The selection of Paul Ryan as his running mate brings the future of Medicare into sharp focus. One side wants to control the rise in Medicare costs by limiting the increase in payments tp providers, improving Medical information sharing among providers and developing data on performance measures. The other side wants to control the amount money provided to individuals, who would then be responsible for purchasing their own insurance. Is it possible for us to have a reasond discussion of the issue. I'm not looking for the the type of response that says I am for my guy because the other guy is a people firing, tax dodging, Nazi, Marxist that learned to pick his nose from Chairman Mao. Policy discussion only please.

The selection of Paul Ryan as his running mate brings the future of Medicare into sharp focus. One side wants to control the rise in Medicare costs by limiting the increase in payments tp providers, improving Medical information sharing among providers and developing data on performance measures. The other side wants to control the amount money provided to individuals, who would then be responsible for purchasing their own insurance. Is it possible for us to have a reasond discussion of the issue. I'm not looking for the the type of response that says I am for my guy because the other guy is a people firing, tax dodging, Nazi, Marxist that learned to pick his nose from Chairman Mao. Policy discussion only please.

Why does the selection of Ryan bring the future of Medicare into sharp focus? Why wasn't it already in sharp focus? Obamacare was passed almost 3 years ago. Did it take Romney pointing out the $700B cuts to Medicare in Obamacare for anyone to realize it was there?

Why does the selection of Ryan bring the future of Medicare into sharp focus? Why wasn't it already in sharp focus? Obamacare was passed almost 3 years ago. Did it take Romney pointing out the $700B cuts to Medicare in Obamacare for anyone to realize it was there?

 

The ACA was passed and we will have to disagree over whether it includes any cuts to Medicare. In fact, there are no cuts in coverage in the ACA. The ACA helps to close the donut hole for prescription drugs and does not reduce what is covered under Medicare in any way. Two starkly different ways to control federal Medicare cost have been proposed. Let's discuss them.

The ACA was passed and we will have to disagree over whether it includes any cuts to Medicare. In fact, there are no cuts in coverage in the ACA. The ACA helps to close the donut hole for prescription drugs and does not reduce what is covered under Medicare in any way. Two starkly different ways to control federal Medicare cost have been proposed. Let's discuss them.

You will have to quit spinning what ACA does before any discussion can take place. Does ACA make any direct cuts to coverage, no. Does ACA cut the funding to Medicare for payments, yes. Do you agree with that? If so then we agree that ACA cuts $700B from Medicare. You can spin it or dance around however you but at the end of the day it is a cut.

 

Now, if you cut payments to providers benefits will be negatively affected. Doctors will stop taking Medicare and coverage will suffer greatly. I'm not saying something doesn't need to be done but just waving a wound and saying we're not paying the current prices isn't the way to do it. Because guess what, your not going to get care.

You will have to quit spinning what ACA does before any discussion can take place. Does ACA make any direct cuts to coverage, no. Does ACA cut the funding to Medicare for payments, yes. Do you agree with that? If so then we agree that ACA cuts $700B from Medicare. You can spin it or dance around however you but at the end of the day it is a cut.

 

Now, if you cut payments to providers benefits will be negatively affected. Doctors will stop taking Medicare and coverage will suffer greatly. I'm not saying something doesn't need to be done but just waving a wound and saying we're not paying the current prices isn't the way to do it. Because guess what, your not going to get care.

 

This

For the record I know at least 5 physicians who have already stopped taking new Medicare patients. In much the same was as has already happened with Medicaid more and more providers will stop taking Medicare patients because like with Medicaid they will not be reimbursed enough to cover their costs.

 

Also, all private insurance reimbursements are tied into a percentage of the Medicare reimbursement. Cut those and all forms of insurance get cut.

 

But that's OK it's just the evil rich physicians that are taking a hit.

 

Here's a novel idea. How about real and meaningful tort reform to cut physicians expenses. But we know that will never happen because the evil greedy lawyers of the world are the ones who write laws.

I firmly believe had we had insurance reform several years ago, healthcare would have been a different animal these days.

I firmly believe had we had insurance reform several years ago, healthcare would have been a different animal these days.

 

Hillary agrees.

Spindoc, is there a shortage of GPs today?

You will have to quit spinning what ACA does before any discussion can take place. Does ACA make any direct cuts to coverage, no. Does ACA cut the funding to Medicare for payments, yes. Do you agree with that? If so then we agree that ACA cuts $700B from Medicare. You can spin it or dance around however you but at the end of the day it is a cut.

 

Now, if you cut payments to providers benefits will be negatively affected. Doctors will stop taking Medicare and coverage will suffer greatly. I'm not saying something doesn't need to be done but just waving a wound and saying we're not paying the current prices isn't the way to do it. Because guess what, your not going to get care.

 

When I wave a wound at my doctor I always get care.

 

We can agree to disagree as to which of us is "spinning" the Medicare numbers. It seems that we both understand what is happening.

 

In a different thread, I made the same point that putting the economic burden on the providers MIGHT result in a shortage of providers. Negotiated rates do not have to result in a loss of service. Insurance companies have been doing it for years and yet, most doctors and hospitals still take insurance. On a recent visit, my doctor charged $409.00. The negotiated rate he had agreed to with my insurance carrier was $196. I don't believe I received any less service because of the lowered rate and I don't think my doctor is planning to go out of business. On the other hand, transfering the economic burden to the users will result in some users not being able to afford the service. That is a form of rationing based on ability to pay.

 

My biggest problem with the Ryan approach to Medicare is that I believe it reflects a fundamental misunderstanding of the problem. His approach is based on the idea that the government is paying an unaffordable amount for Medicare so the extra costs are transferred to the users in the belief that market forces will drive down the costs. That is true, but only because market forces will force those that can't afford the services to do without. The real problem is that we as a society are paying an unaffordable amount for Medicare services. The ACA attempts to lower the total by first trying to increase the efficiency of the system and second, controling the rate of increase in provider payments. That seems to me to be a much more sound approach. The hard choices will come when as technology improves, we have an ability to keep people alive for longer and longer times at greater and greater cost.

Spindoc, is there a shortage of GPs today?

Not that I'm aware of (locally anyway). And this is strictly opinion on my part, if there is a shortage of GPs it's because of the over-specialization of the field of medicine. For instance, there are "general surgeons" these days that are even more specialized that in surgery groups there are sub specialties. Some surgeons don't do anything but gastric bypass, etc. Some of that has been in part due to insurance reimbursement but not entirely. However, with the topic at hand, I can't see how this gets better with what's looming in the package signed into law. Insurance and hospitals have become such a money hole that common sense medicine has flown the coop.

When I wave a wound at my doctor I always get care.

 

We can agree to disagree as to which of us is "spinning" the Medicare numbers. It seems that we both understand what is happening.

 

In a different thread, I made the same point that putting the economic burden on the providers MIGHT result in a shortage of providers. Negotiated rates do not have to result in a loss of service. Insurance companies have been doing it for years and yet, most doctors and hospitals still take insurance. On a recent visit, my doctor charged $409.00. The negotiated rate he had agreed to with my insurance carrier was $196. I don't believe I received any less service because of the lowered rate and I don't think my doctor is planning to go out of business. On the other hand, transfering the economic burden to the users will result in some users not being able to afford the service. That is a form of rationing based on ability to pay.

 

My biggest problem with the Ryan approach to Medicare is that I believe it reflects a fundamental misunderstanding of the problem. His approach is based on the idea that the government is paying an unaffordable amount for Medicare so the extra costs are transferred to the users in the belief that market forces will drive down the costs. That is true, but only because market forces will force those that can't afford the services to do without. The real problem is that we as a society are paying an unaffordable amount for Medicare services. The ACA attempts to lower the total by first trying to increase the efficiency of the system and second, controling the rate of increase in provider payments. That seems to me to be a much more sound approach. The hard choices will come when as technology improves, we have an ability to keep people alive for longer and longer times at greater and greater cost.

And my problem with that is I think they're taking the wrong approach. Why not spend some of the time, money and effort on insurance oversight?

I firmly believe had we had insurance reform several years ago, healthcare would have been a different animal these days.

 

More than anything else, the ACA is insurance reform. I believe that it is a very good first step toward reigning in costs. I think it provides a very viable framework, but there will need to be more done. As a few examples, right now, there is a strong preference in the tax code for employer provided health insurance. With the advent of the group rates available under the exchanges there is no longer a real reason to keep insurance employer based. Severing insurance from employers would allow individuals to purchase a policy from the exchanges that reflected their individual needs. For example, if over the years I build up a $30,000 balance in an HSA, there is no real reason that I shouldn't be able to buy a $30,000 deductible plan from the exchange. On the other hand, if my financial resources are such that I can't pay a high deuctible, I'm not really insured unless I have a low deductible plan. By the way, severing the employer from the insurance decisions would also eliminate the problem with the Catholic church.

And my problem with that is I think they're taking the wrong approach. Why not spend some of the time, money and effort on insurance oversight?

 

I'm not sure what you mean by insurance oversight, but there are requirements within the ACA that insurance companies spend a minimum percentage of premiums on health care. I believe that there are a lot of people around the country that are about to get a refund from their carrier based on that provision.

 

Also, the whole purpose of starting this thread was to generate a discussion of approach. There are advantages and drawbacks, regardless of the approach.

More than anything else, the ACA is insurance reform. I believe that it is a very good first step toward reigning in costs. I think it provides a very viable framework, but there will need to be more done. As a few examples, right now, there is a strong preference in the tax code for employer provided health insurance. With the advent of the group rates available under the exchanges there is no longer a real reason to keep insurance employer based. Severing insurance from employers would allow individuals to purchase a policy from the exchanges that reflected their individual needs. For example, if over the years I build up a $30,000 balance in an HSA, there is no real reason that I shouldn't be able to buy a $30,000 deductible plan from the exchange. On the other hand, if my financial resources are such that I can't pay a high deuctible, I'm not really insured unless I have a low deductible plan. By the way, severing the employer from the insurance decisions would also eliminate the problem with the Catholic church.

 

And therein lies a terrific problem. With every little bill not paid by the insurance carrier, the individual will spend his money in the HSA to cover those bills owed to the provider, never building up enough reserve to "afford" an insurance with a higher deductible and lower premiums. It's exactly what I have in coverage personally now. Pipe dream. Great in theory, not remotely great in practice.