Will this forum become extinct

[HFWR]

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Originally Posted by randyman65 I seriously doubt that any of them actually knew anything at all about any proposals.

And there are plenty of people/PACs/lobbyists/pundits/politicians that like it that way.

The mushroom theory...

[bbbamI]

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Originally Posted by HFWR The mushroom theory...

You must be wary of mushrooms...

[Notmuchlonger]

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Originally Posted by bbbamI You must be wary of mushrooms...

You know. Ive had the darn hankering to make mushroom soup. But have you seen the prices of mushrooms lately! I cant even find any deals either. Ive been patient for months.

Bleh one of these days. Ill ignore the expense factor and just go for it on the soup

[Independent]

Adding to Randyman's town hall meetings, here is a poll: Seniors Most Skeptical of Healthcare Reform

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Seniors are the least likely of all age groups in the U.S. to say that healthcare reform will benefit their personal healthcare situation. By a margin of three to one, 36% to 12%, adults 65 and older are more likely to believe healthcare reform will reduce rather than expand their access to healthcare. And by 39% to 20%, they are more likely to say their own medical care will worsen rather than improve.

I'll agree with the general impression that this probably means they aren't paying attention (though a few with "Medicare Plus Choice" may be correct in worrying that reform will reduce the gov't payment to these plans).

I think this is partially a "don't like anything new" or "don't like bigger government" attitudes, and partially the fact that they have no recent personal experience with losing group insurance.

[samclem]

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Originally Posted by Independent Adding to Randyman's town hall meetings, here is a poll: Seniors Most Skeptical of Healthcare Reform I'll agree with the general impression that this probably means they aren't paying attention (though a few with "Medicare Plus Choice" may be correct in worrying that reform will reduce the gov't payment to these plans). I think this is partially a "don't like anything new" or "don't like bigger government" attitudes, and partially the fact that they have no recent personal experience with losing group insurance.

I'm not sure why people believe the Medicare crowd hasn't thought this through. Both the Senate finance committee proposal and the newly announced House proposal call for very large cuts in Medicare reimbursement rates for doctors. These seniors already know it's getting harder to find care providers that accept Medicare because of the low reimbursement rates. Maybe they have good reason to doubt that these plans will improve their situation.

Interestingly, they might be the only people in America who believe the government will actually do something to reduce Medicare expenditures.

[Independent]

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Originally Posted by samclem I'm not sure why people believe the Medicare crowd hasn't thought this through. Both the Senate finance committee proposal and the newly announced House proposal call for very large cuts in Medicare reimbursement rates for doctors. These seniors already know it's getting harder to find care providers that accept Medicare because of the low reimbursement rates. Maybe they have good reason to doubt that these plans will improve their situation. Interestingly, they might be the only people in America who believe the government will actually do something to reduce Medicare expenditures.

I've been Googling around trying to find something about "very large cuts in Medicare reimbursement rates for doctors". Medicare reimburesments are a complicated issue, here's an article that seems to make some sense Health Reform Threatened by Doctors' Reimbursement Rates - TIME

But it doesn't say anything about the Health bills cutting reimburesments. Maybe you can give me a link?

[samclem]

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Originally Posted by Independent But it doesn't say anything about the Health bills cutting reimburesments. Maybe you can give me a link?

Here's where the White House says it will be saving $309 billion from Medicare and Medicaid (exactly how is not specified. Buying fewer paper gowns?)

This CNN piece has more. The White House says they'd like to cut $110 billion from scheduled increases in Medicare payments. This will "encourage health care providers to increase productivity."

Okay, but what about the proposed legislation from the Senate and the House? Medicare cuts are there, too. The House plan calls for $472.8 bilion in Medicare cuts over the next 10 years. The Senate finance committee ("Baucus bill") calls for $377 billion in Medicare cuts. (A source for more info).

There are three potential things a person can believe regarding this issue:
A) Medicare is a wasteful program and can easily absorb these cuts. We know that low medicare reimbursement rates are already impacting the quality of care for some people. But, to those who believe that Medicare is loaded with fat and able to absorb these giant cuts, I would ask why we are considering handing over more responsibility for US health care to the federal government if they can't fix the waste and insure adequate delivery of services in the government-run health care program that is already in place. If these cuts are possible and prudent now, then the administration should be making them regardless of the other health care reform issues.
B) Medicare is not wasteful, but these cuts will be made anyway. Seems to me that this would give anyone destined to be a Medicare recipient (e.g. almost any US citizen who will ever be older than 65) real reason to oppose this legislation.
C) These cuts are just being included as window dressing to lower the sticker shock of the proposed legislation, the cuts will never be made. History supports this view. The Senate leadership is trying to stop Medicare reimbursement cuts scheduled for this year, why should anyone believe cuts will be made for many successive years as called for in the legislation? Medical care costs are escalating, there's no way these cuts will occur. So, let's be realistic and put the true price tag on this legislation--it won't be paid for by cuts in Medicare. Let's see the real cost without the phony Medicare cuts and with the true (giant) costs of the federal subsidies to individuals once employers stop providing insurance. Then we can have an honest national discussion on health care and health care costs.

[crazy connie]

Well put Sam!

[HFWR]

Quote:

Originally Posted by Milton Most people no longer enjoy pensions.

If I had one, I'd enjoy it...

[Independent]

Quote:

Originally Posted by samclem Here's where the White House says it will be saving $309 billion from Medicare and Medicaid (exactly how is not specified. Buying fewer paper gowns?) This CNN piece has more. The White House says they'd like to cut $110 billion from scheduled increases in Medicare payments. This will "encourage health care providers to increase productivity." Okay, but what about the proposed legislation from the Senate and the House? Medicare cuts are there, too. The House plan calls for $472.8 bilion in Medicare cuts over the next 10 years. The Senate finance committee ("Baucus bill") calls for $377 billion in Medicare cuts. (A source for more info). There are three potential things a person can believe regarding this issue: A) Medicare is a wasteful program and can easily absorb these cuts. We know that low medicare reimbursement rates are already impacting the quality of care for some people. But, to those who believe that Medicare is loaded with fat and able to absorb these giant cuts, I would ask why we are considering handing over more responsibility for US health care to the federal government if they can't fix the waste and insure adequate delivery of services in the government-run health care program that is already in place. If these cuts are possible and prudent now, then the administration should be making them regardless of the other health care reform issues. B) Medicare is not wasteful, but these cuts will be made anyway. Seems to me that this would give anyone destined to be a Medicare recipient (e.g. almost any US citizen who will ever be older than 65) real reason to oppose this legislation. C) These cuts are just being included as window dressing to lower the sticker shock of the proposed legislation, the cuts will never be made. History supports this view. The Senate leadership is trying to stop Medicare reimbursement cuts scheduled for this year, why should anyone believe cuts will be made for many successive years as called for in the legislation? Medical care costs are escalating, there's no way these cuts will occur. So, let's be realistic and put the true price tag on this legislation--it won't be paid for by cuts in Medicare. Let's see the real cost without the phony Medicare cuts and with the true (giant) costs of the federal subsidies to individuals once employers stop providing insurance. Then we can have an honest national discussion on health care and health care costs.

I was looking for something like "The house bill mandates a cut of X% in physician's services, and the Senate has Y%". The headlines really don't give that type of information.

via Mankiw, I found this CBO analysis of the House bill: http://www.cbo.gov/ftpdocs/106xx/doc...3962Rangel.pdf
See Table 3 beginning on page 18.

The 10 year reduction in physician's services is $42 billion, mostly in the second 5 years. From other sources, I can estimate the baseline for physician's charges and get a ratio. It's about 2.5% for the first 5 years and 4.5% for the second 5 years. (I wish I could find a more authoritative source than my own calculations. I'm using 19% of total Medicare expenses from the Kaiser foundation, applied to this projection of total medicare http://www.cms.hhs.gov/NationalHealt...s/proj2008.pdf

But, where's all the other money? Well, $170 billion is in reduced payments to Medicare Advantage plans. That's because the gov't gives MA plans more for their enrollees than it actually spends on similar people in the traditional Medicare program. This is an example of getting rid of "waste", but the waste is in the private MA plans, not in the gov't run program. Certainly, this is something that could be done without all the other provisions of the bill. But, I'd guess it's more politically feasible to bundle it other things that are popular.

$42 billion is in "elimination of coverage gap" in Medicare part D. I don't know about that.

Most of the rest looks like "hoped for efficiencies in hospitals and other places from stuff like electronic records". I think they are looking for those savings for all patients, not just Medicare. Like the physician's services, it seems to be back-loaded.

Now maybe physicians will leave the Medicare system in droves because their fees won't grow as fast as they would have, and they'll come up short 2.5% over the next 5 years. Maybe they won't. I wonder how many of the seniors who are very scared are thinking in terms of 2.5%.

[harley]

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Originally Posted by samclem I'm not sure why people believe the Medicare crowd hasn't thought this through. Both the Senate finance committee proposal and the newly announced House proposal call for very large cuts in Medicare reimbursement rates for doctors. These seniors already know it's getting harder to find care providers that accept Medicare because of the low reimbursement rates. Maybe they have good reason to doubt that these plans will improve their situation. Interestingly, they might be the only people in America who believe the government will actually do something to reduce Medicare expenditures.

I agree with samclem. The Medicare eligible people have good reason to fear these changes. My mother's doctor retired recently, and she had an incredibly difficult time finding another doctor in her small city area who would take a Medicare patient. It might be easier in bigger cities, I don't know. But the reimbursement issue is going to be huge (if it happens).

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Originally Posted by Independent I think this is partially a "don't like anything new" or "don't like bigger government" attitudes, and partially the fact that they have no recent personal experience with losing group insurance.

Just because you're paranoid doesn't mean they're not out to get you.

[RonBoyd]

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Originally Posted by harley Just because you're paranoid doesn't mean they're not out to get you.

(Quote attributed to Woody Allen)

Paranoia.JPG

[randyman65]

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My mother's doctor retired recently, and she had an incredibly difficult time finding another doctor in her small city area who would take a Medicare patient. It might be easier in bigger cities, I don't know. But the reimbursement issue is going to be huge (if it happens).

Imagine how difficult it is from someone with no insurance at all. A single group protecting themselves at the expense of others doesn't have much of a high ground on which to stand.

[harley]

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Originally Posted by randyman65 I'm speaking from the experience of three recent town hall meetings (two of which were held by local congressmen). To a person, the ones screaming were senior citizens. And they were screaming loudly. The most common refrain was literally "Leave my Medicare alone!". I seriously doubt that any of them actually knew anything at all about any proposals.

My response was intended to illustrate that it's entirely possible that your screaming seniors DID know something about the proposals. Just because they don't agree with you doesn't mean they are ignorant of how it will effect their situation.

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Originally Posted by randyman65 Imagine how difficult it is from someone with no insurance at all. A single group protecting themselves at the expense of others doesn't have much of a high ground on which to stand.

It is good to know that there are some out there willing to throw their own self interest under the bus for the greater good. Keep up the good work.

[randyman65]

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It is good to know that there are some out there willing to throw their own self interest under the bus for the greater good. Keep up the good work.

Not everyone is selfish and heartless. Some people willingly sacrifice so others can survive. Others simply don't give a squirt about anyone other than themselves. I know both types.

[crazy connie]

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Originally Posted by randyman65 Not everyone is selfish and heartless. Some people willingly sacrifice so others can survive. Others simply don't give a squirt about anyone other than themselves. I know both types.

We all do, but most of the folks who want to reign in the spending want to help those who truly need the help. Not those who chose not to help themselves. Right now it is a tough job market as many know all too well. But, even when there is not a tough market many seem to prefer to ride the welfare train. I do not mind paying taxes to help the seniors and truly disabled. I resent monies and services for lazy and cash under the table working people who choose to game the system. Many of us know these people as well.

[randyman65]

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I do not mind paying taxes to help the seniors and truly disabled. I resent monies and services for lazy and cash under the table working people who choose to game the system. Many of us know these people as well.

I don't think any of us do. But the amount of actual abuse from the consumer end is pretty limited (or so I was told bya former district attorney who prosecuted Medicaid fraud). What is more salient is that a family of four living on a working wage depends on their employer's ability to pay health insurance premiums. In my state, these would run about $15k per year. The point is not abuse, it is runaway costs of a healthcare system, a cost which has been outstripping inflation and wages by a large margin. The elephant in the room is that while there are inefficiencies and abuse in the current system, the dollars we all spend on healthcare (from both taxes and premiums) eventually make their way into someone else's pocket. While it is popular to paint insurance companies as the big bag wolf, the fact remains that doctors and dentists can make $250k per year, nurses $90k, and x-ray techs $75k. As in most businesses, the majority of costs are in the staffing. Next time you go see your doctor, count the number of people drawing a salary in his office. Doctors are lamenting the Medicare reimbursement rates while driving Bentleys.

[crazy connie]

Randy, there is a fairly large underground cash economy where I live. When the cleaning services for household chores offer "CASH" discounts and the cleaners admit to living in subsidized housing and being on AZ State funded insurance I know what they mean. I called for estimates on yard work for some tree removal just a few months ago. During the bid process I asked if they were insured and had 3 of them tell me they do not need insurance because I have homeowners and it will cover them if they get hurt! I think NOT. Taking everything you can from the government and working for cash is rampant. Many of the sign wavers advertising on the side of the road are paid in cash daily, survey takers in the malls, yard mtc, house cleaners, dog walkers are just a few that pop into my mind. They get the cash with no taxes and get subsidized housing, utilities, groceries and health care and pay no more than sales taxes. This is what is irksome to me. Then when they hit an age of being able to collect SS that is skewed to benefit the low earners. If the low earners have stayed "on the clock" and contributed ok. But I think there needs to be a crackdown on the under the table workers.

PS My Dr drives a 4 year old Honda

[ziggy29]

I think we'll have a physician supply crisis if more and more patients are seen with Medicare's current reimbursement rates -- to say nothing of dropping them even more. I think many doctors (especially the older and more experienced ones) would simply retire or find another way to keep active rather than accept Medicare rates for more and more patients.

The only other way around this would be to prohibit the practice of not accepting Medicare patients, but that seems to have huge legal problems with it.

[nun]

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Originally Posted by ziggy29 I think we'll have a physician supply crisis if more and more patients are seen with Medicare's current reimbursement rates -- to say nothing of dropping them even more. I think many doctors (especially the older and more experienced ones) would simply retire or find another way to keep active rather than accept Medicare rates for more and more patients. The only other way around this would be to prohibit the practice of not accepting Medicare patients, but that seems to have huge legal problems with it.

The same argument was made in 1948 when the NHS started in the UK. In fact British doctors were more opposed to a "single payer system" than US doctors today. However, pay should not be the only motivation for becoming a doctor, vocation must also be considered. The NHS has its problems, but it works well for the vast majority of those concerned. The doctors are well paid and the BMA negotiates their working conditions with the Government. Importantly doctors are salaried, not paid for procedures or the number of patients they see each day. As a consequence the PCP spends more time with each patient and doesn't order unnecessary procedures. PCPs earn about $100k/year and senior surgeons etc earn upto $300k. and don't have the issues with personal liability or educational expenses thaat US doctors do. It is a system where costs can be controlled and that delivers quality health care to 100% of UK residents at half the per capita cost of the current US system. The US really does trail the rest of the world when it comes to the delivery of health care.