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On August 18 2012 02:58 Vega62a wrote:Show nested quote +On August 18 2012 02:53 xDaunt wrote:On August 18 2012 02:50 Vega62a wrote:On August 18 2012 00:36 xDaunt wrote:On August 18 2012 00:35 DoubleReed wrote:
You really think people will buy that Ryan/Romney are on their side for Medicare? That's ridiculous.
xDaunt, your harsh partisanship can be really tiring... When people find out that Obama cut $700 billion Medicare, then yes, they will be. I apologize if "facts" are partisan.
First things first: Neither Obama nor his health care law literally cut a dollar amount from the Medicare program’s budget.
http://www.politifact.com/truth-o-meter/statements/2012/aug/15/mitt-romney/mitt-romney-said-barack-obama-first-history-rob-me/Don't try to pretend like you are even remotely interested in facts. You didn't even try to fact check your claim. You may want to read up further where I call Politifact on its bullshit and direct everyone to the CBO report that proves them wrong. You mean this report where it concludes that medicare outlays are reduced by 700 billion not in benefits, but in payments to insurance companies due to savings provided by the health care law? Essentially, the implementation of the act would reduce the NEED for additional money being provided to medicare, and therefore reduces FUTURE outlays by 700 billion? Did you even read it?
Those are cuts, genius. More importantly, they are severe cuts to providers who are already turning away Medicare patients in ever larger numbers because the reimbursement rates are already so low that the treatment is unprofitable.
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Yeah, the purported sources for the book are widely considered as being rock-solid. Incredible insight. Obama is way too liberal for the likes of Hillary (though her transformative health care push back in the day wasn't a far cry from PPACA) and she doesn't want to be weighed down by his possible loss in 2012 election.
Biden on the other hand ... well he sets a low standard for the qualifications of a VP in general. Any criticism leveled against Ryan on foreign policy and a handful of other topics brings back winces when he's compared to Biden.
Fact Check version: CBO report's actual text. Table 1 might hold the most interest for you, but I recommend a full read in the interests of proving to your own conscience that you aren't just cherry picking your sources. Note how the cuts keep ramping up in changes of outlays (Money SPENT) from 2013 to 2022. It is very logical to talk about how PPACA cuts money out of medicare because the outlays from medicare decreases in the billion-billions per year. Now blow air about how it ends up compensating for the cuts in new shiny PPACA provisions, but these are in fact medicare cuts.
Facts are very partisan. If unemployment numbers are up, you talk about the number of jobs created that month. If unemployment numbers are down, you talk about how many fewer Americans are looking for work.
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On August 18 2012 02:36 xDaunt wrote:Show nested quote +On August 18 2012 02:24 TheTenthDoc wrote:On August 17 2012 16:59 Danglars wrote:On August 17 2012 13:21 xDaunt wrote:On August 17 2012 12:11 SerpentFlame wrote:On August 17 2012 11:25 xDaunt wrote:On August 17 2012 10:57 kwizach wrote:On August 17 2012 10:36 xDaunt wrote:
Just out of curiosity, are any of you liberals/Obama supporters worried about the upcoming debates on Medicare? Quite the opposite (notably because of the two fact-checks listed here - the truth and good policies are on Obama's side). Politifact's articles on the Medicare cuts are precisely the kind of crap that makes them look like a hack outfit disturbingly often. I don't know in what world they can classify what Obamacare does to Medicare as not being a cut. It takes money out of the system. Period. Do the cuts directly reduce services? No. However, the cuts do reduce reimbursements to providers, which will reduce the availability of providers that are willing to take Medicare (and this has already been a problem for a number of years). Regardless, here's the bottom-line problem for Obama. Though Paul Ryan advocated a budget with significant cuts to Medicare that are much like Obama's, Romney has not and will not. In stark contrast, not only Obama proposed significant cuts to Medicare, he has actually enacted them. If I were Romney, I'd remake the DNC ad showing Paul Ryan rolling granny off the cliff and insert Obama instead. Romney declared Paul Ryan's budget "marvelous" in debates. He's advocated time and time again for entitlement reform. That he would not try to alter Medicare, as you seem to say, to is not the platform he's been running on for 4 years. Are you really going to say that someone who has already cut Medicare spending is less of a "danger" to Medicare than someone who previously has advocated Medicare reform but currently proposes no cuts to Medicare and would refund the cuts made from Obamacare? I don't think anyone is going to buy that.
The Affordable Care Act cuts funds from Medicare Advantage, a pilot program designed to cut costs. Ultimately, Medicare Advantage ended up costing 12 percent more without providing higher quality care. The program involves a government subsidy of private insurers to try and encourage competition and drive down costs. It was unnecessary government involvement in the private industry that did not cut costs compared to traditional Medicare. Scaling back funds for this program, (especially for those private insurers that don't meet basic health benchmarks, where much of the savings come from) and strengthening the rest is an obvious, and long overdue solution. In fact, I believe most Republicans call this cracking down on waste.
You realize that the cuts go far beyond just the Medicare Advantage program, right? Medicare Advantage only runs in the neighborhood of $10-15 billion per year, and would only total $156 billion over the next 10 years per the CBO's June report. The vast majority of the cuts to Medicare lower Medicare's reimbursement rates to providers. This will be crippling to doctors and hospitals, who are already beginning to limit or outright refuse service to Medicare patients. So okay, the ACA reduces some money given to private insurers, which by itself would reduce some coverage provided to seniors. Other parts of the legislation, however, strengthen Medicare by providing seniors free annual wellness visits, free preventative services, and a 50 percent discount for drugs in the Medicare "donut hole"; that is, drugs that were not covered at all under the pre-Obamacare law in the (unpaid for Bush era) Medicare Part D. So "Obamacare" removes some of the outlays to a monetarily expensive and inefficient program (Medicare Advantage) and provides it to services that actually go directly to seniors. Hardly rolling granny off a cliff. None of these "cookies" will make up for what has been taken out of Medicare. Preventative services don't really mean shit when you're already old. You need real care and coverage, which is no longer funded as it was. Pretty much identical thoughts here. PPACA says soak the DOCTORS & HOSPITALS for the treatment they provide. From the Washington PostThe Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. Article also includes a pie chart for the medicare cutsThe political reasoning behind the PPACA was to rob Medicare to bring the total to under a trillion dollars (actual 1.2 trillion estimated currently). This helped its passage. The Trustees report of Social Security and Medicare invites plans to reform the program and its funding. Demonization of the Ryan plan in current dialogue is demagoguery. The program is going to die, and any attempts to reform it are compared to Republicans killing granny. The readjustment to hospital reimbursement by and large isn't a direct cut; it comes from a variety of quality improvement strategies that should have been there in the first place. The most noteworthy one that pops to mind is that it prohibits billing Medicare/Medicaid for hospital-acquired infections that were not present at admission, but it also penalizes hospitals with too much administrative overhead and reduces reimbursement if a patient is readmitted with a condition that should have been treated in the first place, all of which are completely reasonable. While some of the specific numbers for a few admissions are probably taking direct hits, as far as I know, that's not where the majority of the cuts come from. If it weren't the case I suspect the hospitals I worked for would have been significantly more perturbed by the act. I'll also note that the article you quoted itself says the hospitals by and large didn't care. The situation for a lot of hospitals in poor areas right now is that they just don't get reimbursed at all for their services to uninsured patients; if those individuals had easier access to insurance (like through state insurance exchanges, which would evaporate without the ACA), they'd at least get SOMETHING. It doesn't matter what the cuts are purported to be for. They are still cuts to the hospitals that take money out of the system, which is the critical bottom-line issue. Also, keep in mind that many providers are already in a rough spot when it comes to treating illegal aliens. This isn't going to help.
Uh, yes it does matter what cuts are for. A hospital should not have an incentive to let you get sick so they can charge the government more. It takes money out of the system that shouldn't go in in the first place. Heck, the whole point of the ACA is to lower the money going into health care! That's a good thing! We don't WANT to spend the most on healthcare in the world if there are more efficient ways to do it.
Healthcare doesn't need to be a gigantic industry to be good healthcare.
On August 18 2012 03:10 xDaunt wrote:Show nested quote +On August 18 2012 03:04 Vega62a wrote:On August 18 2012 03:01 xDaunt wrote:On August 18 2012 02:58 Vega62a wrote:On August 18 2012 02:53 xDaunt wrote:On August 18 2012 02:50 Vega62a wrote:On August 18 2012 00:36 xDaunt wrote:On August 18 2012 00:35 DoubleReed wrote:
You really think people will buy that Ryan/Romney are on their side for Medicare? That's ridiculous.
xDaunt, your harsh partisanship can be really tiring... When people find out that Obama cut $700 billion Medicare, then yes, they will be. I apologize if "facts" are partisan.
First things first: Neither Obama nor his health care law literally cut a dollar amount from the Medicare program’s budget.
http://www.politifact.com/truth-o-meter/statements/2012/aug/15/mitt-romney/mitt-romney-said-barack-obama-first-history-rob-me/Don't try to pretend like you are even remotely interested in facts. You didn't even try to fact check your claim. You may want to read up further where I call Politifact on its bullshit and direct everyone to the CBO report that proves them wrong. You mean this report where it concludes that medicare outlays are reduced by 700 billion not in benefits, but in payments to insurance companies due to savings provided by the health care law? Essentially, the implementation of the act would reduce the NEED for additional money being provided to medicare, and therefore reduces FUTURE outlays by 700 billion? Did you even read it? Those are cuts, genius. More importantly, they are severe cuts to providers who are already turning away Medicare patients in ever larger numbers because the reimbursement rates are already so low that the treatment is unprofitable. It's not a cut. It's a reduction in spending because of reduced need. We've been through this game before - you use incendiary language and try to get away with it, and then try to argue semantics when someone points out that the meaning of your post is incorrect. Either you are saying "yes, the budget is reduced," without telling anybody why that matters, or you are simultaneously trying to imply that the efficacy or reach of medicare is being reduced with your language and pretending you aren't. Which is it? Regarding your last paragraph, I don't know how I can be more explicit than I have over the past few pages, but I'll try again by responding to your first paragraph. No, there is no "reduced need." The demand for services isn't reduced. This an example of bureaucrats deciding unilaterally deciding that they're going to pay providers less for medical services rendered. There are definitely inefficiencies in the medical billing system (we'll save that for a later time), but that doesn't change the fact that the industry is going to be receiving $700 billion less over 10 years than it otherwise would. That's a problem when the industry is already stretched thin when it comes to treating Medicare patients. This is why there's looming shortage of doctors on a national scale coming.
Woah, primary care physician shortage (which I assume you mean by doctor shortage) is an entirely separate issue from Medicare reimbursement. PCP shortage is actually mainly due to financial incentives and lack of people with insurance to actually pay for primary care, which (helpfully enough) the ACA is designed to help.
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On August 18 2012 03:04 Vega62a wrote:Show nested quote +On August 18 2012 03:01 xDaunt wrote:On August 18 2012 02:58 Vega62a wrote:On August 18 2012 02:53 xDaunt wrote:On August 18 2012 02:50 Vega62a wrote:On August 18 2012 00:36 xDaunt wrote:On August 18 2012 00:35 DoubleReed wrote:
You really think people will buy that Ryan/Romney are on their side for Medicare? That's ridiculous.
xDaunt, your harsh partisanship can be really tiring... When people find out that Obama cut $700 billion Medicare, then yes, they will be. I apologize if "facts" are partisan.
First things first: Neither Obama nor his health care law literally cut a dollar amount from the Medicare program’s budget.
http://www.politifact.com/truth-o-meter/statements/2012/aug/15/mitt-romney/mitt-romney-said-barack-obama-first-history-rob-me/Don't try to pretend like you are even remotely interested in facts. You didn't even try to fact check your claim. You may want to read up further where I call Politifact on its bullshit and direct everyone to the CBO report that proves them wrong. You mean this report where it concludes that medicare outlays are reduced by 700 billion not in benefits, but in payments to insurance companies due to savings provided by the health care law? Essentially, the implementation of the act would reduce the NEED for additional money being provided to medicare, and therefore reduces FUTURE outlays by 700 billion? Did you even read it? Those are cuts, genius. More importantly, they are severe cuts to providers who are already turning away Medicare patients in ever larger numbers because the reimbursement rates are already so low that the treatment is unprofitable. It's not a cut. It's a reduction in spending because of reduced need. We've been through this game before - you use incendiary language and try to get away with it, and then try to argue semantics when someone points out that the meaning of your post is incorrect. Either you are saying "yes, the budget is reduced," without telling anybody why that matters, or you are simultaneously trying to imply that the efficacy or reach of medicare is being reduced with your language and pretending you aren't. Which is it?
Regarding your last paragraph, I don't know how I can be more explicit than I have over the past few pages, but I'll try again by responding to your first paragraph.
No, there is no "reduced need." The demand for services isn't reduced. This an example of bureaucrats deciding unilaterally deciding that they're going to pay providers less for medical services rendered. There are definitely inefficiencies in the medical billing system (we'll save that for a later time), but that doesn't change the fact that the industry is going to be receiving $700 billion less over 10 years than it otherwise would. That's a problem when the industry is already stretched thin when it comes to treating Medicare patients. This is why there's looming shortage of doctors on a national scale coming.
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On August 18 2012 03:07 TheTenthDoc wrote:Show nested quote +On August 18 2012 02:36 xDaunt wrote:On August 18 2012 02:24 TheTenthDoc wrote:On August 17 2012 16:59 Danglars wrote:On August 17 2012 13:21 xDaunt wrote:On August 17 2012 12:11 SerpentFlame wrote:On August 17 2012 11:25 xDaunt wrote:On August 17 2012 10:57 kwizach wrote:On August 17 2012 10:36 xDaunt wrote:
Just out of curiosity, are any of you liberals/Obama supporters worried about the upcoming debates on Medicare? Quite the opposite (notably because of the two fact-checks listed here - the truth and good policies are on Obama's side). Politifact's articles on the Medicare cuts are precisely the kind of crap that makes them look like a hack outfit disturbingly often. I don't know in what world they can classify what Obamacare does to Medicare as not being a cut. It takes money out of the system. Period. Do the cuts directly reduce services? No. However, the cuts do reduce reimbursements to providers, which will reduce the availability of providers that are willing to take Medicare (and this has already been a problem for a number of years). Regardless, here's the bottom-line problem for Obama. Though Paul Ryan advocated a budget with significant cuts to Medicare that are much like Obama's, Romney has not and will not. In stark contrast, not only Obama proposed significant cuts to Medicare, he has actually enacted them. If I were Romney, I'd remake the DNC ad showing Paul Ryan rolling granny off the cliff and insert Obama instead. Romney declared Paul Ryan's budget "marvelous" in debates. He's advocated time and time again for entitlement reform. That he would not try to alter Medicare, as you seem to say, to is not the platform he's been running on for 4 years. Are you really going to say that someone who has already cut Medicare spending is less of a "danger" to Medicare than someone who previously has advocated Medicare reform but currently proposes no cuts to Medicare and would refund the cuts made from Obamacare? I don't think anyone is going to buy that.
The Affordable Care Act cuts funds from Medicare Advantage, a pilot program designed to cut costs. Ultimately, Medicare Advantage ended up costing 12 percent more without providing higher quality care. The program involves a government subsidy of private insurers to try and encourage competition and drive down costs. It was unnecessary government involvement in the private industry that did not cut costs compared to traditional Medicare. Scaling back funds for this program, (especially for those private insurers that don't meet basic health benchmarks, where much of the savings come from) and strengthening the rest is an obvious, and long overdue solution. In fact, I believe most Republicans call this cracking down on waste.
You realize that the cuts go far beyond just the Medicare Advantage program, right? Medicare Advantage only runs in the neighborhood of $10-15 billion per year, and would only total $156 billion over the next 10 years per the CBO's June report. The vast majority of the cuts to Medicare lower Medicare's reimbursement rates to providers. This will be crippling to doctors and hospitals, who are already beginning to limit or outright refuse service to Medicare patients. So okay, the ACA reduces some money given to private insurers, which by itself would reduce some coverage provided to seniors. Other parts of the legislation, however, strengthen Medicare by providing seniors free annual wellness visits, free preventative services, and a 50 percent discount for drugs in the Medicare "donut hole"; that is, drugs that were not covered at all under the pre-Obamacare law in the (unpaid for Bush era) Medicare Part D. So "Obamacare" removes some of the outlays to a monetarily expensive and inefficient program (Medicare Advantage) and provides it to services that actually go directly to seniors. Hardly rolling granny off a cliff. None of these "cookies" will make up for what has been taken out of Medicare. Preventative services don't really mean shit when you're already old. You need real care and coverage, which is no longer funded as it was. Pretty much identical thoughts here. PPACA says soak the DOCTORS & HOSPITALS for the treatment they provide. From the Washington PostThe Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. Article also includes a pie chart for the medicare cutsThe political reasoning behind the PPACA was to rob Medicare to bring the total to under a trillion dollars (actual 1.2 trillion estimated currently). This helped its passage. The Trustees report of Social Security and Medicare invites plans to reform the program and its funding. Demonization of the Ryan plan in current dialogue is demagoguery. The program is going to die, and any attempts to reform it are compared to Republicans killing granny. The readjustment to hospital reimbursement by and large isn't a direct cut; it comes from a variety of quality improvement strategies that should have been there in the first place. The most noteworthy one that pops to mind is that it prohibits billing Medicare/Medicaid for hospital-acquired infections that were not present at admission, but it also penalizes hospitals with too much administrative overhead and reduces reimbursement if a patient is readmitted with a condition that should have been treated in the first place, all of which are completely reasonable. While some of the specific numbers for a few admissions are probably taking direct hits, as far as I know, that's not where the majority of the cuts come from. If it weren't the case I suspect the hospitals I worked for would have been significantly more perturbed by the act. I'll also note that the article you quoted itself says the hospitals by and large didn't care. The situation for a lot of hospitals in poor areas right now is that they just don't get reimbursed at all for their services to uninsured patients; if those individuals had easier access to insurance (like through state insurance exchanges, which would evaporate without the ACA), they'd at least get SOMETHING. It doesn't matter what the cuts are purported to be for. They are still cuts to the hospitals that take money out of the system, which is the critical bottom-line issue. Also, keep in mind that many providers are already in a rough spot when it comes to treating illegal aliens. This isn't going to help. Uh, yes it does matter what cuts are for. A hospital should not have an incentive to let you get sick so they can charge the government more. It takes money out of the system that shouldn't go in in the first place. Heck, the whole point of the ACA is to lower the money going into health care! That's a good thing! We don't WANT to spend the most on healthcare in the world if there are more efficient ways to do it. Healthcare doesn't need to be a gigantic industry to be good healthcare.
In an ideal world where all medical services were billed at their market rates, you'd be right. However, that's not how the current medical billing system works.
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On August 18 2012 01:20 DoubleReed wrote:
And you clearly don't care that Romney/Ryan is campaigning with something you're against
I think the US healthcare system could be greatly, greatly improved if Medicare were replaced with something more free-market-based but guess what, even if the US had a Parliament system that gave us a dozen major parties instead of just two, you're still not likely to find many people that agree with you on 10 out of 10 issues. Given the choice between more government control and regulation in medicine or less, I'll go with less, tyvm.
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The "savings" in the CBO report is the "savings" from the government paying healthcare providers less. While that saves the government money it shifts the cost to somebody else so there is no net savings to the economy.
SOME of that savings will be good and lead to efficiencies but not all of it.
Edit: as a whole the ACA is expected to increase the overall spending on healthcare in the country.
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On August 18 2012 03:12 dvorakftw wrote:Show nested quote +On August 18 2012 01:20 DoubleReed wrote:
And you clearly don't care that Romney/Ryan is campaigning with something you're against I think the US healthcare system could be greatly, greatly improved if Medicare were replaced with something more free-market-based but guess what, even if the US had a Parliament system that gave us a dozen major parties instead of just two, you're still not likely to find many people that agree with you on 10 out of 10 issues. Given the choice between more government control and regulation in medicine or less, I'll go with less, tyvm.
I was not saying that xDaunt needs to agree on everything.
I don't understand why people want it to be more "free market based" when socialized medicine has been shown to be cheaper, better, and more efficient in every way. Less regulation means more ways that the health insurance can avoid giving you your payment. And paying for people's healthcare is their whole damn job, so that's a pretty egregious problem.
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On August 18 2012 03:11 xDaunt wrote:Show nested quote +On August 18 2012 03:07 TheTenthDoc wrote:On August 18 2012 02:36 xDaunt wrote:On August 18 2012 02:24 TheTenthDoc wrote:On August 17 2012 16:59 Danglars wrote:On August 17 2012 13:21 xDaunt wrote:On August 17 2012 12:11 SerpentFlame wrote:On August 17 2012 11:25 xDaunt wrote:On August 17 2012 10:57 kwizach wrote:On August 17 2012 10:36 xDaunt wrote:
Just out of curiosity, are any of you liberals/Obama supporters worried about the upcoming debates on Medicare? Quite the opposite (notably because of the two fact-checks listed here - the truth and good policies are on Obama's side). Politifact's articles on the Medicare cuts are precisely the kind of crap that makes them look like a hack outfit disturbingly often. I don't know in what world they can classify what Obamacare does to Medicare as not being a cut. It takes money out of the system. Period. Do the cuts directly reduce services? No. However, the cuts do reduce reimbursements to providers, which will reduce the availability of providers that are willing to take Medicare (and this has already been a problem for a number of years). Regardless, here's the bottom-line problem for Obama. Though Paul Ryan advocated a budget with significant cuts to Medicare that are much like Obama's, Romney has not and will not. In stark contrast, not only Obama proposed significant cuts to Medicare, he has actually enacted them. If I were Romney, I'd remake the DNC ad showing Paul Ryan rolling granny off the cliff and insert Obama instead. Romney declared Paul Ryan's budget "marvelous" in debates. He's advocated time and time again for entitlement reform. That he would not try to alter Medicare, as you seem to say, to is not the platform he's been running on for 4 years. Are you really going to say that someone who has already cut Medicare spending is less of a "danger" to Medicare than someone who previously has advocated Medicare reform but currently proposes no cuts to Medicare and would refund the cuts made from Obamacare? I don't think anyone is going to buy that.
The Affordable Care Act cuts funds from Medicare Advantage, a pilot program designed to cut costs. Ultimately, Medicare Advantage ended up costing 12 percent more without providing higher quality care. The program involves a government subsidy of private insurers to try and encourage competition and drive down costs. It was unnecessary government involvement in the private industry that did not cut costs compared to traditional Medicare. Scaling back funds for this program, (especially for those private insurers that don't meet basic health benchmarks, where much of the savings come from) and strengthening the rest is an obvious, and long overdue solution. In fact, I believe most Republicans call this cracking down on waste.
You realize that the cuts go far beyond just the Medicare Advantage program, right? Medicare Advantage only runs in the neighborhood of $10-15 billion per year, and would only total $156 billion over the next 10 years per the CBO's June report. The vast majority of the cuts to Medicare lower Medicare's reimbursement rates to providers. This will be crippling to doctors and hospitals, who are already beginning to limit or outright refuse service to Medicare patients. So okay, the ACA reduces some money given to private insurers, which by itself would reduce some coverage provided to seniors. Other parts of the legislation, however, strengthen Medicare by providing seniors free annual wellness visits, free preventative services, and a 50 percent discount for drugs in the Medicare "donut hole"; that is, drugs that were not covered at all under the pre-Obamacare law in the (unpaid for Bush era) Medicare Part D. So "Obamacare" removes some of the outlays to a monetarily expensive and inefficient program (Medicare Advantage) and provides it to services that actually go directly to seniors. Hardly rolling granny off a cliff. None of these "cookies" will make up for what has been taken out of Medicare. Preventative services don't really mean shit when you're already old. You need real care and coverage, which is no longer funded as it was. Pretty much identical thoughts here. PPACA says soak the DOCTORS & HOSPITALS for the treatment they provide. From the Washington PostThe Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. Article also includes a pie chart for the medicare cutsThe political reasoning behind the PPACA was to rob Medicare to bring the total to under a trillion dollars (actual 1.2 trillion estimated currently). This helped its passage. The Trustees report of Social Security and Medicare invites plans to reform the program and its funding. Demonization of the Ryan plan in current dialogue is demagoguery. The program is going to die, and any attempts to reform it are compared to Republicans killing granny. The readjustment to hospital reimbursement by and large isn't a direct cut; it comes from a variety of quality improvement strategies that should have been there in the first place. The most noteworthy one that pops to mind is that it prohibits billing Medicare/Medicaid for hospital-acquired infections that were not present at admission, but it also penalizes hospitals with too much administrative overhead and reduces reimbursement if a patient is readmitted with a condition that should have been treated in the first place, all of which are completely reasonable. While some of the specific numbers for a few admissions are probably taking direct hits, as far as I know, that's not where the majority of the cuts come from. If it weren't the case I suspect the hospitals I worked for would have been significantly more perturbed by the act. I'll also note that the article you quoted itself says the hospitals by and large didn't care. The situation for a lot of hospitals in poor areas right now is that they just don't get reimbursed at all for their services to uninsured patients; if those individuals had easier access to insurance (like through state insurance exchanges, which would evaporate without the ACA), they'd at least get SOMETHING. It doesn't matter what the cuts are purported to be for. They are still cuts to the hospitals that take money out of the system, which is the critical bottom-line issue. Also, keep in mind that many providers are already in a rough spot when it comes to treating illegal aliens. This isn't going to help. Uh, yes it does matter what cuts are for. A hospital should not have an incentive to let you get sick so they can charge the government more. It takes money out of the system that shouldn't go in in the first place. Heck, the whole point of the ACA is to lower the money going into health care! That's a good thing! We don't WANT to spend the most on healthcare in the world if there are more efficient ways to do it. Healthcare doesn't need to be a gigantic industry to be good healthcare. In an ideal world where all medical services were billed at their market rates, you'd be right. However, that's not how the current medical billing system works.
Lol "market rates." Confirmed joke poster right here.
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On August 18 2012 03:11 xDaunt wrote:Show nested quote +On August 18 2012 03:07 TheTenthDoc wrote:On August 18 2012 02:36 xDaunt wrote:On August 18 2012 02:24 TheTenthDoc wrote:On August 17 2012 16:59 Danglars wrote:On August 17 2012 13:21 xDaunt wrote:On August 17 2012 12:11 SerpentFlame wrote:On August 17 2012 11:25 xDaunt wrote:On August 17 2012 10:57 kwizach wrote:On August 17 2012 10:36 xDaunt wrote:
Just out of curiosity, are any of you liberals/Obama supporters worried about the upcoming debates on Medicare? Quite the opposite (notably because of the two fact-checks listed here - the truth and good policies are on Obama's side). Politifact's articles on the Medicare cuts are precisely the kind of crap that makes them look like a hack outfit disturbingly often. I don't know in what world they can classify what Obamacare does to Medicare as not being a cut. It takes money out of the system. Period. Do the cuts directly reduce services? No. However, the cuts do reduce reimbursements to providers, which will reduce the availability of providers that are willing to take Medicare (and this has already been a problem for a number of years). Regardless, here's the bottom-line problem for Obama. Though Paul Ryan advocated a budget with significant cuts to Medicare that are much like Obama's, Romney has not and will not. In stark contrast, not only Obama proposed significant cuts to Medicare, he has actually enacted them. If I were Romney, I'd remake the DNC ad showing Paul Ryan rolling granny off the cliff and insert Obama instead. Romney declared Paul Ryan's budget "marvelous" in debates. He's advocated time and time again for entitlement reform. That he would not try to alter Medicare, as you seem to say, to is not the platform he's been running on for 4 years. Are you really going to say that someone who has already cut Medicare spending is less of a "danger" to Medicare than someone who previously has advocated Medicare reform but currently proposes no cuts to Medicare and would refund the cuts made from Obamacare? I don't think anyone is going to buy that.
The Affordable Care Act cuts funds from Medicare Advantage, a pilot program designed to cut costs. Ultimately, Medicare Advantage ended up costing 12 percent more without providing higher quality care. The program involves a government subsidy of private insurers to try and encourage competition and drive down costs. It was unnecessary government involvement in the private industry that did not cut costs compared to traditional Medicare. Scaling back funds for this program, (especially for those private insurers that don't meet basic health benchmarks, where much of the savings come from) and strengthening the rest is an obvious, and long overdue solution. In fact, I believe most Republicans call this cracking down on waste.
You realize that the cuts go far beyond just the Medicare Advantage program, right? Medicare Advantage only runs in the neighborhood of $10-15 billion per year, and would only total $156 billion over the next 10 years per the CBO's June report. The vast majority of the cuts to Medicare lower Medicare's reimbursement rates to providers. This will be crippling to doctors and hospitals, who are already beginning to limit or outright refuse service to Medicare patients. So okay, the ACA reduces some money given to private insurers, which by itself would reduce some coverage provided to seniors. Other parts of the legislation, however, strengthen Medicare by providing seniors free annual wellness visits, free preventative services, and a 50 percent discount for drugs in the Medicare "donut hole"; that is, drugs that were not covered at all under the pre-Obamacare law in the (unpaid for Bush era) Medicare Part D. So "Obamacare" removes some of the outlays to a monetarily expensive and inefficient program (Medicare Advantage) and provides it to services that actually go directly to seniors. Hardly rolling granny off a cliff. None of these "cookies" will make up for what has been taken out of Medicare. Preventative services don't really mean shit when you're already old. You need real care and coverage, which is no longer funded as it was. Pretty much identical thoughts here. PPACA says soak the DOCTORS & HOSPITALS for the treatment they provide. From the Washington PostThe Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. Article also includes a pie chart for the medicare cutsThe political reasoning behind the PPACA was to rob Medicare to bring the total to under a trillion dollars (actual 1.2 trillion estimated currently). This helped its passage. The Trustees report of Social Security and Medicare invites plans to reform the program and its funding. Demonization of the Ryan plan in current dialogue is demagoguery. The program is going to die, and any attempts to reform it are compared to Republicans killing granny. The readjustment to hospital reimbursement by and large isn't a direct cut; it comes from a variety of quality improvement strategies that should have been there in the first place. The most noteworthy one that pops to mind is that it prohibits billing Medicare/Medicaid for hospital-acquired infections that were not present at admission, but it also penalizes hospitals with too much administrative overhead and reduces reimbursement if a patient is readmitted with a condition that should have been treated in the first place, all of which are completely reasonable. While some of the specific numbers for a few admissions are probably taking direct hits, as far as I know, that's not where the majority of the cuts come from. If it weren't the case I suspect the hospitals I worked for would have been significantly more perturbed by the act. I'll also note that the article you quoted itself says the hospitals by and large didn't care. The situation for a lot of hospitals in poor areas right now is that they just don't get reimbursed at all for their services to uninsured patients; if those individuals had easier access to insurance (like through state insurance exchanges, which would evaporate without the ACA), they'd at least get SOMETHING. It doesn't matter what the cuts are purported to be for. They are still cuts to the hospitals that take money out of the system, which is the critical bottom-line issue. Also, keep in mind that many providers are already in a rough spot when it comes to treating illegal aliens. This isn't going to help. Uh, yes it does matter what cuts are for. A hospital should not have an incentive to let you get sick so they can charge the government more. It takes money out of the system that shouldn't go in in the first place. Heck, the whole point of the ACA is to lower the money going into health care! That's a good thing! We don't WANT to spend the most on healthcare in the world if there are more efficient ways to do it. Healthcare doesn't need to be a gigantic industry to be good healthcare. In an ideal world where all medical services were billed at their market rates, you'd be right. However, that's not how the current medical billing system works.
As long as the status quo continues medical billing won't change either, and we can't leave it that way. Right now there's very little incentive for hospitals to treat patients efficiently, and one of the best ways to fix without spending even more money is to reduce the money going into the industry. Almost any efforts to try to force the costs of healthcare into a reasonable model are good, even if it means some hospitals will take a hit to their bottom line in the short term (especially when those hospitals are the ones that are performing most poorly). The disconnect between quality of service and payment is too severe.
Of course the outlook is uncertain, but I can tell you that massachusetts hospitals have benefited tremendously from mandated health insurance and the commonwealth care system (which ACA apes and can only be paid for through some sort of cuts). Our only problem is costs, but funnily enough the only reason costs are spiraling in MA is because of the lack of provisions similar to not paying for nosocomial infections.
Edit: replaced "any" with "almost any," obviously just killing Medicare entirely would be pretty bad.
Editedit:
On August 18 2012 03:21 xDaunt wrote:Show nested quote +On August 18 2012 03:17 JonnyBNoHo wrote:
The "savings" in the CBO report is the "savings" from the government paying healthcare providers less. While that saves the government money it shifts the cost to somebody else so there is no net savings to the economy.
SOME of that savings will be good and lead to efficiencies but not all of it. Yes, that's exactly right. Some of the cuts that Obamacare are good. However, regardless of the desirability of any given cut, the bottom line is that Obama took $700 billion out of the Medicare program to fund Obamacare. He can twist, turn, spin, and justify it all he wants, but he's still going to face the music on that one.
If he can justify it, I don't really see a problem with it.
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On August 18 2012 03:17 JonnyBNoHo wrote:
The "savings" in the CBO report is the "savings" from the government paying healthcare providers less. While that saves the government money it shifts the cost to somebody else so there is no net savings to the economy.
SOME of that savings will be good and lead to efficiencies but not all of it.
Yes, that's exactly right. Some of the cuts in Obamacare are good. However, regardless of the desirability of any given cut, the bottom line is that Obama took $700 billion out of the Medicare program to fund Obamacare. He can twist, turn, spin, and justify it all he wants, but he's still going to face the music on that one.
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This is 100% free market and you can not get surgery cheaper than this :
http://www.surgerycenterok.com/pricing.php
And this is cash-money only pricing.
Their rates are in line with what I paid to get a bone out from my dog's stomach after she snagged a bone-in ribeye. All told it was $2,200 with a couple hundred after the fact.
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I dont understand how you want money to be saved xDaunt. Here is a case where something has been made more efficient to save money, and now you argue that it is still gutting the system because that money is no longer being spent. Yet at the same time you would argue that the government is spending too much money and needs to cut back. This is a prime case where you twist issues to suit your case, even though they logically oppose your actual stance.
There is no better way to save money than to make something more efficient, and save on costs without hurting its effectiveness. Arguing that your incredibly high healthcare costs now need to remain high or the system is being gutted is kind of senseless. There is obviously a way to save money by making your system better, seeing as how every other country in the world has better healthcare for less cost, and that is what these changes are moving toward. Saying "well we spend a lot and now the industry wont have that money because were spending less for the same thing, so the system is going to suffer" is a little bit silly of an argument.
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On August 18 2012 03:28 Focuspants wrote:
I dont understand how you want money to be saved xDaunt. Here is a case where something has been made more efficient to save money, and now you argue that it is still gutting the system because that money is no longer being spent. Yet at the same time you would argue that the government is spending too much money and needs to cut back. This is a prime case where you twist issues to suit your case, even though they logically oppose your actual stance.
There is no better way to save money than to make something more efficient, and save on costs without hurting its effectiveness. Arguing that your incredibly high healthcare costs now need to remain high or the system is being gutted is kind of senseless. There is obviously a way to save money by making your system better, seeing as how every other country in the world has better healthcare for less cost, and that is what these changes are moving toward. Saying "well we spend a lot and now the industry wont have that money because were spending less for the same thing, so the system is going to suffer" is a little bit silly of an argument.
Rather than instituting Obamacare, I'd only address Medicare. I'd make some cuts on the service provider end, but what really needs to happen is that means-testing on the consumer side needs to be phased in.
EDIT: I'd also reduce the base services that Medicare currently covers and leave those for individuals to purchase supplemental insurance.
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I thought this pretty much nailed it, and why I don't think Romney would want this debate:
*** Will the GOP’s 2010 playbook work in 2012? In addition to those charges and countercharges, the Romney campaign unveiled a new TV ad, attacking Obama for making cuts to Medicare. “You've paid into Medicare for years -- every paycheck,” the ad goes. “Now that you need it, Obama cut $716 billion from Medicare. Why? To pay for ObamaCare.” The Romney campaign is trying to do two things here: 1) make it clear they’re playing on offense on the dicey topic of Medicare, and 2) signal to the rest of the Republican Party that they’re going to provide air cover in this battle that’s traditionally been on Democratic turf. As NBCNews.com’s Mike O’Brien writes, this ad suggests that Republicans are taking a page out of their 2010 playbook on Medicare, and it worked for them during the midterms. But here’s the question: Does that playbook work AFTER House Republicans passed the Ryan budget in 2011 and 2012? After all, the Ryan budget doesn’t just make cuts in Medicare; it substantially transforms the program. Here’s another question: Can Republicans win by attacking their own ideology (that Medicare cuts need to be made!)? We’re getting numb to campaigns launching disingenuous TV attack ads. But this one is amazing because it pretty much undermines the GOP’s own belief system on entitlements.
Source
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On August 18 2012 03:38 screamingpalm wrote:I thought this pretty much nailed it, and why I don't think Romney would want this debate: Show nested quote +
*** Will the GOP’s 2010 playbook work in 2012? In addition to those charges and countercharges, the Romney campaign unveiled a new TV ad, attacking Obama for making cuts to Medicare. “You've paid into Medicare for years -- every paycheck,” the ad goes. “Now that you need it, Obama cut $716 billion from Medicare. Why? To pay for ObamaCare.” The Romney campaign is trying to do two things here: 1) make it clear they’re playing on offense on the dicey topic of Medicare, and 2) signal to the rest of the Republican Party that they’re going to provide air cover in this battle that’s traditionally been on Democratic turf. As NBCNews.com’s Mike O’Brien writes, this ad suggests that Republicans are taking a page out of their 2010 playbook on Medicare, and it worked for them during the midterms. But here’s the question: Does that playbook work AFTER House Republicans passed the Ryan budget in 2011 and 2012? After all, the Ryan budget doesn’t just make cuts in Medicare; it substantially transforms the program. Here’s another question: Can Republicans win by attacking their own ideology (that Medicare cuts need to be made!)? We’re getting numb to campaigns launching disingenuous TV attack ads. But this one is amazing because it pretty much undermines the GOP’s own belief system on entitlements.
Source
Romney does want this debate. Again, there's difference between making cuts to Medicare to reduce the deficit and purportedly preserve Medicare, and then cutting Medicare to enact something unpopular like Obamacare. From what I've seen, pretty much all republicans are bullish on the debate.
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While you guys argue about who's plan is better between Obama and Romney, I just want to point out that regardless of who wins the election you can rest assured that private health insurers will continue to exist, while siphoning money from the system to pay people way too much money to read EOBs to indians, bullshit providers as to the status of their claims, and browse the internet all day. I haven't run into too many horribly inefficient systems in my life so I don't have much to compare it to, but private health insurance companies turn healthcare into a massive bureaucratic clusterfuck. Just FYI :D
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On August 18 2012 03:20 TheTenthDoc wrote:Show nested quote +On August 18 2012 03:11 xDaunt wrote:On August 18 2012 03:07 TheTenthDoc wrote:On August 18 2012 02:36 xDaunt wrote:On August 18 2012 02:24 TheTenthDoc wrote:On August 17 2012 16:59 Danglars wrote:On August 17 2012 13:21 xDaunt wrote:On August 17 2012 12:11 SerpentFlame wrote:On August 17 2012 11:25 xDaunt wrote:On August 17 2012 10:57 kwizach wrote:[quote] Quite the opposite (notably because of the two fact-checks listed here - the truth and good policies are on Obama's side). Politifact's articles on the Medicare cuts are precisely the kind of crap that makes them look like a hack outfit disturbingly often. I don't know in what world they can classify what Obamacare does to Medicare as not being a cut. It takes money out of the system. Period. Do the cuts directly reduce services? No. However, the cuts do reduce reimbursements to providers, which will reduce the availability of providers that are willing to take Medicare (and this has already been a problem for a number of years). Regardless, here's the bottom-line problem for Obama. Though Paul Ryan advocated a budget with significant cuts to Medicare that are much like Obama's, Romney has not and will not. In stark contrast, not only Obama proposed significant cuts to Medicare, he has actually enacted them. If I were Romney, I'd remake the DNC ad showing Paul Ryan rolling granny off the cliff and insert Obama instead. Romney declared Paul Ryan's budget "marvelous" in debates. He's advocated time and time again for entitlement reform. That he would not try to alter Medicare, as you seem to say, to is not the platform he's been running on for 4 years. Are you really going to say that someone who has already cut Medicare spending is less of a "danger" to Medicare than someone who previously has advocated Medicare reform but currently proposes no cuts to Medicare and would refund the cuts made from Obamacare? I don't think anyone is going to buy that.
The Affordable Care Act cuts funds from Medicare Advantage, a pilot program designed to cut costs. Ultimately, Medicare Advantage ended up costing 12 percent more without providing higher quality care. The program involves a government subsidy of private insurers to try and encourage competition and drive down costs. It was unnecessary government involvement in the private industry that did not cut costs compared to traditional Medicare. Scaling back funds for this program, (especially for those private insurers that don't meet basic health benchmarks, where much of the savings come from) and strengthening the rest is an obvious, and long overdue solution. In fact, I believe most Republicans call this cracking down on waste.
You realize that the cuts go far beyond just the Medicare Advantage program, right? Medicare Advantage only runs in the neighborhood of $10-15 billion per year, and would only total $156 billion over the next 10 years per the CBO's June report. The vast majority of the cuts to Medicare lower Medicare's reimbursement rates to providers. This will be crippling to doctors and hospitals, who are already beginning to limit or outright refuse service to Medicare patients. So okay, the ACA reduces some money given to private insurers, which by itself would reduce some coverage provided to seniors. Other parts of the legislation, however, strengthen Medicare by providing seniors free annual wellness visits, free preventative services, and a 50 percent discount for drugs in the Medicare "donut hole"; that is, drugs that were not covered at all under the pre-Obamacare law in the (unpaid for Bush era) Medicare Part D. So "Obamacare" removes some of the outlays to a monetarily expensive and inefficient program (Medicare Advantage) and provides it to services that actually go directly to seniors. Hardly rolling granny off a cliff. None of these "cookies" will make up for what has been taken out of Medicare. Preventative services don't really mean shit when you're already old. You need real care and coverage, which is no longer funded as it was. Pretty much identical thoughts here. PPACA says soak the DOCTORS & HOSPITALS for the treatment they provide. From the Washington PostThe Medicare Advantage cut gets the most attention, but it only accounts for about a third of the Affordable Care Act’s spending reduction. Another big chunk comes from the hospitals. The health law changed how Medicare calculates what they get reimbursed for various services, slightly lowering their rates over time. Hospitals agreed to these cuts because they knew, at the same time, they would likely see an influx of paying patients with the Affordable Care Act’s insurance expansion. Article also includes a pie chart for the medicare cutsThe political reasoning behind the PPACA was to rob Medicare to bring the total to under a trillion dollars (actual 1.2 trillion estimated currently). This helped its passage. The Trustees report of Social Security and Medicare invites plans to reform the program and its funding. Demonization of the Ryan plan in current dialogue is demagoguery. The program is going to die, and any attempts to reform it are compared to Republicans killing granny. The readjustment to hospital reimbursement by and large isn't a direct cut; it comes from a variety of quality improvement strategies that should have been there in the first place. The most noteworthy one that pops to mind is that it prohibits billing Medicare/Medicaid for hospital-acquired infections that were not present at admission, but it also penalizes hospitals with too much administrative overhead and reduces reimbursement if a patient is readmitted with a condition that should have been treated in the first place, all of which are completely reasonable. While some of the specific numbers for a few admissions are probably taking direct hits, as far as I know, that's not where the majority of the cuts come from. If it weren't the case I suspect the hospitals I worked for would have been significantly more perturbed by the act. I'll also note that the article you quoted itself says the hospitals by and large didn't care. The situation for a lot of hospitals in poor areas right now is that they just don't get reimbursed at all for their services to uninsured patients; if those individuals had easier access to insurance (like through state insurance exchanges, which would evaporate without the ACA), they'd at least get SOMETHING. It doesn't matter what the cuts are purported to be for. They are still cuts to the hospitals that take money out of the system, which is the critical bottom-line issue. Also, keep in mind that many providers are already in a rough spot when it comes to treating illegal aliens. This isn't going to help. Uh, yes it does matter what cuts are for. A hospital should not have an incentive to let you get sick so they can charge the government more. It takes money out of the system that shouldn't go in in the first place. Heck, the whole point of the ACA is to lower the money going into health care! That's a good thing! We don't WANT to spend the most on healthcare in the world if there are more efficient ways to do it. Healthcare doesn't need to be a gigantic industry to be good healthcare. In an ideal world where all medical services were billed at their market rates, you'd be right. However, that's not how the current medical billing system works. As long as the status quo continues medical billing won't change either, and we can't leave it that way. Right now there's very little incentive for hospitals to treat patients efficiently, and one of the best ways to fix without spending even more money is to reduce the money going into the industry. Almost any efforts to try to force the costs of healthcare into a reasonable model are good, even if it means some hospitals will take a hit to their bottom line in the short term (especially when those hospitals are the ones that are performing most poorly). The disconnect between quality of service and payment is too severe. Of course the outlook is uncertain, but I can tell you that massachusetts hospitals have benefited tremendously from mandated health insurance and the commonwealth care system (which ACA apes and can only be paid for through some sort of cuts). Our only problem is costs, but funnily enough the only reason costs are spiraling in MA is because of the lack of provisions similar to not paying for nosocomial infections. Edit: replaced "any" with "almost any," obviously just killing Medicare entirely would be pretty bad. Editedit: Show nested quote +On August 18 2012 03:21 xDaunt wrote:On August 18 2012 03:17 JonnyBNoHo wrote:
The "savings" in the CBO report is the "savings" from the government paying healthcare providers less. While that saves the government money it shifts the cost to somebody else so there is no net savings to the economy.
SOME of that savings will be good and lead to efficiencies but not all of it. Yes, that's exactly right. Some of the cuts that Obamacare are good. However, regardless of the desirability of any given cut, the bottom line is that Obama took $700 billion out of the Medicare program to fund Obamacare. He can twist, turn, spin, and justify it all he wants, but he's still going to face the music on that one. If he can justify it, I don't really see a problem with it.
I agree that if the cuts can be justified that they are fine IMO. I do have to question the effectiveness of making healthcare providers more efficient by cutting payment rates though. It seems more likely that the quality of service would decline first and foremost.
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EPT
