Healthcare Reform Thread II

[HalfLotus]

My boy Kucinich flipped.

He's taking a longer view that a Democractic political victory here will be better for the country in the long run as they try to push a liberal agenda.

[The Emperor Fabulous]

Can you explain this poll result, Guy?

Health Reform and Primary Care Physicians
• 46.3% of primary care physicians (family medicine and internal medicine) feel that the passing of health reform will either force them out of medicine or make them want to leave medicine.

http://www.nejmjobs.org/rpt/physician-survey-health-reform-impact.aspx

I SURE CAN!

Media Matters for America contacted the New England Journal of Medicine, which confirmed it neither conducted nor published the "survey."

...

The "report" that right-wing media are citing actually appeared in Recruiting Physicians Today, which is an employment newsletter produced by "the publishers of the New England Journal of Medicine." According to Zeis, that report actually "was written by the Medicus Firm," the medical recruitment firm that conducted the "survey."

http://mediamatters.org/blog/201003170036

[The Emperor Fabulous]

http://www.nejmjobs.org/rpt/health-reform-may-reduce-physician-workforce.aspx

Recruiting Physicians Today is a free advertiser newsletter published by the Worldwide Advertising Sales and Marketing Department in the publishing division of the Massachusetts Medical Society. Each issue of the newsletter features research and content produced by physician recruiting firms and other independent groups involved in physician employment.
On December 17, 2009 The Medicus Firm, a national physician search firm based in Dallas and Atlanta, published the results of a survey they conducted with 1,000 physicians regarding their attitudes toward health reform. To read their survey results at The Medicus Firm website, click here.
The opinions expressed in the article linked to above represent those of The Medicus Firm only. That article does not represent the opinions of the New England Journal of Medicine or the Massachusetts Medical Society.

[Drake Tungsten]

As for the "appearance" of deficit reduction, in the second decade the growth in revenues is significantly faster than the growth in expenditures, due to the excise tax.

And due to a reduction in Medicare reimbursements to doctors that is never actually going to happen. How long are you going to keep dishonestly shilling for this POS, Ramo?

[Drake Tungsten]

Even Obama doesn't believe the Dems will be able to sell the public on the benefits of healthcare reform in 2010 or 2012...

As health care lobbying heats up, some members are getting calls from President Barack Obama, like the three Rep. Jason Altmire (D-Pa.) got in the past two weeks.

“He believes that the economy will turn around, that people will be in a better position to judge the effects of this bill later on, that while it may not be a politically popular vote today, a year or two or three from now, it will be viewed as something the American people want,” said Altmire, who voted no last time on health reform but is undecided now.

http://www.politico.com/news/stories/0310/34540.html#ixzz0iTGjSJG9

[DanS]

What's happening to this bill? Intrade went from 70% pass to 35% pass in a single day!

http://data.intrade.com/graphing/jsp/closingPricesForm.jsp?tradeURL=https://www.intrade.com&contractId=709242

[Ramo]

As for the "appearance" of deficit reduction, in the second decade the growth in revenues is significantly faster than the growth in expenditures, due to the excise tax.

And the Medicare doc fix that is never actually going to pass. How long are you going to keep dishonestly shilling for this POS, Ramo?

By the Medicare doc fix, I assume you actually mean the Sustainable Growth Rate formula that the doc fix gets around. The story is nice except that:
1.) The SGR specifically was a poorly designed mechanism that was never intended to create the huge cuts it calls for.
2.) The vast majority of Medicare cuts that Congress imposed over the past couple decades, it followed through with.

The CPBB has a nice bit on this:

Most Previous Medicare Cost-Saving Provisions Have Taken Effect

Significant savings in Medicare have been a major component of every major deficit-reduction package enacted since 1990. [14] (See Box 2 below for details.) In the vast majority of cases, these savings were implemented with little or no modification, despite political pressures to keep them from going into effect.

For example, nearly all of the substantial Medicare savings in the 1990 and 1993 budget reconciliation bills went into effect. Along with a vibrant economy, they played a significant role in producing budget surpluses in 1998 through 2001. Also, virtually all of the savings enacted in the 2005 Deficit Reduction Act took effect.

Congress and the President did moderate some of the Medicare cuts enacted as part of the 1997 Balanced Budget Act (BBA), but even there, the vast majority of the intended cuts were allowed to take effect. For example, CBO estimated that the law’s Medicare provisions (other than the SGR cuts, which accounted for a small fraction of the total savings) would reduce Medicare spending by $56.7 billion in 2007, the last year the CBO estimate covered. According to CBO estimates, Medicare changes enacted in the subsequent nine years (other than changes in the SGR and the addition of the new Medicare prescription drug benefit in 2003) increased program spending in 2007 by a total of $11.3 billion. [15] By this reckoning, even if all of this increase represented backsliding on the savings enacted in 1997, [16] $45.4 billion — four fifths — of the Medicare savings promised for 2007 in the 1997 legislation survived. This finding belies the contention that Congress and the President are not willing to let promised cuts in Medicare take effect.

Furthermore, the decision to relax a modest portion of the savings enacted in 1997 must be considered in light of what was happening with Medicare and the budget as a whole. In the ten years before 1997, Medicare spending grew at an average rate of about 10 percent per year. [17] But, after 1997, spending slowed dramatically — much more than was anticipated as a result of enactment of the BBA.[18] In 1998, Medicare spending grew by only 1.5 percent, and in 1999 — for the first time in the program’s history — Medicare spending was lower than in the previous year. In 1999, Medicare spending was $24 billion (or 10 percent) lower than CBO’s September 1997 projection for that year, which took into account the savings enacted a month earlier in the BBA.

In addition, after 28 years of deficits, the federal budget was in surplus in 1998, 1999, 2000, and 2001. In 2001, both CBO and the Office of Management and Budget projected that if policies remained unchanged, the federal government would amass $5.6 trillion in surpluses over the next ten years. Then-Federal Reserve Board Chairman Alan Greenspan warned Congress that the projected surpluses were too large to be healthy for the economy because the United States would pay off the entire national debt and start using remaining surpluses to buy parts of private companies. Lawmakers’ focus turned from deficit reduction to proposals that would reduce revenues and increase spending. Congress and the President enacted large tax cuts in 2001 and 2003 and a new Medicare prescription drug benefit in 2003, none of which they paid for.

Given these developments, it is not surprising that lawmakers were receptive to requests from certain Medicare providers to modify some of the changes they had enacted to slow Medicare growth in order to reduce deficits. In 1999 and 2000, Congress provided relief from planned cuts in payments to various providers and increased payments to private capitated plans (plans that are paid a set annual amount per beneficiary) serving Medicare beneficiaries under the part of Medicare now called Medicare Advantage.[19] Further changes in payments to some providers and to Medicare Advantage plans were part of the 2003 law that established the prescription drug benefit. Yet despite these changes, nearly four-fifths of the Medicare savings enacted in 1997 outside of the SGR mechanism (which, as noted, was intended to produce only very small savings) survived.

Moreover, it is highly unlikely that the budgetary situation that made Congress more receptive to these changes will be repeated. There seems to be virtually no chance that sustained budget surpluses will reappear anytime in the foreseeable future or that the growth of Medicare spending will slow to near zero, let alone decline.

Finally, some observers have suggested that the Medicare cuts in the pending health reform bills are much larger than the cuts enacted in previous years. Relative to the size of the Medicare program, however, the proposed cuts are not unusually large.

CBO estimates that the net Medicare savings in the bills total around $450 billion over ten years, or about 6 percent of the total Medicare spending (excluding premium income) CBO projects over that period. That is only slightly more than the Medicare savings in the 1990 and 1993 deficit- reduction bills (which equaled about 5 percent of projected spending over five years) and is less than the savings in the BBA of 1997 (which equaled 9 to 12 percent of projected spending over ten years, depending on whether savings from higher Medicare premiums are taken into account). There is no reason to think that the size of the cuts in the health reform bills makes them less likely to be sustained than the previous cuts were. (Even after one adjusts for savings that Congress did not allow to take effect, the savings in the BBA were larger than those in the current health reform bills.)

http://www.cbpp.org/cms/index.cfm?fa=view&id=3021#sgr

To stop the excise tax, you need a majority in the House, support of the President, and 60 votes in the Senate. Not likely to happen.

BTW, the dishonesty assertion is cute when you posted a claim that any person who put in the least bit of effort would know is wrong.

[Drake Tungsten]

What's cute is that you put all that effort into a post that in no way counters the widespread (near-universal?) belief that Congress is not going to cut Medicare reimbursement rates for doctors and that this healthcare reform will not reduce the deficit if this reimbursement rate cut does not take place. There's a reason no one besides shills like yourself and Ezra Klein still talk about the cost reduction benefits of the proposed healthcare reform bill. The reimbursement rate cut is not going to happen; it's just a convenient fiction that gives a budget-busting healthcare reform the thinnest veneer of fiscal responsibility.

[Ramo]

The reimbursement rate isn't going to be cut, regardless of whether reform passes. The SGR is a provision that was never realistic in the first place. Insisting that the baseline budget is one where the cuts happen is disingenuous.

[Drake Tungsten]

The reimbursement rate isn't going to be cut, regardless of whether reform passes.

Of course; everyone already knows this. The CBO is obliged to pretend that the cuts will take place since Congress claims they will, however, which is why the CBO's scoring of the healthcare reform bill as a deficit reducer is highly misleading. It's just another accounting trick, like using ten years of revenues to pay for six years of benefits.

[DinoDoc]

I SURE CAN!

Not really.

[Ramo]

Everyone know this. The CBO is obliged to pretend that the cuts will take place since Congress claims they will, however, which is why the CBO's scoring of the healthcare reform bill as a deficit reducer is misleading.

The SGR will not be imposed. Period. This is completely independent of reform.

[DinoDoc]

My boy Kucinich flipped.

It's kinda sad he sold out for a ride on Air Force One.

[Drake Tungsten]

The SGR will not be imposed. Period. This is completely independent of reform.

Your bull**** obfuscation isn't going to work with me. The money needed to avoid cutting Medicare reimbursement rates (the "doc fix") was included in earlier drafts of the healthcare reform legislation, but was removed when the Dems realized there was no way they were going to get a CBO score showing that healthcare reform was deficit neutral with it included. This exclusion might have been acceptable if the Dems had also excluded savings from Medicare that they were using to justify shifting money to this new healthcare regime, but they didn't do that. They retained all the savings from Medicare that they needed to make this healthcare reform look fiscally responsible, while hiding the increased Medicare expenditures thanks to the doc fix that would make this healthcare reform look like the budget-buster it is.

The Dems linked the doc fix and this healthcare reform together initially, then decided to hide the doc fix expenditures when it became clear that healthcare reform was nowhere near deficit neutral. It's yet another accounting gimmick that only people like you think are an honest way to evaluate the fiscal impact of new policy.

[Ramo]

Yawn. The SGR is a fiction. Eliminating that fiction on the books has no bearing on reform, or the costs associated with it.