$700B in cuts... not the same

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http://www.nationalreview.com/articles/314261/spending-716-billion-twice-grace-marie-turner

The American Medical Association wants a permanent “doc fix” that would end the threat of these cuts, and the fix was the main demand the AMA made when it was at the negotiating table over Obamacare. The White House promised the fix, but reneged at the last minute. The doc fix was yanked from the bill, largely because of its $208 billion price tag. Astonishingly, and much to the dismay of doctors across the country, the AMA endorsed Obamacare anyway, giving the bill an important push over the finish line.

The above is why people like Dung continue chirping how Obama care will lower the deficit. Because people like him want to pretend that the doc fix either won't happen or that if it does happen that the doctors will simply take the hit and not cease treatment of medicare patients.

The president’s plan to “save” Medicare relies primarily on paying doctors and hospitals less and less by keeping in place the 1997 trajectory for spending cuts. According to Medicare actuaries, this would mean that 40 percent of providers eventually will either go bankrupt or stop seeing Medicare patients altogether.

This is why keeping Medicare 'as we know it' is a bad idea. 'as we know it' sucks for patients if fewer doctors will see you.

So now we get to the crucial dispute. Obamacare counts the same Medicare savings twice — once to allegedly extend the solvency of Medicare, and again to pay for Obamacare’s massive new subsidies for private health insurance through the exchanges.

Medicare actuaries have chastised the administration and its allies in Congress for this double-counting. Health and Human Services secretary Kathleen Sebelius was asked about the double-counting during a congressional hearing last year. “Are you using [the Medicare savings] to save Medicare or are you using it for health reform?” asked Representative John Shimkus (R., Ill.). “Both,” Sebelius answered.

When you count the savings twice... what happens in reality to costs?

So here’s the bottom line: President Obama leaves the $716 billion in Medicare reductions in place, and he spends the money again to create a vast new Obamacare entitlement program. Paul Ryan doesn’t double-count this money. His budget leaves the BBA Medicare payment cuts in place, but also creates a plan to make the program more efficient by injecting market forces through competition and consumer choice. Ryan’s premium-support model would require health plans to compete for the business of future seniors by offering better benefits at lower prices. Seniors would be guaranteed coverage because Medicare would fully cover the premium costs of the second-lowest-cost plan or the cost of traditional Medicare, whichever is lower. Those who are older or sicker, or have lower incomes, would get additional help.

The market model has been proven to work in the Medicare Advantage and prescription-drug programs. Three Harvard researchers published a study in The Journal of the American Medical Association (you can find it here, but it requires a subscription) examining how premium support would have worked if it had been in effect in 2009. They found that, nationally, the benchmark plan bid an average of 9 percent below traditional Medicare costs.

Further, the Part D prescription-drug program in Medicare is saving taxpayers money and giving seniors better benefits. Seniors can choose the drug plan that offers them the best benefits at the lowest prices, and these smart shoppers have brought the cost of the program 42 percent lower than expected when the drug benefit was created in 2003.

Yet if memory serves me, it is Medicare Advantage that Obama wants to slash. Can't have market forces showing up the government now can we?

The market model works. Competition forces efficiency.

 

[Haiku]

Market forces are factored in the affordable care act with exchanges. Also...

CMS Proposed Rule Increasing Payments for Physicians Treating Medicaid Patients to Medicare Rates May 2012Proposed rule from the Centers for Medicare and Medicaid Services that "implements Medicaid payment for primary care services furnished by certain physicians in calendar years (CYs) 2013 and 2014 at rates not less than the Medicare rates in effect in those CYs or, if greater, the payment rates that would be applicable in those CYs using the CY 2009 Medicare physician fee schedule conversion factor (CF). This minimum payment level applies to specified primary care services furnished by a physician with a specialty designation of family medicine, general internal medicine, or pediatric medicine, and also applies to services paid through Medicaid managed care plans. It would also provide for a 100 percent Federal matching rate for any increase in payment above the amounts that would be due for these services under the provisions of the State plan as of July 1, 2009."
http://healthreform.kff.org/documen...ting-medicaid-patients-to-medicare-rates.aspx

Medicare payments to doctors aren't a problem that I know of. Check the link it may answer questions for you. Or here http://www.commonwealthfund.org/Health-Reform.aspx

 

[Bonestorm]

The above is why people like Dung continue chirping how Obama care will lower the deficit. Because people like him want to pretend that the doc fix either won't happen or that if it does happen that the doctors will simply take the hit and not cease treatment of medicare patients.

The doc fix has nothing to do with the Affordable Care Act.

This is why keeping Medicare 'as we know it' is a bad idea. 'as we know it' sucks for patients if fewer doctors will see you.

This is the real tell, here. Take a step back from the details of the Medicare debate and ask yourself if you think Medicare, a program started by Democrats that is basically a single-payer health insurance program that Republicans have hated since day 1 (I can dig up the old Reagan "socialist" audio if you like) is likely to be more protected by free marketeers Mitt Romney and Paul Ryan or that Kenyan Socialist Democrat Barack Obama. Let's think on that for a moment.

Also, too, pretending that "competition" and the fragmentation of a huge pool of patients (people over the age of 65) under a single insurer (the government) into a program of fragmented risk pools and numerous insurers will lead to patients having access to more doctors is insane. The government can basically force doctors to accept low reimbursement rates because it has so many insureds in its insurance programs. Once you start fragmenting that pool of insureds, the doctors have less incentive to accept low rates.

When you count the savings twice... what happens in reality to costs?

The savings aren't counted twice. The CBO is abundantly clear on this. The Affordable Care Act slows the costs of Medicare by just over $700 billion. That is a fact. Those are real savings and aren't the product of double counting.

Yet if memory serves me, it is Medicare Advantage that Obama wants to slash. Can't have market forces showing up the government now can we?

The market model works. Competition forces efficiency.

Medicare Advantage costs more per enrolee than traditional fee-for-service Medicare. Obama wants to cut it because it costs more than traditional Medicare. The market model doesn't work.

 

[Cancel 2016.2]

Market forces are factored in the affordable care act with exchanges. Also... Medicare payments to doctors aren't a problem that I know of. Check the link it may answer questions for you. Or here http://www.commonwealthfund.org/Health-Reform.aspx

Thanks... I will certainly read it.

As for the payments to the doctors... it is not a big problem yet because Congress continually issues the 'doc fix' where they don't get hit with the reductions. That has been done every year since 1997.

 

[Haiku]

Thanks... I will certainly read it.

As for the payments to the doctors... it is not a big problem yet because Congress continually issues the 'doc fix' where they don't get hit with the reductions. That has been done every year since 1997.

I think The General does a good job of answering your questions and addressing issues. You can also read here WWW.Healthcare.gov

 

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The doc fix has nothing to do with the Affordable Care Act.

Keep on chirping little parrot.

This is the real tell, here. Take a step back from the details of the Medicare debate and ask yourself if you think Medicare, a program started by Democrats that is basically a single-payer health insurance program that Republicans have hated since day 1 (I can dig up the old Reagan "socialist" audio if you like) is likely to be more protected by free marketeers Mitt Romney and Paul Ryan or that Kenyan Socialist Democrat Barack Obama. Let's think on that for a moment.

It is about protecting the American people and helping create a system where health care costs to not continue to skyrocket. Competition is going to lead to better results, better efficiency.

Also, too, pretending that "competition" and the fragmentation of a huge pool of patients (people over the age of 65) under a single insurer (the government) into a program of fragmented risk pools and numerous insurers will lead to patients having access to more doctors is insane. The government can basically force doctors to accept low reimbursement rates because it has so many insureds in its insurance programs. Once you start fragmenting that pool of insureds, the doctors have less incentive to accept low rates.

How can the government 'force' doctors to accept lower rates? The doctors will simply stop accepting Medicare patients.

The savings aren't counted twice. The CBO is abundantly clear on this. The Affordable Care Act slows the costs of Medicare by just over $700 billion. That is a fact. Those are real savings and aren't the product of double counting.

The savings are most certainly being double counted.

Medicare Advantage costs more per enrolee than traditional fee-for-service Medicare. Obama wants to cut it because it costs more than traditional Medicare. The market model doesn't work.

No, it does not cost more.

The market model has been proven to work in the Medicare Advantage and prescription-drug programs. Three Harvard researchers published a study in The Journal of the American Medical Association (you can find it here, but it requires a subscription) examining how premium support would have worked if it had been in effect in 2009. They found that, nationally, the benchmark plan bid an average of 9 percent below traditional Medicare costs.

 

[Haiku]

How has that competition worked out so far, without the affordable care act? Not so well. That isn't what will keep costs down. Controlling the cost of healthcare is a major part of the law. The savings are not double counted and I think doing some reading is a good idea. http://www.cbo.gov/topics/health-care/affordable-care-act

 

[Bonestorm]

Keep on chirping little parrot.

Says the guy relying on the flagship magazine for the RNC.

It is about protecting the American people and helping create a system where health care costs to not continue to skyrocket. Competition is going to lead to better results, better efficiency.

No, it isn't. It's about trying to cut costs to the government to provide health insurance to old people to justify a tax cut for rich people. I mean, let's get real here. Medicare is a socialized medicine. It's a single-payer system. Pretending that Obama, the guy accused of implementing socialized medicine is try to destroy socialized medicine while the guys who opposed socialized medicine are trying to save it is just plan laughable.

How can the government 'force' doctors to accept lower rates? The doctors will simply stop accepting Medicare patients.

The government can force doctors to accept lower rates the same way that Wal-Mart can force suppliers to accept lower prices.

The savings are most certainly being double counted.

$700 billion in costs savings for Medicare. That's a fact that cannot be disputed.

No, it does not cost more.

Yes, it does. Look it up. Kaiser Family Foundation is a good source. Your study about what might have been in a fictional world is slightly less persuasive than what actually happened in the real world. In the real world, Medicare Advantage costs more per enrollee than traditional fee for service Meidcare.

 

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How has that competition worked out so far, without the affordable care act? Not so well. That isn't what will keep costs down. Controlling the cost of healthcare is a major part of the law. The savings are not double counted and I think doing some reading is a good idea. http://www.cbo.gov/topics/health-care/affordable-care-act

Perhaps, if you don't mind, you would link to the specific piece you wish me to read. I don't have the time to go searching for what you are referring to. Thanks in advance.

 

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Says the guy relying on the flagship magazine for the RNC.

No dear parrot, I know you like to attack the websites rather than what is actually written, but unlike you, I am looking at what was written and the supporting data provided.

No, it isn't. It's about trying to cut costs to the government to provide health insurance to old people to justify a tax cut for rich people. I mean, let's get real here. Medicare is a socialized medicine. It's a single-payer system. Pretending that Obama, the guy accused of implementing socialized medicine is try to destroy socialized medicine while the guys who opposed socialized medicine are trying to save it is just plan laughable.

The above is pure nonsense. You are essentially saying 'because Obama is a liberal, his plan must be the best'... that is what is laughable.

The government can force doctors to accept lower rates the same way that Wal-Mart can force suppliers to accept lower prices.

wrong... the doctors, like Wal-Marts suppliers can choose whether or not to do business with Wal Mart. The doctors can determine if they have enough other patients to simply deny access to Medicare patients. There is nothing the government can do to force them to accept Medicare patients.

$700 billion in costs savings for Medicare. That's a fact that cannot be disputed.

Being counted twice.

Yes, it does. Look it up. Kaiser Family Foundation is a good source. Your study about what might have been in a fictional world is slightly less persuasive than what actually happened in the real world. In the real world, Medicare Advantage costs more per enrollee than traditional fee for service Meidcare.

No, it doesn't.

 

[Haiku]

Perhaps, if you don't mind, you would link to the specific piece you wish me to read. I don't have the time to go searching for what you are referring to. Thanks in advance.

I thought you could use the links for fact checking. You can use the search function for any questions you might have...such as checking what's said in your link. Nothing in particular and no snark...the affordable care act seems to be a mystery and there is a lot of misinformation out there. We should all familiarize ourselves with what the law actually does. I'm in process of learning the facts myself.

 

[Cancel 2016.2]

I thought you could use the links for fact checking. You can use the search function for any questions you might have...such as checking what's said in your link. Nothing in particular and no snark...the affordable care act seems to be a mystery and there is a lot of misinformation out there. We should all familiarize ourselves with what the law actually does. I'm in process of learning the facts myself.

http://www.cbo.gov/sites/default/fi...08xx/doc10868/12-23-trust_fund_accounting.pdf

Bottom of second page... it says:

To describe the full amount of HI trust fund savings as both improving the government’s ability
to pay future Medicare benefits and financing new spending outside of Medicare would
essentially double-count a large share of those savings and thus overstate the improvement in the
government’s fiscal position.

 

[Haiku]

I read that it wouldn't improve the fed's ability to repay because it goes into a 'general' fund and becomes part of the finances of the government to pay other programs. I also read that it does in fact make a significant savings. I'm hoping The General will unravel this for my 'budget challenged' self.

 

[Bonestorm]

No dear parrot, I know you like to attack the websites rather than what is actually written, but unlike you, I am looking at what was written and the supporting data provided.

I'm attacking what was written. You are attacking me for no reason and I'm responding in kind. Also, pretending what was written is an objective account of the dispute is asinine. It isn't.

The above is pure nonsense. You are essentially saying 'because Obama is a liberal, his plan must be the best'... that is what is laughable.

No, I'm saying that as between two parties who both claim to be acting in the best interests of Medicare and Medicare beneficiaries, the party that has historically supported Medicare and Medicare beneficiaries is more likely to be telling the truth than the party that has hated Medicare from day 1. Just sayin.

And if you look at the specifics, it turns out to be the case.

wrong... the doctors, like Wal-Marts suppliers can choose whether or not to do business with Wal Mart. The doctors can determine if they have enough other patients to simply deny access to Medicare patients. There is nothing the government can do to force them to accept Medicare patients.

Yes, they can choose whether or not to do business with Wal-Mart, but as with Wal-Mart suppliers, the doctors will go along with it because they simply cannot lose the volume of business they would lose if they no longer accepted Medicare.

Being counted twice.

At least you agree to the $700+ billion in cost savings.

Also, being counted twice by whom?

No, it doesn't.

This is just a denial of reality here.

 

[Bonestorm]

I read that it wouldn't improve the fed's ability to repay because it goes into a 'general' fund and becomes part of the finances of the government to pay other programs. I also read that it does in fact make a significant savings. I'm hoping The General will unravel this for my 'budget challenged' self.

The double counting thing is more a matter of rhetoric than of substance. The $700 billion in cost savings are real and are not the product of double counting. What the Obama Administration did, though, in talking about the ACA generally (note: this is what the CBO did and the CBO cost estimates did) was to say that the $700 billion both extended the life of Medicare and cut the deficit. But that's not the case. It can't do both. Either $700 billion less comes out of the Medicare/Medicaid trust fund and the life of the trust fund is extended or the $700 billion goes to the general fund and reduces the deficit.

So it's really a matter of talking about the bill, not what the bill does. The CBO cost estimates don't suffer from this flaw. Just ask Paul Ryan:

EK: This is where I think we end up in different places. The philosophical differences are all fair enough. But insofar as the double counting goes, the double counting is an issue of how some Democrats are talking about this. And I agree with you. Saying that the money will do two things at once is out of line. But what I want to make sure is clarified here is that the numbers people are using from CBO are not afflicted by that rhetorical overreach. When CBO says the bill will save this much money, it really will, at least according to the best estimates.

PR: I'm not disagreeing with that. But I think CBO is omitting other fiscal effects that are not in the bill -- unless we plan on cutting doctors 21 percent next month. Unless we plan on doing that, then we're not truly capturing the fiscal effects.

EK: But now we're not talking about double counting. We're talking about the doctor's fix in Medicare.

PR: Right. And I think you and I simply don't agree on this.

http://voices.washingtonpost.com/ezra-klein/2010/03/the_true_cost_of_the_health-ca.html

 

[Althea]

Yet if memory serves me, it is Medicare Advantage that Obama wants to slash. Can't have market forces showing up the government now can we?

The market model works. Competition forces efficiency.

You need to familiarize yourself with the specifics of Bush's unfunded Medicare D, if you want to be able to intelligently present your case.

Until then, you come across like Romney/Ryan, with nothing but unfounded talking points.

 

[Haiku]

The double counting thing is more a matter of rhetoric than of substance. The $700 billion in cost savings are real and are not the product of double counting. What the Obama Administration did, though, in talking about the ACA generally (note: this is what the CBO did and the CBO cost estimates did) was to say that the $700 billion both extended the life of Medicare and cut the deficit. But that's not the case. It can't do both. Either $700 billion less comes out of the Medicare/Medicaid trust fund and the life of the trust fund is extended or the $700 billion goes to the general fund and reduces the deficit.

So it's really a matter of talking about the bill, not what the bill does. The CBO cost estimates don't suffer from this flaw. Just ask Paul Ryan:



http://voices.washingtonpost.com/ezra-klein/2010/03/the_true_cost_of_the_health-ca.html

Thank You!

 

[Haiku]

You need to familiarize yourself with the specifics of Bush's unfunded Medicare D, if you want to be able to intelligently present your case.

Until then, you come across like Romney/Ryan, with nothing but unfounded talking points.

Excellant point!

 

[Cancel 2016.2]

You need to familiarize yourself with the specifics of Bush's unfunded Medicare D, if you want to be able to intelligently present your case.

Until then, you come across like Romney/Ryan, with nothing but unfounded talking points.

You need to familiarize yourself with what I am actually discussing, that way you don't come off sounding so foolish.

 

[Althea]

You need to familiarize yourself with what I am actually discussing, that way you don't come off sounding so foolish.

I see. So you have no idea what you're talking about.

Pretty much what I thought.

Do your homework, and get back to us.