Healthcare Reform Thread II

[Ogie Oglethorpe]

I refuse to believe that you're actually this obtuse. The only other option is that you're being disingenuous.

We have a winner.

[Kuciwalker]

Cutting payments to doctors is precisely what we're not talking about. That's just playing chicken with the docs to see at what point they start refusing to treat medicare patients. I'm talking about HARD decisions. Like "we aren't going to fund this modern treatment because there are only marginal improvements" type of hard. Medicare PRECISELY DOESN'T do this.

I remember a few years ago when you assured me it was our moral obligation to pay for any treatment to keep someone alive, no matter the expense

[KrazyHorse]

I remember a few years ago when you assured me it was our moral obligation to pay for any treatment to keep someone alive, no matter the expense

I remember a few years ago when I liked other people.

[Kuciwalker]

You were pretty misanthropic back then too.

[KrazyHorse]

I'm not a misanthrope. I just play one on the internet.

[Kuciwalker]

I'm not a misanthrope.

Why the hell not?

[KrazyHorse]

Because of my deep and abiding love and trust in the fundamental goodness of mankind.

Unfortunately I'm surrounded by all the bad apples.

[Dr Strangelove]

Cutting payments to doctors is precisely what we're not talking about. That's just playing chicken with the docs to see at what point they start refusing to treat medicare patients. I'm talking about HARD decisions. Like "we aren't going to fund this modern treatment because there are only marginal improvements" type of hard. Medicare PRECISELY DOESN'T do this.

No, they have cut payments to doctors and lots of doctors have refused to take medicare. That time has been here for long time. Medicare reimbursement tends to be 1/3 to 1/2 of the general going rate.
One problem with trying to control costs is that lots of people are playing fast and loose with the data. I remember several years ago Medicare decided to try to limit payments to hospitals based on data that showed that hospitals had been the single largest source of cost and the larges source of cost increases in the preceding year. Miraculously the next year it turned out that physician's offices were the largest cost item in Medicare's budget. How could this possibly be? Simple. During that year, all across the country hospitals restructured so that they could reclassify a substantial portion of their services as private physician's offices. Also during that year someone, for some mysterious reason, decided that free standing radiology services would be counted as physician's clinics. This may be the single largest reason why medical costs can't be controlled. Information gathering isn't being governed in a logical, consistent fashion and therefore decision making about cost containment isn't logical and consistent.

I remember about 12 years ago we visited my wife's relatives in Pittsburg. I counted a dozen free standing MRI centers south of the river alone. Those machines cost millions of dollars apiece. One way to control costs would be to reduce the number of extremely expensive diagnostic centers around the country.

[Drake Tungsten]

I'm not a misanthrope. I just play one on the internet.

You were surprisingly personable IRL.

[KrazyHorse]

Should have tried to hook up with the two asian chicks.



just kidding

[Drake Tungsten]

Should have tried to hook up with the two asian chicks.

I agree.

[KrazyHorse]

My wife would have stabbed me, the two chicks, and you for introducing us.

[Drake Tungsten]

I have an excuse; I was extremely drunk. I can't be expected to protect other people's marriages when I'm in that state, so surely she'd only maim me?

[KrazyHorse]

She's an unforgiving woman.

[DinoDoc]

Ramo?

Looking ahead to the decade beyond 2019, CBO tries to evaluate the rate at which the budgetary impact of each of those broad categories would be likely to change over time. The net cost of the coverage provisions would be growing at a rate of more than 8 percent per year in nominal terms between 2017 and 2019; we would anticipate a similar trend in the subsequent decade. The reductions in direct spending would also be larger in the second decade than in the first, and they would represent an increasing share of spending on Medicare over that period; however, they would be much smaller at the end of the10-year budget window than the cost of the coverage provisions, so they would not be likely to keep pace in dollar terms with the rising cost of the coverage expansion. Revenue from the surcharge on high-income individuals would be growing at about 5 percent per year in nominal terms between 2017 and 2019; that component would continue to grow at a slower rate than the cost of the coverage expansion in the following decade. In sum, relative to current law, the proposal would probably generate substantial increases in federal budget deficits during the decade beyond the current 10-year budget window.

http://www.cbo.gov/ftpdocs/104xx/doc10400/07-26-InfoOnTriCommProposal.pdf