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Doctors: Senators 'took a vacation,' left Medicare a mess

donsutherland1

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Today, CNN revealed:

The AMA's TV, radio and print ads slam senators for failing to pass the "doc fix" before taking their week-long break. The group has a long history of pushing to reform the formula used to calculate Medicare payments to doctors…

"Medicare payments are stuck where they were in 2001, while medical costs are up by 20% according to the government's own data," Rohack said.
http://money.cnn.com/2010/06/03/news/economy/AMA_doc_fix/index.htm

The Medicare payments argument is greatly inconsistent with the larger picture associated with Medicare expenditures. If one examines Medicare enrollment and Medicare expenditures data, one finds Medicare expenditures per Medicare enrollee came to:

2001: $6,181
2008: $10,357
Change: +67.6%

Moreover, in its latest Article IV consultation with the U.S., the International Monetary Fund explained:

Per capita health spending in the United States is the highest in the OECD, and is still rising. U.S. health spending represents over 15percentof GDP, compared to less than 10 percent in the G-6 group, and grew by about 5 percent a year in real terms over 2000-06 compared with 3 ½ percent in G-6. Without major reform, the Council of Economic Adviser project that health care’s share of GDP will continue to rise rapidly, reaching around 28 percent of GDP in 2030 and 34 percent in 2040 (15 percent of GDP accounted by Medicare and Medicaid). Despite the large spending, health outcomes in the United States are less favorable than in many OECD countries.

In my opinion, the issue over Medicare reimbursements is an early litmus test as to whether the special interest appetite for taxpayer financing will take precedence over fiscal discipline. If Congress appeases the AMA, it will send a dramatic signal that the very modest cost-savings measures in the recent health care law are not credible. Moreover, it will send a worrisome signal that Congress is not capable of making the even tougher decisions that will be necessary for the U.S. to return to a fiscally sustainable path. In the long-term, fiscal sustainability will depend on far-reaching health care reform that addresses that industry’s chronic excessive cost growth issue.

Although I had supported easing the transition on Medicare payments, but only if it were fully funded by offsetting spending reductions and/or tax hikes, this salvo fired by the AMA leads me to believe that in the larger interest of moving toward credible fiscal consolidation, the far better approach would be for Congress to draw the line and reject any changes to Medicare payments. Such payments per patient have exploded by more than 67% since 2001.

In the long-run, Congress will need to spend less than it would otherwise under base law. Transferring spending from one sector to another is a much weaker approach, as it indicates that Congress lacks the ability to actually rein in spending.

Unfortunately, as government has typically demonstrated a bias toward accommodation, my guess is that Congress will cave in to the AMA’s pressure. That development will likely embolden other special interest groups to seek increased taxpayer payments, even as the nation’s debt continues to climb and its long-term fiscal imbalances remain yet to be addressed.
 
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The Prof

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ok, but if you don't do the doc fix our doctors are gonna ditch

it's already happening

Texas doctors fleeing Medicare in droves | Houston & Texas News | Chron.com - Houston Chronicle

they'll refuse to treat certain classes of cases

http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html

it's been going on for years

http://www.nytimes.com/1992/04/12/u...icare-patients.html?pagewanted=2?pagewanted=2

as always, there's just no way out

as always, these things are so predictable

ie, everyone KNEW what was in this bill

and, as almost always, if not always, it aint gonna happen

that is, no one's gonna be standin up to no ama

sorry

good thread, thanks
 
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donsutherland1

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Redress,

It's the industry's excessive cost growth issue, which results from a combination of industry structure and functions that is largely responsible. The age structure changes of the Medicare population is far too small to explain the dramatic increase in payments per patient.
 

donsutherland1

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ok, but if you don't do the doc fix our doctors are gonna ditch
That would open up an opportunity for increasing competition in the field e.g., allowing licensed foreign medical doctors to enter into the U.S. market. With medicare payments per enrollee increasing at a nearly 7.7% per year clip (2001-2008), compensation is hardly a credible argument why some are choosing to leave the field. The health cost growth curve is not sustainable. Congress needs to begin to move toward fiscal discipline.

ie, everyone KNEW what was in this bill
As I noted in several theads on the health care law, arguably its biggest flaw was what was omitted: no effort to address the excessive cost growth issue. It expanded coverage and was, theoretically budget neutral due to a combination of tax hikes/cost savings. However, the unsustainable problem at the heart of U.S. health care was not addressed. Moreover, it remains more likely than not that Congress will retreat on the small cost savings provisions when faced with having to implement them, just as appears likely on the so-called doctor's fix issue.
 

Redress

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Redress,

It's the industry's excessive cost growth issue, which results from a combination of industry structure and functions that is largely responsible. The age structure changes of the Medicare population is far too small to explain the dramatic increase in payments per patient.
The portion I bolded went right over my head. Could you explain it a little more please.
 

The Prof

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compensation is hardly a credible argument why some are choosing to leave the field
Texas doctors fleeing Medicare in droves | Houston & Texas News | Chron.com - Houston Chronicle

Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.
The opt-outs follow years of declining Medicare reimbursement that culminated in a looming 21 percent cut in 2010. Congress has voted three times to postpone the cut, which was originally to take effect Jan. 1. It is now set to take effect June 1.
The uncertainty proved too much for Dr. Guy Culpepper, a Dallas-area family practice doctor who says he wrestled with his decision for years before opting out in March. It was, he said, the only way “he could stop getting bullied and take control of his practice.”
The growth in Texas Medicare opt-outs began in earnest in 2007, when 70 doctors notified Trailblazer Health Enterprises, the state's Medicare carrier, they would no longer participate, up from seven in 2006. The numbers jumped to 151 in 2008, fell back to 135 in 2009 and are on pace for 200 in 2010. From 1998 to 2002, by contrast, no more than three a year opted out.

Now, according to a Texas Medical Association new poll, more than four in 10 doctors are considering the move.
As I noted in several theads on the health care law, arguably its biggest flaw was what was omitted: no effort to address the excessive cost growth issue. It expanded coverage and was, theoretically budget neutral due to a combination of tax hikes/cost savings. However, the unsustainable problem at the heart of U.S. health care was not addressed. Moreover, it remains more likely than not that Congress will retreat on the small cost savings provisions when faced with having to implement them, just as appears likely on the so-called doctor's fix issue.
word
 

donsutherland1

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Redress,

Industry structure pertains to how the system is set up ranging from the payers to hospitals, regulatory protections that inhibit interstate competition, inconsistent tax treatment, etc. Industry functions/practices concern such matters as licensing, premature adoption of technology (at the stage when it is costliest/least value-added), etc. FWIW, the IMF has estimated that up to half the increase in medical costs is associated with technology procurement practices.
 

donsutherland1

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This is a problem that has existed for years but kept being pushed back. It looks like that politicians wont be able to push it back anymore.
Now that the AMA has made the issue a high-visibility one, policy makers would do well to avoid capitulating. Past practice of avoiding the modest fiscal discipline set forth in current law undermined fiscal credibility. If the nation is to reduce risks of a medium-term debt crisis, it will need to build fiscal credibility. Congress has an opportunity to make a modest downpayment in that direction by rejecting the AMA's demands and affirming the modest budget savings measures that exist within current law. Congress should seize that opportunity.
 

jambalaya

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There is going to be some backlash any time you try to do something responsible. **** the threats by the doctors. Congress needs to do this. Welcome to government funded healthcare and the limits to coverage and service. It is a necessary evil if you want the government involved in healthcare. We will no longer see the level of care and service that we have today for people who have healthcare coverage. Those days are over now that we have decided that everyone deserves healthcare. For the record I think the current plan we have is irresponsible but I do agree that we have to address the issue of people who truly cannot afford healthcare. But we don't need to spend massive amounts of money to accomplish it.
 

The Prof

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**** the threats by the doctors. Congress needs to do this. Welcome to government funded healthcare and the limits to coverage and service. It is a necessary evil if you want the government involved in healthcare. We will no longer see the level of care and service that we have today for people who have healthcare coverage. Those days are over now that we have decided that everyone deserves healthcare.
with all due respect, a sales pitch like the above is probably the biggest reason congress will NEVER act responsibly, ie, the way almost all of us, left, right and middle, almost consensually agree they need to

in other words, we're on the fast track to greece and there's no way out

i'm very sorry
 

Deuce

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There is going to be some backlash any time you try to do something responsible. **** the threats by the doctors. Congress needs to do this. Welcome to government funded healthcare and the limits to coverage and service. It is a necessary evil if you want the government involved in healthcare. We will no longer see the level of care and service that we have today for people who have healthcare coverage. Those days are over now that we have decided that everyone deserves healthcare. For the record I think the current plan we have is irresponsible but I do agree that we have to address the issue of people who truly cannot afford healthcare. But we don't need to spend massive amounts of money to accomplish it.
What's your proposal? How do you "address the issue" of people who can't afford health insurance without spending money? That insurance costs a certain amount, and they don't have it.

I actually somewhat agree with you about this healthcare bill, but for almost opposite reasons, as strange as it sounds. Our current system is fundamentally flawed, that much should be obvious to everybody by now. We love to focus on single-issues. It's the greedy insurance companies' fault. No, it's malpractice lawsuits and defensive medicine. No it's prescription drugs being too expensive and being prescribed to too many people. No it's a lack of proper competition. In reality, it's all of these things and more. The underlying system is broken, and this bill slaps a few very expensive pieces of duct tape on it. Yes, there are a lot of people that this bill will help, but in the end we still have the broken machinery to deal with. The pre-existing conditions problem had to end. Yes, it costs money to do that, but it's necessary. We need a serious change. Yes, that means big scary government will have to do things. No, that doesn't mean it will be a single federal agency taking direct control of everything. This may come to a surprise to some people, but there are countries with universal health care that deliver care entirely through private insurance companies and private practitioners. (well, almost. there's usually a few state-run hospitals thrown in the mix or VA-type hospitals)

Personally, I think we need to treat health insurance more like a utility. There's still plenty of state and local control, but you can also eliminate some of the waste by taking out profit motives. There are certain services in this country that we decided were too basic or too important to be left to the free market. Other services don't lend themselves well to the normal market pressures for various reasons. You know, we liberals prefer private industry as a rule too. Generally speaking, market competition is good for the consumer. Unfortunately, health care is a service who's need can't be predicted, the cost of a single event can easily overwhelm the average family's finances, and it can literally be life-or death. This totally screws up the usually supply/demand balance. Making things worse, you have very little ability to judge your insurance "product," because you pay for it for years before you actually receive it. (health crisis arises and you submit a claim) Only then can you find out whether your insurance company is going to treat you well. If Toshiba sells you a broken TV, you bring it back and next time you buy a Sony. If your health insurance company denies a claim, you're stuck with a huge bill and have already paid out tens of thousands of dollars in premiums.
 

The Prof

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how can any thinking, reading person expect united states political leadership, 2010, to exhibit suddenly the courage, far sightedness, patriotism, maturity, etc, required to take these draconian steps towards fiscal balance even little malia obama understands are required?

just as it's in-your-face obvious that daddy needs to plug the leak, malia also perceives, almost primordially, that you can't get 20 gallons of water out of a 10 gallon bucket

yes, we all know what needs to be done, but exactly what is it in the real world that inspires anyone even half as intelligent as the fellas and felines in these forums to feel any confidence that any kind of follow-thru is forthcoming?

from these folks?

why all the misplaced faith?

THIS IS THE POLITICAL LEADERSHIP, you must bear in mind, THAT IS TOO PUSILLANIMOUS EVEN TO PROPOSE A BUDGET FOR 2011

Budget woes? Just don't pass one - Los Angeles Times

one can learn a great deal from post grad texts, there's no substitute for em, tis true

but if one keeps one's nose in em exclusively without looking around at, y'know, people and events, one might well miss the obvious

such as, it might be misguided to hold out a lot of hope for responsible leadership from a group of politicos too poltroonish, too paper tiger to produce even a basic blueprint

again, i'm very sorry
 
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hazlnut

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Damn, that just scares me. What accounts for such a steep rise?
Old people like to talk.

And they tend to be hypercondriacs.

And with better technology, people live longer.
 

The Prof

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and don't forget, after the doc fix (a quarter T), the double counting called out by cbo (another quarter T), the 10 years of taxes vs only 6 of benefits, there is also this murderous "mother of unfunded mandates" making miserable such prominent blue gubs as bill richardson, bill ritter, christine gregoire, phil bredesen, brian schweitzer...

that's another 200B that's by definition not paid for

Governors balk over what healthcare bill will cost states - The Boston Globe

so, putting aside all our pretty ideals and perfect-world posings...

and, after closing up our TEXTBOOKS and looking around...

for us remaining realists, it is all sadly exactly what it is

THIS bill is a PIG

sorry
 
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American

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Today, CNN revealed:



AMA launches ads slamming senators for not passing 'doc fix' - Jun. 3, 2010

The Medicare payments argument is greatly inconsistent with the larger picture associated with Medicare expenditures. If one examines Medicare enrollment and Medicare expenditures data, one finds Medicare expenditures per Medicare enrollee came to:

2001: $6,181
2008: $10,357
Change: +67.6%

Moreover, in its latest Article IV consultation with the U.S., the International Monetary Fund explained:

Per capita health spending in the United States is the highest in the OECD, and is still rising. U.S. health spending represents over 15percentof GDP, compared to less than 10 percent in the G-6 group, and grew by about 5 percent a year in real terms over 2000-06 compared with 3 ½ percent in G-6. Without major reform, the Council of Economic Adviser project that health care’s share of GDP will continue to rise rapidly, reaching around 28 percent of GDP in 2030 and 34 percent in 2040 (15 percent of GDP accounted by Medicare and Medicaid). Despite the large spending, health outcomes in the United States are less favorable than in many OECD countries.

In my opinion, the issue over Medicare reimbursements is an early litmus test as to whether the special interest appetite for taxpayer financing will take precedence over fiscal discipline. If Congress appeases the AMA, it will send a dramatic signal that the very modest cost-savings measures in the recent health care law are not credible. Moreover, it will send a worrisome signal that Congress is not capable of making the even tougher decisions that will be necessary for the U.S. to return to a fiscally sustainable path. In the long-term, fiscal sustainability will depend on far-reaching health care reform that addresses that industry’s chronic excessive cost growth issue.

Although I had supported easing the transition on Medicare payments, but only if it were fully funded by offsetting spending reductions and/or tax hikes, this salvo fired by the AMA leads me to believe that in the larger interest of moving toward credible fiscal consolidation, the far better approach would be for Congress to draw the line and reject any changes to Medicare payments. Such payments per patient have exploded by more than 67% since 2001.

In the long-run, Congress will need to spend less than it would otherwise under base law. Transferring spending from one sector to another is a much weaker approach, as it indicates that Congress lacks the ability to actually rein in spending.

Unfortunately, as government has typically demonstrated a bias toward accommodation, my guess is that Congress will cave in to the AMA’s pressure. That development will likely embolden other special interest groups to seek increased taxpayer payments, even as the nation’s debt continues to climb and its long-term fiscal imbalances remain yet to be addressed.
Come on Don, it could have been worse. Imagine if they'd have stayed in Washington. :shock:
 

Orion

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FWIW, the IMF has estimated that up to half the increase in medical costs is associated with technology procurement practices.
That is really interesting. I had no idea. Thanks for that tidbit.
 
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