Republicans are offering healthcare suggestions

[charrison]

your an idiot......instead of spouting nonesense support what your saying....

You have not been paying attention. The dems with their super majority have largely been ignoring the minority party.

 

[nyker96]

For instance...

http://www.youtube.com/watch?v=HYkAVtiarRY

I just happened to stumble across that. Let's ignore what channel it's on, and pay attention to what has actually been said. Dems are trying to push this bill through all or nothing, and aren't listening to anything by Republicans apparently.

This is how liberals are supposed to be reaching across the aisle?

I'd take this seriously if it's on CNN, but this piece is produced by republican senate just too partisan to be 'news'. I do agree that Dems needs to listen to everyone's suggestions including Republican's but it seems to me that recently the republican's gone very extremely right, and they don't accept any compromise except total and 100% their way. That I'm afraid would mean this Health care thing is going no where. Also what's up with republicans and democrates cleaning out the centrist members? even McCain is getting challenged!?

 

[Fern]

Let's suppose for a moment (and I don't believe what I say next) that Republicans are genuinely interested in improving health care.

If that were the case they would still be going about it bass ackwards. In any significant undertaking one evaluates the situation in as objective a fashion as possible, get expert opinions with those familiar with the situation, assess options and probable outcomes along with the various costs of each. You then formulate a plan based on the knowledge and expert opinions you have obtained.

You don't write a bunch of regs and plans without understanding what's going on, then scramble to fix what you screwed up. In war and medicine that gets people killed.

There are some Repubs like that; it's the Physicians Caucus. IIRC, there are 13 repubs and 6 Dems physicians who make up the caucus.

I've heard one of them on TV, Chris Murphy IIRC, make what sounded like some very good points. I.e., they have great suggestions.

Looks like the problem is that nobody on either side of the aisle (nor the Admin) will listen to them.

Fern

 

[First]

The Republicans' suggestions for healthcare don't cover 30+ million people, they cover about 10% of that number, and they don't save any money either (a few billion a year in malpractice reform is nothing, and that's straight from CBO), and they also don't actually put the screws to insurance company practices.

In the end, the Dems are the stinky corpse alternative to the rotting, flaming turd that is the Republican plan.

 

[Fern]

Funny how repubs thought healthcare was just peachy when they ran the Senate, HOR, and the Whitehouse in 2003-2007... obviously didn't need to do anything at all when they were running things, huh-uhh...

Now that they're on the outside looking in, why, they're just full of ideas, because those other guys just can't do anything right, and we need to start over, obviously- maybe we can just put this off, again, maybe we can just go back to yukking it up in our plush offices with our industry cronies...

In republican parlance, "Start over" means "It hurts! Make it stop, mommie, make it stop!"

Anybody who didn't notice that the video isn't on any particular channel but is rather a carefully edited RNC hackjob really needs to pull their head out of their ass... Like the OP, for instance.

No, that's not correct (and just drips with partisanship).

Looks to me like they want (and have tried) to approach it first by solving the cost problem before expanding coverage. I agree with that approach.

IIRC, during that time they had only a 1 vote majority in the Senate. As we can now see even with a 60 vote 'super majority' HC reform isn't easy. About all they could do was smaller incremental changes, which is what they did do. An example is HSA's (as already mentioned). I was following the legislation at the time, basically they could get nothing through the Senate re: HC without Ted Kennedy's approval. IIRC, he allowed HSA's to pass, but required that they be initially limited to only 100K HSA plans (people) nationwide.

Fern

 

[Fern]

The Republicans' suggestions for healthcare don't cover 30+ million people, they cover about 10% of that number, and they don't save any money either (a few billion a year in malpractice reform is nothing, and that's straight from CBO), and they also don't actually put the screws to insurance company practices.

In the end, the Dems are the stinky corpse alternative to the rotting, flaming turd that is the Republican plan.

No, malpractice reform (if done properly) would amount to huge savings. However, it's not from the malpractive premiums or court costs etc that the CBO and others base their estimate on. The savings are from 'defensive medicine' (unnecessary and/or redundant procedures). And there are plenty of studies out there that demonstrate this.

Fern

 

[First]

No, malpractice reform (if done properly) would amount to huge savings.

Then cite and link where malpractice reform saves significant dollars, because pretty much no study or analysis that isn't from partisan conservative outfits shows malpractice reform would save anywhere near enough money to be worth scrapping a whole bill.

However, it's not from the malpractive premiums or court costs etc that the CBO and others base their estimate on. The savings are from 'defensive medicine' (unnecessary and/or redundant procedures). And there are plenty of studies out there that demonstrate this.

Fern

You'll first have to explain why some defensive medicine is bad since it merely holds doctors accountable for their actions in the best case and costs a few extra billion in the worst case, which is nowhere near enough savings in the long run to matter in a $14T/yr economy.

EDIT: Oh, and I especially like how you ignored the part about covering 30M+ more people.

 

[Throckmorton]

No, malpractice reform (if done properly) would amount to huge savings. However, it's not from the malpractive premiums or court costs etc that the CBO and others base their estimate on. The savings are from 'defensive medicine' (unnecessary and/or redundant procedures). And there are plenty of studies out there that demonstrate this.

Fern

That hasn't happened in Texas.

 

[dmcowen674]

The dems with their super majority have largely been ignoring the minority party.

Stop lying the Dems do not have a super majority.

 

[Fern]

Here's a reputable source. The AMA has also made similar claims.

http://www.massmed.org/AM/Template....MPLATE=/CM/ContentDisplay.cfm&CONTENTID=23559

About the Massachusetts Medical Society The Massachusetts Medical Society, with more than 20,000 physicians and student members, is dedicated to educating and advocating for the patients and physicians of Massachusetts. The Society publishes the New England Journal of Medicine, a leading global medical journal

Waltham, Mass. -- November 17, 2008 -- A first-of-its-kind survey of physicians by the Massachusetts Medical Society on the practice of “defensive medicine” – tests, procedures, referrals, hospitalizations, or prescriptions ordered by physicians out of the fear of being sued – has shown that the practice is widespread and adds billions of dollars to the cost of health care in the Commonwealth. The physicians’ group says such defensive practices, conservatively estimated to cost a minimum of $1.4 billion, also reduce access to care and may be unsafe for patients.

Cost is in Billions: Sethi and Aseltine estimated the costs of the tests to be $281 million for the eight specialties surveyed, based on Medicare reimbursements rates in Massachusetts for 2005-2006. In addition, the cost of unnecessary hospital admissions was estimated to be $1.1 billion, for a combined total estimate of nearly $1.4 billion. The authors said the dollar estimates do not include tests and diagnostic procedures ordered by physicians in other specialties, observation admissions to hospitals, specialty referrals and consultations, or unnecessary prescriptions. The eight specialties represented in the survey account for only 46 percent of the physicians in the state.

Because of those excluded elements and the fact that less that half of the state’s doctors were represented in the survey, the researchers said that the actual cost of defensive medicine in Massachusetts is significantly higher than the survey quantified.

Defensive medicine may come in various forms, including the ordering of medically unnecessary laboratory or radiologic tests, prescriptions, specialist referrals, invasive procedures, and hospital admissions. Also included would be the avoidance of high-risk procedures or even the avoidance of high-risk patients.

I'll also try to find US rep Tim Murphy's (edited to correct name) interview where he explains this pretty clearly. He's a physician in Congress.

BTW: I'm not ignoring your claim about 30M coverage thingy. For one thing the issues of (1) cost savings and (2) extending coverage are two seperate things. For another, I don't know what Repub plan you're specificially referring to, hence can't comment about 'extending coverage' under it. Finally, I'm interested in the cost savings issue so that's what I'm commenting on. You may feel free to make as many different points as you like in your posts, likewise I may feel free to comment on as many or few as I choose.

Fern

 

[Fern]

That hasn't happened in Texas.

IIRC, the reform in TX is about limiting or capping awards in some cases.

But that's so completely NOT the issue at hand. Malpractice premiums, legal costs, court awards etc are a small part of what is at issue. While IMO these savings are worth pursuing, the real 'silver bullet' is reducing "defensive medicine" which, as you'll see in my link in the other posts, results in inferior care and unnecessary and/or redundant procedures. The latter are estimated to have huge costs.

In a nutshell, we have a unique situation combining two things (1) our medical community lacks standardized treatment guidelines (i.e., safe harbors from malpractice claims), and (2) an aggresive tort system that encourages lawsuits. These two things combine to motivate physicians to order/approve all kinds of unnecessary and redundant costly procudures etc paid for by HI companies and Medicare/caid. I don't believe other countries have that.

Fern

 

[Fern]

-snip-

Here's another link, it's the remarks by Dr. Tim Murphy I mentioned above:

MURPHY: ....for example, in the president's proposal, when he talks about waste, it's accounting methods and it's oversight for fraud, et cetera. That's not what we're talking about. Ninety-five percent of Medicare spending is for chronic illness, and 75 percent of spending overall. Of that money, there's huge disparities in what's done between doctors and hospitals and regions in terms of how they treat illness. And those differences can be in the hundreds of thousands of dollars per patient per illness. But only about 4 percent of that variability has to do with the disease severity itself ..

Now, when we're looking at waste, fraud and abuse in Medicare, oh, about 10 percent or less of the cost. If 95 percent of those costs is chronic illness, shouldn't we focus on managing chronic illness better? But the proposals don't talk about that.

[Savings] The New England Institute for Health Care (INAUDIBLE) estimated about $700 billion to $800 billion [out of about $2.5 trillion annual HC spending]

http://www.foxnews.com/story/0,2933,587208,00.html

I think washington (and the Dems specifically since they have the power) should be looking into what the doctors etc are saying. Focus on treatment for chronic illness and look at ways to reduce unnecessary/redudant procedures driven by defensive medicine/lawsuits.

Even if they are off by a factor of 50% there are huge savings to be had. Once huge savings are achieved extending coverage because much more do-able.

Fern

 

[bamacre]

If the Republican Party really cared about health care, they would have done something about it while they had 6 years of control of the Oval Office and both houses of Congress. Of course, all they did was throw gasoline on the Medicare fire.

 

[First]

Here's a reputable source. The AMA has also made similar claims.

http://www.massmed.org/AM/Template....MPLATE=/CM/ContentDisplay.cfm&CONTENTID=23559

I'm trying to see your perspective here but the numbers are entirely on my side; $1.4B is so utterly measly, I'm really not sure how you think that's anything resembling a sensible alternative to the sweeping healthcare changes this country needs as we become more and more inferior to the rest of the planet on a per capita basis. The unquantified claims of "significantly higher" are entirely open to interpretation and can never be quantified since, eventually, you could save all sorts of dollars if you cut out basic commonsense regulation like seatbelt laws. Eventually there's a line you cross when you prioritize the minimization of doctor's liability for purely cost-centered reasons and protecting consumers from doctors that simply don't care about practicing medicine responsibly.

I'll also try to find US rep Tim Murphy's (edited to correct name) interview where he explains this pretty clearly. He's a physician in Congress.

BTW: I'm not ignoring your claim about 30M coverage thingy. For one thing the issues of (1) cost savings and (2) extending coverage are two seperate things. For another, I don't know what Repub plan you're specificially referring to, hence can't comment about 'extending coverage' under it. Finally, I'm interested in the cost savings issue so that's what I'm commenting on. You may feel free to make as many different points as you like in your posts, likewise I may feel free to comment on as many or few as I choose.

Fern

It's really not that hard to find; http://cbo.gov/ftpdocs/107xx/doc10705/hr3962amendmentBoehner.pdf. CBO says a Republican plan covers 3M more Americans by 2019, Dem plan 36M by 2019. Simple numbers. They change incrementally as new plans come out but the bottom line is that Republican plans offer nothing in the way of full coverage or anything approaching it.

Btw, picking and choosing what you want to respond to the point of not even mentioning probably the most critical point in the entire healthcare debate (i.e. coverage) is simply another way of saying you don't have an informed response to far and away the largest problem facing healthcare in the U.S., next only to pre-existing conditions.

 

[Fern]

If the Republican Party really cared about health care, they would have done something about it while they had 6 years of control of the Oval Office and both houses of Congress. Of course, all they did was throw gasoline on the Medicare fire.

Firstly, the Repubs didn't have the majority in the Senate as you claim. The Dems had the majority in the first couple of years of GWB's term and Daschle was the leader.

Secondly, as has been noted above, they were able to pass incremental reforms aimed at cost reduction, again e.g., HSA's.

While I think the Repubs can be fairly blamed for quite a bit, not passing major HC reform isn't one of them. During the best of times they held 51 or 52 seats in the senate. Considering how difficult HC reform has been for the Dems with a 60 vote 'super majority' it's hard to the Repubs for not being abkle to do it. BTW: during that time you weren't getting a damn about HC passed that Ted Kenndey didn't approve of.

Fern

 

[First]

Here's another link, it's the remarks by Dr. Tim Murphy I mentioned above:



http://www.foxnews.com/story/0,2933,587208,00.html

I think washington (and the Dems specifically since they have the power) should be looking into what the doctors etc are saying. Focus on treatment for chronic illness and look at ways to reduce unnecessary/redudant procedures driven by defensive medicine/lawsuits.

Even if they are off by a factor of 50% there are huge savings to be had. Once huge savings are achieved extending coverage because much more do-able.

Fern

Please do not obfuscate the differences between efficient practice of medicine and medical malpractice reform. You think Dems (or Repubs) would truly turn their nose up at the opportunity to cut $800B/yr in spending without effecting healthcare quality if it were as simple as saying "Let's just do that!". Gimme a break, it's just sad and insulting to suggest you can cut that much spending by waving a magic wand and pretending that private doctors and hospitals just aren't aware of this massive inefficiency. It's fantasy-land crap. Cutting Medicare Advantage isn't though, that didn't exist until very recently.

 

[First]

To further drive a stake into the heart of that nonsense $800B figure being attributed to mostly medical malpractice savings (Repubs want malpractice as their cornerstone for some reason), here's a summary of the very Massachusetts outfit (NEHI) you just cited:

Wasteful Spending: NEHI research found that a full third of health care spending, or $800 billion, could be cut without adversely impacting quality.[6] A 2008 series of reports identified the key sources of wasteful spending, including physician practice variation, overuse, underuse and misuse of prescription drugs, and use of emergency departments for non-urgent care.[7]

Primary Care: In 2009, NEHI developed research highlighting the root causes of the crisis in primary care delivery due to increased demand by older, sicker patients and decreased supply of primary care practitioners. The research identified a set of innovations that could enhance the quality, efficiency and effectiveness of primary care in the United States.[8]

In other words, hospital emergency room care from, surprise surprise, the tens of millions of uninsured Americans. And yes, while that certainly includes irresponsible Americans who can afford coverage, the lions share of those tens of millions have absolutely no reasonable way of affording private health care insurance. Meanwhile countries like France and Britain can manage 97%+ coverage for their populations at nearly half the rate of GDP we spend at. So we offer better medical care, but at the cost of being able to afford it and being sicker throughout our most productive years economically because we prioritize the ability to afford premium coverage over slightly more tame quality coverage but for everyone.

And yes, there's a cost associated with that. There's always a cost associated with caring for and protecting Americans and that has been our legacy since the Revolution. You increase standards of living via both innovation and spending, not one or the other. Both. It's true in both business and gov't.

 

[Jhhnn]

Yeh, right, Fern. Physicians and the people they hire to "study" the situation claim that tort reform is the be-all and end-all of healthcare reform, the magic bullet that'll save us all a ton of money.

It's like citing a DEA sponsored study about the evils of Marijuana...

And Repubs citing the need to control costs before spending money is laughable- Hell, the Bush Admin went to war in Afghanistan and Iraq, bought oodles of coldwar military hardware, cut taxes (mostly at the top, naturally) all at the same time. Pork for the home crowd wasn't exactly ignored, either.

But now, well now, things are *different*, because the recipients of govt largesse just aren't their kind of people, are they? and the whole thing is really just an exercise to *Beat Obama!* anyway...

 

[Fern]

I'm trying to see your perspective here but the numbers are entirely on my side; $1.4B is so utterly measly,

Wat? You didn't read the article carefully.

The $1.4 billion is only for Mass, and only for a portion of physician practices (they didn't extrapolate the saving to all fields of care, just quantified it for those they studied).

The authors said the dollar estimates do not include tests and diagnostic procedures ordered by physicians in other specialties, observation admissions to hospitals, specialty referrals and consultations, or unnecessary prescriptions. The eight specialties represented in the survey account for only 46 percent of the physicians in the state.

So it's for less than half than doctors, let's double it to $2.4 billion (yes I realize that may not be accurate but serves as an illustration). Then multiple it out for all 50 state, that's over a $100 billion in annual savings. That's huge.

I've seen estimates much higher. I don't know what the correct amount might be. I do know that medical institutions and physicians themselves are saying that this is something we can do to both substanially decrease AND improve care. I have not seen any other proposal that offers anywhere near this level of benefit. (While it does not directly address extended coverage, a substanial reduction in costs makes extended coverage much easier to achieve).

Congress needs to consider this, but so far they aren't. And any discussion of tort reform that doesn't include this aspect of the issue is misleading, and purposefully so I think.

I don't know why those of us on both the left and the right can't agree to at least listen to what the physicians and their associations have to say. It seems to me to be something (for a change) that we could all agree on - at least just listen to what they have to say.

So far as best I can tell, neither the Dems (including the admin) or the Repubs will even give them a seat at the table. I noticed that they (the physicians in Congress) were excluded from the recent HC summit.

Fern

 

[First]

Wat? You didn't read the article carefully.

The $1.4 billion is only for Mass, and only for a portion of physician practices (they didn't extrapolate the saving to all fields of care, just quantified it for those they studied).



So it's for less than half than doctors, let's double it to $2.4 billion (yes I realize that may not be accurate but serves as an illustration). Then multiple it out for all 50 state, that's over a $100 billion in annual savings. That's huge.

I've seen estimates much higher. I don't know what the correct amount might be. I do know that medical institutions and physicians themselves are saying that this is something we can do to both substanially decrease AND improve care. I have not seen any other proposal that offers anywhere near this level of benefit. (While it does not directly address extended coverage, a substanial reduction in costs makes extended coverage much easier to achieve).

Congress needs to consider this, but so far they aren't. And any discussion of tort reform that doesn't include this aspect of the issue is misleading, and purposefully so I think.

I don't know why those of us on both the left and the right can't agree to at least listen to what the physicians and their associations have to say. It seems to me to be something (for a change) that we could all agree on - at least just listen to what they have to say.

So far as best I can tell, neither the Dems (including the admin) or the Repubs will even give them a seat at the table. I noticed that they (the physicians in Congress) were excluded from the recent HC summit.

Fern

Then it's even worse than I originally thought since it's limited to Mass. and has to be extrapolated to the rest of the country. The CBO makes no such ridiculous claims of $100B a year in savings from medical malpractice reform. It's pie in the sky and there's no basis for it.

And yet again, the Repubs still don't have an answer for covering 30M+ people. They just don't and it's why they shouldn't be taken seriously. It's just as important as getting rid of pre-existing conditions, something both sides can thankfully agree on.

 

[Fern]

Yeh, right, Fern. Physicians and the people they hire to "study" the situation claim that tort reform is the be-all and end-all of healthcare reform, the magic bullet that'll save us all a ton of money.

It's like citing a DEA sponsored study about the evils of Marijuana...

And Repubs citing the need to control costs before spending money is laughable- Hell, the Bush Admin went to war in Afghanistan and Iraq, bought oodles of coldwar military hardware, cut taxes (mostly at the top, naturally) all at the same time. Pork for the home crowd wasn't exactly ignored, either.

But now, well now, things are *different*, because the recipients of govt largesse just aren't their kind of people, are they? and the whole thing is really just an exercise to *Beat Obama!* anyway...

Are you purposefully being dense (or just partisan as your post indicates - " same ole "Bush, Iraq etc")?

Your also saying that doctors are biased and can't be trusted in any HC reform discussion? He asked for links to non-politically biased souces and I give him the outfit that publishes the NE Journal of Medicine and you dismiss it as biased?

Geez, that's stupid. If you'd bother to read what they're saying it comes down to doing less procedures, less hospital stays less drugs. That means less billable work for them. Clearly there's no benefit in that for them. Clearly there is no evidence of bias and so their suggestions shouldn't be dismissed out-of-hand (as you suggest).

BTW: The Repubs have been pushing cost control long before Obama picked it up as a mantra to push this version (then dropped it). So nothing's new or *different* as you erroneously claim.

The exact HC reform fight we've been seeing has been going on for decades, even before Clinton. Heck, some of the language used in these bills is so old it's out-of-date. Little or none of this is new.

Fern

 

[Fern]

Then it's even worse than I originally thought since it's limited to Mass. and has to be extrapolated to the rest of the country. The CBO makes no such ridiculous claims of $100B a year in savings from medical malpractice reform. It's pie in the sky and there's no basis for it.

There's no logical way that can be "worse". Huge savings from one small state? WTH?

Fern

 

[First]

Heck, some of the language used in these bills is so old it's out-of-date. Little or none of this is new.

Fern

Fundamentally the U.S. economy has become more dependent on private health care affordability to cover people for decades, so since nothing has change in that time with regards to covering more people (decreasing the % of people not covered instead of allowing it to increase) this really shouldn't surprise you. The fact that Repubs and some Dems are opposed to "old" language is an entirely useless point to make.

 

[First]

There's no logical way that can be "worse". Huge savings from one small state? WTH?

Fern

Mass isn't a small state for one (lmao), and two I'm not sure you understood the point. Malpractice reform is a red herring, it doesn't actually address the lion's share of healthcare savings we'd get from reducing emergency room visits or addressing pharmaceutical costs or any of a number of things that are far more important. You're hypnotized by something the CBO themselves says addresses a single digit share of our entire healthcare picture. It's nothing like that BS $800B figure either, of course.

Oh, and covering people. Yeah, I know, selective responses FTL.

 

[Zebo]

This is what I heard: Make $200K a year, Don't get sick, and if doc cuts off wrong leg for treating your diabetes don't plan on suing.

PS Chairman of Bristol MS still makes 75 million salary and 70 million taxed at 15% in options. Gotta a problem with that?

Yes the Dems is a joke but the Repulican plan(s) are nothing more than rich get richer poor and middle is shit outta luck.

Real reform will not happen until we go single payer and remove overhead just like every other country who insures EVERYONE for half or less than half $.