok, Barack, Nancy and all the others, we are now finding out what's in what you passed.

The budget scam that would have made Bernie Madoff blush. Medicare won't be cut.
And then there are all types of administrative money devouring costs and discretionary spending that CBO didn't mention in the original draft but are now part of the final health care legislation.


[A]dministrative expenses for the Department of Health and Human Services and the Internal Revenue Service for carrying out key requirements of the legislation.

Explicit authorizations for future appropriations for a variety of grant and other program spending for which the act identifies the specific funding levels it envisions for one or more years.

(snip)

Explicit authorizations for future appropriations for a variety of grant and other program spending for which no specific funding levels are identified in the legislation.
The $115 billion cost overrun doesn't even include the third item.

Ok the law was passed in what Pelosi believed was the most open process ever.

Greece, here we come! But who will loan us money then? China? Saudi Arabia?

hat tip: David Hogberg, investors.com

http://www.americanthinker.com/blog/...savings_w.html

[classicman]

I read something about that last night. IIRC, it appears as though there were OPTIONS for some discretionary spending that could be as much as $115 Billion.

The right picked up on it and repeated it as gospel. I don't think it was quite that cut and dried.

[TheMercenary]

Originally Posted by classicman

I read something about that last night. IIRC, it appears as though there were OPTIONS for some discretionary spending that could be as much as $115 Billion.

The right picked up on it and repeated it as gospel. I don't think it was quite that cut and dried.

Yea, the CBO report actually said the numbers were not written in stone. Here is another report on the subject from CNN:

CBO doubles some health care spending estimates

http://news.blogs.cnn.com/2010/05/11...ing-estimates/

Bottom line is it will cost more and the propaganda fed to the publick about "Deficit neutral" was bullshit...

[classicman]

Long story short ... it's a work in progress. The R's better figure out why the Single payer/Universal plan they fought off is worse than this clusterfuck of unknown shit.

[TheMercenary]

Originally Posted by classicman

Long story short ... it's a work in progress. The R's better figure out why the Single payer/Universal plan they fought off is worse than this clusterfuck of unknown shit.

They don't really have to figure out shit until they are in power again in some form. Until them it is all in the Dems lap; lock, stock, and barrel.

[classicman]

Not in my book. The R's fought long and hard for what they thought was better than the Single payer/Universal the D's wanted.
IMO, both parties have to tel me why this is the best for America.
"Because thats all we could get." is not an acceptable answer for me.

[TheMercenary]

Originally Posted by classicman

Not in my book. The R's fought long and hard for what they thought was better than the Single payer/Universal the D's wanted.
IMO, both parties have to tel me why this is the best for America.
"Because thats all we could get." is not an acceptable answer for me.

The Repblickins made a half-assed attempt to be involved even though they were completely shut out of the final move to get a Bill to Congress. They really had little to do with it other than to bitch about it. Not that they did not have a right to bitch, and even those mod R's complained that the D's failed to follow through with an open amendment process after the fact, as Ms Snow was told (according to her anyway).

[classicman]

That is a matter of perspective. I'm not interested in hearing that anymore.
The D's will say that the R's just said "NO". . .
The R's say they were shut out. . .

I don't give a shit. These are the men and women that are supposed to LEAD our country. Figure it the fuck out. That what they are paid for.
I'm way past sick and tired of hearing them whine like children. ALL. OF. THEM.

[TheMercenary]

Kick every frigging one of them out in Nov. I have joined that group.

I just ordered some awesome bumperstickers for my truck.

[classicman]

Texas doctors opting out of Medicare at alarming rate

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.

Two years after a survey found nearly half of Texas doctors weren't taking some new Medicare patients, new data shows 100 to 200 a year are now ending all involvement with the program. Before 2007, the number of doctors opting out averaged less than a handful a year.

“This new data shows the Medicare system is beginning to implode,” said Dr. Susan Bailey, president of the Texas Medical Association. “If Congress doesn't fix Medicare soon, there'll be more and more doctors dropping out and Congress' promise to provide medical care to seniors will be broken.”

More than 300 doctors have dropped the program in the last two years, including 50 in the first three months of 2010, according to data compiled by the Houston Chronicle. Texas Medical Association officials, who conducted the 2008 survey, said the numbers far exceeded their assumptions.

The largest number of doctors opting out comes from primary care, a field already short of practitioners nationally and especially in Texas. Psychiatrists also make up a large share of the pie, causing one Texas leader to say, “God forbid that a senior has dementia.”

The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.

Link
Is this a national, regional or local trend? Anyone know?

[jinx]

The cost of medicalizing human conditions

Medicalization of human problems is a growth industry -- but what does it cost?

The researchers, led by Brandeis sociologist Peter Conrad, evaluated 12 conditions that had been defined as medicalized by physician organizations, and for which there were current medical spending data. The other conditions considered in the study were anxiety and behavioral disorders; body image; male pattern baldness; normal sadness; obesity; sleep disorders, and substance-related disorders.



The robust trend toward ever-greater medicalization of human conditions is undeniable, with an increasing number of medical diagnoses and treatments for behavioral problems and normal life events. Conrad and his colleagues analyzed medical spending on these disorders—payments to hospitals, pharmacies, physicians and other health care providers—and discovered that they accounted for $77.1 billion in medical spending in 2005—3.9 percent of total domestic health care expenditures.


"We spend more on these medicalized conditions than on cancer, heart disease, or public health," said Conrad. "While medicalization is unlikely to be a key driver of skyrocketing health care costs, $77 billion represents a substantial dollar sum."