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Now that the first (although least controversial of my ideas) to fix the terrible Senate bill appears likely to be adopted in the conference committee, now is no time to let up. I see their one improvement, and raise them another 15 changes that need to be made. Here are 16 more ideas to add to my original list of 35 ideas:
- Extend everyone’s COBRA coverage until the reform kicks in (like in the House bill).
- Better define the term “medical loss ratio” in the bill to prevent insurers from gaming the regulation.
- Give the IRS power and duty to enforce insurance companies’ MLR regulation.
- Remove the six-month wait for the temporary high-risk pools for people with pre-existing conditions. If you can’t get affordable health insurance, it is immoral that the bill makes you go uninsured for six months before you get care.
- Set up the exchange and all corresponding regulations for small business as soon as possible (a few months). They delayed the exchange because the regulations in the individual market require the expensive affordability tax credits. The small business market will not get expensive affordability tax credits, so there is no reason not to start the exchange just for the small group market as soon as possible.
- Let insurers in the new exchange use a reimbursement rate based on Medicare plus some percent. (This idea from Jacob Hacker would have similar cost controlling effects as my previous suggestion of having the exchange commissioner force all insurers using PPO’s to negotiate one standard provider reimbursement rate.)
- Use the OPM exchange to replicate something similar to the Swiss or German system. (Only allow only new CO-OP plans to take part. Mandate a 93% MLR, precisely define benefit packages, and have them collectively pool their negotiating power with providers and manufacturers. Make all co-ops on the OPM exchange share provider networks, reimbursement rates, and forms for PPOs plans or out-of-network charges. Create a robust internal risk adjuster and give all plans in the OPM exchange the power to reimburse at Medicare rates plus 10% for the first several years while the co-ops and OPM exchange gets off the ground.
- Allow people below 190% of FPL, but who are not poor enough to qualify for Medicaid, to buy in to the program.
- At least allow people who were on Medicaid but have incomes that increase just slightly above the Medicaid qualification cut off to “buy in” to Medicaid so that they can keep a seamless coverage despite minor fluctuations in income.
- Fully Federalize the whole Medicaid program.
- Provide serious special benefits to insurance plans that score very high on precisely defined sets of metrics (MLR, cost effectiveness, consumer reviews, survival rates, speed of claim reimbursement, easy of appeal process, customer retention, etc.)
- Encourage states and local governments to find a way to merge their state employer insurance exchanges with the new exchange as long as it can be done in a way that does not reduce the quality or increase the cost of coverage for state employees.
- Encourage community health care centers to work together to create new fully integrated, cost-effective health care plans to cover individuals in Medicaid, the new “basic health program,” or on the new exchange. (like the Community Health Network of Connecticut)
- Have all insurance plans that provide coverage for young children have zero cost sharing for the health care of the child.
- At least make all health insurance plans covering children have extremely low co-pays, deductibles, and out-of-pocket limits for the coverage of the child.
- Have all young children in the country without insurance coverage, regardless of legal status, automatically enrolled in some form low out-of-pocket public health care program. (No child on US soil or anywhere else on Earth should ever die due to lack of access basic affordable health care.)
The more I think about the Senate health care bill, the more glaring failures I see in its design–but pointing out that there is a problem is always the first step towards fixing any problem. Maybe if supposed “liberal/progressive” media spends more time drawing attention to all the failings in the current Senate bill, and less time telling the grassroots they need to just accept any awful bill, the bill would not be so terrible.
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“Letter to a Sincere Leftist”
http://www.jewishworldreview.com/1209/tracinski122309.php3
All of us ‘should’ take Jon’s list and send it to our Reps and Senators and say ‘This is what you SHOULD be legislating.
Jon, Jon, Jon. Keep this up and & I’m going to become a Jon groupie. Happy Holliday to you, you’ve REALLY earned it.
Huff.Post is reporting Obama believes it’s going to take until Feb. for him to get his way on HealthCare. I’ll chaulk this up as one more serious misread of his FORMER supporters.
Amazing, simply amazing.
Add on more … swap the Senate Employee Mandate for the House pay or play, with 4% going into the employee exchange account and 4% into the general fund … and then, since this is a more effective mandate than the individual mandate, scrap the individual mandate.
How many of these 50-odd improvements would be moot/unnecessary if we simply adopted a singler-payer/Medicare-for-all system?
only one i can think of is the start date. :)
thanks for the reminder — there is a progressive policy for universal healthcare.
Jon, when you talk about Federalizing Medicaid, you are going to run into two immediate problems that I can think of: 1)Medicaid eligibility requirements vary from state to state and 2)state supplied Medicaid funds, in those states that allow it, are the only source poorer women have to fund abortions.
Specifically, in Illinois, regardless of your income, if you have at least $2000 in assets (say an older car that you use to commute to your low-paying job at Walmart), you can’t qualify for Medicaid. Across the border from Illinois, in Wisconsin, income level is the only test for Medicaid eligibility. Unless you can find some way to force every state legislature to change eligibilty requirements, just changing who foots the bill doesn’t necessarily make it easier to obtain Medicaid.
Secondly, some states, as I understand it, allow abortions for Medicaid recipients to be paid out of the state portion of Medicaid contributions, thereby avoiding problems with Federal restrictions such as the Hyde Amendment. Until you can guarantee that all women have, as a right of citizenship, full control over all of their own medical decision-making, Federalizing Medicaid payment could actually be harmful to women in certain states where abortions for poorer women are still available.
Finally, doctors are already beginning to decline Medicare patients, even with Medi-gap insurance. Finding a doctor to treat Medicaid patients is even more difficult because of the reimbursement rates. Medicaid recipients simply do not receive the level of care that they deserve. They are still being denied access to quality care simply based on income.
Fantastic post. Your points are all well-taken, but perhaps the disagreement on the left wouldn’t be so divisive if you weren’t mischaracterizing the positions of those you disagree with. I don’t know any liberal whose stance on the Senate bill could be accurately described as “just accept any awful bill”. That’s simply untrue.
In fact, as someone who begrudgingly supports the passage of the Senate bill, I spent last week pushing hard for the adoption of some of the outstanding amendments which would have improved the bill (incl. Leahy’s amendment to repeal the anti-trust exemption). While all this was going on, the “supposed ‘liberal/progressive’ media” as you describe it was ignoring these pending amendments in favor of highlighting the old “Democrats divided” narrative via a parade of liberal heroes shouting “kill the bill” by which they mean “kill *this* bill” by which they mean “*fix* this bill”. Which is what the “pass the bill” people want to do as well.
6. Let insurers in the new exchange use a reimbursement rate based on Medicare plus some percent. (This idea from Jacob Hacker would have similar cost controlling effects as my previous suggestion of having the exchange commissioner force all insurers using PPO’s to negotiate one standard provider reimbursement rate.)
This is a nice idea, but while Medicare does save money with low hospital and provider rates, it does a poor job negotiating prices for durable medical equipment (DME) and is forbidden by law from negotiating drug prices. The VA does a much better job doing both. It publishes a Federal Supply Schedule that Congress could allow private insurers to buy DME and drugs from (and Medicare could be allowed to use the even lower “Federal Ceiling Price” that the VA negotiates for itself).
And while even Max Baucus supports expanding Medicare (to the residents Libby, MT at least), I still think the Pentagon’s existing public option plan for reservists, Tricare Reserve Select, is a better program and could be opened to civilian buy-ins. Tricare use Medicare rates for hospitals and providers and VA prices for DME and drugs.
this is a terrific list jon, your insight is invaluable
These amendments are about as convoluted as the original bill is. As soon as they decided to memorialize workplace plans and build around them, they created a monster. Amending the monster will only create more unintended weirdnesses.
Why can’t we ever just solve problems instead of treating some of the symptoms, why are the elegant solutions always “off the table” around here?
There are two huge gaps we are dealing with here.
The first, the gap between what Congressional Democrats and Obama promised us on the campaign trail and what they “delivered”, is already beyond closing.
But the second is now just as crucial.
That’s the gap between what Democrats voting for the bill call progressive reforms and how these “reforms” actually play themselves out when they become the law of the land. How much money and manpower will the government expend to make sure the health care industry does not “game the system”; and how much money and manpower will be expended to enforce the law against those who do game it?
This is where folks like Jon become crucial. They are the ones who will be following up on this gap. They are the ones who can tell us down the road just how much of what’s left of the progressive rhetoric becomes reality.
Without any and all of this fraud being exposed it will be that much harder to make changes later.
OT, but important. Maybe you don’t know that the gov is punking seniors and the disabled with their “no COLA” raise this year, while Congress gave THEMSELVES a big $5000 COLA
Here’s a petition COLA
Once again taking their money for their wars and bailouts from the bottom. It’s disgusting. And it[s barely enuff to live on as it is for the disabled like me.
There are a couple of bill in the House to use different accounting methods for determining the COLA:
New Bill Seeks Guaranteed COLA for Seniors
HELP!
The MSM is working overtime, To help OBAMA and his Clan pass HCR.
The most important issue of the day is JOBS.
The Job issue is about helping the people of the nation, we don’t want to help the people of the nation.
But we are being told daily that HCR is a do or die situation. If you don’t do HCR now it will never come up again. WOW! Classic Shock Docrine.
One Big Problem if the USA Health Care System is about to collapse, like congress people say, I think it would be force to come up again, and very soon. Why do it NOW? Dems are not good at SHOCK DOCRINE.
The use of words “HEALTH CARE REFORM” is the deception being used here.(You cannot call it let give trillions to the RICH, they need more money)
Once you read the BILL you realize that this is an INSURANCE BAIL OUT PLAN.
Can’t tell USA citizens we got to Bail Out Insurance Companies.
What is so funny about Congress and People Like Senator Boxer.
Boxer declares that Insurance Companies hate this HCR BILL.
While everybody with a Brain looks at Wall Street and sees Health Care Stock Soaring.
THE BEST THING ABOUT THIS HCR BILL IS THAT PROGRESSIVES ARE NOT SUPPORTING IT!
ORahm and the elites are trying to destroy the Progressive Movement. tHIS IS FAILING DAILY. yOU ARE WAKING UP PROGRESSIVES.
People in power, always attack the educated class, because they are the biggest threat to their power.
However, Sen. Boxer probably needs to stay off of television until she gets some better talking points. Insurance companies do not hate this Bill.
This Shock Docrine stuff has some serious FLAWS.
At the end of day, this is not about HEALTH CARE at all, this is about WEALTH TRANSFER.
All the Health Care talk is just NOISE, once you read the BILL, you will see that keeping people Healthy is not a part of this Bill.
thank god for the DUMB DEMS, the DEMS in congress are the gang that can’t shoot straight. These DUMB DEMS may just EXPOSE THE SHOCK DOCRINE TO THE WORLD!
The elites cannot be happy, with the way DEMS HAVE SOLD HCR. This is going to end BADLY! laughing
tHE LESSON HERE IS DEMS DON’T DO SHOCK DOCRINE WELL. i DON’T THINK PEOPLE SUPPOSE TO KNOW YOU ARE ROBBING THEM BLIND.
THIS IS GOING TO RESULT IN A LOT OF NEW DEMS COMING TO CONGRESS. (THESE DUMB DEMS ARE USEFUL AFTER ALL)
I’m signing it, that’s really wrong. Thanks!
Let insurers in the new exchange use a reimbursement rate based on Medicare plus some percent. (This idea from Jacob Hacker would have similar cost controlling effects as my previous suggestion of having the exchange commissioner force all insurers using PPO’s to negotiate one standard provider reimbursement rate.)
Jon,
just curious but how many doctors do you think would retire if this ever happened? Aren’t you concerned about an access problem?
BTW, most of the largest insurers that cover most of the country’s employer sponsored population have a very similar negotiated discount. The difference is pretty negligible.
As a fellow Illinois resident, your comment was very interesting. Is it possible to mandate that doctors accept Medicare patients?
That investigation should start by figuring out how many docs have retired owing to current situation.
You could tie it to their license to write prescriptions for Federal Scheduled Drugs. That’s one way.
In other words, they won’t get their DEA license to write prescriptions unless they agreed to accept Medicare/Medicaid patients. I’ve been advocating this for some time.
by current situation do you mean where they get to bill insurers and patients without insurance whatever they like and make gobs of money off the system and are allowed to own ASC’s, stakes in labs etc with absolutely no reporocussions? That system? I’m sorry but i think docs much prefer that to a system that ties them to a medicare + rate (especially with an impending doc fix) that will be hard to pass.
why not put a gun to their heads and MAKE them treat you and when they don’t cure you from being oh, let’s say FAT then you can go ahead and sue their ass for their entire life’s savings. Just think, YOU could own your doctor’s second home (and his first!)
On the Ed Show the drone line according to several Ed Show guests is Congress cannot do HCR next year or the year after or for some years to come.
So what is Congress doing next year that prevents it to do HCR again?
What is the United States Congress doing in 2011 that it cannot do HCR again?
This is a stinkpile piece of sell out and fixed politics done to AHIP and Big Pharma custom order. Watching the D Party fall all over itself with the pat on the backs and florid prose today should be considered fully inflated pomposity and reality evasion.
If Congress has to do HCR again in 2010,2011,2012 and again 2013 so what?
What else do these 535 Americans have to do that does not allow HCR to be gone over again? What?
This smells more like a false lead that has more to do with the nature of the money politics involved. Congress has been paid lots of K Street attention which comes with big price tags for the entrenched interests who want the fixes put in. The fixes that are back roomed to stay in.
If the current 535 Americans in Congress feel they are overworked,underpaid and have really lousy benefits then they should get out of Congress. Meanwhile get to work and work. If this stinkpile HCR fraud that is being called a historic and lifetime event by the D Party and Barack Obama implodes then do it again. Since it is so historic.
Just stop with this BS about how Congress cannot return to another round or two or three rounds to do HCR. More than one thing going on at the same time? Guess what? There is this thing called multi-tasking. Check it out.
Do the job. Get to work. There are millions of Americans who are looking for work and doing Congress work sure pays well and seems to get lots of personal holiday time and other benefits many American workers have not ever seen. Get to work. Do the job. HCR comes with the job.
Clean up your act. The stench is hard to avoid. Oh–one more thing. You work for the American people. Not AHIP or Big Pharma. Got that straight?
It’s the paperwork thingy, especially when what docs order gets nixed by the insurance corps.
WTF are you talking about?
and docs don’t get denied from Medicare? I read a study earlier this year that Medicare denied more claims than every single insurer in a year’s time.
Sure insurers should have set guidelines that require that standardize things like step therapy for drugs for example etc but you do realize that the “paperwork” thing is many times doctors fault too right? I can’t tell you how many times I’ve called my doctor’s office and they never bothered to call my insurer to get what is needed and I need to do it myself. Have you ever talked to one of those kooks in their offices who handles these things? Its simple crap and they haven’t a clue.
i’m talking about you saying we should FORCE doctors to accept Medicare patients. I saw on CNN a couple months back where a doctor said that if the doc fix didn’t pass and they were cut 21% that he’d be forced out of business?
is that aspect of this ever considered? Many specialists will start January 1st with a $200k bill for their malpractice insurance premium due that they then will have to spend the year to work off. Now i’m not saying we should bother with malpractice reform as its a red herring but we need to find a better way to do this and just saying “FORCE THEM TO ACCEPT ALL MEDICARE PATIENTS” is a dumb answer.
I TOTALLY AGREE
this is just crazy
The whole U.S. “system” is dysfunctional. Now and in the foreseeable future.
Somehow, medical care gets delivered in other countries of comparable development for half the per capita cost of the U.S. current system, and with better health outcomes (less infant mortality rates, longer life spans, lower obesity, etc.). And docs are not starving. And hospitals are not going bankrupt. Can’t say that the evidence supports current U.S. medical industry.
If the reimbursement rates are too low (which they are), then they need fixing. But there is nothing “dumb” at all about tying their desire to have the privilage of writing prescriptions with a Federal governments license with their need to recognize the same Federal government’s social safety net programs.
I would argue it’s “dumb” not too.
ok, you want proof. here you go:
http://www.ama-assn.org/ama1/pub/upload/mm/368/reportcard-short.pdf
don’t get me started on obesity because that to me is the LEADING cause of all our costs/issues/problems but since it doesn’t play into progressive’s back pockets it NEVER gets talked about.
also, cbsnews ran a report on a study that showed that IF the US had no smoking and no obesity the life span of US citizens would RISE by 4 years putting us right at or near the top of the world. Currently we’re 30% obese. in 10 years we’re on pace to have 50% obesity but that gets little play here.
http://www.cbsnews.com/stories/2009/11/30/health/webmd/main5829670.shtml?tag=contentMain;contentBody
and actually, hospitals ARE going bankrupt.
http://www.entrepreneur.com/tradejournals/article/204857945.html
I live in NJ and in 2007 and 2008 I believe the number was 14 have been through some form of bankruptcy. So yes, they are going bankrupt.
Docs are another story and they’re doing just fine.
well you didn’t say anything about increasing rates.
And honestly what i’d prefer is capitation. its the one thing that controled cost.
Just connect the dots. The mainstream media rely in part on advertising dollars from the health care industry to pay their bills. So, of course they are going to support legislation that, for all intents and ourposes, could have been written by the health care industry.
This simple dollars and cents relationship is often completely missed by those who get their “news” from it.
The links in your prior comment did not address my point about how other developed countries have better health outcomes at a much lower cost. And my comment about hospital bankruptcies referred to other developed countries. I know U.S. hospitals are going bankrupt. That was precisely my point.
If you want a good source on obesity, here.
just curious but how many doctors do you think would retire if this ever happened?
Every year, thousands of foreign doctors who train here are required to go home. Current immigration law requires foreign physicians to leave for at least two years before they can applying for a visa (unless they get a J-1 waiver).
Its funny how we give out more work visas for engineers than we need but not enough for doctors– I have no idea how that can be. :o)
http://www.sfweekly.com/2007-03-07/news/free-trade-in-doctors
Is this trying to put a dress on a pig?
It annoys the pig and it wastes your time?
Absolutely! It may not help in the end to change votes, but without the input to your representatives, there is no chance at all. Also push on
Nancy Pelosi at http://www.speaker.gov/contact/
to get the bill into open committee and for changes to the existing Senate bill if it passes.
And for those of you expecting transparency during House/Senate reconciliation please read:
http://hotair.com/archives/2009/12/23/fund-dems-will-probably-bypass-conference-committee-for-ping-pong/
Not throwing up my hands in despair yet as the issues are too important to give up trying for reform.
Transfer all their assets, and don’t buy the insurance.
I think some of the major teaching hospitals that have doctors groups affiliated with them have to take Medicare patients as part of the deal for obtaining Federal research funding. But if the doctor just has hospital privileges, and is not in a group that is affiliated with the hospital, I’m pretty sure there is no requirement.
The reason I say that is a friend of mine, who has Medicare plus a full-blown secondary plan that he received as a retirement benefit (not just a Medi-gap plan), recently tried to find a doctor in Evanston rather than having to travel to Northwestern Memorial in downtown Chicago. Two of the three doctors said they weren’t taking new patients, and the third, after asking him who covered his insurance, told him that they weren’t interested in taking him as a patient. Additionally, all the turn-downs came in spite of a doctor referral. All three doctors had privileges at Evanston Hospital–a teaching hospital–but none were affiliated with an Evanston Hospital doctors group. So, the long answer, as things stand right now, it’s pretty easy for most doctors to refuse Medicare patients. I think you have a better chance of finding a doctor who will take Medicare if you’re near Chicago than elsewhere.
The sad thing is that, since going on Medicare, Medicare has never refused my friend any of his charges. It was the private insurer that balked at paying certain of his hospital and test fees.
I didn’t know that. Interesting. Think how many people might get good medical care if we had doctors opening their own clinics in rural areas. We have a lot of things backwards in this country.
Free market ideologue/troll.
Doctors won’t want to heal people because they don’t make $x million any more because medicare + 10% is only $x/2 million.
I wonder if he has read Atul Gawande’s June piece on Medicare billing in McAllen and El Paso. Somehow the El Paso doctors are healing people just fine.
Oh yes. Definitely the solutiion to U.S. medical woes. Seccund the docs from developing countries. /s
“BullS”eye!
Oh boy, the obesity excuse again.
It’s not like any of the countries that do far better than us on health outcomes have unhealthy habits too. I mean, it’s not like the country with the best rated system in the world, France, is full of smokers and enormous alcohol consumption.
Oh wait. Damn.
Everyone knows they can’t do real legislation in an election year. Of course, that means they get full pay for woring halftime. But who’s counting.
MLRs appear to only apply to premium dollars. They need to apply to all insurer income, or for-profit companies must be barred from having a financial interest on the provider side (else the entire country will look like McAllen, TX).
According to the book I linked at 34, France and all the other developed countries are quickly catching up to the U.S. At the risk of going OT, it’s the increasing penetration of manufactured foods as the short version.
According to an 2005 EU report I’m looking at right now, many European countries approach US rates for Male Obesity, and at least 2 exceed our rates for female obesity. Greece is up there at 38% female obesity.
Europe is more overweight than the US. (Overweight is the broader category, BMI of 25 or above, whereas obesity requires a BMI of 30 or more.)
But hey, we all know US healthcare is lousy because of the fatties.
God what a troll.
LOL. Well the Senate is certainly working full time for Big Pharma, Aetna, Cigna, et al, to give everyone of them a terrific stocking stuffer. Burned the midnight oil to earn their corporate contributions if not their salaries paid for by the taxpayers. Not counting, mind you.
beowulf wrote:
Having worked in the DME business for 25 years (only 5 years less than I have been a democratic voter), let me tell you right off the bat that you don’t have any idea what you are talking about it here.
First of all, Medicare does not negotiate rates with DME providers. They set a fee schedule and the provider can take it or leave it. There is no “negotiating” about it. We don’t make enough money to afford legions of lobbyists to pay off politicians.
Second, DME is responsible for saving the Medicare system at least 3x what it costs because it allows people to manage chronic diseases in their home environment instead of being housed in costly healthcare facilities. Many of the quick discharges we have seen from hospitals and nursing homes over the past 30 years would not be possible without DME providers.
Thirdly, you clearly have no clue of the cost of providing DME to Medicare beneficiaries given the myriad and stringent requirements of the Medicare program that DME providers are legally obliged to provide.
Contrary to what the MSM likes to misinform you of, it’s not just dropping off a wheelchair or oxygen system at the patients home. There is a boatload of medical documentation that the provider is required to obtain (even if the doctor chooses not to get off his/her butt and provide it. If it isn’t provided there is no penalty to the prescriber — the DME provider just doesn’t get paid.
In addition, the DME provider must stand behind the product for 5 years, regardless of how the product is treated by the patient. Yes, they can literally run over the wheelchair with their car, drop it off a balcony smashing it to the ground, or literally take a sledge hammer to it and the DME provider must replace or repair at no or little reimbursed charge.
Oxygen? Patients get an all you can eat buffet of portable oxygen for $37 dollars a month. Never mind that just one of the four average deliveries per patient a month will cost the provider at least $50. Oxygen concentrators are paid for a total of 36 months, the the provider must provide an additional 24 months of service and repair for about $120 per year.
Now add the cost of mandatory accreditaton, mandatory surety bonds, and general liability insurance, and subtract the number of items that are denied because the physician refused to do the paperwork, and you will find that most DME providers are barely eeking out a living.
Lastly, Tricare does not pay at VA rates. Where you got that I have no idea. The VA buys equipment direct from the manufacturer and pays DME providers a small fee to do the set-up, instruction, and follow-up on the equipment. Tricare fees are more in line with Medicare, but without the additional legal requirements.
Moral of the story: don’t get on a public forum and act like an expert on a topic you don’t know anything about.
“…the six-month wait for the temporary high-risk pools for people with pre-existing conditions.”
I hadn’t heard about the 6 month wait. That is unconscionable. To make matter worse, some of those people will have already been waiting because they couldn’t get private insurance and couldn’t get into jammed up State high risk pools. They can go bankrupt or die in 6 months.
Care delayed is care denied.
That’s the point. If they die, it saves a lot of money.
I do some financial work for doctors and group practices.
Medicare plus a percentage? That’s already done for many of the managed care programs and a few of the out-of-network plans. It is just that the rates tend to be anywhere from even with Medicare to up to 40% higher for managed care and much higher for out-of-network.
As it is, established doctors who have been practicing for 20 or 30 years are able to have a mix with most of the money coming from out-of-network or straight commercial payors. New docs need the volume and the money and start out taking what they can get it. New docs depend on a very small amount of “cadillac” patients to bring home much of their take home (after expenses).
The other issue that is left unaddressed is medical school debt. In many countries, the government absorbs the cost of educating doctors. Perhaps in exchange for seeing a quota of Medicare and Medicaid patients, the US could pay off medical school debt which would put less pressure on docs to game the system for more cash.
seriously? nice cherry picking statistics.
how about this study?
http://www.nationmaster.com/graph/hea_obe-health-obesity
so by your theory that overweight is just as important as obesity you’d assume someone that smokes a cigarette a day is as likely to die from cancer as someone who smokes 3 packs a day? RIGHT! Someone that works building skyscrapers and working all day from 300 ft+ above the ground isn’t more likely to die from an accident than someone sitting behind a desk. RIGHT!
You add in the lack of access here that’s fixed with this bill and obesity and we’re at or above everyone else. The point is you seemingly won’t even consider obesity an issue here compared to the rest of the world.
whatever…
Both Chairman Harkin and Ranking Member Arlen Specter (R-PA) expressed
support for competitive bidding as a means to hold down costs to the
Medicare program and to provide savings to beneficiaries. The IG report
was used as a justification by Chairman Harkin to expand competitive
bidding beyond two demonstration sites authorized under the Balanced
Budget Act of 1997. Throughout the hearing, Senator Harkin also
referred to the oxygen reimbursement debate several years ago as further
reason competitive bidding for DME and medical supplies would save money
for Medicare and beneficiaries.
The IG report contains estimated savings to the Medicare program if
purchased at the rates obtainable by other payers such as the Veterans
Administration (VA), Medicaid, the Federal Employees Health Benefits
Program (FEHBP), or on the retail market. The report highlights 16
particular DME and supply items, no orthotic or prosthetic devices or
services. For instance, as Chairman Harkin described with a box of
blood glucose testing strips (Medicare Code A4253), Medicare pays a
median price of $38.42, whereas the VA pays $19.50-a 49% difference.
Also included on the list are two types of wheelchairs, the standard
(K0001) and the motorized/programmable wheelchair (K0011). The standard
wheelchair is 78% lower in price than Medicare reimbursement when
purchased by the VA and the motorized/programmable wheelchair is 47%
less.
http://lists.ufl.edu/cgi-bin/wa?A2=OANDP-L;Jk65uw;20020615120836-0400
Got to love #3. I created a website called fliptheirs.com a couple years ago, proposing the IRS be used to regulate ALL governmental spending, with the power to say NO before checks were written.
and when and IF those docs lost that “gravy train” that sustains their practice how many do you think would keep practicing?
Oh and you do realize that its that “out of network reimbursement” that drives costs higher right? Money’s gotta come from somewhere right?
Jon,
QUIck response,
I agree that without Single Payer or something akin to Public Option, MLR is an extremely CRITICAL issue. Gaming the MLR is to insurers as creating mortgage backed derivatives with no real estate in the deal are to banksters.
IRS is the wrong entity to enforce insurers. They have NO COMPETENCE in this space. There are forensic accountants and various Inspectors General with the skills.
I’ve never been in the military and have never been a DoD contractor, so I’ll concede your point that Tricare doesn’t pay the lower FSS (e.g.VA negotiated) price. I thought they did only because legally they can. To quote a 2002 GAO report:
The VA negotiates prices for and purchases medical equipment, supplies, and drugs through the Federal Supply Schedule. Federal Supply Schedule prices are available to any federal agency that directly procures pharmaceuticals or medical equipment and supplies, including VA medical centers, the Department of Defense, the Bureau of Prisons, the Public Health Service, and other designated entities such as the District of Columbia, U.S. territorial governments, the Indian Health Service, and some state veterans homes.
http://www.gao.gov/cgi-bin/getrpt?GAO-02-833T
As for Medicare, after Sen. Harkin and others beat up CMS for their poor negotiating skills (or nonexistent negotiating skills, if you prefer), they now have their DME competitive own bid process. The GAO has another report on the topic out earlier this month.
The GAO published “Medicare: CMS Working to Address Problems from Round 1 of the Durable Medical Equipment Competitive Bidding Program,” (GAO-10-27) on Dec. 7, 2009. This report examines the results of CBP round 1; the major challenges CMS had in conducting CBP round 1; and the steps CMS has taken to improve future CBP rounds. http://www.gao.gov/new.items/d1027.pdf
COBRA sucks ass. EXPENSIVE AS FUCK.
Screw your COBRA crap.
In these interesting suggestions I see a receding tail with many suggestions being only derivatives of those already in the bill. This is a list (mostly) for another round of reform a few years down the road.
I wish this kind of list had existed 6 months ago. Getting good ideas in the U.S. political system isn’t always easy. When people with creative minds don’t realize their ideas may be valuable they don’t speak…and that limits the range of possibilities.
For foul-mouthed-femblogging dirty f’in hippies these suggestions are coming a bit late.
A major reason for huge medical school debt is the AMA RACKET. Kill off the AMA with their quotas and control over med school and do as someone upthread mentioned: have the government cover much of the cost.
Medical doctors are a social benefit and necessity.
Without huge medical school debts more people could become doctors. Also, control the specialization process to prevent everyone from trying to be plastic surgeons or heart surgeons. We need MANY more general practitioners.
In any case, you either take your medical oath seriously (there is nothing in that oath about getting rich) and seek to HELP PEOPLE and CURE DISEASE AND INJURY and quit just trying to get rich…or don’t be a medical doctor. We don’t need nor want money-grubbing greedy bastard doctors anymore than we need or want greedy-assed bastard bankers or Wall Streeters.
Jon,
Good list, but are you letting Medicare Advantage off the hook?
I didn’t cherry pick anything you ass, I put the executive summary of the EU’s own evaluation up here (the section on adult obesity; the report is divided up). Since you seem to have a reading comprehension problem, you obviously missed that the EU paper is compiled from a number of national sources and studies, not just one. So if there was cherry-picking, it wasn’t by me.
Nor did I say anywhere that being overweight is as bad as being obese, so thanks again for lying about what I said. It would not be fair, however, to note that some of these countries have relatively low rates of obesity without noting their high rates of overweight individuals. The EU report specifically notes that health problems begin to appear far before obesity.
But regardless, I never made the claim you said I did. You have now officially been proven a liar.
Good job.
The EU study notes that some countries (Greece, Malta for women) have worse adult obesity than the United States. Your information is from an aggregate website and is FURTHER OUT OF DATE YOU HALFWIT.
The EU report is from 2005. You’re arguing with out of date information.
So not only are you a liar, you’re an illiterate who cuts corners and can’t be bothered to read to the end of a chart. Good job. Does Mommy still cut the crusts off your sandwiches?
Go play somewhere else, troll.
But just to finish you off, let’s pull the World Health Organization data on two countries with high obesity rates, Greece and the United States.
Total Expenditure on Health as percentage of GDP:
United States: 15.3
Greece: 9.9
Adult Mortality Rate (per 1000)
United States: 109.0
Greece: 76.0
Healthy Life Expectancy at Birth (both sexes):
United States: 69.0
Greece: 71.0
So Greece is comparably obese to us (or worse), yet they live longer, healthier lives and spend far less on healthcare.
Gee, maybe the problem is more than obesity.
beowulf posts:
I hate to break it to you, but 1997 was 12.5 years ago. Since then DME provider reimbursment from the Medicare program has been reduced 35% to 45% depending on the product you are referencing. That might be because DME providers can’t afford the 161 million dollars the health insurance companies spent buying off politicians over the past 2 years. You might want to at least try to reference more up to date information when pretending to be an expert on a topic in a public forum.
The VA program purchases their own equipment and pays DME providers to deliver it. The care is far from outstanding, as most people know who have paid any attention to the VA program problems that have come to media attention in the last few years. Is that what you want to duplicate for all of our seniors? I sure as hell hope not.
And just to clue you in, the paperwork from the medical record that Medicare requires to pay for a “K0001″ or a “K0011″ (sorry, but I laugh to see you use those codes when it’s so obvious that you have no idea what they mean) can fill a 6 foot table. Again, if the physician will not cooperate and provide it, guess who doesn’t get paid? The DME provider. Do you even have clue one what it costs a DME provider to track down and hound the physician for that required paperwork? Of course not. Well here are the facts: the average time to obtain the documentation is 6 months!! That means the provider has a 6 month gap in cash flow between providing the product and getting paid. I guess you have never been a business owner, because Mickey D’s sure as hell could not afford to front you 6 months of meals and be promised payment 6 months later.
But, your only comment of “whatever” pretty much says it all — you have no clue what you are talking about.
Just did it. Kerry, Kirk, Frank and Pelosi got both (older and more recent) lists from me. I particularly like #7 on the more recent list. (and of course #35 – Single Payer).
Thank you so much!
Your posts add so much substance to the discussion that it’s almost overwhelming.
Better than that, I’ll tweet and facebook them.
A week or so ago, I tweeted every senator I could find on Twitter (D or R), I was not particular.
Sure, COBRA is expensive, but it goes away in 18 months.
Sure P, some cant afford it. But some can. And it is cost free to the government and the taxpayer.
It is particularly important to those over 55–who got screwed by Lieberamn when he aced the Medicare expansion.
Those folks cant buy insurance on the public market because they take a pill or two a day, or worse, have had cancer or high blood pressure.
Dont write it off. The House should stand up for COBRA extension for the unemployed, which is in the House bill, Section 113. We need to help the unemployed keep their insurance until the exchanges start, without forcing them into expensive high-risk pools.
Section 113 of the House bill permits the unemployed, many of whom can’t get individual coverage because of pre-existing conditions, to buy into their old group insurance until the insurance exchanges start in 2013.
also, you should get some manners.
Just listening to the goings on this morning, Senator Reid said he is going to hear an “earful” when he goes home an “earful” of positive comments.
Know Jane and team will continue to give Reid an “earful”