There is politics and there is policy.
On the policy front what we saw today was the same exchange of the old talking points we have watched for a longtime. No progress was made toward any kind of health care bill. That is no surprise–this was never going to be the place to
fashion any kind of compromise.
At the end the President asked the Republicans if it was worth it to spend another month or six weeks trying to come to some agreement. I am glad he did that. I am not optimistic but a “yes” from the Republicans would be the right answer for the country.
On the political front this was a win for Republicans because it was a draw. Granted, they have a very thin health care agenda but all they had to do was hold their own over the course of the day. Politically, if not on policy, they did that. No minds were changed in the room and likely none out in the country. The left will still say get on with passing this, those on right will say kill it, and the majority of critical swing voters will still be concerned that the Democratic bills are going too far too fast in the face of the Great Recession. This is the biggest reason I don’t hold out a lot of hope there will be a lot of Republican willingness to come to the table–at least before the November elections.
Ironically, this “bipartisan summit” may have just increased the political cynicism in the country because it went off so predictably.
Most importantly, I don’t see the President and the Democratic leadership having accomplished their real goal: To “stiffen the spines” of the moderate Democratic votes they need to ram their health care agenda through using reconciliation rules.
A week from now, I expect the polls will still show only about the same 40% approval rating for the Democratic health care agenda and the moderate Democrats won’t have the political cover they need to vote for a reconciliation strategy.
Unless the President gets a positive response from the Republicans on his offer to spend a few weeks trying for a bipartisan bill, it will be on to “Plan B” for the Democrats.
Categories: Uncategorized
Someday i felt tied,then i walked and walked…
Does anyone remember when you paid for insurance and then never saw a bill for going to the doctor…you paid for your insurance and that was all. You maybe had to pay extra for a private room when you were in the hospital but that was it. You and your doctor decided what was best in the way of treatment. But rising costs made insurance rates go up and people complained…next came some hair brain idea about HMO’s and PPO’s. Now I have to check to see if my doctor is on the “list” and if I need a “specialist” I have to go see a doctor (general practitioner) who does not specialize in that problem first to be “refered” to the doctor I wanted to go see in the first place. Oh and now I have to pay a co-pay to not one doctor but two. And then if the insurance company deems that the costs are too high they’ll only pay a certain amount then I get a bill for the rest! So now instead of insurance I’m just prepaying a discounted rate…God forbid the doctor prescribe a name brand drug…I pay the highest co-pay and if he has to prescribe more than 30 pills per month I can expect to pay the highest copay for the first 30 pills then full price for the next…so a 60 dollar perscription can end up costing me over $400! All because the insurance company’s “experts” think I should only have 30 pills or I need to use some generic that I’ve tried and doesn’t work as well.
TRUE REFORM would be if you have insurance they should charge reasonable rates and cover whatever the Dr. prescibes as a reasonable treatment. If people do not have insurance then they need to pay for treatment out of pocket by setting up a payment plan with the doctor or treatment facility that they can both agree to. People do not have to go broke paying for medical care but at the same time they should not get it for free! They should also not expect those of us that fork over a third of our takehome pay for insurance to pay for their care either. I pay my bills. The last time I had surgery…insurance paid their part then I paid what I could each month till it was paid in full. Personally insurance should have paid my entire bill not just what they wanted to. But thanks to the inventers of our current healthcare system they won’t.
True Reform will not come out of the current crap Mr. Obama wants rushed through and passed…it has to many tack on’s and pork. The middle class will foot the bill and suffer the most. Doctors have to take an oath to “DO NO HARM”….I think our President and Congress needs to take the same oath before tampering with something none of them will be affected by. ARE there any Medical Doctors in congress? I don’t think so. Untill then they need to focus on costs and capping them. Flat fees for operations, flat fees for new drugs, flat fees for drugs that have been around 10 or more years. That way there are no surprises when you open the bill from the hospital… No more $100 band-aids or $50 ibuprofen tablets…etc. Then people could set up repayment plans based on income not the dictates of the insurance or medical industry. Everyone is out to make a profit…but they do not have to overinflate costs to the extent they do. Just like if a ibuprofen cost $.03 ($10.00 bottle of 300) yes charge $.06 or $.10 for that tablet not $50… you’re still making a profit but you are not taking advantage of the most needy….get the picture!
jd I would further argue, not in a yelling manner though, that the equal protection clause was meant specifically to prevent the vote buying we see today. The Cornhusker kickback and Louisana Purchase undermine democracy at its core.
jd in regards to the success of socialist vs libertarian states which of these 10, 20 or 40 successful countries would you say are improving on their standard of living? Liberalism doesn’t kill a nation overnight, it slowly strangles it over generations. Take Greece for example, they are clearly without doubt on their way to collapse, Debt exceeds GDP, every indicator is they must make changes…and Unions are protesting in the Street for Status Quo.
The fall of Rome didn’t happen over night and it was a great empire up till the end, that doesn’t change what killed it though, and that which did kill it wasn’t what made it great.
“A free people can choose that in a Democracy.”
Is it still a democracy if 51% vote to confiscate the wealth of the other 49%? While technically a Democracy when votes are out right bought you can no longer call it freedom.
Does anyone ever learn anything in these debates? I think Margalit has evolved some the longer she has posted. Not sure anyone else has.
There have been dozens of howlers in this thread, and if I were unemployed I might even have the desire to engage them all. As it is, I’ll just point out again that the failure of both private and public insurance to control costs is primarily a failure to control the cost of health care. Obvious, yes, but it bears repeating. Both fail for similar reasons that come down to public attitudes and expectations (and lack of knowledge), which provides an opportunity for industries and their interest groups to press the advantage to grab a larger and larger share of the national income.
Nobody, not Nate or Peter or Mr. Laszewski or President Obama, will be able to solve our health care cost problem until we are able to reset public expectations and break the power of the provider/supplier lobbies. It is clear from examples across the world that this can be done using a single payer or multiple private or quasi-private payers. The coverage vehicle in this sense doesn’t matter. What matters is the politics, the culture and whether power is able to serve the public interest.
Which brings me to one political point: it was asked whether any non-liberal nation has been successful (which I’ll interpret to mean: is there any non-socialist nation in the top quartile for standard of living). The United States absolutely must be considered socialist or a capitalist-socialist hybrid: Social Security, public education system, Americorps, Medicare, Medicaid, VA, food stamps, huge funding for basic research at govt and non-govt institutions, modestly progressive tax system designed to redistribute wealth, etc. The US government spends as much on health care per capita as nations with single payer universal health care systems.
There are no non-socialist nations in the top 10, or top 20, or top 40 nations. Nor will there be. In simpler times, when the bonds of family and community were strong, things could be taken care of at that level in a way they cannot be taken care of in our fluid, free society. Huge, complex, socially free societies fall apart when government doesn’t step in to smooth the rough patches, ensure safety and protect people from some aspects of failure when they strike out on their own or are left on their own. If that weren’t the case, and Libertarian ideals worked, don’t you think you’d see a single example of it? Even with the US, the states that are the least Libertarian tend to have the highest economic success.
I don’t mean that we don’t see Libertarian elements in successful societies. Certainly, we do, and protecting certain kinds of freedom and responsibility can be very effective and valuable in their own right. But there is no “Libertarian” society today because those ideals are as stupid in their understanding of human nature as Communist ideals.
The best way to kill Libertarianism is for a modern nation to embark on the project of becoming a purely Libertarian political system. It won’t survive first contact with the real world, just as Communism didn’t. We’re all going to live with massive government involvement to structure the economy for the rest of our lives, just as we have lived with it for our entire lives up to now. The questions to ask have to do with the best way to make government work, and yes, that means people are making decisions that impinge on the freedoms of others. A free people can choose that in a Democracy. And they have. And they will continue to do so. No amount of yelling will change that.
“You live in a fantasy world that is determined by factually unsupported extreme rightist ideology.”
Typical Wendell, wild claims and not one example to back it up. Argue any point I made Wendell….you can’t, you can’t even man up and debate a single thing I said. Grow a pair then post buddy.
“If you aren’t hung as an enemy of the people.”
Didn’t I read in the Liverpool Care Pathways that hanging was the preferred treatment for old age and many other age related conditions?
“But pretending that certain markets such as the market for medical services lend themselves to competition when they in fact do not, have not and cannot for the most part, is foolish and an impediment to rationale discussion of alternatives.”
ya ya and man made global warming will melt the glaciers in 50 years, and islands will be under water, and this year will be a horrible hurrican season, and ALL THE SCIENTIST agree. It is exactly your ignorance of the ability for medical services to be competitivly purchased that you try to hard to deny it. It is this same ignorance of what is possible that your ideology always fails. You ignore the viable solutins asimpossible and implement the impossible as viable…and are shocked when it never works out.
You can’t expect poor people to provide for their own hosuing so we’ll just round them all up into projects….wow can’t imagine why that failed.
You can’t hold parents and their kids accountable for showing up to school and getting an education so we’ll just socially promote them…uuugggg why didn’t that work it made so much sense on paper.
poor people can’t saveup money to buy houses so we’ll let people with no money and poor credit buy houses to….why in the world would they default we gave it to them for nothing
I could go on all day. Each of these problems had an obvious solution that was viable, liberals and Wendells, couldn’t see the obvious so they instead went with the obvious to fail….and low and behold fail they did.
Nothing in healthcare is beyond competition, only small minded liberalism prevents it.
It’s time Americans aggressively voice their support for a bipartisan approach. Call your congressman today and demand that the Healthy Americans Act (Wyden Bennett) get its hearing!
archon41: Nate is the contributor here who raises ideological irrelevancies. Not only that but socio-economic systems are complicated. If one wants to characterize portions of the USA healthcare system as competitively determined versus administered, that has some meaning.
But those characteristics are largely devoid ideological content which almost never serves any positive role in any case. Those characteristics represent mechanisms for pricing and bridging supply and demand.
I suspect that anyone without a special political or ideological axe to grind but otherwise across the political spectrum would prefer see to supply and demand for services or products met by a competitively-determined market.
But pretending that certain markets such as the market for medical services lend themselves to competition when they in fact do not, have not and cannot for the most part, is foolish and an impediment to rationale discussion of alternatives. Much better to identify those segments of the market that can set by competitive forces and therefore make policy choices that permit or encourage that.
And here we have, writ large, a demonstration of why attempts at “bipartisanship,” “dialogue” and “compromise” are futile. If you aren’t on board with the agenda, you are a sociopath, and need to STFU.
Don’t worry, Nate, you’ll get your fair share of monopsonized health care, equal, uniform and precision cut. If you aren’t hung as an enemy of the people.
“You cant regulate a free market system.”
Healthy free markets are, by definition, regulated, at least according to Adam Smith. For example, automotive market has always been regulated: you can’t sell a car unless it meets several regulations. The food market is regulated: you cannot sell food that does not meet certain quality regulations. Most markets are similarly regulated. We have anti trust laws.
Basically the government’s job is to make sure the consumer is not being sold dangerous stuff and that sellers don’t collude to set unfair prices.
So why is it that it becomes a Stalinist horror story when the government proposes to regulate the minimum quality of health insurance plans? If anything, the government is guilty of doing too little too late.
And Nate, why are talking about Mao and Pot and Stalin when we are discussing liberal views which have nothing to do with rabid Communism? Should we discuss Fascism whenever “the good of the country” is mentioned with utter disregard for the good of the citizens?
Nate: You live in a fantasy world that is determined by factually unsupported extreme rightist ideology. Your praise of capitalism and condemnation of other social systems are laughable. I doubt you even know how to define capitalism and its characteristics, both good and bad.
Still unclear what it is that you do for a living, but you should stick to reporting on the details of that rather than extrapolating from your specific occupational experience to grand theories about society or economics.
At least those details add something positive to this weblog. The rest is utter nonsense and uses up electrons that could otherwise be used more productively.
“This president is great at pointing at problems but his greatest problem his is that is an idealogue.”
Not that GW Bush was or the GOP is of course. He’s only one man, not king and not god. He can’t even control his own party, let alone Congressional leaders elected by their state voters. Do you want a king?
“And the governments emergence and evasive policies into our economy have caused nothing but harm.”
You might want to look at how a lack of government regualtion in the financial industry brought us this latest crisis. The “government” that started all this “evasive policies” (I think you mean invasive) was a Republican, Alan (hands off regualtion)Greenspan, a Republican, GW (free market) Bush, and a Republican, Henry M. (700 Billion bailout) Paulson, Jr. Do you think that extensions of unemplyment insurance, COBRA subsidies and taxpayer money sent to local communties for projects “have caused nothing but harm”?
“You realize Reagan believed in trickle down economics.”
If he believed in it he actually legislated “trickle up” economics.
“But just talk to a few people in finance.”
You mean the ones who got bailed out and their bonuses secured by “government”?
“but that is because industrial capitalism has been killed off by purely financial capitalism, which does not ever “trickle down” anything but debt.”
There are 12-20 million illegal immigrants that would disagree with this. NOTHING in the history of man has brought more people out of poverty then capitalism and free markets. No soical engineering or liberal feel good program even scratches the surfce of the success of freedom. Wealth redistribution, as history has shown time and again, brings everyone down instead of raising everyone up.
technically Moa, Pol Pot, and Stalin “helped” people. The problem is the tens of millions that died to accomplish it. Liberalism has the same success, for every person it marginally helps it destroys many times that. The problem isn’t that communism, facism, liberalism, or even free markets kill people, people will die under any system no matter what, the problem is Liberalism like communism and socialism removes the opportunity for individuals to determine their own destiny. Liberalism sentences people to death. It sentences entire generations to it actually. See public housing and education.
You realize Reagan believed in trickle down economics.
And of course you also realize that socialism is just trickle down economics from a shallow water pot?
Id venture that you dont truly understand the trickle down theory. Few do.
You asked for a non liberal country that had been mildly successful.
Youre living in one.
The name of the problem is corruption among the government. Ya know how that happens? BIG GOVERNMENT!
Yes, Obama is great at talking something to death. Thats really all hes got going for him in more ways than just a few.
I dont understand why He repeats himself over and over concerning the problems with the HC system. How can you be alive and not ‘know’ what they are? This president is great at pointing at problems but his greatest problem his is that is an idealogue. And the governments emergence and evasive policies into our economy have caused nothing but harm. But just talk to a few people in finance.
You cant regulate a free market system. Why? Because you cannot predict free markets responses to regulations. And unless youre a psychic or God you cannot. Obama has left the credit card companies with nothing but the opportunity to find even more deceptives to get more money out of americans which at the end of the day hurts more than it helps.
I think Obamas banking ventures and automotive ventures and yes, even Health Care Reform is nothing more than what the little boy does when he thinks mom and dad wont get what a good idea he has in mind until he just goes and does whatever is in his mind without first asking. Then when mom and dad see what a great idea it is theyll see after the fact they woulda been wrong to say no.
Thats what Obama is entourage are. Children. Children that think big government and a more socialistic approach is the best thing and when Americans see what a good idea it is we’ll do like the mom and dad…feel foolish more thinking it was a bad idea.
Every intervention this administration has made into our lives has left us with short term and long term difficulties even more severe than the ones they were first trying to circumvent.
Obama puts ideals and ideas above this country and its people. Thats why hes dangerous and a horrible president.
Hes not on fire about Healthcare because he just genuinely loves the american people. What Obama is genuinely in love are his personal beliefs about government and society.
Next time someone runs on the promise of the hope of change. Maybe people will look more closely at the facts
and not turn a blind eye to the facts as they did concerning this mans past and his affiliations.
Birds of a feather and all that…
“Who exactly has Liberalism ever helped?”
I of course could write an essay in response, but I think you know what the contents would be. Unfortunately, we can not run RCTs to prove the point, but I would like you to give me one example of a non-liberal country in this whole wide world that is even mildly successful.
And please remember that our country has been at the front line of liberalization from the day they put it in writing that all men are created equal.
I do agree with you that we are being forced to contemplate more social support lately, but that is because industrial capitalism has been killed off by purely financial capitalism, which does not ever “trickle down” anything but debt. So maybe the solution is somewhere deeper than just health care.
“For me the entire country is the entire country – 100% of its citizens.”
You mean like how Medicare raised senior poverty from 13% to 19%? All the people in public housing who liberalism helped? Liberalism claimed to help people but hasn’t. Who exactly has Liberalism ever helped?
“…it really is in the best interest of the entire country if you let [liberalism] die and we learn from its failures.”
How do you define “the entire country”, Nate? Is it the 80% than can survive? Maybe the 1% that gets richer and richer every day? For me the entire country is the entire country – 100% of its citizens. So maybe you want to rephrase that and say that it is in the best interest of a large portion of the country.
At that point I will argue that you cannot really have a successful country where large segments are doomed to all sorts of deprivations. These are not just “bums” any more. These are hard working folks, and it’s getting worse.
I don’t feel warm and fuzzy at the prospect of Medicare, Medicaid and Social Security going away, leaving millions of elderly, sick and poor to fend for themselves in abject poverty. What exactly are we trying to achieve here? Arab Emirate status?
Let’s look at it from a different angle. If some inner workings of the food industry would cause 45 million Americans to be unable to afford the purchase of basic food, like bread, do you think the government should intervene? And by intervene I don’t mean suggestions of eating cake, or dropping dead quickly.
“I am saying that with all the fraudulent schemes out there, people are leery about unknown small players.”
I need a theme song, if I had one then people wouldn’t be leery. Wonder if I could get a grant to buy and market a theme song, surly there must be some government program for theme songs.
I don’t see nearly the leerynees you claim Margalit. Sitting down in front of them and shacking their hand seems to resolve a lot of that, unlike some faceless insurance company 2-3 states away you can barely get on the phone let alone to come to your office. There is also that worthless broker the left loves to hate that supposedly does nothing but leach off the system. When they say they know me and have been doing business with me for years then people don’t seem to have concerns about my leerinspiring nature.
For being 600% more expensive and so inefficient, compared to Medicare as Liberals like to claim, when we administered Medicare Supplements the seniors loved us. They could come sit down in our office and talk, they would get the same person on the phone when they called, and we knew them by name not number. Geanted we got paid nicely for it, them seniors know how to cook, we could have opened a confectionary store with all the sweets we would get around holidays.
“but I have seen numerous allowable schedules.”
You know you can create a comparison between any two numbers correct? A private fee schedule is always some percent of Medicare. That doesn’t mean it was created based on Medicare. You can look at every single allowable schedule in the world and that still wouldn’t support your argument. You can only look at the actual contract to see if it is based on 125% of Medicare.
“the private sector seems unable to provide care for all its constituents.”
? The private sector is the sum of those that buy policies not the sum of everyone under age 65. Is VA broken becuase people are uninsured? How about Indian Health Affairs? Care for the poor has been a responsibility of Medicaid since early 1960s. It has been broken since roughly 5 years after it passed.
Private Insurance is self sustainable, it can’t fail as it corrects itself by raising rates to cover its risk every year. It can only collapse if artificial restraints are placed on it, like being required to write policies on people after they are sick and haven’t been paying premium or being required by law to allow people to lie on their policies.
Further government has been shifting Medicaid liability to private insurance for years and now allowing them to charge for it. They have also been shifting Medicare cost to private insurance. So once again you are completly wrong, Private insurance, far from being broken, is the only thing keeping Medicare and Medicaid alive. If Medicare and Medicaid could not transfer cost to private insurance they would have already collapsed.
The liberal opinion is both must be addressed but not for the reason you claim. All three pillars of liberalism are on the verge of collapse; Medicare, Medicaid, Social Security. If liberals can’t find 100 trillion+ to shore these up it will be the death of your dogma. The average person can name pretty easily segments of our economy where you can raise 100 trilion over the next decade or two;
Healthcare
Energy
Banking
What are liberals main “reform” efforts these days?
Healthcare Reform
Cap and Trade
Finance Reform
What a shock all are comprised of MAJOR new taxes and regualtion and questionable benefits. The only failure happening here is the failure of Liberalism, I know it is scary for you Margalit but it really is in the best interest of the entire country if you let it die and we learn from its failures.
Without reform private insurance will still be here in 20 years. Without reform Social Security, Medicare and Medicaid won’t.
Nate, I am not saying that smaller companies, like yours, are not offering better value than the giants. I am saying that with all the fraudulent schemes out there, people are leery about unknown small players. Why did those two Ohio companies go bankrupt, and what happened to their customers?
As to the fee schedules, we will have to agree to disagree. Obviously your experience is different than mine. I did not negotiate any contracts, but I have seen numerous allowable schedules.
So Medicare is broken in the sense that its costs are escalating. Private insurance is similarly broken (the sum total, not your company). However, unlike Medicare, in addition to escalating costs, the private sector seems unable to provide care for all its constituents. In the liberal opinion, both failures must be addressed simultaneously, and if one should have precedence, then universal coverage should come first. I think this is where we differ.
“Patients or employers are the ones selecting the insurer, and they are less likely to pick ACME insurance even if the price is slightly lower.”
And you base this on how many thousands of policies you have sold? Why do you make statements like this? You have to know you have no basis of knowledge to even begin to form an opinion let alone state emphatically they won’t buy ACME. Ohio has had 3 insurers go out of business this year, 2 of which were only a couple years old. Both had business and that business was gained SOLELY on the grounds of cheaper rates. There are new insurance companies formed every year and they compete SOLELY on rates. Insurance is a commodity, like life and auto and all other insurance you buy based on price. There is very little to sell insurance on besides rate, your comment is completely inaccurate.
“it usually takes the form of 1.25 Medicare, or something like that, and then applied to each and single 90000.”
How many contracts have you signed? Personally I have done thousands and when you include the other networks we use over a million. Short answer, um no. Long answer Medicare has the most convoluted fee schedule money can design, people go out of their way to avoid linking anything to Medicare because you then need to spend the time to calculate Medicare allowable. Conversion factors seldom have any relation to Medicare. When we came up with our conversation factors Medicare was never consulted once, we looked at what other PPOs were able to get, estimated what we could get away with at our size then came up with numbers we could get the doctor to take.
“The brightest lights are going to be shining on Medicare’s business in the coming years. It will have to change.”
Then why not fix Medicare and prove they can fix Medicare before they destroy the rest of it? If someone has never once in their life succeeded at something why would you continually trust them with more and more responsibility? That makes as much sense as trusting the med student that can’t find a vein to do your open heart surgery. They can’t give an injection, diagnosis a cold, or treat a sprain but sure they can do open heart surgery, there bound to get something right sooner or later.
Looks like “universal single payer” is the default modality here. If anyone is still interested in the President’s Proposal, I wish they would explain to me the rationality of subsidizing, for the uninsured, the purchase of insurance from the private insurers who are feasting on hapless consumers (cue, in your mind’s eye, Goya’s hideous giant devouring a human torso.) How on earth are they going to manage copays, deductibles, and gaps in coverage? Is there some ideological fastidiousness here about creating “second class patients”? You’ve already done that with Medicare. You would like for me to participate in funding broader benefits than those available under Medicare, perhaps? And what about these obscene insurer profits and “administrative costs”? Surely tax dollars can be put to use more effectively, with greater practical relief to the beneficiaries.
The problem with your Anthem strategy, Nate, is that the business is not conducted just between providers and payers. Patients or employers are the ones selecting the insurer, and they are less likely to pick ACME insurance even if the price is slightly lower. Name recognition and viability and financial stability are big factors in that choice. Maybe that’s wrong, but it is what it is. So basically the whole thing is a chicken-and-egg sort of thing. As much as a provider may dislike Anthem, if they stand to lose half their patients if they don’t take Anthem, they will bite the bullet, complain and sign the contract.
This is why I agree with you that these giant insurers need to be broken down, just like the giant hospitals need to be.
As to the payments, the x.xx offered for the 90000s, it usually takes the form of 1.25 Medicare, or something like that, and then applied to each and single 90000. And when contract time comes around next, and the newest Medicare fee schedule is up, the game starts afresh. These are the allowables we are talking about. What the provider bills out is much higher and only relevant if you are uninsured.
As to other professions, yes teaching is a horrible mess and an example of why we shouldn’t do anything across the board and “on the cheap”. However, in the service market, a good lawyer makes more than a lousy one and a good plumber gets more business than a crappy one.
You can always figure out ways why nothing can change and why we are doomed to failure, but the entire premise of Change is to affect Change. Which means changing how Medicare reimburses providers and changing how it deals with fraud and changing all the wasteful ways it squanders our money. The brightest lights are going to be shining on Medicare’s business in the coming years. It will have to change.
Obviously Congress doesnt want to change-their intent to fight each other rather than do some good for the public. Most of them have dated solutions that dont work as they are relatively untroubled about the problems in the country-after all unless they feel our pain they can be as indifferent as they chose to be- and are. Its up to us to foster change for Congres is too neurotic to do much for anyone but themselves
I don’t know if the Republican Senators at the summit are sociopathic, but I do know this: they are FORMER doctors as being a Senator is a full time position, so they do not practice medicine at this point in their lives. So, their perpective is PAST perspective, not current. And, their loyalty is evident per comments to party needs, not public needs.
In my opinion, it is time for medicine as a DISCIPLINE to find a way to mark when a doctor is not actively practicing clinical care, so his/her credentials reflect that to the public, maybe like “pMD” for Prior Medical Doctor.
Me, some people should be defined as “daMD” for DUMB ASS! Sorry, I know this is a rude comment, but, it is what it is to me. They are not advocates for what physicians should be advocating.
“If Anthem owns half the lives in a particular state, you have to take whatever they give you.”
This is where I must point out that for being bright enough to get a medical degree most doctors aren’t bright enough for basic business logic. What doctors did in the past was agree to aggressive rates from Anthem then try to gauge the smaller people. This created an excessive price disparity between B(lues)UCA and everyone else that drove more business to BUCA which gave them greater pricing power. Business 101 would have told providers my enemies enemy is my friend. They would go to the small players and give us contract 5-10% higher then BUCA. Those players could not compete with BUCA and take business away from them and decrease their pricing power.
Sorry I’m not going to pity providers for their own poor business decision, that is how a free market works, you make a mistake you pay a price. We are actually seeing aggressive moves from providers, mostly hospitals, to strengthen the competition to BUCA. It won’t happen over night but easily in under 5 years.
Mt technology is as good as BUCA, my disease management and care programs are better, and my service is better, the ONLY reason people choose BUCA over the smaller players is the discrepancy in discounts. Lie with dogs don’t complain about the fleas.
“For every other profession, payment is somewhat tied to outcomes and quality and mastery.”
Margalit you must be joking. You really mean to argue public education is tied to quality and mastery? How about politics? Just about anything union? When I go to the DMV all those workers are the best out there?
Read Barry’s link but disagree with what you’re taking away from it. Just because I use RBRVS doesn’t mean my allowables are tied to Medicare. We might use the same RVUs but what we pay per RVU have no relation to each other. In our PPO contracts we would agree with the physician or other provider to pay a dollar amount per class of RVUs, 90000s get $x.xx while your 80000s get $y.yy. When Medicare changes what they pay per unit that doesn’t allow us to break our contract and start paying less per RVU. It’s the same as AWP and why that lawsuit was such a joke, all AWP and RVU are is arbitrary values assigned to a service. It’s the value you assign to that arbitrary unit that matters and private insurance and Medicare are not that closely linked.
So that’s your defense for the failures of Medicare, tell me to learn some facts? You sold me, I’m now a believer, based on Wendell’s overwhelming logic I believe Congress will for the first time successfully run a healthcare program, deliver all the benefits they promise, and do it cheaper then what they claim. Further never again will Congress make empty promises to physicians or the public only to break them 5-10 years later. Wow Wendell I only wish you had enlightened me earlier.
Please excuse me while I go out and prophesize the Hope and Change….Margalit can I borrow some of your signs?
Accept it Mr Laszewski and followers of this guru who has been in DC too long.
We will have long overdue major US health care reform very soon.
It will be accomplished through reconcilitation because the Republicans and some fringe Democrats have the audacity/immorality to say we need to “start all over”
As Chris Dodd said,yes,it’s complex and all connected, but expanded COVERAGE is the lynchpin of reform
Sorry Mr Laszewski – US History is about to be made.
We will figure out fair and ethical methods of controlling costs about which you seem to obsess.
Dr. Rick Lippin
Southampton,Pa
To invite two sociopathic uncaring Republican doctor-politicians to the summit was an ethical low point for the nation and the US medical profession.
Dr. Rick Lippin
Southampton,Pa
Not only is the means of price setting that Mr. Carol cites accurate but most primary care physicians bill for only 10 of the over 7000 billing codes. The balance of the codes are for any conceivable procedure, mostly, but not exclusively performed by specialists. From this perspective the pricing is 100% administered and in large part (the conversion factor into monetary units is set by Congress for Medicare at least) is set by the service providers themselves.
Not done nefariously, but the outcome, particularly over decades, is predictable and renders the current level of reimbursement.
The AMA website among other sources has a straightforward description of the RUC and of the RBRVS process.
archon14: mono + opsōnein = single to buy = single buyer. You are looking in the wrong place. The counterpart of better-known monopoly mono + polein – single to sell = single seller.
Nate: Please learn a few relevant facts about economics before writing once in a while.
“all this utopia”
It is called an administered market not utopia. The market for medical services will largely continue to be an administered one. At least the diagnostic part will be. Procedures that lend themselves to a “factory method” for performance can increasingly be offered in a competition-determined marketplace.
Margalit, I have no doubt you believe what you are saying about the willingness of doctors to treat Medicare patients, but you are quite mistaken. I reside on the outskirts of a fairly large metropolitan area with an extensive medical community. Not so very long ago, I broke my upper arm. I was bound up in the ER, and referred to the orthopedist “on call.” I contacted his office the next morning, and was told he had been on vacation for a week and wouldn’t be returning for another week. So, I sat down with the yellow pages and starting making calls. Over a period of several hours, I heard a multitude of variants of “Dr. So and So isn’t accepting new Medicare patients.” My arm was swelling and turning blue, and I was getting a little desperate, so I contacted the ER physician to see if she had any ideas. She didn’t. I kept calling individual orthopedists, unaware that a number of them were part of the same practice. Late that afternoon, one finally agreed to see me. He was part of the same group to which the doctor on vacation belonged. I suspect the only reason he accepted me for treatment was concern that I would go back to the hospital and blab that the ortho “on call” was on vacation. Later, I questioned a physical therapist associated with the orthopedic group, and he told me the group decided several years ago to withdraw from both Medicare and Workers Compensation practice. Too much “hassle” for too little pay, as he put it. Yeah, I heard that duffer who claims to be Obama’s personal physician warble about how much better Medicare is than private insurance. What a flack.
Yes, Barry, but the reform bill has several provisions for changing the status quo and for starters CMS is proposing to equalize the office visit reimbursements between specialists and PCPs.
BTW, Nate, you should click on Barry’s link. AAFP says that about 85% of private payers tie reimbursements to Medicare. Maybe the AAFP is more credible than I am… 🙂
If I recall correctly, medicare had limited the number of Patients a Doctor Could treat and so the urgent Care Facilites and walk ins are seeing more of these Patients.They are (Medicare Patients) methodically being exploited for (monitary gain)testing and then Threatened to be turned away because of Government reimbursement rates? Death Panels or Good Business?What ever lets us sleep at night.
I don’t think this industry realize that this Group (Elderly) is their Bread and Butter.
I may not be accurate in my observations.However, I think that Insurance and the providers carry the Blame for Medicare’s problem as much as Government. Facilities and Insurance has erronously collected for Medical Errors and Hospital Acquired infections for decades. Government has been complicit in allowing it. No wonder Medicare is in trouble.
The simple solution would indeed to be to put the patients down at a Certain Age. Its apparent that they are falling thru the cracks from Fractured Medical Care system and I see NO Point in feeding Insurance Companies, Hospitals and their related Representatives for services to maximize Financial Gain.When your dying!
Sounds cold and Callious? The fundamental premise of Insurance and providers although more refined in covering up actual motivations. Often times lead to the same outcomes. Dead Broke!
if you can manage it lets get technical Wendell. Besides the concept of governement even dictating labor prices you have the way in which they do it. I don’t have any problem with the reimbursement per code for most provide labor, it is all the labor that shouldn’t be done. Government has never tried to seperate good care from bad, they just pay less for all care, this is extremly counter productive.
Next up global budgets. If one type of provider or speciality or new area of medicine is to be paid more then an existing one must be paid less. There is no logic to support this, its a perverse outcome of flawed ideology.
Please feel free to defend global budgeting, broken promises of past and unit price controls, share with us all this utopia of yours where it all works
“Maybe if government sets all rates it will result in a more equitable distribution of income amongst physicians. Primary Care has only to gain from this.”
Margalit – Medicare sets physician payment rates based on a concept called RBRVS which stands for Resource Based Relative Value Scale. A 29 member group called the Relative Value Scale Update Committee (RUC) updates these payment rates each year. The committee is dominated by specialists which accounts for why primary care reimbursement has been historically shortchanged. For a more detailed discussion of the RUC see: http://www.aafp.org/fpm/2008/0200/p36.html
Nate, the system we have in place now is as unfair to physicians as it is to patients. Doctors don’t decide what to charge for their labor. Insurers decide what they are willing to pay. And please don’t say that the doctor doesn’t have to accept it. If Anthem owns half the lives in a particular state, you have to take whatever they give you.
This system also favors large physician groups and organizations. So basically, if you are a “not so brilliant” doctor and you are part of a group, you will get better reimbursement than if you are a magnificent doctor in a small office across the street. The same inequities exist based on geography and hospital affiliation.
For every other profession, payment is somewhat tied to outcomes and quality and mastery. It’s not exactly so for physicians.
I am NOT saying that physicians should not have high incomes. Every profession that requires so many years of training and has such enormous responsibilities should be equally well reimbursed. However, just like everything else in the healthcare system, physician reimbursement, the way it is now, makes no sense and is wasteful in many cases.
The prime example is Primary Care, which is being taken for granted, disrespected and underpaid, and we all pay the price in health and wealth for this short sighted, market inflicted, indignity.
People such as Wendell should be branded with a S for single payor, then if the time ever does come that government dictates prices and we have a physician shortage we know who to treat last….if at all