RSS Feed MenuByron York in the Examiner today digs deeper into a point made yesterday by FF’s Gusher: President Obama’s healthcare scheme rests heavily upon Medicare cuts.
For conservatives battered by years of Democratic Medi-scare campaigns, it’s tempting to repay the Democrats with a taste of their own medicine.
York:
“It’s not going to be painless,” says Sen. Tom Coburn, the Oklahoma Republican who is also a family-practice physician. “You can’t say there’s not going to be an impact from taking a half-trillion dollars out of Medicare in the next ten years, when large numbers of doctors won’t take new Medicare patients and we’re going to have the retirement of the baby boomers.”
America’s seniors seem already to have intuited Tom Coburn’s warnings. For all the angry talk of socialism, what seems to irk many older voters is that the Obama plan implies less socialism for them.
The question for conservatives: If President Obama is willing to volunteer to put his hand into this beehive… why not let him? Don’t we also want a less expensive Medicare program? Indeed, without Medicare savings, the national tax burden must inevitably rise by at least four or five points of GDP as the baby boomers retire. History is full of ironies, and it may be that the success of the Medicare portion of Obama’s health plan is the essential precondition for the next Republican tax cut.
ottovbvs // Aug 11, 2009 at 8:37 am
…….Tom Coburn is an objective source? Personally I expect to see the advantage program go although I participate in it but it’s a minority program that was always a bit of health insurance industry boondoggle……..you’re having your medicare taken away by the democrats is a bit of laugh coming from people like Coburn who’ve been demonizing the program for years and calling for its abolition……just another scare tactic like death panels
Asteriodboy // Aug 11, 2009 at 10:06 am
I have another question for conservatives. If you are serious about deficit reduction, why not support medicare reforms that reallocate subsidies to insurers like the advantage program rather than undermine everything proposed? Given persistent out-of-hand inflation in medical costs, the growing proportion of discretionary non-defensive spending medicare accounts for, and the prospect of the medicare trust going into deficit around 2017, doesnt it make sense to at least put forward a few serious proposals to cut medicare spending and risk pissing off doctors and a few other vested interests rather than betting the farm on the failure of health reform?
liv&win // Aug 11, 2009 at 2:16 pm
Doctors get compensated in a three tier system, Medicaid which pays the lowest, MediCare which pays the next lowest and private coverage which pays the most. the only problem with the government options is their reimbursement levels are so low, doctors “prey” on private providers to make up their shortfall. This problem is largely the result of too few taxpayers for each medicaid or medicare beneficiary. The only fair response would have been to raise taxes 30 years ago when this deficit was intially identified. We are now in a place where at a place where there are no easy solutions to address the underlining cost of health care. And let’s be clear, this is the crux of all our healthcare problems.
ottovbvs // Aug 11, 2009 at 3:03 pm
liv&win // Aug 11, 2009 at 2:16 pm
“doctors “prey” on private providers to make up their shortfall. ”
……..I’m not sure who you mean by “private providers”…..do you mean insurers or other private providers of healthcare like hospital systems? …….And so depending on your definition, you’re saying there is widespread fraud by doctors against private insurers or other care providers like hospitals in order to “balance their books.” Is that correct?……Since roughly 25% of medical payments are made by Medicare (I’m not sure what the Medicaid number is but probably fairly similar) the fraud must be on a vast scale
liv&win // Aug 11, 2009 at 5:36 pm
When I use a term in quotes, I would expect you to know that it is my lose use of the term and therefore subjective, otto. I never used the term fraud, that would be illegal. However, simple math makes my point. If a doctor thinks $1 is the fair price for his service and medicare and medicaid pay $0.75, which the doctor has no choice but to accept, the doctor is going to try to get more from the private payers, who can’t dictate, but can only negotiate terms. He then will charge private payers $1.25 to average out his revenues. Cost shifting is a fact, it happens.
This just in from fact check and the ama
http://www.ama-assn.org/amednews/2009/02/23/bisa0223.htm
http://www.factcheck.org/2009/08/insurance-co-profits-good-but-not-breaking-records/
ottovbvs // Aug 11, 2009 at 5:54 pm
liv&win // Aug 11, 2009 at 5:36 pm
……So you mean insurers?…..ok that’s clear…..of course fraud is illegal …… you can sugar coat in quotes but it’s still fraud you’re suggesting…..I don’t disagree btw in fact I’m well aware it happens …. after all doctors are in business and they have to maintain their margins…….as for the suggestion ” the doctor is going to try to get more from the private payers, who can’t dictate, but can only negotiate terms” that insurers don’t “dictate terms” you have to be kidding me…….Anthem BCBS just almost cut off our local hospital because it wasn’t willing to accept the terms they “dictated”………..So in summary you believe the entire medical profession is engaged in fraud in order to maintain its margins……the fact that those margins might be too high in the first place never crosses your mind?
ottovbvs // Aug 11, 2009 at 6:02 pm
liv&win // Aug 11, 2009 at 5:36 pm
……no need to attach the links….I already know pure health insurance plays have a collective net of around 6.25% in 08 (not the 3% you insisted on the other day) and had a thin year in 08/09 because of a fall in enrollments consequent on the recession…..but then 6.25% of roughly $1.1 trillion in disbursements is still quite a lot of stuckey!! ……and that was after management paid themselves mega bonuses!!
liv&win // Aug 11, 2009 at 6:21 pm
otto, I am not suggesting fraud, fraud is illegal. I am talking about what happens in a free market when the government sets prices…doctors have no choice but to charge what they can where they can. As for Anthem…ALMOST is a very interesting term. Having witnesses just a few of these negotiations, ALMOST happens ALMOST all the time. First, Anthem wasn’t cutting them off, they were cutting themselves out. Anthem doesn’t provide care, they help finance the cost of care. Anthem has a duty to its policy holders to try to keep costs down. What if Anthem said to your hospital, sure, we’ll negotiate higher reimbursement. They would then be forced to turn around and raise rates on all the policyholders. Wow, great idea, not. In a free market, buyers and suppliers are free to set the price. If they can’t agree, there is no deal. You are talking out of both sides of your mouth.
“the fact that those margins might be too high in the first place never crosses your mind?” First, you are always focused on profits. Why? retorical question.
nwahs // Aug 11, 2009 at 7:42 pm
I think if Obamacare extended Medicare to cover dental expenses, there would be less fear among seniors (“I’m getting something in this deal”) and you would have a whole new ballgame.
ottovbvs // Aug 11, 2009 at 7:42 pm
liv&win // Aug 11, 2009 at 6:21 pm
‘otto, I am not suggesting fraud, fraud is illegal. I am talking about what happens in a free market when the government sets prices…doctors have no choice but to charge what they can where they can. ”
…….Actually you are, if you say they are falsely inflating private insurers claims to compensate for shortfalls elsewhere…..trust me you are(given schedules of charges this would actually be quite hard to do)
“ALMOST happens ALMOST all the time. First, Anthem wasn’t cutting them off, they were cutting themselves out.”
……..By refusing to accepted a dictated …..oops sorry “negotiated”……..schedule of payments…..sorry you’re the one talking out of both sides of your mouth…..firstly you say insurers don’t “dictate” they “negotiate” payments…..then you say they “have to dictate” because they’re running a business and if they didn’t dictate it would result in various bad outcome…..the fact is both medicare and insurers dictate prices
” First, you are always focused on profits. ”
………..not really it’s just often necessary to respond to your continued obfuscations in this area which probably fly over most people’s heads but I find just a little dishonest
JohnMcC // Aug 11, 2009 at 11:18 pm
Here’s how it works. Physician decides his price for an office procedure–say a complete physical. He figures based on market rates where he (excuse me—of course many are women!!) decides that $150 is adequate income for his business and fair for the patient. He sets the price at $180. Why? Because medicaid will pay him $80. Medicare will pay him $100. Private policies will pay variable amounts between $100 and $150. And the poor schmoe who pays cash gets the $180 charge.
For the Doc, it works out close to his goal of $150. For the taxpayer, it’s a bargain. For the private insurers it’s an issue in a negociation. For the uninsured, it’s getting screwed.
If the Doc had much simpler administrative costs (billing M-caid, M-care and all the private plans requires skilled administrative work and plenty of time waiting for the check), he could lower his fee. If he didn’t need to spent $25K/yr for malpractice insurance, he could lower his fee. If there were a common rate for different insurance plans, he could average out his savings and come up with a price of–say–$120.
Thus simply making things more uniform could result in a 20% lowering of costs without anyone being the poorer (except the skilled administrative worker who now has to look for another line of work.)
balconesfault // Aug 12, 2009 at 5:52 am
I’m thinking that the Republican attacks on the end-of-life planning provisions are an unfortunate sign that they are willing to toss every ideological principle overboard in their desire to kneecap Obama.
Fiscal conservatives have been pleading for years for some sort of cost-containment in Medicare over the phenomenally expensive pricetag we pay for treatment of the elderly on their deathbeds. End of life planning is a societally responsible pathway to helping place the decision for end of life care in the hands of the patient in consultation with their physicians, rather than potentially guilt-ridden kinfolk and profit-seeking hospital managers.
And in fact, the current provisos have been proposed by Republicans. So faced with Democratic healthcare legislation incorporating those provisions as a means to freeing up healthcare dollars to expand coverage through a public option, Republicans opposed to the public option could:
a) continue to oppose the public option, while stating their support for Democrats finally acknowledging that the public till cannot afford uncontrolled expansion of existing programs, and committing to work with Dems after Obamacare goes down on legislation that provides for end of life planning as a means of preventing Medicare costs from continuing to expand and suck tax money.
b) point out to people that this is a place where the free-market could properly regain lost ground in the healthcare debate, as it is a pathway to limiting government expenditures on high dollar end of life care and expanding a private insurance market for those who want greater coverage than the federal government can afford to provide for all.
b) run to the closest camera and start talking about “death boards”
One could argue that the impulse seen in liberalism to have the state provide for the individual is wholly consistent with their embrace of medicare expansions over conservative opposition in the past. There is nothing ideologically consistent with conservatives demonizing with over-the-top language a proposal that is seemingly a necessary pathway to keep Medicare costs from continuing to suck an ever increasing portion of the budget.
Cforchange // Aug 12, 2009 at 7:07 am
Incorporating medicare fears into the protests has made me wonder – really what does the GOP stand for? County First- flat out funny. Are the GOP seniors too not ready for retirement, can they not take care of themselves after a life long career. If so why can’t they concede that we as a nation need to change course and repair healthcare, faltering wages, failing infastructure.
But really I’m not surprised at the selfishness, these preaching whiteheads are the hatchers of the me generation. We are looking at the crowd that started the never ending preoccupation with – what am I worth today, let me keep score everyday.
ottovbvs // Aug 12, 2009 at 8:35 am
johnmcc // Aug 11, 2009 at 11:18 pm
…….In other words it’s a shell game……there’s actually a very good piece about it in today’s NYT because AHIP (liv&win will love this) have conducted a survey which they are trumpeting which shows that not they but the doctors/hospitals are the bad guys……..I actually think there’s much truth in this…..despite my efforts to hold liv&win’s feet to the fire on the role of the insurance companies the major cost inflation problem is at the delivery end because basically the providers (doctors, hospitals, the whole lot of them) are running businesses and it is the rational business manager’s task to maximize profit…..nothing wrong with this because it’s how the the competitive economic model functions…….I have two friends who are doctors one is a very succesful surgeon in the south and the other works in an emergency room outside DC…..both are Republicans…..both make no secret of the fact their aim is to maximize income……but over a Glenmorangie both admit the system is pretty f***** up but in any rejig they want to hold onto their piece of the pie.
barker13 // Aug 12, 2009 at 10:44 pm
Re: Johnmcc // Aug 11, 2009 at 11:18 pm (#11) –
“Here’s how it works. Physician decides his price for an office procedure–say a complete physical. He figures based on market rates where he (excuse me—of course many are women!!) decides that $150 is adequate income for his business and fair for the patient. He sets the price at $180. Why? Because medicaid will pay him $80. Medicare will pay him $100. Private policies will pay variable amounts between $100 and $150. And the poor schmoe who pays cash gets the $180 charge. For the Doc, it works out close to his goal of $150. For the taxpayer, it’s a bargain. For the private insurers it’s an issue in a negociation. For the uninsured, it’s getting screwed.”
Right you are, Johnny boy!
(*RESPECTFUL NOD*)
And, yes… agreed… “norming” of fee schedules is part of the optimum solution. The problem is… this “norming” would force medicare/medicaid to INCREASE, not decrease, reimbursement schedules since right now they’re basically gaming the system – as you noted.
BILL
mickster99 // Aug 13, 2009 at 8:55 pm
The continual rightwing advocacy of tax cuts for the wealthy to fix everything that ails this country is so wornout. The idea of a NewMajority based on just more tax cuts is to continue with a dead policy. Even Reagan figured that one out. 20 years ago. What I would like to see is what thr ultimate rightwing tax revenue pie would look like. I am thinking it would inlude complete elimination of corporate taxes (McCain), elimination of taxes on capital (gains, etc), leave the tax on labor, introduce a flat tax of say 15%, eliminate social welfare spending completely but raise defense-related expenses, pass a balanced budget amendment, etc. So I am thinking rightwing advocates saying spending 80% of federal revenues on defense and the rest on keeping the government running e.g. Supreme Court, FCC, FEMA, FDA, perhaps. Is this close?
Obama Tax Cuts // Sep 7, 2010 at 10:09 am
Are they really cuts if we still have to pay them?…
Is Obama for real? he must think we are stupid….