Althouse: "We know that cuts in Medicare are being used to fund national health care reform."

September 28, 2010

"We know that cuts in Medicare are being used to fund national health care reform."

"We became concerned by the long-term viability of Medicare Advantage programs in general... And we also had concerns about our ability to build a network of health care providers that would meet the needs of our seniors."

88 comments:

TWM said...: College plans being dropped, plans for children being dropped, and now this . . . the list keeps getting longer and longer.

Yep, that Obamacare is one sweet deal alright . . .; 9/28/10, 2:57 PM
chickelit said...: There goes the senior vote...; 9/28/10, 3:01 PM
Methadras said...: I wonder how President Erkle, didn't use his powers of omniscience to see the unintended consequences of his bankrupt ideology as a function of this legislation that mockingly bears his name.; 9/28/10, 3:08 PM
TWM said...: "I wonder how President Erkle, didn't use his powers of omniscience to see the unintended consequences of his bankrupt ideology as a function of this legislation that mockingly bears his name."

Unintended? I'm thinking the destruction of the private health care insurance industry was very much intended by Barry, Nancy, Harry and the rest. Single payer all the way, baby!; 9/28/10, 3:13 PM
traditionalguy said...: Obama and Pelosi's intentional destruction of the USA's medical care delivery industry appears to be happening right on time to make what's left a Single Payer disaster zone with bad service at a huge price equally for all. The Demon-Rats (once a political Party called Democrats)from Marin County and Nairobi have earned that new name.; 9/28/10, 3:18 PM
Jana said...: I still don't see how this all works. All of this crumbling and failure...and people will come crawling for national health care down the line?

I, for one, will never, ever trust anyone with a "D" after their name with health care policy ever again.; 9/28/10, 3:19 PM
Rumpletweezer said...: Wouldn't it be worse if health care hadn't passed? Just like unemployment would be ten times worse if we hadn't spent a gazillion dollars on stimulus?; 9/28/10, 3:24 PM
Dust Bunny Queen said...: TOLD YOU SO.

Obama's plan is purposely destroying the insurance industry and will ultimately force private insurance companies into bankruptcy.

The destruction of the US economy is also on track.

Working as intended. If we don't vote these people out in November and reverse the evil destruction that they are wreaking, it will be too late to turn this sinking ship around.

Pure evil.; 9/28/10, 3:24 PM
SteveR said...: The cost curve is bending you over; 9/28/10, 3:25 PM
Big Mike said...: If you're on Medicare, you have a duty to die.

I think I'll keep working until they carry me out the front door in a zipped-up body bag. As long as I'm paying taxes and not collecting Social Security and Medicare then maybe the Democrats will try to keep me alive.; 9/28/10, 3:25 PM
Martin L. Shoemaker said...: But if you like your coverage, you can keep it!

Honest!

Would he lie to you?; 9/28/10, 3:25 PM
rhhardin said...: I'd advise against all health insurance, as a nice alternative.

There'd be a big medical shakeout of course, as armies of paperwork disappear.

Then you'd get what's called a market.; 9/28/10, 3:26 PM
lemondog said...: There goes the senior vote...

Did anyone notice back in February when Congress cut 21% in Medicare payments?

Doctors face 21 percent cut in Medicare payments

Are docs dumping their seniors?; 9/28/10, 3:27 PM
Dust Bunny Queen said...: Are docs dumping their seniors?

Yes. And Medicaid/Medi-Cal patients as well.

If you aren't already a patient you are going to be lucky to get ANY doctor to see you. So.....you go to the emergency room and further stress out the system and bankrupt the hospitals too.

Great plan.; 9/28/10, 3:31 PM
I'm Full of Soup said...: The ruling class is math challenged and in love with turning the simple into the complex. What could possibly go wrong?; 9/28/10, 3:33 PM
Jana said...: My family doc no longer sees Medicare patients, and he criticized it in my husband's presence.

Of course, he also admitted to voting Obama, so I just have to assume he's a sucker.; 9/28/10, 3:41 PM
Scott M said...: it will be too late to turn this sinking ship around.

This assumes, of course, that the heading is what's driving you underwater. Wouldn't you want to get the ship afloat first before changing the heading?

The above is NOT an allegory for politics. I just want to be crystal clear on the maritime aspects of what DBQ is saying. It's absolutely critical.; 9/28/10, 3:42 PM
The Drill SGT said...: Dust Bunny Queen said...
TOLD YOU SO.

Working as intended.

It's not a bug, it's a feature.; 9/28/10, 3:43 PM
Original Mike said...: Chickens ... roost ...

You know the rest.; 9/28/10, 3:47 PM
Anthony said...: From the article: "The decision by Wellesley-based Harvard Pilgrim, the state’s second-largest health insurer, was prompted by a freeze in federal reimbursements and a new requirement that insurers offering the kind of product sold by Harvard Pilgrim — a Medicare Advantage private fee for service plan — form a contracted network of doctors who agree to participate for a negotiated amount of money."

So this problem is in part the result of a freeze in federal medicare reimbursements. What's ironic about the complaints in the comment section of this blog is that the planning of the health care bill had included various options to fix the medicare reimbursement problem that has been steadily growing. (Over the last ten years Congress has simply applied 1-year patches, and not actually addressed the real issues with the SGR). So now everyone is complaining about how medicare reimbursement freezes have contributed to the problem of private insurers dropping medicare advantage programs, when in fact, it was fiscal conservatives that were opposing changes to the SGR because it would have been too expensive.

So which is it? Spend the money to provide doctors with the necessary medicare reimbursement payments that republicans blocked? Or stop complaining about the snowball effect this had on private insurers?; 9/28/10, 4:02 PM
Dust Bunny Queen said...: it will be too late to turn this sinking ship around.

Not being a sailor or all that familiar with boats, I was thinking more like: Get this leaking ship back to the docks so we can repair it before it sinks under for good.

Just seems that if you are out at sea in a leaking boat, you should turn and run for the shore. Instead.....Obama and the Dems want to go full steam ahead for the middle of the ocean, chumming for sharks the entire way.; 9/28/10, 4:20 PM
KCFleming said...: New hospitals will be designed, and old ones refurbished, by Rafael Viñoly Architects, all with a special sitting area for Medicare patients.; 9/28/10, 4:20 PM
former law student said...: By increasing federal reimbursement from 95% of fee for service to 115%**, Republicans' Medicare Advantage plan* was ultimately unaffordable.

* http://clerk.house.gov/evs/2003/roll332.xml

Mar. 6--Humana and Aetna earned the biggest profits among Florida health maintenance organizations in 2007, but CarePlus, which does only Medicare, raked in by far the biggest profits per member, thanks to lucrative payments from the federal government, according to a study being released Friday.

The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve. Democratic leaders propose to cut their benefits and use the savings to fund reforms.

"Companies like CarePlus are getting their profitability to a large extent from the federal government," said Allan Baumgarten, author of the study, Florida Health Market Review.

He noted that in earlier years, the Medicare HMOs, now called Medicare Advantage Plans, were funded at about 95 percent of what a patient would be expected to cost under fee-for-service.

**Under the George W. Bush administration, that rate was increased to 115 percent of fee-for-service, in an attempt to privatize Medicare by pushing members toward commercial insurers.

CarePlus, a subsidiary of Humana, had a profit of $56.2 million with an enrollment of 55,541, according to Baumgarten's report. That worked out to a profit of $1,012 per member.

(Miami Herald article archived at) http://www.insurancenewsnet.org/html/LifeInsurance/2009/0309/In-Florida--Medicare-Plus-Means-Big-HMO-Profits.html; 9/28/10, 4:21 PM
KCFleming said...: Anthony said..."So which is it? "

Neither.
Yours is a misstatement or a lie. Mebbe both.; 9/28/10, 4:21 PM
Big Mike said...: The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve.

You're still missing the point, FLS. Neither I nor Pogo nor anybody else who has kept their sanity for the past two years wants you, or Obama, or anybody else deciding what people "deserve" to make.; 9/28/10, 4:24 PM
KCFleming said...: "The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve."

Of course they do.
Meanwhile, on planet Earth, where Medicare funding has been below the cost of overhead, doctors are stiff-arming patients new to Medicare.

Heckuva job, Barry.; 9/28/10, 4:25 PM
DaveW said...: This comment has been removed by the author.; 9/28/10, 4:26 PM
DaveW said...: This is news to any of you? Obama SAID he wanted to get rid of Medicare Advantage. Medicare put out a flier months ago explaining that killing MA was "improving" it. Hell that's the biggest fight I've had with my wife in years. She started explaining to me how it wasn't flatly dishonest to say in that mailing that MA was being "improved".

3 years ago I had a huge swath of choices on MA. Basically, you sat down with your list of prescriptions, downloaded each plan's formulary, checked your list against theirs to ensure your drugs were covered and how much each plan would cost out of pocket, called your doctors and made sure they would accept the plan, then figured out which was the best fit. It was a pain in the ass.

(Complicated by the fact that what you pay out of pocket for prescriptions counts as part of your benefit from medicare. So every penny you pay for a prescription puts you closer to the donut hole. Believe it or not.)

Last year my choices had dwindled to 1. There was only one plan offered in my area in 2010.

3 years ago my plan was essentially free, my medicare benefit was paid to the insurance company and they paid medicare rates for my health care. What I got out of the deal was no deductible and drug coverage, a small vision coverage ($100 on a pair of glasses) and a similarly small dental (1 annual cleaning). In exchange I paid a higher co-pay for doc visits.

This year my plan cost me $40 per month out of pocket and the co-pays went from $25 to $45. And the drug co-pay went from $25.00 to $37.50. I didn't complain about having to pay more, I'm grateful I have the best medical care in the world. I'm dying of heart disease. I NEED to have good medical care and if it cost me $40 per month, or $400, it's worth it.

Next year I expect to have nothing but naked medicare, completely exposed to possible bankruptcy on its simple 80/20 plan. No vision care. No dental care. And I'll have to pay out of pocket for the deductible up front.

Health care "reform" my aching ass.; 9/28/10, 4:27 PM
KCFleming said...: Hell, the Obama administration believes that all businesses are generally getting more money than they deserve, and that they should redistribute the money 'the right way', meaning to their friends.; 9/28/10, 4:27 PM
KCFleming said...: The Obama administration believes that Medicare patients are generally getting more healthcare than they deserve.; 9/28/10, 4:29 PM
DaveW said...: And yes, doctors are fleeing medicare. There was a story about it in the Houston Chronicle a few weeks ago.

Docs that are good and can get the rich clients are dropping medicare and tailoring their services to rich folks.

Docs that suck and can't get rich clients will take medicare rates and churn old folks in and out the doors.

Thus, the ghettoization of medical care in the United States.

I seriously doubt I'll lose my doc though, just because I've seen him for years now and I don't think he'd drop me. My cardiologist though...that may be another story. They slashed cardiologist compensation 4 months after Obama took office. And my cardiologist is perfectly capable of having a practice filled with nothing but rich folks, the guy is a freaking scientist and works from 7am to 1am most days.; 9/28/10, 4:34 PM
former law student said...: Neither I nor Pogo nor anybody else who has kept their sanity for the past two years wants you, or Obama, or anybody else deciding what people "deserve" to make.

I thought you guys were opposed to the government being generous with the funds it extorts from the taxpayers. Why the change?; 9/28/10, 4:35 PM
I'm Full of Soup said...: FLS:

The Obama administration just called to say you they think you make too much money so your salary is being decreased.; 9/28/10, 4:36 PM
The Drill SGT said...: FLS said...CarePlus, a subsidiary of Humana, had a profit of $56.2 million with an enrollment of 55,541, according to Baumgarten's report. That worked out to a profit of $1,012 per member.

I read the article, and what I saw indicated that the definition of "Profit" amounted to everything that wasn't a medical reimbursement.

everywhere else, "profit" is defined as the much smaller number left after you pay all your overhead costs

overhead is not profit. e.g. rent, computers, a CFO, admin, etc; 9/28/10, 4:36 PM
former law student said...: pogo -- how did your MA reimbursements compare to your traditional Medicare reimbursements? Were you in practice in the Medicare+Choice days? Can you compare?; 9/28/10, 4:38 PM
KCFleming said...: fls, Medicare and Medicaid have been national healthcare style plans functioning entirely by subsidization from commercial insurance and taxes.

The fundamental problem, via Thomas Sowell:
"Nothing is easier for politicians than to rail against the profits of pharmaceutical companies, the pay of doctors and other things that have very little to do with the total cost of medical care, but which can arouse emotions to the point where facts don't matter. As former Congressman Dick Armey put it, "Demagoguery beats data" in politics.

Economics and politics confront the same fundamental problem: What everyone wants adds up to more than there is. Market economies deal with this problem by confronting individuals with the costs of producing what they want, and letting those individuals make their own trade-offs when presented with prices that convey those costs. That leads to self-rationing, in the light of each individual's own circumstances and preferences.

Price controls create lower prices for open and legal transactions -- but also black markets where the prices are higher than they were before, because the risks of punishment for illegal activity has to be compensated. Price controls also lead to shortages and quality deterioration.

But politicians who take credit for lower prices blame all these bad consequences on others. Diocletian did this in the days of the Roman Empire, leaders of the French Revolution did this when their price controls on food led to hungry and angry people, and American politicians denounced the oil companies when price controls on gasoline led to long lines at filling stations in the 1970s. It is the same story, whatever the country, the times or the product or service.

The self-rationing that people do when prices are free to convey the inherent impossibility of any economy to supply as much as everybody wants is replaced, under price controls, with rationing imposed by government, which cannot possibly have the same knowledge of each individual's circumstances and preferences -- least of all when it comes to medical care, where patients differ in innumerable ways.

Here, as elsewhere, there is no free lunch -- even though politicians get elected by promising free lunches. A free lunch in medical care is one of the most dangerous illusions of all."; 9/28/10, 4:47 PM
I'm Full of Soup said...: Using the state of Florida to establish a baseline analysis for medicare vs non medicare profits seem odd and stupid since the medicare population is such a large % of the total population.; 9/28/10, 4:49 PM
I'm Full of Soup said...: IOW, I bet the statistician's study found just what he was told to find.; 9/28/10, 4:50 PM
former law student said...: All that CarePlus provided was Medicare Advantage plans, to 50,000 "Medicare eligibles" in three Florida counties. Yet upon closing the deal to acquire them in February 2005, Humana immediately raised its 2005 earnings per share estimate for all of Humana from $2.05 to $2.20.

http://www.getonlinequotes.com/blog/43/humana-completes-acquisition-of-careplus-health-plans-of-florida.html

So private insurance companies profited even if the providers didn't.; 9/28/10, 4:52 PM
KCFleming said...: The Democrats will blame Medicare patients for not being able to get doctors.

Buck up!, sez Uncle Barry.; 9/28/10, 4:55 PM
former law student said...: Hey pogo -- why does the US have fewer doctors per capita than the UK (2.4/1000 vs. 2.5), and 50% less than the EU average?

Doctors flourish under universal health care is the only conclusion I can draw.; 9/28/10, 5:09 PM
Bruce Hayden said...: "The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve."

The problem there, to me, is that they have taken it upon themselves to determine this. That their version of "deserving" is what matters.

And, personally, I think that is part of the problem. The "seasoned" citizens have had some of their benefits taken from them to pay for people who didn't have coverage.

And, I think that if it came down to it, many of us in this country would consider granny on Medicare more deserving of health care dollars than someone who wasn't working, but should be. Maybe they can't because they have some sort of dependency problem, or because they dropped out of high school to have kids. But why should granny be penalized for these bad life decisions of others?

The reality all along was that they couldn't increase the number of people with health care, without increasing premiums and without reducing coverage. It was impossible, because it implied sticking more in the same sized sack. And, they promised to do all this by passing a 2,000 page bill that no one had read, that will result in thousands of lines of new regulations and dozens of new boards, commissions, etc.

So, of course, they lied. If they had admitted the truth up front, those voting for the bill would have come back to their districts to find their homes burned down and faced being tared, feathered, and run out of town on a rail.

Now, instead, they are just going to lose their seats in Congress.

But that does bring up the question, who were the bigger fools? The constituents who would have tarred and feathered their Congress people if they had known the truth up front? Or those Congress people in swing districts who actually believed that voting for this might help their chances of reelection?; 9/28/10, 5:10 PM
KCFleming said...: Why?

Artificial restrictions, regulatory barriers to entry, state-mandated licensing, overpriced schools, guild effects, greater use of specialists, better care for cancer and heart disease.

To name a few.; 9/28/10, 5:13 PM
Bruce Hayden said...: I thought you guys were opposed to the government being generous with the funds it extorts from the taxpayers. Why the change?

Because they lied about it, and pretended that none of this would happen, in order to cover those (IMHO) less deserving.

By the time that someone is on Medicare, and, esp. after a couple of years, they have no other choices. They can't work another job to pay for higher health care costs. The highest Medicare costs are for those least able to do anything about it. And, yes, that means killing granny so some unwed mother can continue having kids out of wedlock without having to pay for her health care, and all those twenty-somethings who would rather party than work are now covered.; 9/28/10, 5:17 PM
Original Mike said...: The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve.

On the one hand, Obama says Medicare HMOs are getting more money than they deserve. On the other hand, a Medicare HMO closes up shop because they can't make a go of it.

And FLS believes Obama.

Get a clue, man.; 9/28/10, 5:20 PM
Bruce Hayden said...: Artificial restrictions, regulatory barriers to entry, state-mandated licensing, overpriced schools, guild effects, greater use of specialists, better care for cancer and heart disease.

There really are a lot of artificial restrictions. For one thing, the AMA has traditionally strictly controlled the number of medical schools, as well as the size of classes in those schools. They try to predict ten years out the need for doctors in different specialties, and, not surprisingly, fail miserably.

But don't know how more regulations, written by lawyers, will help this problem one little bit.; 9/28/10, 5:25 PM
Original Mike said...: Or, FLS, do you think they are cutting off their nose to spite their face?; 9/28/10, 5:26 PM
Dust Bunny Queen said...: The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve.

THIS attitude, that the government can decide who is deserving and who is not, it the crux of the problem. People like fls buy into this idea that some people are more deserving than others and that those who have made successes of themselves 'deserve' to be punished or robbed in order to level the playing field.

This is stealing and morally reprehensible and the American people know it to be wrong.

Charity is a voluntary means of helping those who are in less fortunate circumstances. Often the less fortunate are their by their own actions and their own choices. Other times not. Either way, charity is a good thing.

Stealing from people, confiscating their property, confiscating their earned wealth and telling them how much money they deserve to make or keep is morally wrong. But.....liberals don't see this because they never ever want to pull their heads out of their asses and recognize the unintended consequences of their misguided and morally corrupt policies.; 9/28/10, 5:30 PM
Methadras said...: SteveR said...

The cost curve is bending you over

To the point that it will break your back.; 9/28/10, 5:31 PM
Bruce Hayden said...: And FLS believes Obama.

Of course he does. Mindless obedience to the elitist cabal has always been a requirement for being a liberal.

This is why they have to print up their signs for them when they are bussed to protests. They can't be expected to stay on message all by themselves.; 9/28/10, 5:32 PM
Martin L. Shoemaker said...: former law student said...

Hey pogo -- why does the US have fewer doctors per capita than the UK (2.4/1000 vs. 2.5), and 50% less than the EU average?

Question 1: Do we have more doctors per capita or fewer than the UK or the EU?

Question 2: Do we have more doctors per capita or fewer than we had before health care reform?

I care a whole lot more about Question 2 than Question 1. Right now, the anecdotes aren't looking good on Question 2; but it will take some time to get actual data.; 9/28/10, 5:34 PM
The Drill SGT said...: Pogo said...
The Democrats will blame Medicare patients for not being able to get doctors.

Obamacare made an interesting change in Medicaid. Previously, the law said that states had the obligation provide Medicaid coverage. Now the law says that Patients have the right to Medicaid care. Then they cut Medicaid funding.

which means the number of Medicaid patients has gone up, while funding per capita drops, and doctors are walking away from new or any Medicaid patients.
This leaves states holding the bag for class action lawsuits by the trial lawyers when a patient cant get a doctor.; 9/28/10, 5:53 PM
former law student said...: And FLS believes Obama.

Of course he does. Mindless obedience to the elitist cabal

I believe Humana. Medicare Advantage was a little pot of taxpayer-provided gold they wanted to scoop up. Our tax money went right to Humana's bottom line.

The one problem Republicans had with Medicare was that none of our tax money flowed to private health insurers. Well, that particular flow is being cut back.; 9/28/10, 6:03 PM
Dust Bunny Queen said...: Our tax money went right to Humana's bottom line.

So, what is your position on GM bail out, stiffing GM bond holders and tax payer money backfilling the UAW pension coffers?; 9/28/10, 6:09 PM
Unknown said...: I forget whether it was pb&j, HD, Ritmo, or somebody else telling me in this bandwidth that ZeroCare wasn't affecting Medicare, etc.

Interesting they're conspicuous for their absence.; 9/28/10, 6:12 PM
Robert Cook said...: "I'm thinking the destruction of the private health care insurance industry was very much intended by Barry, Nancy, Harry and the rest. Single payer all the way, baby!"

I try not to be insulting to other commenters on this thread, but...how fucking stupid can one be?

Obama's healthcare plan is a gift to the private insurance industry, and has probably put off any hope of the institution in America of a much-needed Single Payer plan for years or forever.; 9/28/10, 6:13 PM
Big Mike said...: ...how fucking stupid can one be?

Obama's healthcare plan is a gift to the private insurance industry ...

You asked your question, and you answered it yourself.; 9/28/10, 6:19 PM
Big Mike said...: @FLS, let me repeat. I. Do. Not. Want. You. Or. Obama. Or. Anybody. Else. Deciding. What. People. "Deserve." To. Make.

None of you are bright enough to do anything but screw it up.; 9/28/10, 6:24 PM
Robert Cook said...: "Are docs dumping their seniors?"

"Yes. And Medicaid/Medi-Cal patients as well.

"If you aren't already a patient you are going to be lucky to get ANY doctor to see you. So.....you go to the emergency room and further stress out the system and bankrupt the hospitals too.

Great plan."

Yep...it sounds like gold--as in new revenue streams--to the private insurers who will be waiting eagerly as Medicare patients, abandoned by doctors who will be paid less and less by the underfunded government health plan, are forced to sign up for their overpriced coverage with likely meager coverage.

Sounds like just what you "conservatives" have wanted all along: the destruction of government health care, a pernicious entitlement for the old--who, by definition--are the undeserving!

One down! It's on to the destruction--I mean, privatization--of Social Security! Hooray!; 9/28/10, 6:25 PM
former law student said...: wasn't affecting Medicare, etc.

Obamacare's at war with Republicare. Medicare Advantage was Bush's attempt to dismantle traditional Medicare by privatizing it.

Dave didn't say traditional Medicare was being stiffed, only that his Medicare Advantage (i.e. Hastertcare) plan that the Republicans pushed through in 2003 would cost him more for less.; 9/28/10, 6:26 PM
The Drill SGT said...: former law student said...
Hey pogo -- why does the US have fewer doctors per capita than the UK (2.4/1000 vs. 2.5), and 50% less than the EU average?

A better Guild in the EU?

I looked up the numbers and every source I checked said it was like EU 3.4/1000, US 2.5/1000, and UK in last place.

maybe it's like all other economic activity, looking at labor productivity gives you a false impression unless you look at the use of capital, e.g maybe in the US we supplement docs with more MRI's and better drugs.

5 MRI/million in the UK
27 MRI/million in the USA

afterall, if just docs is the measure, then Cuba at 5.9/1000 wins, but don't get your heart attack there.

reminds me of a Milton Friedman story that applies to Democrat labor policy. Visiting China, Milton saw a couple of thousand coolies digging with shovels working on a Dam. He asked if it wouldn't be more productive, if they used a couple of buldozers and a back hoe. The Chinese host said, no, the people needed jobs. Milton suggested they use spoons then instead.; 9/28/10, 6:29 PM
former law student said...: I. Do. Not. Want. You. Or. Obama. Or. Anybody. Else. Deciding. What. People. "Deserve." To. Make.

What should replace competitive bidding then? Pull names from a hat, or eeny meeny miney mo?; 9/28/10, 6:31 PM
The Drill SGT said...: former law student said...
What should replace competitive bidding then? Pull names from a hat, or eeny meeny miney mo?

in Federal contracting, particularly in Firm Fixed Price bids, the quality of the product and the total price (e.g. best value) is generally the standard. You don't select vendors based on comparing their profits, nor their costs, but rather in comparing their Price (labor plus materials plus overhead, plus fee).

Those that can reduce their overhead, can relatively speaking clear a higher fee and still win the bid.

imagine, being efficent leads to winning the contract; 9/28/10, 6:42 PM
former law student said...: Drill Sgt.: Exhibit 3 of this report:

http://preview.tinyurl.com/27yjjpo

One important takeaway:

The [United States] now ranks in the bottom quartile in life expectancy among OECD countries and has seen the
smallest improvement in this metric over the past 20 years.; 9/28/10, 6:44 PM
Dust Bunny Queen said...: abandoned by doctors who will be paid less and less by the underfunded government health plan, are forced to sign up for their overpriced coverage with likely meager coverage.

It doesn't matter what kind of coverage you can "sign up for" (pay for out of a seniors limited fixed income stream) if there are no fucking doctors who will take you on as a patient. Idiot.

Most Seniors have Medicare part A and part B (which is about 92$ a month...not free) they then IF they can afford it have a Medicare Sup plan (starting at over $100 a month at the younger ages for the J plan) or Medicare Advantage. We haven't even touched Part D yet.

Also, in case you didn't notice, the insurers are cutting back on all of the types of plans that they are offering, for all ages. This is because when the Obama plans kick in many of the high deductible/catastrophic plans will be illegal. And the reason the plans are going to go up steeply in costs is because they will be mandated to take on everyone no matter what their health status is.

That isn't insurance. It is government mandated welfare at industry expense.

So out from the get go, the Seniors have to pony up about $220 EACH for coverage. And now they are facing a shrinking supply of providers and services. Great plan Obama.

Even then, with coverage....many doctors do not want to add to their Medicare load because they are underfunded/reimbursed in relation to real costs.

Where Obama's plan is sinking the ship is by adding more and more people to the Medicaid rolls and demanding that States pick up the slack.; 9/28/10, 6:45 PM
Bruce Hayden said...: The [United States] now ranks in the bottom quartile in life expectancy among OECD countries and has seen the smallest improvement in this metric over the past 20 years.

Not sure what your point here is with this irrelevancy. You could better use this statistic to argue for better gun control laws, than impute the quality of our health care system from it.; 9/28/10, 6:47 PM
Bruce Hayden said...: What should replace competitive bidding then? Pull names from a hat, or eeny meeny miney mo?

How about the moral stance - they earned it, it is theirs.; 9/28/10, 6:48 PM
Dust Bunny Queen said...: What should replace competitive bidding then? Pull names from a hat, or eeny meeny miney mo?

You weren't talking about competitive bidding. You were saying that the Government or some other entity gets to decide how much money a person/company 'deserves' to make.

You should butt the fuck out and let the free market place take its natural course.

You can't do that though....can you? You just have to meddle and fiddle and totally fuck up the economy.

It isn't up to YOU to determine who 'deserves' to make a living or how much they 'deserve' to make.

It is none of your business and I repeat myself...sincerely.... BUTT OUT AND FUCK OFF.; 9/28/10, 6:51 PM
Dust Bunny Queen said...: Sorry to be so crude.

I can't help it in the face of such monumental stupidity that is destroying the country and the future of my children and grandchildren.

vw: broked. Obama done broked the country; 9/28/10, 6:53 PM
The Drill SGT said...: DBQ, don't forget to add, replacing actuarial based rates (e.g. people that get sick, pay more) with community based rates means that the premiums that the healthy pay amount to transfer payments that subsidize the sick.; 9/28/10, 7:01 PM
Phil 314 said...: Please note:

Harvard Pilgrim is a NOT FOR PROFIT Health Insurance company.

I suspect the uncertainty made it too high risk for them PLUS:

since their major line of business is commercial insurance in Massachusetts I assume they'd rather simplify their live and only fight the battle on one front:

MassHealth.

We shouldn't forget their recently completed comprimise with the State Insurance Commmission about rate increases.

Once again let me repeat:

HARVARD PILGRIM IS A NOT FOR PROFIT INSURANCE COMPANY

AND

MASSACHUSETTS HEALTH REFORM IS THE BLUE PRINT FOR OBAMACARE; 9/28/10, 7:06 PM
Robert Cook said...: "It doesn't matter what kind of coverage you can "sign up for" (pay for out of a seniors limited fixed income stream) if there are no fucking doctors who will take you on as a patient. Idiot."

Who's talking about coverage? That's besides the point! The private insurers will sign up the former Medicare patients and--voila!--new revenue streams for them! Whether the "covered" actually get anything for their premiums is not worth bothering about...in fact, the less coverage provided the greater the profits for the insurers...just as is already the case with many "insured" Americans who find out that when they need their coverage...it's not (or barely) there!; 9/28/10, 7:11 PM
Sprezzatura said...: Somewhere in your hearts I know that many of you complaining cons know that Medicare needs to be drastically cut (you can't continue to have per capita cost increase of nearly 80% over ten years, on top of the additional costs associated w/ a nearly 20% increase in enrollment, on top of W's drug company giveaway).

But, at least you've seen how fun (and effective) it can be to demagogue the coming reality. Soon, you'll find yourselves back on the realist side of this argument, when the Ds take back their rightful status.

Hope you're having fun while it lasts.; 9/28/10, 7:29 PM
dick said...: I have been reading a local message board from my home area in central Ohio and the commenters there are already talking about how the doctors are canceling patients and cutting services and not taking new patients at all, particularly medicare patients. Costs are going up as well.

And fewer people are going to medical school also. Doctors are leaving the field as well. A friend's doctor told her that he had to keep 3 people working just to keep up with the paperwork now for his practice and it will be worse coming up. He is lucky that his undergrad degree was in engineering. He is shutting down and going back into engineering instead. It is just not worth it to him to put up with all the nonsense.; 9/28/10, 7:50 PM
former law student said...: You could better use this statistic to argue for better gun control laws,

Really? Fewer than 30,000 people die from gunshots every year. (Half of them kill themselves, btw.); 9/28/10, 7:59 PM
former law student said...: So, what is your position on GM bail out, stiffing GM bond holders and tax payer money backfilling the UAW pension coffers?

Well, if Medicare Advantage was a temporary bailout program for health insurers, they shouldn't be surprised if it goes away after seven years -- that stretches the definition of temporary.

I can't speak to people who hold bonds in a bankrupt company -- maybe they'd settle for some of the shuttered factories? Start up their own car company?

Thanks to ERISA (signed by Jerry Ford I believe) the tax payer would be paying those UAW pensions anyway under PBGC, as they are for the parts plants spinoffs.

UAW retirees and their spouses just got their health benefits significantly slashed by the way But I haven't seen any frowny-face posts about this on Althouse.; 9/28/10, 8:06 PM
former law student said...: A friend's doctor told her that he had to keep 3 people working just to keep up with the paperwork now for his practice

Single payer would have eliminated all that. But insurance co. personnel need to eat, as do insurance salesmen.; 9/28/10, 8:07 PM
former law student said...: You weren't talking about competitive bidding. You were saying that the Government or some other entity gets to decide how much money a person/company 'deserves' to make.

Suppliers should not be the sole judge of how much they "deserve" to make. They aren't when insurance companies pay them and they shouldn't be when the government pays them. Competitive bidding drives prices down and increases efficiency -- the idea of what the bidder thinks he deserves doesn't enter into it.; 9/28/10, 8:14 PM
Sprezzatura said...: "So, what is your position on GM bail out"

Ha ha ha ha ha.

Now you're a bad con if you're not in favor of paying 100 cents on the dollar to folks who own nearly worthless bonds (where many (most?) of the owners of those bonds bought them when they were already seriously discounted from face value because the writing had been on the wall for quite some time, but the tax payers should give them a completely financially unjustified premium).

Terrible how they only received somewhere around 20 cents on the dollar, i.e. the actual value of the paper. And, they agreed to this, i.e. they signed off on the agreement.

You, cons are funny.; 9/28/10, 8:18 PM
Revenant said...: The Obama administration has said that it believes Medicare HMOs are generally getting more money than they deserve.

Well, yes. There's a phrase for the money people actually deserve: "pre-tax income".

Obviously when you have a government program that involves taking tax money and giving it to people with more political clout -- like the Bush Medicare plan did, like Obamacare does, etc -- those people wind up getting "more than they deserve".; 9/28/10, 8:24 PM
Bruce Hayden said...: Single payer would have eliminated all that. But insurance co. personnel need to eat, as do insurance salesmen.

Why do you think that? Medicare is single payer, and not only does it sometimes not cover actual costs, but the paper work is often worse than required for insurance companies.

But, I guess the assumption is that under a single payer all the problems are going away, and therefore this make sense.

It is almost like the proponents of single payer have some glorified view of the government and how it operates. My boss tells people that the USPTO is like the world's biggest DMV. Single payer would make that agency look like a mom-and-pop store.; 9/28/10, 8:31 PM
Revenant said...: "A friend's doctor told her that he had to keep 3 people working just to keep up with the paperwork now for his practice"

Single payer would have eliminated all that.

By replacing them with 4 government bureaucrats. :); 9/28/10, 8:35 PM
Sydney said...: @ dick,

A friend's doctor told her that he had to keep 3 people working just to keep up with the paperwork now for his practice and it will be worse coming up. ....He is shutting down and going back into engineering instead. It is just not worth it to him to put up with all the nonsense.

It is nonsense on stilts. Those who run Medicare have convinced themselves that the best way to cut costs is to assume that everyone they deal with is a crook.

Example: A few years ago, when my diabetic patients wanted to use their Medicare benefit to pay for their diabetic testing supplies, they could just take a prescription written and signed by me. Then, they had to have a prescription that also stated their diagnosis, how many times a day they tested (and why if the frequency was more than usual) and whether or not they used insulin. Now pharmacies are sending me requests for patient medical records so they can put them on file to prove to Medicare that they aren't committing fraud by filling these prescriptions. My word is no longer good enough. And my patients' medical records are no longer private. (Needless to say, there is a lot more documented at every visit than their diabetic control. Maybe things they wouldn't want their diabetic equipment supplier to know.)

Another example: Medicare has outsourced its auditing work to companies that get paid per offense found. Imagine if the IRS paid its auditors that way. It a system ripe for corruption and over-zealous prosecution.

Not worth the hassle to deal with them. I suspect that is why the insurance company is giving up their Medicare Advantage plan. Too much hassle. (They, too, are subject to the auditors.); 9/28/10, 9:07 PM
Jason said...: Sydney,
When they request medical records for that purpose, aren't you required by HIPAA to redact information that has no relevance to their purpose?; 9/28/10, 11:08 PM
IgnatzEsq said...: I'm honestly confused as to what position to take on this issue. All the evidence points to MA plans costing the Government around 12% more per patient as opposed to normal Medicare FFS. (While the original idea of MA, was that the involvement of private insurers would end up reducing the costs, this has been proven false). Of course people on MA get enhanced benefits, with the additional coverage subsidized by the government with this extra cost.

See for example the CBO and GAO reports on this issue:
http://www.gao.gov/new.items/d08359.pdf
http://www.cbo.gov/ftpdocs/82xx/doc8268/06-28-Medicare_Advantage.pdf

This is a relatively simply scenario - expanding or extending MA will cost the government more, but give some extra benefits to the recipients, cutting MA will save money, but former MA recipients will be forced on normal Medicare - no one would be cut off, but some would be put onto FFS. Obviously for people with chronic conditions, it's better to be on MA, but which is better public policy, and why?; 9/28/10, 11:56 PM
DaveW said...: Dave didn't say traditional Medicare was being stiffed, only that his Medicare Advantage (i.e. Hastertcare) plan that the Republicans pushed through in 2003 would cost him more for less.

In the first place FLS, I didn't keep ranting about how screwed up this is becoming because I thought my post was too long already.

Secondly, Medicare Advantage was passed in 1997, signed into law by Clinton. Hastert was the speaker from 1999-2007. Perhaps he was involved in the drafting of the original legislation as a minority member but calling MA "Hastertcare" is a bit much.

Are you perhaps thinking of the part D prescription drug coverage that was added in 2003? If so, that's not MA. MA plans may or may not offer part D, and part D can be purchased solo.; 9/29/10, 7:52 AM
Sydney said...: Jason,

Yes, you have to redact the non-pertinent information, which makes it even more of a pain to process the requests. Not worth the hassle, frankly.; 9/29/10, 9:03 AM
JAL said...: a new requirement that insurers offering the kind of product sold by Harvard Pilgrim — a Medicare Advantage private fee for service plan — form a contracted network of doctors who agree to participate for a negotiated amount of money.

(In the choices available in my area this immediately means you do NOT have free choice to see the doctor you prefer without paying a penalty. How many lies does that add up to again?)

If the amount the physician / provider receives is the same ... why does the government see the need to mandate *how* MA providers organize themselves? This hit me as being one more intrusion of the feds into healthcare. One that gives them more control over the providers.

Of course, with the Advantage plan, the feds are out of the loop so to speak, in that the company receives a lump sum every month for each person covered (IIUC) so the actual parsing out of the money is therefore out of the feds hands. And as can be seen with GM bonds and the student loan crap that was passed, the feds don't want anyone else making the decisions with the money.

The feds do not like the private fee for service plans. They *want* HMOs.

Also someone is confused in the comments: Medicare is not Medicaid. And Medicare Advantage is different than Medicare.

Also Advantage plans are *not* all HMOs.; 9/30/10, 12:07 AM