Bush Administration Plans Medicare Changes (payments cut 20-30%)

[conjur]

http://www.nytimes.com/2006/07/17/us/17...1d4b18fa6636a&ei=5094&partner=homepage

WASHINGTON, July 16 ? The Bush administration says it plans sweeping changes in Medicare payments to hospitals that could cut payments by 20 percent to 30 percent for many complex treatments and new technologies.

The changes, the biggest since the current payment system was adopted in 1983, are meant to improve the accuracy of payment rates. But doctors, hospitals and patient groups say the effects could be devastating.

Federal officials said that biases and distortions in the current system had created financial incentives for hospitals to treat certain patients, on whom they could make money, and to avoid others, who were less profitable.

Michael O. Leavitt, the secretary of health and human services, said the new system would be more accurate because payments would be based on hospital costs, rather than on charges, and would be adjusted to reflect the severity of a patient?s illness. A hospital now receives the same amount for a patient with a particular condition, like pneumonia, regardless of whether the illness is mild or severe.

We all know something needs to be done.

There was an excellent article a year or so ago in the WaPo called, "Almost Unnoticed: Bi-Partisan Budget Anxiety".
http://www.washingtonpost.com/wp-dyn/co...rticle/2005/05/17/AR2005051701238.html

In that article it's accepted across the board that future obligations cannot be met with current tax levels, revenue, spending rates, etc.

The US Gov't *will* go bankrupt if nothing is done.


That said, I'd rather see spending curtailed related to defense spending and I certainly want to see more details on this Medicare spending change. If people truly won't be affected in being able to receive care and if this cuts out waste from hospitals charging for services that are not necessary for the given diagnosis, then this could be a help.

But, there still remains the chance for fraud in intentionally submitting different or add'l diagnoses which is why a powerful, strict, and OPEN auditing process needs to be implemented, too. That would help pave the way toward nationalized health care which, imo, is where we really should be headed as it would off-load so much money from corporations to be used for R&D, salary increases, capital investment, etc. and would allow people, esp. the 45 million+ uninsured, to receive medical care, esp. the all-important preventive variety.

 

[zendari]

Excellent job reducing a very bloated burden on taxpayers.

 

[Darkhawk28]

Collective bargaining with drug companies and fraud audits on the SUPPLIER side would practically solve the Medicare problem on its own.

But I also agree, a national healthcare system would be best and would stimulate the economy.

 

[alchemize]

You can nickel and dime a system down, but Medicare is unsustainable, as pretty much all healthcare models are, when you have an "unlimited treatment" and "basic human right" model. In these models, the majority of healthcare is consumed by a very small minority (i.e. diabetes/obese). Private enterprise is much more effective in limiting these expenses, but then they are considered "evil HMO's".

I personally think a "national umbrella policy" to supplement private healthcare is the best model.

 

[HombrePequeno]

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

 

[nweaver]

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

 

[zendari]

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

The defense budget has $68 trillion in liabilities?

 

[Darkhawk28]

Originally posted by: nweaver

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

What invading army is attacking us? What country is going to invade us? I'm sorry, but more than 50% of all our federal dollars goes to "national defense". That's a ripoff.

 

[Jaskalas]

More taxes, more authoritarian government, more medical care?

 

[nweaver]

Originally posted by: Darkhawk28

Originally posted by: nweaver

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

What invading army is attacking us? What country is going to invade us? I'm sorry, but more than 50% of all our federal dollars goes to "national defense". That's a ripoff.

ever wonder WHY no one is invading us? It's not because the are all nice neighbors...

 

[Darkhawk28]

Originally posted by: nweaver

Originally posted by: Darkhawk28

Originally posted by: nweaver

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

What invading army is attacking us? What country is going to invade us? I'm sorry, but more than 50% of all our federal dollars goes to "national defense". That's a ripoff.

ever wonder WHY no one is invading us? It's not because the are all nice neighbors...

Ya, we gotta watch out for those Canadians.

 

[Strk]

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

Good thing he added a few trillion to it first with the medicare prescription drug bill..... :roll:

 

[theeedude]

So first this Moron-in-chief adds liabilities to Medicare with this prescription drug debacle to pander to seniors, then that doesn't work out so he wants to cut the same program.

 

[zendari]

Originally posted by: Strk

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

Good thing he added a few trillion to it first with the medicare prescription drug bill..... :roll:

Unfortunately Gore had an even worse idea, so it was coming anyway.

 

[Strk]

Originally posted by: zendari

Originally posted by: Strk

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

Good thing he added a few trillion to it first with the medicare prescription drug bill..... :roll:

Unfortunately Gore had an even worse idea, so it was coming anyway.

He had a plan that was worse than paying full price for retail prescription meds with no ability to negotiate? Oh, and even if he did, it wouldn't have gone through. Republicans tend to live up to their rhetoric when Democrats control the presidency.

 

[HombrePequeno]

Originally posted by: zendari

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

The defense budget has $68 trillion in liabilities?

Don't worry, I agree with cutting Medicare. It definitely needs to be cut and restructured.

But I also think that having a half trillion dollars (not including emergency spending for Iraq and Afghanistan) is way too much for a military budget. Our military spending is over 4% of our GDP. No other industrialized country even comes close to that.

This administration needs to pull on the reins of governmental spending. In Bush's first term, domestic discretionary spending rose an average of 8% a year. Add to that the fact that the military budget is going through the roof and you can see the Bush administration cares nothing about keeping the budget in check.

Great, he wants to cut some of Medicare (after adding on to it). But that's only part of the problem. We could easily have a balanced budget right now. All it would take is a little bit of spending restraint.

 

[alchemize]

Might want to have a chat with these guys too:

Baucus (D-MT)
Breaux (D-LA)
Carper (D-DE)
Conrad (D-ND)
Dorgan (D-ND)
Feinstein (D-CA)
Landrieu (D-LA)
Lincoln (D-AR)
Miller (D-GA)
Nelson (D-NE)
Wyden (D-OR)

Oh, and don't forget Lieberman and Kerry who didn't vote.

 

[outriding]

Originally posted by: nweaver

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

We spend on our military that the rest of the world combined

 

[theeedude]

Our military is super inefficient too, we need to outsource occupations to China or Russia.
Just have them bid against each other. Russia spends $20B total on their whole defense budget, that's like a couple months in Iraq for us. And they have a lot of people with experience fighting in Chechnya who can be hired for $10K/year instead, and equipped reasonably cheaply.
Here is what we should do. We should take bids from foreign mercenaries to take over sectors of Iraq from us. Why are we sending national guard units there, that means people who could be working, creating value and paying taxes in the US, who are instead in Iraq. We lose more tax revenue from these people being away from work than it would cost to hire mercenaries to replace them, that is not including all the expense per unit that our government incurs over there, which is on the order of $1M/year if my math is correct on top of the lost tax revenue.

 

[Genx87]

Originally posted by: outriding

Originally posted by: nweaver

Originally posted by: HombrePequeno

Originally posted by: zendari
Excellent job reducing a very bloated burden on taxpayers.

I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

We spend on our military that the rest of the world combined

And? I fail to see how having a competent military with the most upto date equipment is a bad thing.

We could go back to the isolationist model we had before WWII and see how far we get.

Our military spending compared to the gdp of our country has been going down almost every year for the last 40. In the 50s I believe we were pushing near 20-30% of our GDP spent on the military. No surprise why eisenhower feared the military industrial complex. Today he'd probably be scared to see how little we spend compared to the size of our economy.

 

[conjur]

Originally posted by: nweaver

Originally posted by: HombrePequeno
I wish Bush would call for a reduction in the bloat that is the defense budget.

yes, because it's not like we need to defend our selves from anyone...

Engage in bullsh*t rhetoric much? (And this goes to Genx87, too)

Who is saying to cut the defense to the point that the US can't defend itself?

We're spending over 50% of the fiscal budget EACH YEAR for the military and that doesn't include the supplementary spending bills for Iraq/Afghanistan. Where's the return on the investment? The world is now a more dangerous place with terror attacks quadruple over levels a few years ago. Oil prices have tripled and gas prices have doubled since engaging in the "war on terror". And, there's no end in sight to this "war".

Over 50% of the discretionary budget is spent on national defense and that % has been rising over the last several years.

 

[nweaver]

National Defence is a bit of a misnomer. The reason we have, since pre WWII had the largest military, (and most up to date) is because we felt somewhat responsible for what Hitler did. We (sometimes too often) step in situations that arn't ours, and we have been wrong in the past with some of that. The point is, we are the nation who carries the big stick, in hopes of keeping some of the little guys a bit more in line. Should we? That's another debate.


Also, just want to second a previous post. We do spend way to damn much on everything, across the board. I vote for min. wage @ 40hr/week pay for our senators, with housing equivilent to an O3, with the same medical care given to our soldiers. Net result? More common joe's who actually get the price of a loaf of bread because they just bought one, rather then having it on a card during their speach, and care about our country, not about the fame/power/money.


btw, this only works if we beat the crap out of Special Interest groups and campaign financing (it shouldn't cost 10 mil to run for president!)

 

[BaliBabyDoc]

Bush is a tool.

How else can you explain the massive expansion of Medicare (Drug Benefit) and then follow it up with claiming Medicare costs are out of control?

Having said that . . . Medicare had fundamental flaws BEFORE the idiot came into office. Many of those same ailments afflict the broader healthcare system. Namely, physicians and hospitals get paid to treat sick people . . . and compensation is directly proportional to the illness. I'm not saying physicians and hospitals ignore low reimbursement conditions or totally eschew prevention and health maintenance . . . at least not consciously . . . maybe.

But let's limit the discussion to healthcare for old people . . . old people that are typically sicker yet living longer than any previous generation. Astonishingly, alchemize is pretty close to what has to be done. Medicare should be dramatically reformed or even abolished. The new program called HealthChoice would basically be a barebones healthcare system that either offers moderate reimbursement to physicians (current system), employs its own physicians (closer to National Health Service), or does both. There are pluses and minuses to each option.

The Choice comes in when it comes to the true expanse of healthcare available. Unlike the current crappy (market-based) bungling of CMS in Medicare, HealthChoice would actually enlist physicians and healthcare economists with some sense (not political hacks) to determine what private plans qualify to be offered to enrollees. People would have multiple choices from national private plans which would be exempted from current state rules governing those plans.

In essence, the government focuses on keeping older people healthy through prevention and effective treatment of chronic disease, while the market would be left to offer silver, gold, platinum, and uranium level plans. It would dramatically control the public cost of healthcare for the elderly, while giving the 'market' the opportunity to prove it can efficiently (and profitably) provide healthcare instead of their current model where they primarily profit from NOT providing healthcare.

 

[BaliBabyDoc]

NYT

One recent sun-splashed afternoon, executives who run some of America?s leading nonprofit hospitals met at a stately Colorado resort for an unusual mission: to advise companies confidentially on how best to sell their drugs, medical devices and financial services to hospitals.

I'm sure it's purely based on efficiency and cost-savings.

Founded five decades ago, the company, known as H.R.D.I., has maintained a low profile, despite an elite membership that one government official calls ?the health care titans of America.? Earlier this year, the institute declined to even say who belongs to it. But that is changing.

Hmm, Energy Task Force anyone?

Mr. Mecklenburg not only runs a large nonprofit hospital, Northwestern Memorial in Chicago, but he also serves on the board of Becton, Dickinson and Company, a major supplier of medical devices to hospitals around the world, including his own. Becton, Dickinson pays the institute for marketing advice, and the institute pays Mr. Mecklenburg $50,000 a year, mostly for participating in two national conferences, according to the group.

Again, I'm sure that marketing advice is good for profits . . . I mean patients.

Only two competing companies in any specific field are generally allowed to join, according to the group. Mr. Blumenthal said limiting membership raised antitrust concerns, adding that his office was investigating whether companies used their membership to improperly divide sales territories. ?These arrangements are more than just a bunch of corporate C.E.O.?s and health care executives enjoying golf games or cocktails,? he said.

 

[alchemize]

Originally posted by: BaliBabyDoc
Bush is a tool.

How else can you explain the massive expansion of Medicare (Drug Benefit) and then follow it up with claiming Medicare costs are out of control?

Having said that . . . Medicare had fundamental flaws BEFORE the idiot came into office. Many of those same ailments afflict the broader healthcare system. Namely, physicians and hospitals get paid to treat sick people . . . and compensation is directly proportional to the illness. I'm not saying physicians and hospitals ignore low reimbursement conditions or totally eschew prevention and health maintenance . . . at least not consciously . . . maybe.

But let's limit the discussion to healthcare for old people . . . old people that are typically sicker yet living longer than any previous generation. Astonishingly, alchemize is pretty close to what has to be done. Medicare should be dramatically reformed or even abolished. The new program called HealthChoice would basically be a barebones healthcare system that either offers moderate reimbursement to physicians (current system), employs its own physicians (closer to National Health Service), or does both. There are pluses and minuses to each option.

The Choice comes in when it comes to the true expanse of healthcare available. Unlike the current crappy (market-based) bungling of CMS in Medicare, HealthChoice would actually enlist physicians and healthcare economists with some sense (not political hacks) to determine what private plans qualify to be offered to enrollees. People would have multiple choices from national private plans which would be exempted from current state rules governing those plans.

In essence, the government focuses on keeping older people healthy through prevention and effective treatment of chronic disease, while the market would be left to offer silver, gold, platinum, and uranium level plans. It would dramatically control the public cost of healthcare for the elderly, while giving the 'market' the opportunity to prove it can efficiently (and profitably) provide healthcare instead of their current model where they primarily profit from NOT providing healthcare.

Astonishingly? You should say "as usual" 😛 And of course prevention is critically ignored at great expense (as are my suggested "motivational" premiums for obese/smokers).

But what about the other side of the equation, BBD. Again, we're still nickel and diming. We both know that huge portions of the cost of healthcare are borne by a small (but growing) minority population. Do we cease multiple organ transplants? Cease treating preemies prior to a certain age? Does spending $100 million trying to save 50 lives, and only saving 1 justify the expense? "high tech" expensive solutions are only going to continue to be developed for more and more complex diseases. I know it may sound callous, but I think we have to re-examine how healthcare is delivered to critically ill patients.