The corporate democrats are hitting the media circuits preparing everyone for the grand bargain that almost made it through during the debt ceiling crisis. Third Way Democrats want to be sure we know that corporate taxes will be cut and as such, entitlements will see big cuts to pay for it. Alice Rivlin is a Clinton Administration leftover as is Bowles of Simpson-Bowles and both are fiscal, Reagan Republicans. As such the plan they advocate mirrors that the Clinton Administration made during his term. He stated Welfare had to go and used that to pay down the deficit Reagan had left and pretended to make a compromise in making the rich pay by raising taxes on the rich. Well, as is true each time these pols do this, all the subsidies and loopholes that made the rich and corporations pay their fair share reappeared in just a few years and we know they ended up like bandits. The poor who depended on Welfare, everyone knew would not be able to find work or work that would support them fell into the deepest poverty ever experienced in the history of the US and remain there today. The poverty is third world and that is what expanded the push to black market drug dealing and criminal activity as the only means of support. Yet, that is praised as good policy by fiscal Republicans like Bowles and Rivlin.
Well, they are back to get the second part of the poverty programs of Johnson and Kennedy.....the entitlements. That is indeed the purpose of this fiscal cliff charade. Making it appear that limiting these programs must be done. When Rivlin appeared on several NPR/APM programs as the Democrat of the panel, I wrote in describing Rivlin as such, demanding that they have a fiscal progressive on these panels and the moderators did indeed bring my comment forward to which Rivlin scolded.....'I am a Democrat'! HOOEY!
Make no mistake, these cuts Third Way Democrats are going to pretend they have to make will effectively end these programs because people will not be able to access most health care if they are forced to co-pays that go up in Medicare's case and for Medicaid.....they plan to eliminate that. Even now in Maryland there was an article that says health costs were lower, meaning the state paid less but at the same time Medicaid clients are writing they can no longer get cancer treatment or afford Asthma medication. People are dying already in Maryland from lack of care. Now, Baltimore already has one of the greatest longevity GAPS between rich and poor.....20 years.....because they have never had much coverage, but what we are seeing now is a setup that is basically public health checkups that monitor whether the public has transferable (communicable) disease like Typhoid/Polio/HIV/Whopping Cough and many more people are falling into this category. This will fast become Medicare as well as these corporate pols are working for global businesses that are profit-makers. They are not working for the poor and elderly.
What we are seeing already as far as the next massive health care fraud is the primary care emphasis on diet as prevention of disease like diabetes and heart disease. So to continue receiving hundreds of thousands of dollars more than they should as they have these past decades, they are bringing these seniors and poor patients in every three months for office checkups where they review blood draws and analysis for diet related levels like Vitamin D, Cholesterol, or sugars. If someone questions all those visits and draws, the doctor and office becomes indignant as if the patients may lose access to this doctor. The costs to the poor are huge and the Medicaid funds lost to this fraud means that coverage for real threats won't be there.
IT IS CRITICAL THAT WE SHOUT OUT THAT WE WILL NOT TOLERATE OUR HEALTH CARE ACCESS BE CUT WHEN CORPORATIONS/DOCTORS OWE FRAUD AND DO NOT NEED BILLIONS IN PROFIT FOR PUBLIC SERVICES LIKE HEALTH CARE. ALL OF MARYLAND'S POLS WILL VOTE FOR CUTS!
VOTE YOUR INCUMBENT OUT OF OFFICE!!!!!!
For those who think their incumbent won't vote for this.......they have already said they would.......now, we can reverse this but you need to get rid of the farm team!
The Health Care Blog
By JOHN GOODMAN, PhD
Congressman Paul Ryan (R-WI) and Alice Rivlin, former director of the Congressional Budget Office (CBO), have proposed an entitlement spending reform plan that is striking both for its boldness and its left-right-coming-together origins. There are a number of interesting parts, but I want to focus on the three most important:
- Medicare would, for the first time, be transformed into rational insurance. Beginning in 2013, all enrollees would be protected by a $6,000 cap on out-of-pocket expenses; in return they would pay for more small expenses on their own.
- After a decade, people newly eligible for Medicare would receive a voucher to purchase private insurance instead. The value of the voucher would grow at the rate of growth of GDP plus 1% (note: for the past four decades, health care spending per capita nationwide has been growing at about GDP growth plus 2%).
- Medicaid would be turned into annual block grants to the states. The value of the block grants would also grow at GDP growth plus 1%.
How Does This Plan Compare with the Affordable Care Act (ACA)? Given that Ryan has been previously attacked by Paul Krugman and others on the left because of his ideas about voucherizing Medicare, a natural question arises. How does the Ryan/Rivlin slowdown in Medicare spending compare to the health reform bill Congress passed last spring — a bill supported by some of the very people attacking Ryan?
Answer: Ryan/Rivlin reduces government spending on Medicare by less than the ACA does! As previously reported, the health reform act begins slowing the rate of growth of Medicare payments to doctors and hospitals almost immediately. By the end of this decade, Medicare rates will fall below Medicaid rates for everyone enrolled in Medicare! As the Medicare actuaries office has affirmed this will affect access to care for all seniors, not just new enrollees in future years.
Under Ryan/Rivlin, by contrast, everyone 55 years of age and older is grandfathered, so to speak. Lower spending only kicks in for people under the age of 55.
[Note: The CBO score of Ryan/Rivlin assumes that the proposal will be tacked onto the ACA, which is current law.]
How Does This Plan Compare to Other Entitlement Reform Proposals? Clearly, Washington is in the mood to talk about entitlement reform. We previously analyzed the Bowles/Simpson deficit commission report [see PowerPoint and full report], which was followed by a Domenici/Rivlin report. All these plans try to limit federal spending to the growth rate of GDP plus 1% — the ACA, by reducing fees for providers; Domenici/Rivlin, by having enrollees pay larger premiums; and all three private sector proposals, by a premium support approach, under which the federal government makes available a fixed number of dollars (or vouchers), beneficiaries add to that amount from their own resources and health plans compete against each other. The ACA, by contrast, limits spending to the growth rate of GDP and has no premium support!
Will any of this actually work?
Are the Cuts in Medicare Spending Realistic? Everyone agrees we are on an unsustainable path. But if we don’t get off the path, efforts to limit government spending will only unload costs onto the private sector. That is, costs won’t be controlled; they will only be shifted.
The ACA makes incentives more perverse for patients (by making more care free of deductibles and copayments), leaves provider incentives (to maximize against reimbursement formulas) largely in place, creates hurdles for private sector efforts to control costs (e.g., by blocking attempts to reduce benefits or increase cost sharing) and puts all its cost-control faith in the federal government’s ability to conduct pilot programs, do comparative effectiveness research and other unlikely initiatives.
Domenici/Rivlin shifts premium costs to the beneficiaries but gives no new tools to patients or providers to control spending.
Both Bowles/Simpson and Ryan/Rivlin reform Medicare by capping catastrophic expenses and increasing patient exposure for small medical bills. (There is an across-the-board deductible of $600 in Ryan/Rivlin.) This by itself will dampen spending, as patients are forced to compare the cost of small dollar care with the value they place on other uses of money. It would probably also obviate the need for Medigap insurance, which, after all, only exists because gaping holes in Medicare expose beneficiaries to catastrophic costs.
Still, we could do much better.
Making the Proposal Better. We have previously proposed a way of building on these ideas and going further to liberate 310 million patients, 800,000 doctors and countless other provider personnel to solve the problems before us with three fundamental Medicare reforms:
- Using a special type of health savings account, beneficiaries would be able to manage at least one-fifth of their health care dollars, thus keeping each dollar of wasteful spending they avoid and bearing the full cost of each dollar of waste they generate.
- Physicians would be free to repackage and reprice their services — thus profiting from innovations that lower costs and raise the quality of care.
- Workers (along with their employers) would save and invest 4 percent of payroll — eventually reaching the point where each generation of retirees pays for the bulk of its own post-retirement medical care.
These reforms would dramatically change incentives. Whether in their role as patient, provider or worker/saver, people would reap the benefits of socially beneficial behavior and incur the costs of socially undesirable behavior. Specifically, Medicare patients would have a direct financial interest in seeking out low-cost, high-quality care. Providers would have a direct financial interest in producing efficient, high-quality care. And worker/savers would have a financial interest in a long-term financing system that promotes efficient, high-quality care for generations to come.
With assistance from NCPA Senior Fellow Andrew J. Rettenmaier, we have been able to simulate the long-term impact of some of these reforms. The bottom line: Under reasonable assumptions, we can reach the mid-21st century with seniors paying no more (as a share of the cost of the program) than the premiums they pay today and with a taxpayer burden (relative to national income) no greater than the burden today.
What about Low-Income Beneficiaries? Ryan/Rivlin have a nice idea here. For Medicare beneficiaries whose low income also qualifies them for Medicaid (the dual eligibles), forget Medicaid and deposit $6,600 for each of them in a health savings account. This gives them the financial resources to pay the $6,000 in out-of-pocket expenses they are potentially exposed to plus $600 to boot.
This post first appeared on John Goodman’s Health Policy Blog.
John C. Goodman, PhD, is president and CEO of the National Center for Policy Analysis. He is also the Kellye Wright Fellow in health care. The mission of the Wright Fellowship is to promote a more patient-centered, consumer-driven health care system. Dr. Goodman’s Health Policy Blog is considered among the top conservative health care blogs on the internet where pro-free enterprise, private sector solutions to health care problems are discussed by top health policy experts from all sides of the political spectrum.
This basically ends health coverage for most people. Remember, these costs will go up as the world becomes the patient for which these health systems work. JUST ONE INCIDENT WILL WIPE OUT THE CAP. It will work just like gas as far as supply and demand.....not on what is good for society. America is the only first world country doing this
IT IS EVIL.........GET THESE CORPORATE POLITICIANS OUT OF OFFICE!!!! COSTS ARE LOW BECAUSE MANY PEOPLE DIE 20 YEARS EARLY DUE TO LACK OF ACCESS..... IT'S CALLED THE THIRD WORLD MODEL....AND THEY THINK THIS IS A GOOD NATIONAL MODEL!!!!
MARYLAND'S ACCESS, HEALTH WAGE, AND QUALITY OF CARE ALL RANK LOW BECAUSE OF THE EMPHASIS ON PROFIT-MARGIN FOR THE INSTITUTIONS OVER THE QUALITY OF CARE AND QUALITY OF LIFE FOR ITS EMPLOYEES.
Health care costs How Maryland keeps its costs down Mar 3rd 2010, 16:52 by M.S.
MAGGIE MAHAR reports on how Maryland has bent down the curve on healthcare inflation.
In 1977, Maryland decided that, rather than leaving prices to the vagaries of a marketplace where insurers and hospitals negotiate behind closed doors, it would delegate the task of setting reimbursement rates for acute-care hospitals to an independent agency, the Maryland Health Services Cost Review Commission. When setting rates, the Commission takes into account differences in labor markets and how much a hospital pays in wages; the amount of charity care the hospital does; and whether it treats a large number of severely ill patients. For example, the Commission sets the price of an overnight stay at St. Joseph Medical Center in suburban Towson at $984, while letting Johns Hopkins, in Baltimore Maryland, charge $1,555...Since the program started, the Wall Street Journal reports that Maryland hospitals have enjoyed a steady profit margin, unlike hospitals in other states that often make more money during boom years and less during a recession...
What is most remarkable is how state regulation of prices has contained costs. When the program began in 1977, the state's hospital costs were 25% higher than the national average. Today, Maryland's hospital costs are 2% lower than the national average. MARYLAND'S HEALTH WORKERS ARE THE POOREST PAID AS WELL. THE BLIGHTED NEIGHBORHOODS AROUND JOHNS HOPKINS WERE FILLED WITH HOPKINS' POVERTY LEVEL WORKERS
In contrast, Ms Mahar writes, Massachussetts has some of the highest hospital costs in the nation. That's because brand-name hospitals like Mass General and Boston Women's and Children's know that insurers can't afford to leave them out of the provider network. They can thus negotiate reimbursement rates two or three times as high as their generic competition, even though their health outcomes are often no better.
Ms Mahar's article gibes with Ian Crosby's argument that insurance-company consolidation can make health care cheaper (since it allows insurers greater price-setting power), whereas producer consolidation makes it more expensive. Maryland's Cost Review Commission essentially removes the power of large, consolidated providers like Johns Hopkins to charge higher prices at will. Interestingly, this is essentially the same kind of system used in private-sector universal health-insurance systems in Europe to control costs. In the Netherlands, Germany, Switzerland and France, government price boards are crucial in keeping medical inflation down, and are part of the reason European countries have costs half to two-thirds as high as America's, with outcomes that are just as good. THE DIFFERENCE IS THAT ALL PEOPLE IN EUROPE HAVE EQUAL ACCESS AND IN BALTIMORE THE POOR DIE 20 YEARS EARLIER BECAUSE THEY CANNOT ACCESS CARE. THE PRICE CONTROL IS TO ASSURE PROFITS, NOT COVERAGE!
The usual argument against cost controls is that they prevent the market from rewarding investment in services that have high demand. The argument fails to account for how different health care is from normal markets (a difference recognised by, among others, Friedrich Hayek). Costs are inevitably paid by third-party buyers (insurers or government) to ensure the moral guarantee that everyone have access to care. And doctors exercise such power over complex care decisions that neither patients nor insurers can usually decide whether drugs or procedures are worth the price. Ultimately, when trying to figure out how to hold health-care costs down, theory and ideology only get you so far; you have to look at what works. Clearly, whatever Maryland is doing, it works.
Maryland Bills adding major costs to State Employees health care by Dan Seiler on March 20th, 2011 This is a call for action: All State employees both active and retired need to contact their Delegates and Senators now. Communicate your concerns about provisions contained in HB72, SB87 and SB628. The following link is a good way to do that, http://mlis.state.md.us/mgaweb/mail32.aspx
Below you will find a copy of the letter that was sent to the Western Maryland Delegation Members. If you would like to use any of the talking points, please do so. You may copy and paste all or any part of the below letter onto your email that you are sending to your local State Senators and Delegates. If you would like your personal letter posted on this site, please send it to Dan Seiler at firstname.lastname@example.org
Here is a letter from a public employee.....A STATE TROOPER.... about state pension benefits. Keep in mind that O'Malley and Rawlings-Blake have for decades defunded these pensions with the knowledge that they would be renegotiated. As the letter writer says access to health care will be extremely affected......THAT'S FOR WHAT THESE THIRD WAY POLS ARE GOING ......FEWER PEOPLE GETTING ACCESS!
To: Maryland Legislature
From: Dan Seiler
I am a retired State Trooper who retired with the expectation and hope that the State of Maryland would abide by legal or at least moral obligations to continue providing the same or better health care coverage.
During the time I served the State of Maryland, I would have never believed that the Maryland Legislature would ever propose bills that would reduce my standard of living! My primary attraction to state service was a promise of life long health care. This is why I am opposed to several sections in HB 72, SB87 and SB628 involving proposed cuts to retired and active State employee health care.
For many years the State of Maryland has made implied guarantees to provide State employees with health care that does not cause financial hardship. The sponsors of these proposed legislative acts go against this promise. The people most affected by these proposed bills would be the retired State employees.
For example a proposed provision in HB 72 and SB 87 allows the State to establish separate health insurance benefit coverage for retirees that differs from those for active state employees. Proposed prescription drug coverage provisions in SB 628 show a drastically inequitable difference in coverage between active and retired State employees. This disparity would cause significant adverse financial impact on the retired State employees who are on fixed incomes and who do not receive full social security benefits.
As depicted in SB 628 any change in the current (COLA) Cost of Living Adjustment structure would aggravate even more the financial life altering burden on active and retired State workers making it difficult to keep pace with rising inflation.
I call on you as an elected member of the Maryland Legislature to find another way to balance the State Budget.
Sgt. Dan Seiler – Retired
401 Thames Street
Hagerstown, Md. 21740
AS YOU SEE BELOW, THE PHYSICIANS FOR A NATIONAL HEALTH PROGRAM AS PUSHING FOR JUST THE PROGRAM WE NEED. IN MARYLAND, OUR HEALTH CARE FOR ALL PUSHES THE PRIVATE HEALTH SYSTEM OF JOHNS HOPKINS WITH HEALTH CARE FOR THE VERY FEW AS INDICATED ABOVE. WE HAVE NO ADVOCATES IN MARYLAND FOR UNIVERSAL HEALTH CARE BECAUSE THE EMPHASIS IS FIRST PROFIT THEN PATIENT AND IT IS DRIVEN BY JOHNS HOPKINS.
YOU WILL NOTE THAT EVEN WHEN THE BEST ADVOCATE FOR THE PEOPLE SPEAKS, A DOCTOR WILL NOT MENTION RETRIEVING TRILLIONS IN HEALTH FRAUD AS A STARTING POINT.
VOTE YOUR INCUMBENT OUT OF OFFICE!!!
Physicians for a National Health Program, and founding member of Mad As Hell Doctors.
The Eighth Factor Driving Up Health Care Costs
By Samuel Metz, MD
The Bipartisan Policy Center, quoted in the Oct. 24 PBS NewsHour program, “Seven Factors Driving Up Your Health Care Costs,” missed the most expensive factor making the US the world’s costliest health care system, yet with the worst record in public health in the industrialized world.
Financing our health care system with American private insurance is an ongoing disaster. It leaves millions of us with limited or no access to health care. It consumes $350 billion in administration that might otherwise provide real health care. This factor dwarfs the effects of everything mentioned in the report.
Five of the factors described in this report (fee-for-service payment, increasingly older populations, demand for better treatment, limited information about best practices, and hospitals dominating a market) are also challenges in other industrialized countries. Yet these countries provide better care to more people for less money than we do.
A sixth factor in this study identifies a “strength”–the cost of patients seeking care is low. That's because no other industrialized country uses high deductibles, high co-pays, excluded conditions, and lack of coverage for medications to discourage patients from seeking care. Apparently these more advanced countries believe that patients should not decide if they (or their family) need health care before seeing a physician, but that a physician should decide if a patient needs care after she sees the patient. Cost-sharing, or “skin in the game,” increases health care costs and worsens patient outcomes.
Yes, because barriers to seeking care are so low, patients in other industrialized countries see their physicians two to four times as frequently as we Americans do, and spend more time in the hospital. Yet these patients ultimately spend half what we spend, and they are healthier for it. Clearly, encouraging patients to seek care immediately brings costs down, not up, and improves public health.
What about the seventh factor, the ever-present spectre of lawsuits? Americans do pay far more to cover malpractice premiums and fund defensive medicine than our more civilized neighbors. But the $55 billion spent on premiums and unneeded treatment because of defensive practices is 2% of our $2.6 billion health care spending. We do need tort reform, but don’t expect tort reform to bring health care to more people or perceptibly reduce patient costs.
In contrast to this study, peer-reviewed comparisons of the US health care system to other industrialized countries identify one critical factor making ours the world’s worst: our insurance system that denies access to the sick, makes the healthy pay premium prices, and diverts premium dollars away from patient care and into administration.
American health care is not the industrialized world’s worst because our population is sicker, older, or abuses tobacco, alcohol, or food. Japan has an older population and their care is less. Americans have the lowest rate of smoking in the industrialized world (except for Sweden), and our high obesity rate is rapidly being approached by every other country. And what about the costs of these poor habits? The $350 billion lost to financing by American private insurance is more than what we spend on tobacco and obesity-related diseases combined.
American health care is not the industrialized world’s worst because our nurses, doctors, and hospitals are the worst in the world. On the contrary, wealthy people come to the US for some of the most advanced care in the world. The problem is that our citizens can’t access that care because they don’t have the money that wealthy foreigners do.
And that’s our more important problem in health care. Unlike the rest of the civilized world, we are alone in rationing care by the amount of money you have. Yes, we have the best care that money can buy, but if you have no money, you get no care. It’s that simple.
That points to the simple solution neglected by the Bipartisan Policy Center. A publicly funded, nationwide, universal health care system with no financial impediments to patients seeking care would provide comprehensive health care to every American for less money than we spend on health care now.
Eventually, each of the factors listed by the Bipartisan Policy Center deserves attention; correcting them as best we can will improve efficiency. But if we want guaranteed lifetime access to care for our families, reduced costs to us, and better results, we must focus on the big enchilada, not the small potatoes: eliminate the American private insurance industry and create publicly funded universal care.
To help make this a reality, please visit Health Care for All-Oregon. We are an alliance of over 60 organizations who want this vision of better health care to start right here in our state. Find out how you can become an advocate for your family’s health care needs, how you can play a vital role in changing our health care system for the better, and help us turn Oregon into a shining example of cost-effective comprehensive health care for everyone. Join us!
Samuel Metz is a private practice anesthesiologist, HCAO representative from the Portland chapter of Physicians for a National Health Program, and founding member of Mad As Hell Doctors.