*Note if the money for $245 billion SGR fix was instead used to improve affordability in the current health care reform bills, it would be more than enough money to actually provide affordable universal health insurance for all Americans.

Stunning.. just stunning.

Proving yet again that if the US Senate wants to pass something right away, they can and they do.

“It needs to be done but I couldn’t vote for something that is going to raise the deficit by $245 billion, not at a time when we are already hemorrhaging red ink,” Bayh said.

So Bayh about those war funding votes have you looked at how much more the wars cost?

*Note if the money for $245 billion SGR fix was instead used to improve affordability in the current health care reform bills, it would be more than enough money to actually provide affordable universal health insurance for all Americans.

Money Quote.

Conrad again. Interesting.

Handling this separately blows Conrad’s cover. He no longer can gripe about Medicare rates putting providers in ND out of business.

And notice that he’s a fiscal hawk when it serves his purposes.

I’d like to know why KO or Rachel doesn’t bring the cost of the wars up in this context when they talk to these lame ass members of Congress. How many Dem Senators voted NO on the supplemental, not counting Sanders? Of those who’ve been in the Senate since 2000 how many Dems have voted NO on war funding, again, not counting Sanders? Two faced motherfuckers.

Back to the cesspool.

Namaste

Agreed

MAYO for all.

Can’t fix this with republican support either senator. Don’t even consider it unless it is part of the overall package to provide us with basic human rights. You aren’t getting the message are you?

If this did not pass is there any doubt they just would keep passing short term “patches” to keep the rate from dropping that much?

No one doubt that the SGR will always be patched. It is like the AMT no one wants to acknowledge that a budget projections are pure fantasy.

Let’s see did Bayh and Conrad vote for the 2002 war resolution? Did they think about the numbers then when they voted for a war based on a “pack of lies”

Let’s see the names of those who voted for that war. They sure were not thinking about the blood and money spent on an unnecessary war. Now they have concerns about cost?

these are the 22 that voted against the war. Conrad is one of them
* Daniel Akaka (D-HI)
* Jeff Bingaman (D-NM)
* Barbara Boxer (D-CA)
* Robert Byrd (D-WV)
* Lincoln Chafee (R-RI)
* Kent Conrad (D-ND)
* Jon Corzine (D-NJ)
* Mark Dayton (D-MN)
* Richard Durbin (D-IL)
* Russell Feingold (D-WI)
* Robert Graham (D-FL)
* Daniel Inouye (D-HI)
* James Jeffords (I-VT)
* Edward Kennedy (D-MA)
* Patrick Leahy (D-VT)
* Carl Levin (D-MI)
* Barbara Mikulski (D-MD)
* Patty Murray (D-WA)
* Jack Reed (D-RI)
* Paul Sarbanes (D-MD)
* Debbie Stabenow (D-MI)
* Paul Wellstone (D-MN)
* Ron Wyden (D-OR)

Please tell me how this ought not to be a part of health care reform legislation? This is like Bush passing a “supplemental” bill to cover the “unexpected” and “emergency” costs of his two wars. It is legislating the way CEO’s “disclose” their total compensation in SEC documents: a little here, a little there, and pretty soon, you can’t follow the thread.

How is this politically a much easier bill to ram through than credible reform, of which this bill is a small part? Or is that the point? It’s a small part that doesn’t change any of the ground rules, it just doles out more money to the same players, like the bankster bail-out.

It cracks me up how they are all worried about the deficit now. Where were all these assholes when Bush was spending billions per week in Iraq and Afghanistan at the same time he was giving away unprecendented tax cuts to the rich?

Thanks for this informative post. I think this issue has wider implications than just Medicare. The system for classifying procedures and tasks that doctors do, and the method of determining the compensation are based on decisions of a few small AMA committees that are dominated by high cost specialty doctors and that have resisted input from anyone concerned about the bigger picture of what the supply of doctors and reimbursements should be in order to serve the US population’s healthcare needs at a reasonable cost

This system pushes reimbursements above what has been deemed the sustainable growtth rate almost every year, and Congress usually nixes the SRG adjustment to avoid starting a fight over reimbursement policy with health professionals.

These systems started before Medicare was passed, since medicine was getting so complex that allowing individual discretion in charging ‘usual and customary fees’ was just not working anymore. The movement towards systematizing procedures and reimbursement started in the early 1960s.

These days much of private industry uses a modification of the Medicare system as a reference point for determining reimubusements in contract negotiations.

Assuming we can make some progress on health care reform, the next step is reforming the determiniation of health professional reimbursement and supply. This task will involve taking on the AMA’s control of the process.

A similar short term budgetary fix has been imposed on federal funds for training more doctors, and cuts or program freezes for that do get imposed on a regular basis because heavily indebted medical students, and prospective medical students are not a very powerful constituency. So you have this dysfunctional feedback of a chocked off supply of docs, and formulas the push towards higher compensation. If there were an expansion of supply to meet needs to maintain popualtion health, there would be some countervailing force, but it cannot be there with the current system.

The AMA controls this process and is responsible for it. The AMA cannot function any longer both as an industry interest group, and as an impartial scientific body making these decisions because the conflict of interest is just too severe. Medicare part D reimbursement policy greatly expanded the avenues that let other health professionals, such as pharmacists, nurse practioners, etc. in on the gravy from this system, so fixing the reimbursement mess may mean taking them on too, to some extent.

Ahmm, this is making my head hurt.

Am I reading it wrong?

The country could raise all the cash needed to pay for “people” projects, including health care, education, plus make a huge annual dent in infrastructure repair and replacement. The solution is unbelievably simple: get out of Iraq. Now. Get out of Afghanistan. Now. Curtail all nuclear weapons upgrade projects. Now. Cut the war mongering budget by fifty percent. Now. Allow military spending on legitimate defense projects only. Now. Let the M.I.C. eat cake. Now.

Voila.

There is an interesting post on the Seminal Reader Wire that gives a glimpse into the process that determines how medical procedures and physician tasks are classified and reimbursement set. Anyone interested in how it works should take a look.

My only comment is that I do not think that it is an intentionally corrupt system. This approach to physician reimbursement began as a way to control individual doctors and payers from gaming the previous system of ‘usual and customary fees’ when medicine got so complex and sarted changing to rapidly that it no longer worked well. The problem is that this fix to a previous system has been captured by the AMA and is now a very serious source of a conflict of interest for the AMA. It has ossified into a inflexible proprietary system almost completely controlled by the AMA. They have copyrights on most of it. Not only the public, but individual doctors complain that they have trouble getting enough information about it.

Mad as Hell Docter Paul Tells About Crashing the White House and a secretive AMA Committee
By: montanamaven Thursday October 15, 2009 5:08 pm

http://seminal.firedoglake.com/diary/9748

“Reagan proved that deficits don’t matter.” (Dick Cheney)

I have a great idea: Cut “Defense” budgets by, say, 75%, or whatever it reasonably takes to reduce to a defense only budget. No more aggressive war, no more interference, none of that crap. Then write a new law that says all wars other than strictly defensive retaliation will be financed solely and completely by tax hikes on anyone that makes more than, say, $250,000. And if need be, every penny above that baseline $250,000 can be confiscated to pay for war. If that’s not enough, then take some more. After they attain “middle class” status, reevaluate. Give them a break on their health care premium, maybe.

Yep, I’m as sick of war as I am sick of the ever-richer fuckers that milk the same old cow year after year. Halliburton, KBR, Blackwater, et al. et al. anyone?. Been watching one or another episode of the same stupid crap all my life. My first three years (Oct. 1942-Sept. 1945) were legit defensive war. Nothing since then has even come close. How goddamned stupid can an “enlightened” people such as ourselves be?

Bayh is the one who makes my head hurt

Gov’t put into place healthcare price restraint and the industry just ignored them. Surprise surprise.

Now the cuts have piled up or the healthcare prices have skyrocketed and the ‘patch’ would be rather large. So, all of a sudden they want to be fiscally responsible.

What it really shows is that gov’t can be bought and the real restraint to healthcare prices is competition.

Public Option NOW!

LOL, yeah mine too.

I just couldn’t figure out whether those names voted FOR the war or AGAINST the war. And it’s 23 names, not 22.

So I be cornfused.

I mean seeing Paul Wellstone and Russ Feingold on that list makes me think these were the ones that voted AGAINST the war. So Conrad voted against the war?

It’s amazing how quickly Reid can work to get something passed, and how skillfully he can get the votes, when it benefits the establishment or the major corporations. When it’s something for the people? It’s always too hard to “get the votes” or some other pitiful excuse.

On one hand, 14,000 people lose their health insurance every day. 45,000 people die every year because they can’t afford health care. What does the Senate do? Stall, delay. Just be patient, Americans. And by the way, these reforms won’t be available to you for another three years (minimum) anyway, so what’s the hurry?

Doctors are going to take a cut in their reimbursement rates. What does the Senate do? Rush that baby through the Congress so that the rate cut never happens and the doctors never lose a dime.

This is how our Congress represents us.

It is disgusting that the physicians are able to get their fix ahead of health reform, without any guarantee that they will support real reform in return.

The price for the fix should be supporting a Medicare+5% public option, nothing less.

As an an anesthesiologist, in favor of the public option for the greater good, I must note that when medicare instituted its payment structure, based on a research study, the study did not include anesthesia services. So, in the early 90’s, when relative value adjustments were made based on the study, and somebody asked, “What about Anesthesia?”, the answer was “What’s left?”. While most specialities were cut 25 – 30 % of the amount billed, Anesthesia was cut 66%–what was left over.
Therefore you can understand the trepidation of the Anesthesia community when the public option wishes to extend medicare rates to a larger pool. I cannot speak for other specialities.

That kind of ridiculous decision making you mention is the reason why the current system has to be reformed. I agree that trying to force the current Medicare payment systems into the public option with no modification is going to cause hardship for some providers and some regions. I think the whole topic is being avoided for now in order to keep major interest group players like the AMA from outright opposition to any reform at all.