Health Care: To Reform a la Socialists Part Deux: We've Lost the First Battle, But NOT the War
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So the Swiss will need to pay physicians more and charge the citizenry less before their new fad recipe for containing costs can be implemented. Where's the money going to come from - other taxes, screwing specialists, and/or rationing care even more? Stealing money with your right hand and placing it in your left pocket won't trick everyone forever they have been scammed
The concept of "medical homes" is a Clinton retread and was bullshit then and bullshit now with a dress-up of computerization.
Accountable care organization is a bean counter term for trying to shoehorn illnesses into guaranteed outcomes which determine reimbursement. Basically this is hubristic meddling that thinks healthcare can be controlled, ie patients less sick and costs contained, if physicians, though implementing appropriate treatment plans, are held accountable for effects of disease and illness despite the patient's genetics, compliance and lifestyle. More Liberal bullshit that defies the natural world and medical science in order to increase bureaucratic power and deflect reality.
When I was in residency, a fellow resident who had trained in Mexico told me they were required to do service somewhere in the country. His was in a rural area where custom had been that if the people thought the physician had not tried hard enough or did the right things and the patient died, the townspeople would seek violent retribution on the physician, even if that physician had done all that could be done according to professional standards and available equipment and medicines. Makes the Left's fantasies seem tame in comparison.
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Synopsis
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A preliminary evaluation of a two-year national demonstration conducted by the American Academy of Family Physicians suggests that it is possible to transform a primary care practice into a patient-centered medical home. The results also suggest that those leading other medical home demonstrations around the country vastly underestimate the magnitude, timeframe, technology, and capital required to implement this transformation.
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Key Findings
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* Transforming a primary care practice into a patient-centered medical home requires wholesale practice redesign and continuous commitment to enhancing the patient experience. Transformation will likely include a host of interdependent components, such as new scheduling arrangements, better coordination with other parts of the health care system, more point-of-care services, and development of team-based care, among others. "Change is hard enough; transformation to a patient-centered medical home requires epic whole-practice reimagination and redesign."
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* Developing and implementing an information technology infrastructure to support this transformation is more difficult and time-consuming than may be anticipated. Information technology is currently underdeveloped to meet the needs of the patient-centered medical home.
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* Transformation involves a shift from physician-centered care to a team approach, in which patient care is shared among office staff.
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* Rapid transformation can result in staff burnout, turnover, and financial distress
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* Moving toward the patient-centered medical home model is a developmental process that can take up to five years to achieve; successful transformation is highly dependent on local conditions that affect health care practices and their surrounding health care system.
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The Bottom Line
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Transforming primary care practices into patient-centered medical homes will require substantially larger investments than those currently made in time, money, and physician and technology support.
If the startup costs of medical homes are being misunderestimated. :), I have to wonder if the whole concept of cost savings of medical homes is also being underestimated.
The authors warn:
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The authors of this report caution that the rush to demonstrate the viability of the patient-centered medical home could undermine its effectiveness.
A hat tip to the authors for their honesty. I know some of the folks at the Case Western Reserve Department of Family Medicine. They are fine folks who truly want to do good Medicine. I had the honor of being mentored by the former Chairman Jack Medalie, M.D., M.P.H., FAAFPMD, a man who was instrumental in promoting the bio-psycho-social model that forms part of the foundation of Family Medicine. For the American Academy of Family Physicians, the Patient-Centered Home Model appears to be a natural extension of the bio-psycho-social model.
The study utilized highly cherry-picked practices:
- "Thirty-six family practices were selected from 337 practices completing a well-publicized, comprehensive on-line application."
This means that even the most motivated of the motivated to complete and participate had trouble "transforming".
The goal of these folks is to have every practice eventually transform into a Patient-Centered Medical Home. It didn't go so well for them. However, they will persevere as they are "Progressives" and will not stop until whatever the fad of the day is bludgeoned into existence regardless of desire, cost or utility.
As I said, PCMH are nothing more than Clinton-era re-warmed Gatekeeper leftovers with a side of computerization. The reality of more work for no or under reimbursement and underwhelming improvements will not enthrall the rank and file. Unfortunately, once government gets involved, which is a distinct possibility since they are already imperiously forcing certain events onto medical practices***, then a wish by some may become a requirement in all.
***Medicare was the first to require computerized billing or else suffer a penalty. Medicare is now requiring a number of prescriptions to be prescribed via computerization or else be penalized a percentage on reimbursements for all Medicare patient encounters. To demonstrate how out of control the government is, the program begins in 2012 but you will incur a penalty in 2012 if you don't E-prescribe beginning in 2011.
I have no problem with electronic billing or E-prescribing. I do have a problem with forcing everyone to do it under threat of penalty, especially the old timers who will need to make large capital investments they will never make back or who prefer to not change for whatever reason.
Bolding mine.
In Year Two of the Health Care Overhaul, the Wonks Will Really Go to Work
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What's Next
The way HHS officials structure the core benefit package arguably will have a more direct impact on consumers than anything else they do in the coming year of implementation.
The law requires insurers to cover treatments in general categories, such as outpatient and inpatient care, emergency services, pediatric dental visits, wellness care, rehabilitation therapy and mental health benefits. But HHS officials now must translate that into specifics that patients can count on from insurers.
"The lobbying has begun," said Ian D. Spatz, senior adviser to Manatt Health Solutions and the principal in the Rock Creek Policy Group. "Along with the individual mandate, it is the unresolved question of health care reform."
Spatz predicted that because the issue of benefits is politically sensitive, the administration may delay final decisions until after the 2012 elections.
"The balance there is to make sure there is enough in there that's important without saddling the plans with too much cost burden," said Dan Mendelson, a former Clinton administration official and CEO of consulting firm Avalere Health.
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"without saddling the plans with too much cost burden" - Who really thinks that HHS isn't going to add too much cost burden to a core benefits package, especially if lobbyists get their way. This is one of the major reasons I didn't think Obamacare was going to be able to reduce premiums, even though we were told it would.
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Health care lobbying boom continues
Jennifer Liberto
March 25, 2011 -
To date, more than 180 groups have registered to continue shaping the law, the Sunlight Foundation and center reports. President Obama's drive for health care reform has been a years-long boon for lobbyists. Over 2009 and 2010, $1.06 billion was spent on lobbying, with more than $500 million spent on lobbying the issue in each year, according to the Center for Responsive Politics. In addition, lobbyists for 1,251 organizations disclosed that they worked on health care reform in 2009 and 2010, according to the center and an analysis by the Sunlight Foundation. The number of individual lobbyists who reported working on health related legislation last year hit 3,154 in 2010.
In the Obama model of governance, healthcare lobbying will be a method of rewarding political patronage and the lobbyists helpful idea men to help HHS to more quickly bankrupt private insurers.
Shortly after the details began emerging about ObamaCare it became apparent that one of the major mechanisms of driving private insurance companies out of business, the goal of all good statists, is ever increasing mandatory coverage combined with ceilings on what can be charged to cover costs. Require insurers to cover all manner of procedures, illnesses, and flavors of the day holistic fads and you can drive insurers out of business if they can't raise premiums for increased coverage/usage. If insurers are granted rate increases, it will be used against them by a compliant media regardless of the legitimacy of the insurers' position. This has already occurred. The result/goal is people herded towards government exchanges, further consolidating the single payer statist model until eventually it is the sole portal to and of care.
Unfortunately the Republican leadership, beginning with Boehner in the House, has been spineless in defunding ObamaCare other than a symbolic vote to repeal. Ditto for their fecklessness in reducing the budget and debt. I just heard that the $100 Billion cut the Repubs promised was for an entire fiscal year, so, since this year is partly over, they will try for the $100 Billion in September for the next fiscal year. Add to this their scuttlebutt of not being able to defund ObamaCare because it's already built into the bill and my worries of "business as usual" old guard Republicans seems more and more borne out.
We need more of the likes of Bachmann, West, Rubio, Demint, Ryan, etc. ASAP to do what the country mandated in the last elections - get rid of ObamaCare and fix the debt.
The result/goal is people herded towards government exchanges, further consolidating the single payer statist model until eventually it is the sole portal to and of care.
Your observation has been confirmed Strat:
Conyers: Obamacare Is ‘Platform’ for Creating Single-Payer System
March 14, 2011
Rep. John Conyers (D-Mich.), the ranking member of the House Judiciary Committee, told CNSNews.com today that the health-care law that President Barack Obama signed last March is a “platform” for building a single-payer health care system in the United States.
During a newsmakers program at the National Press Club on Monday, Conyers said that after discussing the issue with Rep. Dennis Kucinich (D.-Ohio) he voted for the health-care law because he saw it as a necessary "platform" for building toward a single-payer health-care system in the United States.
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Thanks for the article, Par. I can't claim the observation as my own. A video of one of the people responsible for designing ObamaCare, as well as others, have stated Socialist Medicine as the end game, necessitating the extinction of private insurers.
This is one of those times I believe what the Left says. They think they are teflon on this topic. I'm hoping the American people are not suckered and continue to vote these fools out in 2012 as they did in the 2010 elections. Same goes for spineless Republicans who fail to work to defund ObamaCare and make significant inroads on overspending and debt.
From the CBO's March, 2011 report - Reducing the Deficit: Spending and Revenue Options
Preface
The Congressional Budget Office (CBO) regularly issues a compendium of budget options to help inform federal lawmakers about the implications of possible policy choices. This volume—one of several reports that CBO produces regularly for the House and Senate Committees on the Budget—presents more than 100 options for altering federal spending and revenues. Nearly all of the options would reduce federal budget deficits.
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On page 215: Revenues—Option 32; Repeal the Individual Health Insurance Mandate
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The option would eliminate the requirement that individuals obtain health insurance, while maintaining other provisions of the new health care legislation. The loss of revenues from eliminating the individual mandate penalties would increase the deficit; but the estimated savings from reduced subsidies are greater—yielding net savings of about $282 billion over the 2012–2021 period. Most savings (about $149 billion) would come from lower Medicaid enrollment. On balance, federal subsidies for the purchase of insurance through the exchanges would be about $69 billion lower. Primarily because reductions in employer coverage would result in more taxable compensation for employees, the removal of the mandate would increase tax revenues by about $80 billion. The remainder of the budgetary effect would come from a modest increase (about $8 billion) in employer penalties and a modest reduction (about $3 billion) in tax credits for small businesses.
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The tentacles this ObamaCare monster grows, is already growing, and galaxy devouring appetite it has will eventually overwhelm any tumors they cut out today. This beast is unidirectional, ever expanding and never satiated.
NO! Get rid of ObamaCare completely. Start over again.
Durbin takes aim at Obama’s detente with drug industry
By Alexander Bolton - 03/12/11 01:31 PM ET
Two Democratic members of President Obama’s fiscal commission are taking aim at a deal the president struck with the drug industry to pass healthcare reform in the last Congress.
Senate Democratic Whip Dick Durbin (D-Ill.) and Rep. Jan Schakowsky (D-Ill.) have introduced legislation that would require the secretary of Health and Human Services to negotiate lower prices for beneficiaries of the Medicare prescription drug program.
The legislation threatens a behind-the-scenes agreement Obama forged with Pharmaceutical Research and Manufacturers of America (PhRMA) in 2009 to win the powerful trade association’s support for healthcare reform legislation.
In exchange for the president agreeing not to push a Democratic-favored proposal to empower the Secretary of Health and Human Services to negotiate drug prices on behalf of all Medicare Part D beneficiaries, the drug industry also agreed to provide $80 billion worth of drug discounts to seniors, according to media reports and Democratic sources.
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Families USA, the National Committee to Preserve Social Security and Medicare, SEIU and AFSCME support the Durbin-Schakowsky proposal.
Granted, that Durbin has been an advocate of this even prior to the "behind-the-scenes agreement" between Obama and PhRMA. However, I can't help but wonder if Obama would fight to keep his agreement in place if need be.
This is just like cost shifting from the uninsured to the insured in the emergency room.
Charge the "haves" more to make up for the "have nots".
Net effect, zero savings, with a huge cost due to all of the accounting gimmickery.
I love Georgia Girl's comment below, too...first I'd heard of that.
These bastards need to get out of the health care industry, pronto. There has yet to be, in almost two years worth of discussion, one GOOD reason for the federal government to be involved.
Again, a great post.
Mechanisms are in place for extensions on drug patents. See here, here, and here for examples and explanations of what happens, why it happens and how some want to expand the pathways to extension based on improving research and more concretely proving outcomes (such as the rarer head-to-head clinical trials of two drugs versus placebo stacked up against the drug under consideration).
I don't know of any proof of the Obama Administration interfering with drug patents... yet. Politicizing drug patents would make for a nightmare, one that we have been warning against in general with ObamaCare's road to perdition. This kind of ideological tinkering, favors for your goombahs, in the medical research field will smother innovation and development of new drugs, equipment and procedures which will contribute to actual deaths in the population. Having a single payer government run system that is the sole determinant of what will be granted approval for use, ie reimbursed, is the other side of the research killing coin.
You are most welcome, Georgia Girl.
Do you recall the name of the drug that received a patent extension?
No, but I know it was one to treat migraines. I recall her telling me that none of the cheaper ones worked for her -- the only one that did was one of the most expensive ones -- of course! ^_^
I found this list of drugs going off patent beginning in 2009. There are several migraine drugs listed for the timeframe you mentioned: Ortho-McNeill's Topamax (topiramate); Novartis' Migranal (dihydroergotamine); and GSK's Imitrex (sumatriptan). Merck's Maxalt (rizatriptan) is scheduled to go off patent in 2012.
Of these listed, Topamax would be the most expensive, Imitrex a distant second, and then the others for about the same, generally speaking. YMMV depending on use, insurance and the pharmacy you obtain medications.
One of the more expensive and esoteric ones, that is not currently on the Medicaid/Medicare formulary.
Big surprise, eh!
Topamax is primarily used as an anti-seizure medication that is sometimes used to prevent migraines. The other meds listed above are used when a migraine is occurring.
Trying to get a med not on formulary is a tremendous time killer and a paperwork hassle. I believe the gub'mint and their proxies purposefully created these obstacles to dissuade physicians and staff from attempting to secure off-formulary medications in the first place, not because they are so busy when you call. It's operant conditioning using punishment and extinction techniques to teach physicians how to behave within the collective. (sarcasm, but not by much)
Once upon a time, I was the Executive Director of an epilepsy non-profit. The Novartus rep was a terrific girl, with a huge, huge expense account, if you catch my drift.
Actually, the drug reps were a great help, providing my neurologists with drugs that their Medicare/Medicaid patients couldn't get.
Everyone paints big Pharma as some sort of evil demon, when the truth is quite the opposite.
In regard to prescriptions, do you know if several patent extensions (longer than normally would be given) were "blessed" during this time (2009)? In other words, was that part of the deal with certain pharmaceuticals? One of my friends was waiting, waiting, waiting for a patent for an expensive drug she takes to expire in 2009 and go generic -- and it was extended to 2023! It seems like that was another one of the deals that I heard about at the time, but it's hardly ever talked about.
I haven't heard or read anything about patent extensions in the PhRMA "deal". The most extensive article I have read about the deal is
which doesn't mention anything about patents.
Panel Republicans want further WH probe
By Jason Millman - 03/10/11 06:43 PM ET
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The House Energy and Commerce Committee last month asked the White House’s health reform office to provide in-depth details about meetings it held with outside groups as the healthcare reform law was crafted.
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White House counsel Bob Bauer rejected the committee’s request last week.
“To provide all possible information encompassed by your request – ‘every meeting, briefing or telephone call’ – would constitute a vast and expensive undertaking,” Bauer wrote to the committee.
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“We are concerned because your letter suggests that there have been more secret meetings than we originally thought – otherwise a search for records would be neither ‘vast’ or 'expansive,’” Energy and Commerce Committee Republicans wrote.
My first thought, after reading "would constitute a vast and expensive undertaking" was, how many of these "outside group" type meetings were there?
I thought the Obama Administration was to be the most "plugged-in" (computerized) gang evah. Computer searches don't take long to see who met with whom and then pull up the documents from those meetings. Unless there are statements and visitors the Obama Administration would rather not divulge. Nah, that couldn't be the reason, could it?
Counsel cannot refuse to divulge documents just because it would take a while or cost money. Boo hoo hoo. Let sunlight in to illuminate the collusion and Machiavellian plotting of these Marxists. Then let's disinfect ObamaCare from America.
An interesting take on the subject.
Obama’s refusal to provide records on healthcare meetings should sound alarms
posted at 8:48 am on March 14, 2011 by SusanAnne Hiller
Here's a pic of Kaiser Foundation Health Plan Chairman and CEO George Halverson next to Obama at a what looks like another teleprompter session extraordinaire. The other guy is president of the AMA. Halverson is obviously a fellow traveler. AMA man may be one too or just paying his dhimmitude to Imam bin Obama. Either way, he's being used.
An article that discusses the $500 Billion savings from Medicare.
Those Magic Billions
Accounting fraud you can believe in
From the last line in the article:
The fact that Obamacare relies on accounting that would trigger well-deserved fraud indictments on Wall Street is yet another reason why this stinking mess should be sealed in a 55-gallon drum and buried deep inside Yucca Mountain.
Senator Snowe Cosponsors Legislation to Repeal Employer Mandate in Health Care Law
March 1, 2011
WASHINGTON, D.C. – U.S. Senator Olympia J. Snowe (R-Maine) cosponsored legislation today to repeal the employer mandate imposed by the new health reform law. Senator Snowe, who opposes this mandate requiring employers to offer health insurance to their employees, filed an amendment during Senate consideration of the health care legislation to strike the provision altogether. Additionally, Senator Snowe is a cosponsor of legislation to fully repeal the health care law.
“When I offered an amendment in December of 2009 to repeal the employer mandate, I asserted it simply was not the time to be imposing new mandates on employers that could inhibit them from creating new jobs or even retaining the employees already on their payrolls,” said Senator Snowe. “Nearly a year and a half later as the national employment rate continues to stagnate at or above 9 percent and 13.9 million Americans are unemployed, this toxic mandate endures to the detriment of job creators, employees and families nationwide.
“From the beginning, I strongly opposed this mandate, which will require small businesses with more than 50 workers to offer health insurance as a workplace benefit – or be subject to a fine of up to $2,000 penalty per employee. Worse still, the employer mandate captures part-time workers and seasonal workers who are employed for more than 120 days in determining whether a firm will be subject to the mandate. For Maine, this mandate means small businesses with fewer than 50 employees who should be exempt will suddenly face a fine of $2,000 per worker if they don’t offer health insurance – solely because they utilize part-time and seasonal workers. This will be an absolutely crushing blow to the job creation potential of many Maine industries – including restaurants, retailers, inns and hotels, and the service and tourism industry – who would now be subject to an employer mandate that accounts for $52 billion in revenue according to the non-partisan Congressional Budget Office.”
“It is regrettable that full repeal of this flawed legislation, an effort I strongly support, failed to pass the Senate last month,” Senator Snowe continued. “And now it is incumbent upon Congress to dismantle the most egregious portions of the health reform bill to protect small businesses and families from the harmful consequences many of these provisions will have when they take effect. As long as provisions like the employer mandate loom overhead, potential job creators will continue to sit on the sidelines while the economic climate for growth remains uncertain.”
This is good news. I've had my concerns about the Senators from Maine in the past.
Republicans going after Medicare chief
By Ricardo Alonso-Zaldivar
of The Associated Press
WASHINGTON — Unable to repeal President Obama's health care law, Republicans are trying to oust the official who is quarterbacking the overhaul of the nation's medical system.
In a letter released Thursday, 42 Republican senators asked the president to withdraw the nomination of Dr. Donald Berwick as Medicare administrator, saying his experience isn't broad enough and past statements raise fundamental questions about his views on policy.
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Republicans would need 41 votes to block Berwick's confirmation by the full Senate, and the letter indicates they have more than enough.
The loss of Berwick, a well-known medical innovator and advocate for patients, would be a blow to the administration as it moves ahead with critical building blocks of the health care remake.
Obama bypassed the Senate last year to install Berwick as a recess appointment.
Under the rules, that means that unless Berwick can be formally confirmed, his appointment would run out at the end of this year.
White House spokesman Reid Cherlin said Berwick is “far and away the best person for the job” and the president will not withdraw his nomination.
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Needs to be done. Obama knew he could not get confirmed, so he waited untill the house was out of session. I fail to see how this could be construed as anything but good.
I agree. It's good news. I hope Senate Republicans hold firm. However, I am a little surprised that Obama has decided not to withdraw the nomination, given that the odds of Berwick being confirmed appear to be slim to none.
Berwick is qualified for the position, just not to Conservatives' satisfaction. Making the argument he is not qualified is not only dumb, it also detracts from the important reason that Berwick is all about Statism with Medicine molded in that ideology. Hatch is on the wrong track.
Berwick is not a patient advocate. He is the State's advocate whose job is to cut and squeeze patients, medical personel, and Insurers. Care costs money and Berwick is on a mission to cut care. The sugar of creating greater "efficiencies" will be overwhelmed by less care available (rationing), greater delays in receiving care (rationing), disincentives for medical personel in their work as well as recruitment of top domestic candidates, etc..
Ignoring Republican calls for selecting another candidate may be explained by Obama's desire to use Berwick as spike to begin the lurch towards Socialized Medicine as well as the thought that maybe Republicans will back down over time. Either way, Obama wins the longer Berwick remains. January 2012 is far enough away for myriads of byzantine and essentially clandestine changes to be implemented by the troika of Berwick-Sebelius-Obama, making the task of eradicating ObamaCare from existence that much more difficult.
I just saw this link and posted it here for reference. If you haven't seen it, I recommend it.
GOP Rep. Paul Ryan Exposes the ObamaCare Fiscal House of Cards – Video
Love that guy. Really wish he'd throw his hat into the ring.
Short, sweet and to the point. Thanks.
Occasionally, I'll check out technorati to scroll through its list of the top 100 blogs. This article caught my attention, so I thought I'd post the link.
Those are the Rules - Dutch Healthcare Not Up to Par
Great blog.
And I wish Dutch healthcare WAS "up to Par" -- and American healthcare was as well. Yes, please let Par decide! ;)
As Obamacare becomes fully implemented, I think we're going to be hearing "those are the rules" more often than not.
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Senator John Ensign (R-NV) argued that the regulations are already overburdening the American people and have exploded to over six thousand pages.
I’ve printed off many of the regulations in the bill here before us today. Look at the size of this thing, and they’re not even close to being done writing the regulations. I challenge anybody with any company or any American to try to understand this bill and its regulations. It’s virtually impossible. It takes a team of lawyers and health care experts to even come close to understanding all the implications of this bill, according to my staff’s calculations, so far about 6,200 pages in regulations. This could go to at least 26,000 pages. I think it is safe to say the devil really is in the details with this health bill. The American people are going to learn more about the unintended consequences of this legislation as more and more of these regulations roll out.
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The following article talks about ACO's and doctors:
Healthcare déjà vu
By Dr. Raymond Fabius - 02/25/11 04:35 PM ET
I’m having a case of health care déjà vu.
In the early 1990’s the health care industry plowed forward with managed care and in a short period of time millions of Americans enrolled in Health Maintenance Organizations (HMO’s) – changing the face of health care delivery in this country. Physician sentiment was not exactly positive during that transition. During care visits, we listened to our doctors tell us why participating in an HMO was sub-optimal. Many believe that this grassroots campaign of sorts, perpetuated largely through individual doctors’ office visits, significantly contributed to the fall of the “capitated” managed care movement.
And now we’re seeing the same problem all over again.
The 2011 Thomson Reuters/HCPlexus National Physicians Survey was conducted during another time of transition in healthcare delivery – probing physicians for their opinions on how the outcomes of healthcare reform will affect their patients, their practices, their profession, and their compensation.
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The results convey a negative sentiment among physicians regarding the present health care reform efforts. Sixty-five percent believe that the quality of health care in the country will deteriorate and 58 percent believe the impact on patients will be negative.
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The primarily negative reaction to health care reform signals a troubled physician population – be it primary care physicians or specialists – with many expressing strong feelings that either they or their colleagues may soon be disenfranchised. That’s a big problem for the reform agenda.
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Based on current physician sentiment, the government may have created a participation-based incentive structure that will have few participants. At this pace, if the current healthcare reform legislation survives its most recent judicial and legislative challenges, it will surely face more concerning battles in the clinical setting. To keep history from repeating itself at great cost to the American taxpayer and even greater political cost to the administration, steps need to be taken quickly to educate and engage frontline physicians and other providers on the value of ACOs, as well as lobby for their support of the initiative. The alternative is a practical insurrection that will dash any hopes for efficiencies of scale from coordinated care as costs skyrocket in response to the huge influx of the newly insured. Policymakers and administrators must start to include doctors in the discussion.
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"as costs skyrocket in response to the huge influx of the newly insured"? I thought Obamacare was going to bend the cost curve down.
Ohio is facing a tsunami of a fiscal crisis partially created by the wealth redistributing scam known as ObamaCare.
The $500 Billion to be drained from use in the Medicare program over the next decade is a major funding "investment" for Medicaid. Obviously, the Left anticipate greater numbers of Americans qualifying for Medicaid as their economic policies work its magic. To "stimulate" the rolls of Medicaid, the Left continue to lower the eligibility for programs like Medicaid and SCHIP but curiously not for Medicare. OK, not that curious. (400% of poverty limit qualifies for SCHIP in NY, for example. Seriously?)
Now comes an article about hospitals in Ohio wanting to cut deals with the new governor, Kasich (R), to prevent cutting of their reimbursement for Medicaid.
Hospitals make Ohio Gov. Kasich a deal on Medicaid: keep paying fee in return for no rate cutsBy Reginald Fields, The Plain Dealer
- "Two years ago, Ohio hospitals howled in protest, some complaining they would have to lay off medical personnel, over a plan that forced them to pay a special fee to help the state cover health care costs for the poor, disabled and elderly."
Let's not forget that hospitals give away millions in care that is not reimbursed by government or paid back by the patient. Former Ohio Governor Strickland (D) hit hospitals with a "franchise fee" (nicer name for a tax) on top of the "free" care they already provide. What a guy!
- "But now, as the state stares down an $8 billion budget deficit worsened by uncontrolled Medicaid spending, the Ohio Hospital Association is ready to make a deal: keep paying the dreaded franchise fee in return for a promise from Gov. John Kasich to not cut Medicaid reimbursement rates."
The author does recognize that Medicaid is spinning out of control but fails to connect the Democrat policies that set this debacle up in the first place - mandatory loosening of Medicaid eligibility combined with a crippling push for even more Medicaid via ObamaCare on top of an aging population and high unemployment.
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"The franchise fee was introduced during the 2009 budget negotiations under former Gov. Ted Strickland to help the state draw down more Medicaid federal matching dollars. It was a two-year temporary fee set to expire this summer."
First, the fee was done to promote Liberal entitlement policies. Second, by expanding Medicaid, Strickland locked in increasing numbers of enrollees which the State would need to cover after the Federal Government began to decrease their participatory amounts. Yes, the States were by design to be left eventually on the hook for a greater share than at the beginning of this particular wealth redistribution scam. Way to go again, ex-Gov. Strickland!
- "Think of it as hospitals loaning money to the state to allow Ohio to leverage the funds and bring in more federal money. "
!!!NO, NO NO!!! Think of it as being fed a tripledecker crap sandwich while being assured there's no crap in it. My head nearly exploded reading this, but, thanks to Motherbelt's inexhaustible supply of duct tape, I survived.
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"But with Ohio starting budget talks next month and facing a huge budget deficit, Kasich has indicated he is open to doing anything to shrink health care costs -- including cutting payment rates charged by hospitals and nursing homes.
Hearing that, the OHA decided it wanted to strike a deal."
So let me see if I have this right. All those hospitals like the Cleveland Clinic and others who supported Obama, Pelosi, Reid and Strickland in the Dante's Inferno of ObamaCare NOW see a problem? Better late than never, huh. (see link for more on the nine circles of Hell of ObamaCare)
- "We think there are certain changes we can make to the franchise fee to make it more sustainable and create a win-win for the state in a temporary situation," Biles said. "It's certainly not at the top of our list of things we want to do but is something we are willing to do given the current situation."
Ok. Maybe I was overstating the nine circles of Hell thing. The OHA sounds more like they are vasilating between "bargaining" and "denial" which Kubler-Ross defined in her 5 Stages of Grief . Look out if they ever hit "anger". To the moon, Alice!
- "Medicaid expenses this year will top $18 billion, which means about one in every three dollars Ohio spends is on health care for the poor, disabled and elderly."
And will keep going up under ObamaCare. Opps! Was I not supposed to say that? Boy, did I let the cat out of the bag or what.
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"Over the past two years, hospitals paid a franchise fee of 1.6 percent of hospital expenses, minus Medicare expenses. That amounted to about $580 million paid over three installments.
Cleveland hospitals are among those that have paid the highest fees. For example, the Cleveland Clinic will pay about $32 million between last year and this year, University Hospitals $15.4 million and MetroHealth Medical Center, the area hospital highest in Medicaid spending, paid a fee of $11.7 million.
Putting the fees toward Medicaid spending allowed Ohio to draw down an additional $1.2 billion from the federal government in matching funds."
By my calculation, Ohio has spent nearly $36 Billion over two years to receive $1.2 Billion, and did it by swelling the ranks of Medicaid and taxing hospitals, all the while knowing that Federal matching will wither eventually and the State will have to cover the balance. Awesome deal! I want the genius who put this sweetheart deal together to negotiate my next contract.
BTW, the Hospitals were taxed, uh, accessed fees over two years at a rate of 1.6% to collect the $580 Million amount. Is the $1.2 Billion in matching funds based on ONE year's fees or TWO year's fees, and is the $1.2B Fed money a one time thing at this matching level or, Obama forgive, ever? Enquiring minds want to know.
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"The hospitals are now being repaid the fee in a complicated reimbursement system based on how much care at a given facility is covered by Medicaid. And in many cases, the money is not coming back in an equitable fashion -- some hospitals are getting more than others despite how much they might have paid into the fee system.
[...]
That's not fair, the OHA argues."
Just figured that out, huh? From Blonde's cluebat: It never is fair in the land of wealth redistribution.
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"Biles said the OHA is offering to up the franchise fee over the next two years of the budget to 2.5 percent, for a total of about $900 million. That would allow Ohio to again draw down about $1.2 billion extra in federal matching money that Kasich could apply to the budget deficit.
In return, in addition to the rate freeze, the OHA wants the hospitals to get back what they paid into the system. OHA also wants to pay the fee over five or six installments instead of three."
So hospitals are willing to pay more confiscatory fees. Must not be hurting as much as they claim. Nice cave. It also appears Ohio will need to collect and/or spend more in order to receive this "extra" Fed matching money. Nice to know Obama has some "extra" cash laying around while this year's federal annual budget deficit is projected at over $1.7 Trillion and the national debt at over $14 Trillion.
The laugher of the article is OHA thinking each hospital will get back what they pay in. Another rap with Blonde's clue bat: Ummm, no. It's all about wealth redistribution, you dummies.
I have to say I liked the article in that the author, Mr. Fields, did a good job presenting the numbers and detailing the OHA's side. Not too much from the Kasich administration for their response. I'm sure I will in good time.
Bill to kill Ariz. Medicaid system to get hearing
Associated Press - February 21, 2011 12:44 PM ET
PHOENIX (AP) - The chairman of an Arizona Senate committee has scheduled a hearing on his bill to repeal the state's Medicaid program, the Arizona Health Care Cost Containment System.
[...]
Biggs is among majority Republicans who bemoan the financial burden that the Medicaid program places on the state.
[....]
Gov. Jan Brewer has proposed suspending coverage for approximately 280,000 adults, The federal government says the state has leeway to drop 250,000 next fall when the program is up for routine renewal.
Study: Doctors order tests out of fear of lawsuits
By MARILYNN MARCHIONE
Feb 16, 6:56 PM (ET)
SAN DIEGO (AP) - CT scans, MRIs and other pricey imaging tests are often more for the doctor's benefit than the patient's, new research confirms.
Roughly one-fifth of tests that bone and joint specialists order are because a doctor fears being sued, not because the patient needs them, a first-of-its-kind study in Pennsylvania suggests.
The study comes a day after President Barack Obama began a push to overhaul state medical malpractice laws as a way to reduce unnecessary tests that drive up health care costs.
[...]
Previous studies of how often this happens have relied on doctor surveys. This is the first one to enlist doctors in advance to track their decisions over time.
[...]
Surprisingly, the study found that newer doctors were less likely to be defensive.
"That's counterintuitive," Flynn said. "You would expect when you're new in practice, not as trustful of your clinical judgment, you'd order more."
Doctors who have been sued in the last five years were more likely to order tests defensively, said Robert Miller, a Temple University medical student who helped lead the study and presented the results at the conference. The authors said similar studies are needed on defensive imaging in other specialties.
[...]
I was surprised to read that the President has started to push for medical malpractice reform:
The study comes a day after President Barack Obama began a push to overhaul state medical malpractice laws
Is he throwing trial lawyers under the bus?
- "Doctors who have been sued in the last five years were more likely to order tests defensively,..."
And in other news today... a $40 Billion, multicenter, ten year HHS study has determined water is wet.
Training nowadays makes a concerted effort in teaching frugal diagnostic test ordering. For some physicians, the fear of mapractice and the desire to safeguard from incomplete diagnosis does not occur until your first 180 day letter - the legal document signaling an attorney is trying to find a reason to litigate. For others, it takes being deposed, going to court, or actually losing a case (in court or your liability carrier settling). Until your first letter, one may live in a blissfully immune state.
Obama says a lot of things. Mostly he's just paying lip service. This costs him nothing. Action costs. We'll see.
Healthcare Reform Law Requires New IRS Army Of 1,054
By Paul Bedard
Posted: February 15, 2011
The Internal Revenue Service says it will need an battalion of 1,054 new auditors and staffers and new facilities at a cost to taxpayers of more than $359 million in fiscal 2012 just to watch over the initial implementation of President Obama's healthcare reforms. Among the new corps will be 81 workers assigned to make sure tanning salons pay a new 10 percent excise tax. Their cost: $11.5 million.
[...]
In its request, the IRS explained that the tax changes associated with health reform are huge. "Implementation of the Affordable Care Act of 2010 presents a major challenge to the IRS. ACA represents the largest set of tax law changes in more than 20 years, with more than 40 provisions that amend the tax laws."
Unsaid: The requests are just the beginning, since the new healthcare program is evolving and won't be fully implemented until about 2014.
[...]
Pelosi was partially correct, the health care law is creating jobs, IRS jobs. From the article, a quote by Wyoming Sen. John Barrasso:
Adding hundreds of new jobs and millions of dollars to the IRS isn't going to make care better or more available for anyone.
[Edited] An afterthought. The President recently said "I didn't raise taxes once". If so, then why would the IRS (in the President's own budget) be requesting money for additional IRS agents to enforce new tax increases put into a bill the President signed into law.
Medicare Chief Dodges Republican Health Law Questions in House Testimony
By Jim Angle
Published February 11, 2011
Dr. Donald Berwick, the man in charge of Medicare and at the heart of implementing President Obama’s health care law, faced a barrage of questions from House Republicans over concerns about the plan and on his own controversial past positions.
But Berwick mostly praised the embattled new law and sidestepped questions about his own opinions on government-run health care.
[...]
Berwick was pressed on several of his previous statements, such as saying that competition doesn't help in health care, that he loved the British state-run health system, and another quote in which he said a single-payer system, meaning government-administered health care, is "the only sensible approach."
Camp asked him if he still feels that way, and got a lengthy treatise on the benefits of the new law.
"I am really excited,” Berwick responded, "about the promise the affordable care act offers, Mister Chairman, to American health care. I think we found our way to a really open door here now to a solution to the American health care problem. It's an investment in better care, better health, lower costs through the improvement of care."
While Republican Rep. Geoff Davis of Kentucky expressed disappointment with Berwick’s “lack of candid answers” the Obama appointee’s glowing description of the new law's benefits greatly pleased Democrats on the panel.
"I love your testimony,” Rep. John Lewis, D-Ga., gushed. "Not just like it, but I loved it."
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Thank you for this first installment of Berwick Robot Theater where Congress and the American people were treated to a Progressive's adaptation of the absurdist classic Waiting For Godot. The names and places have changed but we still wait in vain for answers.
Nancy Pelosi said on January 27, 2010: “The health care bill alone would produce four million jobs in the life of the bill,”
Fast forward to February, 2011: CBO Director Says Obamacare Would Reduce Employment by 800,000 Workers
[...]
Chairman [Paul] Ryan: “[I]t’s been argued...that the new health care law will create jobs and increase labor force participation. But if I recall from your analysis, it was quite the opposite. Is that not the case?”
Director [Douglas] Elmendorf : “Yes.”...
[...]
I'm still wondering how Pelosi determined 4 million jobs would be created.
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A subscription to Health Affairs is required to read the entire article, but the abstract is interesting.