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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsHoward Dean Attacks Important Piece Of Obamacare (updated 3x)
Last edited Mon Jul 29, 2013, 07:18 PM - Edit history (2)
In a Wall Street Journal op-ed Monday, Howard Dean calls for the repeal of an important piece of Obamacare -- the board set up by the law to contain Medicare costs at a certain level.
The Independent Payment Advisory Board, set to take effect in 2015, is tasked with cutting reimbursements to health providers if Medicare costs per patient in a given year exceed per-capita GDP plus one percent. Although it's a key cost-control mechanism, IPAB is not essential to the functioning of Obamacare.
"The IPAB is essentially a health-care rationing body," Dean writes. "There does have to be control of costs in our health-care system. However, rate settingthe essential mechanism of the IPABhas a 40-year track record of failure."
A former governor, Democratic National Committee chair and 2004 presidential candidate, Dean is now a senior strategic adviser and consultant on health care and energy issues for the lobbying firm McKenna Long & Aldridge LLP, which has some health provider clients.
- more -
http://livewire.talkingpointsmemo.com/entry/howard-dean-attacks-important-piece-of-obamacare
Oh my, Dean attacks "death panels." Any thoughts on the issue?
Why Sarah Palin Is Still Wrong About Death Panels
http://thinkprogress.org/health/2010/12/10/171830/death-panel-palin/
Rep. Renee Elmers Revives Death Panel Lie: IPAB Will Make Coverage Decisions On Case By Case Basis
http://thinkprogress.org/health/2011/07/06/262114/rep-renee-elmers-revives-death-panel-lie-ipab-will-make-coverage-decisions-on-case-by-case-basis/
Health Care Cost Reform Rediscovers an Old Progressive Idea
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x8037705
Republican Leaders Refuse To Make Appointments To Key Obamacare Panel
http://tpmdc.talkingpointsmemo.com/2013/05/boehner-mcconnell-letter-obama-ipab-obamacare.php
Updated to add this from Dean's op-ed:
To date, 22 Democrats have joined Republicans in the House and Senate in support of legislation to do away with the IPAB. Yet because of the extraordinary partisanship on Capitol Hill and Republican threats to defund the law through the appropriations process, it is unlikely that any change in the Affordable Care Act will take place soon.
The IPAB will cause frustration to providers and patients alike, and it will fail to control costs. When, and if, the atmosphere on Capitol Hill improves and leadership becomes interested again in addressing real problems instead of posturing, getting rid of the IPAB is something Democrats and Republicans ought to agree on.
http://online.wsj.com/article/SB10001424127887324110404578628542498014414.html
Here are the bills and co-sponsors.
H.R.351 - Protecting Seniors' Access to Medicare Act of 2013
http://beta.congress.gov/bill/113th-congress/house-bill/351/cosponsors?pageSort=firstToLast&Political_Party=Democratic
House - 169 Republican and 21 Democratic co-sponsors. Democrats:
Rep. Schwartz, Allyson Y. [D-PA-13]*
Rep. Bishop, Timothy H. [D-NY-1]*
Rep. Christensen, Donna M. [D-VI-At Large]*
Rep. Courtney, Joe [D-CT-2]*
Rep. Sanchez, Linda T. [D-CA-38]*
Rep. Matheson, Jim [D-UT-4]*
Rep. Capuano, Michael E. [D-MA-7]
Rep. Pascrell, Bill, Jr. [D-NJ-9]
Rep. McIntyre, Mike [D-NC-7]
Rep. McCarthy, Carolyn [D-NY-4]
Rep. Ruiz, Raul [D-CA-36]
Rep. Maloney, Sean Patrick [D-NY-18]
Rep. Barrow, John [D-GA-12]
Rep. Negrete McLeod, Gloria [D-CA-35]
Rep. Maffei, Daniel B. [D-NY-24]
Rep. Scott, David [D-GA-13]
Rep. Sanchez, Loretta [D-CA-46]
Rep. Barber, Ron [D-AZ-2]
Rep. Lynch, Stephen F. [D-MA-8]
Rep. Sinema, Kyrsten [D-AZ-9]
Rep. Kirkpatrick, Ann [D-AZ-1]
S.351 - Protecting Seniors' Access to Medicare Act of 2013
http://beta.congress.gov/bill/113th-congress/senate-bill/351/cosponsors
Senate - 34 Republican and one Democratic co-sponsors.
Democrat: Sen. Pryor, Mark L.
All Dems Opposing Medicare Panel Have Major Industry Ties
http://www.motherjones.com/mojo/2011/04/all-dems-opposing-medicare-panel-have-major-industry-ties
Update 2:
Howard Dean's misplaced IPAB fight
http://maddowblog.msnbc.com/_news/2013/07/29/19758220-howard-deans-misplaced-ipab-fight
Update 3:
Howard Dean serves up IPABlum on Obamacare
http://www.dailykos.com/story/2013/07/29/1227496/-Howard-Dean-serves-up-IPABlum-on-Obamacare
cali
(114,904 posts)Yikes.
ProSense
(116,464 posts)Why do you think it shouldn't be posted?
PoliticAverse
(26,366 posts)ProSense
(116,464 posts)Puzzledtraveller
(5,937 posts)Professional posters, maybe they get paid by an outside consulting firm that employees people to post in message boards to persuade opinion or to keep a constant effort in place to legitimize and when necessary de legitimize opposition. Yes I know it's "tinfoil" of me but I do wonder.
mattclearing
(10,091 posts)mattclearing
(10,091 posts)Puzzledtraveller
(5,937 posts)I had not seen this, thanks.
ProSense
(116,464 posts)So you're saying that posting Howard Dean's op-ed means I'm a "paid" shill?
Why did Dean write it if it can't be posted anywhere without "tinfoil" popping up?
zipplewrath
(16,646 posts)They probably already thought you were a paid shill. I just so happens that today was the day for posting about Dean's comments.
ProSense
(116,464 posts)"I just so happens that today was the day for posting about Dean's comments."
Yeah, but what are your thoughts on Dean's call to repeal the panel.
I mean, I really don't care if you or anyone else thinks calling me or anyone else a "paid shill" is cool or bolsters your progressive credentials. You can go on thinking that, announce it in every thread if it makes you feel better, but at least comment on the topic...or not.
I look forward to the next thread and the "paid shill" accusations.
zipplewrath
(16,646 posts)I just explained that you had the logic backwards.
ProSense
(116,464 posts)It's a cheap deflection tactic.
My comment was snarky and I didn't need your explanation. You likely knew that, but decided to offer it any way.
zipplewrath
(16,646 posts)I was commenting on your logic, that tried to place the conclusion that you were a paid shill as a function of the OP.
By the way your comment was also a deflection tactic, trying to avoid the subject of whether you are a paid shill or not.
Oh, and I'm also glad to see you admit that you were snarky. Now, back to whether you are a paid shill.
ProSense
(116,464 posts)Oh, and I'm also glad to see you admit that you were snarky. Now, back to whether you are a paid shill.
...and you're really not that clever. Again, I look forward to more of this from you in upcoming threads. Enjoy.
kelliekat44
(7,759 posts)That Dean's employer has health care clients that stand to lose money from IPAB is a relevant detail that the Wall Street Journal's editorial board did not include for readers to consider. (In 2011, Salon asked the lobbying firm and Dean's office for a list of his clients. They both declined.)
quinnox
(20,600 posts)I'm not familiar with all the complexities of this area, but I think Dean knows what he is talking about when it comes to health care and the medical field, since he is a physician.
Bunnahabhain
(857 posts)Just because Dean is a physician does not mean he understands healthcare economics. However, he's right in this case. Tying together two such disparate things is stupid. What the metric of per capita GDP should have to do with Medicare payments is beyond me.
cali
(114,904 posts)is health policy would indicate that he does indeed understand the economics of the field.
Bunnahabhain
(857 posts)The sole criteria given was because Dean's a physician, now wasn't it? I find many people seem to think being a healthcare practitioner means they understand healthcare economics and nothing could be more remote from the truth 99.9% of the time. You will also note that I stated he was correct in this case.
cali
(114,904 posts)don't you think they know about his expertise? I believe they do and I think people tend to say he's Dr. as a shortcut.
Bunnahabhain
(857 posts)"...since he's a physician."
Have a nice day.
cali
(114,904 posts)ta ta
Hoyt
(54,770 posts)McKenna Long, that represents a lot of hospitals, physicians, etc. Consequently, I now have to take his opinions about like I would the Hospital Association, sometimes right, but always biased.
ProSense
(116,464 posts)It says pretty clearly that payments shall be cut based on per capita GDP. How am I misrepresenting anything?
ProSense
(116,464 posts)"It says pretty clearly that payments shall be cut based on per capita GDP. How am I misrepresenting anything?"
...not the point. It's to reduce inefficiencies, control costs and improve the quality of care. The notion that this is simply about cutting payments is where the "death panels."
This could help to significantly reduce drug prices, etc.
Bunnahabhain
(857 posts)I agreed with Dean and said I think tying per capita GDP with rate cuts makes no sense. From there you infer I am misrepresenting the panel into some sort of Palin-esque bullshit? Umm, okay.
ProSense
(116,464 posts)Bunnahabhain
(857 posts)If part of the charge of the panel, as you said, is to improve quality of care and find efficiencies, will these recommendations be listened to? I tend to doubt this and would use as an example what happened when an expert panel made recommendations concerning breast cancer screening. Obama and Sebelius completely threw that panel of experts under the bus and ignored their advice. I was completely floored and thought it was a very Republican move to ignore science like that.
ProSense
(116,464 posts)"If part of the charge of the panel, as you said, is to improve quality of care and find efficiencies, will these recommendations be listened to? I tend to doubt this and would use as an example what happened when an expert panel made recommendations concerning breast cancer screening. Obama and Sebelius completely threw that panel of experts under the bus and ignored their advice. I was completely floored and thought it was a very Republican move to ignore science like that."
...if no one is going listen to the recommendations, then what's the concern?
Bunnahabhain
(857 posts)The concern would be twofold. First wasting the time and money to have said panels make said recommendations and the second would be ignoring sound advice that would lead to both improved quality of care and saving scarce medical resources.
ProSense
(116,464 posts)"The concern would be twofold. First wasting the time and money to have said panels make said recommendations and the second would be ignoring sound advice that would lead to both improved quality of care and saving scarce medical resources."
... how is offering "sound advice" wasting "time and money"?
I mean, concern that the "sound advice" would be ignored is not justification for repealing the panel.
Bunnahabhain
(857 posts)then it's a waste of money. The impact is zero yet the costs of acquisition of said advice were incurred, this the system is at a net negative. This is not apparent to you?
It also has other various collateral effects such as creating an anti-science attitude. It's bad enough the Republicans want to ignore science we really do not need the Dems to get that way too.
ProSense
(116,464 posts)That's not a good reason to repeal the law. Good recommendations, "sound advice" needs to be presented. People can work on pushing elected officials to enact them. Happens all the time.
Bunnahabhain
(857 posts)that indicate politics will get in the way of big decisions. Yes, I cannot predict the future with 100% accuracy but I feel very safe in predicting that politicians, of all stripes, will want to get re-elected or be well thought of by their base for legacy if not up for re-election. I feel very confident this will tend to make decisions driven by politics and not science.
Btw, by "repeal the law" are you talking about the entire ACA or merely tweaking parts of it? I mean, it's not a binary situation here.
Scuba
(53,475 posts)ProSense
(116,464 posts)In fact, this is a call for repealing an important provision that will strengthen Medicare.
mattclearing
(10,091 posts)I still think it's questionable to throw Dean in with Sarah Palin, and it's not clear to me that his complaint is in the same ballpark as "death panels," but at least this isn't a jab in the eye of Dean supporters masquerading as a policy dispute.
think
(11,641 posts)Mr. David
(535 posts)Who happens to be a doctor and knows EXACTLY what he is talking about?
Dr. Dean's right.
If he knows what's wrong with the rate setting, and has first-hand experience about it, then he doe have the right to attack the IPAB. He clearly says "IPAB is not essential to functioning of Obamacare" - and I happen to agree, and will back Dean 100% on this.
I certainly hope Dr. Dean decides to announce his candidacy in 2016. I know he is a centrist, but he is a true centrist that won't back down from stupid Republicans. I am ready to help him fill in the bat once again.
tridim
(45,358 posts)Because of this the price of HEALTHCARE is going to fall very quickly after 2014.. The free ride is over for doctors, hospitals and insurers. No more collusion.
Competition is key, something we have never had in this country.
Bunnahabhain
(857 posts)they are using a silly metric for said rate setting. Dean is completely correct here.
Mr. David
(535 posts)and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.
No, it's still not going to happen. Dean is thinking about throwing his hat in 2016, and if he does announce, I will be happy to fill his bat once again.
He got screwed in 2004, and he won't be screwed again.
Had he not gotten screwed back then, Dean would have been ready to retire last year, paving the way to maybe a older and wiser Obama.
But now he's gotta move the Party back to the progressive side, and to do that, he has to pull the Party out of the right end of the spectrum first.
And that OP of yours is an failing attempt to destroy Dean. And you are comparing apples and oranges with Sarah Palin.
ProSense
(116,464 posts)I disagree with Dean's call for repealing part of the law.
Your CT is beyond bizarre.
Mr. David
(535 posts)Not trash it.
There are more ways to improve Obamacare - and this happen to be one of them, and thanks for the CT designator. It just means you're a bully.
ProSense
(116,464 posts)"I think Dean intends to repeal that part of the law to IMPROVE on Obamacare..."
...is being led by Republicans. Only one Senate Democrat, Mark Pryor, supports it.
"There are more ways to improve Obamacare - and this happen to be one of them, and thanks for the CT designator. It just means you're a bully."
That hilarious. You're calling me a "bully" for saying that this comment:
http://www.democraticunderground.com/10023364911#post20
...is a CT.
Mr. David
(535 posts)Downthread...
And being selective about it too. And just proving my "conspiracy theory" each time. Repeatedly.
ProSense
(116,464 posts)Downthread...
And being selective about it too. And just proving my "conspiracy theory" each time. Repeatedly.
...that you're name calling and pushing a CT throughout the thread, and then claiming that I am a "bully."
Just Saying
(1,799 posts)I understand what the law is attempting to do but apparently Dr. Dean believes it's patients who will lose out and I'm sure that wasn't the intention.
I hate the term "death panels" as this was just a GOP talking point used against government involvement in healthcare when any rational person knows they already exist-in the insurance industry.
leftstreet
(36,109 posts)Comparing Dean to Palin...so he's running then?
PowerToThePeople
(9,610 posts)The Op Ed that your livewire blurb quotes is much better. He is trying to do the right thing for the public. That is why I wanted him instead of Kerry. I still despise that the Dean scream smear campaign was successful.
ProSense
(116,464 posts)Bunnahabhain
(857 posts)to deliver. Your link, which is a good one, says:
Accountable Care Organizations could eliminate duplicative services and prevent medical errors while seeking to reduce costs for individuals, particularly if their creation ultimately leads to the end of fee-for-service medicine, as I believe it will.
The problem is the ACO concept, as currently designed, is failing. Of the 32 original pioneering ACOs, nine have already given up and I read something last week that another 14 are going to dissolve. The one I am involved in went from 0 to 100 mph and then 100 mph to 5 mph. Basically the initial enthusiasm is all gone and people are realizing what is at stake and the complexity of this system. IMO, the only good thing is an ACO is provider driven vs. being driven by insurance but even that is not completely true. The carrot and stick is still being held out by CMS, so at its root, the ACO mechanism is to punish organizations that do not adequately meet the metrics determined by CMS. I think involving providers in determining the metrics would be a more intelligent move as decision makers at CMS are often pretty removed from real life health care delivery.
Just IMO.
ProSense
(116,464 posts)Those are among the best things in the health care law.
"The problem is the ACO concept, as currently designed, is failing. Of the 32 original pioneering ACOs, nine have already given up and I read something last week that another 14 are going to dissolve. The one I am involved in went from 0 to 100 mph and then 100 mph to 5 mph. Basically the initial enthusiasm is all gone and people are realizing what is at stake and the complexity of this system. IMO, the only good thing is an ACO is provider driven vs. being driven by insurance but even that is not completely true. The carrot and stick is still being held out by CMS, so at its root, the ACO mechanism is to punish organizations that do not adequately meet the metrics determined by CMS. I think involving providers in determining the metrics would be a more intelligent move as decision makers at CMS are often pretty removed from real life health care delivery. "
That is not accurate.
Providers Form 106 New Accountable Care Organizations
Doctors and health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, ensuring as many as 4 million Medicare beneficiaries now have access to high-quality, coordinated care across the United States, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.
Doctors and health care providers can establish Accountable Care Organizations in order to work together to provide higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the ACO. Accountable Care Organizations share with Medicare any savings generated from lowering the growth in health care costs, while meeting standards for quality of care.
Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare, said Secretary Sebelius. Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.
ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative could be up to $940 million over four years.
The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20 percent of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.
The group announced today also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicares ACO partners will serve more than 4 million beneficiaries nationwide.
Also today HHS issued a new report showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.
For more information on the HHS issue brief, Growth in Medicare Spending per Beneficiary Continues to Hit Historic Lows, visit: http://aspe.hhs.gov/health/reports/2013/medicarespendinggrowth/ib.cfm
Additional information about the Advance Payment Model is available at http://www.innovations.cms.gov/initiatives/ACO/Advance-Payment/index.html.
The next application period for organizations that wish to participate in the Shared Savings Program beginning in January 2014 is summer 2013. More information about the Shared Savings Program is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/
For a list of the 106 new ACOs announced today, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html
http://www.hhs.gov/news/press/2013pres/01/20130110a.html
Bunnahabhain
(857 posts)and my personal experience. Nine of the original 32 ACOs are gone, I've read more are on the way. I can tell you my personal work experience. What I have said is accurate. Your choice whether to believe it or not.
As I said, they need tweaking. I am far from the only person that actually does this for a living saying that. You find it surprising that CMS want you to believe CMS got it right on the first try? Given the level of complexity does that even give you any pause? It's okay to say something is not working quite as intended and needs tweaking.
Feel free to share your personal experience too.
ProSense
(116,464 posts)"Nine of the original 32 ACOs are gone, I've read more are on the way. "
...have a link to this information?
Bunnahabhain
(857 posts)That's just one quick link. This info is all over the place in trade publications.
"Pioneer models benchmarks can move throughout the plan year," he wrote in an emailed statement. And that's like trying to get a bull's eye on a moving target. Because of how the benchmarks were set, Plus ACO is at risk of paying $6 million to $9 million in annual penalties.
The other eight saying sayonara to the Pioneer program include: Prime Care Medical Network; University of Michigan; Physician Health Partners; Healthcare Partners Nevada ACO; Healthcare Partners; California ACO; JSA Care Partners; and Presbyterian Healthcare Services.
For Denver-based Physician Health Partners one of the nine groups dropping out of the Pioneer model but vowing to continue with a shared savings plan the benchmark setting process within the Pioneer needed some serious re-working.
Considering theres still significant tweaking going on with benchmarks, "We cant take that much risk when the game keeps changing a little bit," Kenneth Nielsen, president and CEO of Physician Health Partners, told Healthcare IT News, especially when these adjustments arent geographically based. "The Denver market, where our benchmark was $8,000 per beneficiary, per year is a lot different than an East Coast market where their benchmark was twice that."
Notice the criticism was with the metrics, just as I said above.
ProSense
(116,464 posts)...article about financially-strapped organizations. That aspect has nothing to do with the effectiveness of the ACOs. In fact, the article mentions a number of ways in which they were effective in meeting the objectives.
<...>
The good news, he points out, is that all of the ACOs did well from a reporting standpoint in terms of quality. Ten of the 32 also produced collective shared savings of $87.6 million last year.
Here's a similar article:
Blame ObamaCare
http://www.democraticunderground.com/10022780631
Bunnahabhain
(857 posts)Do you expect them to continue participating?
ProSense
(116,464 posts)"If it's not financially viable for the participants
Do you expect them to continue participating? "
...mentioned a letter to CMS explaining what can be done. The article goes on to say that the organization was determined to make the program work.
Not all programs are running into difficulty. See the HHS piece in my previous comment.
by David GornFriday, July 26, 2013
Accountable care organizations could be the linchpin of successful health care reform, according to experts at a forum last week in San Francisco.
"ACOs only take up seven pages in the uncountable number of pages in the Affordable Care Act but they are at the moment one of the fastest growing and most important elements of reform," said Wendy Everett, president of NEHI, previously known as the New England Health Institute, which sponsored the July 17 event in San Francisco.
"They're changing how health care is delivered and paid for in this country," Everett said, "and they're a vital and important part of what we're doing."
Everett said there are currently about 250 ACOs in the country, "with another 500 new groups that have submitted to be an ACO so far this year," she said.
- more -
http://www.californiahealthline.org/capitol-desk/2013/7/will-acos-pave-the-path-to-reform
Bunnahabhain
(857 posts)I did not say "all programs are running into problems." Time to pull out the logical fallacies now, eh?
And you never answered my direct question: if an organization finds the ACO not to be financially viable for them do you expect them to continue participating?
I am completely unsure why you are so against modification of ACOs so they are a huge success. The two links I gave you clearly echoed the criticism from my real life experience namely that of metrics. Do you want the ACA to fail? I mean, what's your agenda here for fighting the concept that the first iteration of ACOs is not going to work and intelligent changes need to be made?
ProSense
(116,464 posts)"I did not say 'all programs are running into problems.' Time to pull out the logical fallacies now, eh?"
I didn't say you did. In fact, no where in my comment does it say "all programs are running into problems."
I said in reference to the articles I posted that "not all programs are running into difficulty."
Bunnahabhain
(857 posts)Have a great day.
Mojorabbit
(16,020 posts)Bunnahabhain
(857 posts)that specifically deals with what I have said repeatedly; metrics.
http://aishealth.com/sites/all/files/marketplace_pdf_samples/abn0413.pdf
It also brings up the interesting issue of possible anti-trust situations. ACOs basically want to align into vertical market sharing groups and this could be an issue.
ProSense
(116,464 posts)asking for time to ramp up and financial support in the interim.
Bunnahabhain
(857 posts)but you can't make him think.
There is always room for improvement in my world. If we are not going to get single payer I want ACOs to be the best they can be...and they currently have problems as I have clearly demonstrated. Your choice to ignore the data I have so kindly shared (which is exactly what I'm have already predicted will happen, no? You're just proving that point for me.)
ProSense
(116,464 posts)"There is always room for improvement in my world. If we are not going to get single payer I want ACOs to be the best they can be...and they currently have problems as I have clearly demonstrated. Your choice to ignore the data I have so kindly shared (which is exactly what I'm have already predicted will happen, no? You're just proving that point for me.)"
...I stated has anything to do with a "choice to ignore the data." In fact, I read the articles carefully, and they are about improving the ACOs, which was not the point of your first comment. These are new organizations implementing a new program. There will be adjustments and growing pains.
Bunnahabhain
(857 posts)I mean, you missed where I said that in almost every post I have made to you?
ACOs are not currently viable. They need improving.
Please feel free to share your relevant real life experience as I have. Otherwise, have a great day.
ProSense
(116,464 posts)Your words, and you provided a couple of articles that have nothing to do with the "concept" or that it's "failing."
The articles you posted were about the struggles of financially-strapped organizations. Both articles show that the objectives were being met, but more time and funding are needed.
Given the short period of time these organizations have been in existence, I'd say that it's remarkable that they can show positive results.
Bunnahabhain
(857 posts)because you started off asking for proof nine of the original 32 ACOs are gone. Now I just have you rationalizing why they left so that is improvement.
And after repeated requests you have yet to share your relevant real life insight. Arm chair quarterbacks never want to believe what people actually in the trenches have to say. More proof for my prediction above.
ProSense
(116,464 posts)That's "progress" too.
Bunnahabhain
(857 posts)But hey, if that's what you need to do to continue supporting whatever it is you're supporting...more power to you.
ProSense
(116,464 posts)You didn't say that?
Bunnahabhain
(857 posts)There is a huge difference between your initial misquote and what I actually said. Why are you playing such stupid games? I mean, do you think I have demonstrated such a low level of intelligence, reading comprehension, critical thought and actual real life experience that your silly games would confuse me?
Give it a rest. We all see what you're about.
ProSense
(116,464 posts)Give it a rest. We all see what you're about.
Please tell me what this:
"The problem is the ACO concept, as currently designed, is failing."
...meant if not that the "ACO concept" is "failing."
I really want to know.
Bunnahabhain
(857 posts)Leaving out that very important clause, "as currently designed," is selective editing. Selective editing is a cheap trick and blocks any actual dialogue. If you have to dice and splice my words to support some position you feel I hold I obviously do not hold it and one must wonder your intent in so doing. So I really want to know...what is your intent in what must be intentional misportrayl of what I'm saying? I have taken the time to engage you, offer relevant facts and insights, given my honest input on a course correct, and your response is to use stupid high school rhetoric tricks vs. maybe learning something?
ProSense
(116,464 posts)"Leaving out that very important clause, 'as currently designed,' is selective editing."
...they aren't "failing" "as currently designed."
I repeat, the articles you posted were about the struggles of financially-strapped organizations. Both articles show that the objectives were being met, but more time and funding are needed.
Given the short period of time these organizations have been in existence, I'd say that it's remarkable that they can show positive results.
Bunnahabhain
(857 posts)you have now taken to selective data picking.
I repeat: if the program is not financially viable it's a failed program! When participants are dropping out for a reasonable and identified dissatisfier it only makes sense to fix it. Payment methodologies are not simple; it's not like we have a FFS in the age of DRGs, co-morbidity modifiers/add ons, PPS, etc. along with claw backs, penalties, and potential at risk payments. In particular participants have also identified the metrics used for program success criteria to need work.
You can keep repeating your bullshit or you could make everyone here think you are intelligent and simply acknowledge ACOs, if they do not change, will probably fail. Things have to be a win for the providers or it is completely unreasonable to expect their participation let alone their willing participation.
Also, surprise, surprise, you're misrepresenting the article. In my first link only one organization, the first one, speaks of being "financially strapped." Why are you continuing to be so deceitful? What is your agenda?
ProSense
(116,464 posts)"Ignoring your selective editing you have now taken to selective data picking."
You keep repeating that, but your original statement is clear, including the comment about "failing."
You now say:
That's like claiming that Solyndra is an indication of a "failing" program.
The organizations are struggling financially, that doesn't mean the ACO concept is a failure, and especially because there are others that aren't financially strapped, and all indicate the concept is effective.
Bunnahabhain
(857 posts)You've grown boring. From the article:
For PHP, it wasnt all bad news, however. They were able to decrease their readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasnt viable. They reported shared losses for fiscal year one, which was anticipated, Nielsen says, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just werent able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "Were between bleeding edge and cutting edge."
MedeAnalytics Perez says this is all too common. Stepping down to a shared-savings ACO, he opines, is better than ditching the models altogether, but dont expect the big paybacks years down the road. "Its kind of like saying, 'We were in the English Premier League in soccer, and we didnt do very well, so now were going to play in the United States, or play basketball in Australia versus the NBA,'" said Perez. "So youre still in the game, except Kobe Bryants not going to shoot over you."
This will be my last post to you on this topic so please feel free to post another non-responsive or intellectually false reply and deem yourself the victor of this conversation. Anyone reading this can see exactly what I've said, how I've supported it, and my obvious actual knowledge on the topic. They can also see you for what you are.
ProSense
(116,464 posts)For PHP, it wasnt all bad news, however. They were able to decrease their readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasnt viable. They reported shared losses for fiscal year one, which was anticipated, Nielsen says, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just werent able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "Were between bleeding edge and cutting edge."
MedeAnalytics Perez says this is all too common. Stepping down to a shared-savings ACO, he opines, is better than ditching the models altogether, but dont expect the big paybacks years down the road. "Its kind of like saying, 'We were in the English Premier League in soccer, and we didnt do very well, so now were going to play in the United States, or play basketball in Australia versus the NBA,'" said Perez. "So youre still in the game, except Kobe Bryants not going to shoot over you."
This will be my last post to you on this topic so please feel free to post another non-responsive or intellectually false reply and deem yourself the victor of this conversation. Anyone reading this can see exactly what I've said, how I've supported it, and my obvious actual knowledge on the topic. They can also see you for what you are.
What does that have to do with the ACO concept? You're posting analysis of a few financially strapped organizations.
As I pointed otu earlier, the article mentions a number of ways in which they were effective in meeting the objectives. The next paragraphs:
One problem, however, is that a handful of the 33 quality measures pertain to preventive screenings.
"The problem with it, of course, is that preventative care screenings dont give you a short term financial benefit," Perez explained. "Theyre good solid pillars of population health management, but they show the benefits three, four, five years down the road."
Thus, at the end of the day for the Pioneer model, patience does indeed prove itself a virtue, but also a luxury that many cannot afford, as many providers simply don't have the financial or psychological stamina to stick with it and reap the long-term rewards.
The article addresses a case study of a specific group of ACOs related to their financial viability. More time and funding is not about the ACO concept. It's about financial stability of a startup organization.
Mr. David
(535 posts)(snipped Prosense's selective word choices)
You're just losing the battle with BB, so you just don't know when you can quit, can you?
ProSense
(116,464 posts)Mr. David
(535 posts)She called me a Conspiracy Theorist when she is being attacked.
It's a sign of a bully running away from the subject when called upon it.
Nonsense wanted a smear article to get rid of potential candidates to her beloved Hillary Clinton.
She has earned the nickname "Nonsense" and wants to push shill articles favoring the Third Wayers and not progressives.
That's the best you can do.
ProSense
(116,464 posts)It's a sign of a bully running away from the subject when called upon it.
Nonsense wanted a smear article to get rid of potential candidates to her beloved Hillary Clinton.
She has earned the nickname "Nonsense" and wants to push shill articles favoring the Third Wayers and not progressives.
That's the best you can do.
...you are dealing with some issues.
http://www.democraticunderground.com/10023364911#post20
Yikes!
Mr. David
(535 posts)Just proving yourself a bully. And ignoring what everyone else has told you - REPEATEDLY to shove your agenda.
Not working here, and it's failing. Your ways are gone, forever.
ProSense
(116,464 posts)They're your words. Why do you equate quoting you with "attacking you"?
"Just proving yourself a bully. And ignoring what everyone else has told you - REPEATEDLY to shove your agenda.
Not working here, and it's failing. Your ways are gone, forever. "
You're upset that I have my own opinions and defend them?
This:
and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.
http://www.democraticunderground.com/10023364911#post20
...is quoting you. The fact that it makes no sense is on you. I characterized it as a CT, IMO.
Mr. David
(535 posts)And I bet you want to have the last word on this. So goodbye and I won't be responding to any more of your silly bullshit.
ProSense
(116,464 posts)zipplewrath
(16,646 posts)I strongly suspect this horse isn't paid to think. They are paid to promote.
Bunnahabhain
(857 posts)ProSense
(116,464 posts)Welcome to DU!
Where was my manners?
ProSense
(116,464 posts)zipplewrath
(16,646 posts)ProSense
(116,464 posts)Mr. David
(535 posts)Yeah, the nag is a fully paid Democratic strategist for the Third Way politics.
In other words, a shill.
So I'm not buying one single iota of NonSense's bullshit. And you shouldn't too.
ProSense
(116,464 posts)Mr. David
(535 posts)Soon you'll be crying.
ProSense
(116,464 posts)and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.
http://www.democraticunderground.com/10023364911#post20
PowerToThePeople
(9,610 posts)n/t
wtmusic
(39,166 posts)Pretzel_Warrior
(8,361 posts)He hadn't just written a NYT op-Ed attacking part of Obamacare.
I think he wants the controversy. So ProSense is actually helping further publicize Howard Dean.
ProSense
(116,464 posts)freshwest
(53,661 posts)Last edited Mon Jul 29, 2013, 08:20 PM - Edit history (1)
Single Payer health care financed by general revenue is where such a mechanism makes sense as it maintains basic care for all of its citizens regardless of income.
IMO, the ACA was designed to convince Americans to accept Single Payer in time. But there is a form of 'rationing' in Single Payer countries Americans don't want to accept as a reality. But it is not for profit and is not unjust.
Many Americans see themselves as more entitled than others by the lives they have lived. We have a mixed system since a majority don't really support Single Payer for that reason. The issue isn't in Washington. It's more personal than some are willing to admit.
For example, should a person who is mobility impaired be guaranteed a regular wheelchair or a top of the line, all bells and whistles, high powered scooter?
The answer to that question in a Single Payer system is a snapshot of the prosperity of a nation and its tax funded health care system. It is proof of unspoken beliefs about equality. I was brought up with this meme:
'Budgets are moral documents.'
Because they show what a nation values. Some Americans don't care about equality in that arena, despite their lip service to it.
They have worked hard and their SOL has been good enough to afford what they feel they deserve and pressure the current system to give them the best, even if that mixed system means others get little or nothing.
Freedom isn't free and neither is Equality. People need to consdier the costs before they blithely say it's easy. This is where Single Payer gets down to the Nitty Gritty.
Visualize our population of raging Tea Partiers running around on taxpayer funded electric scooters, cursing socialized medicine.
Or just look at the Tea Party to see arrogance in action to others in need in help. A trip down memory lane during the ACA debate, even before the Republicans called for the death of the uninsured for 'freedom and liberty.' They dare talk about Death Panels?
Oh, well:
Connecting to GDP reflects the overall health of the economies of single payer systems. This doesn't have to be a denial of care issue.
But it'll be demagogued in 2014 and 2016 without looking at the larger picture. Because the media and many people are refusing to discuss what PBO wants us to consider for the path to take:
PBO believes we will not let those 50 million people down in 2014.
It will be hard to get honest discussion of this anywhere.
ProSense
(116,464 posts)One Senator, Mark Pryor?
He voted against the health care law.
GlashFordan
(216 posts)He's principled, progressive and likeable.
He would have been a more formidable candidate than John Mittens Kerry.
Have Dean get to work in January 2005 and the disaster that was Shrub II may have been averted.
ProSense
(116,464 posts)He's principled, progressive and likeable.
He would have been a more formidable candidate than John Mittens Kerry.
Have Dean get to work in January 2005 and the disaster that was Shrub II may have been averted.
...posting his op-ed and disagreeing with him is an "attack"?
"John Mittens Kerry"?
GlashFordan
(216 posts)Came across as a blue blooded elitist. Bush 2004 was weak and a different candidate would have won. Or maybe it was because Kerry was FOR the war before he was against it lol.
Dr. Dean is a great man. But he will never be elected because he doesn't meet the corporate cookie cutter mold. For the same reason, Elizabeth Warren is one of the most noble progressives in the country but the corporate and MIC overlords will never let her rise...
ProSense
(116,464 posts)Still, what does anyone of that have to do with Dean's op-ed?
karynnj
(59,504 posts)Last edited Mon Jul 29, 2013, 09:18 PM - Edit history (1)
It doesn't matter if everyone you know hated him - more than half the country didn't. Now, you can say that his numbers fell to slightly below 50 and that many self proclaimed sage pundits said that anyone below 50 was very likely to lose. In fact, at the time I knew this was a "rule" based on NO Presidential data - there were no Presidents before that were in the high 40s. My fear was that some of those who did not approve were people like Buchanan - not approving of Bush, but extremely right wing and very likely to vote for him. (This is also why Obama polled ahead of Romney while under 50%)
Polls in January 2004 showed that Dean polled less well against Bush than generic Democrat. Kerry, polled in February polled better than generic Democrat. (Kerry was not polled in January as no one thought he could get the nomination and after Iowa Kerry was the one polled.) Nice that you repeat a Republican smear from 2004 - Kerry was not for the war - any more than Dean was.
I have no problem with Dean, he and Kerry were the candidates that I wanted to win. As to not being "corporate cookie cutter", I suggest you google Kerry BCCI investigation. The fact is that he was more liberal and fought powerful people in the Democratic party far more than Dean did as a centrist Democratic governor of Vermont.
ProSense
(116,464 posts)freshwest
(53,661 posts)Cha
(297,317 posts)been posted. Then a discussion ensues. Do you agree with Dean's position or not?
AllINeedIsCoffee
(772 posts)freshwest
(53,661 posts)Well, either of them would have been, but Kerry earned his bonafides back in the VVAW days and since then.
Enough to make the RW machine have to invent a new smear tactic called Swiftboating.
Different from Atwater's racist Southern Strategy, but similiar to Segretti's Ratfucking method.
Which they have never stopped using, as they did all the time Clinton was in office as well as Obama.
The GOP is the party of dirty tricks, law breakers and chicken hawks. It pays so well.
Rex
(65,616 posts)Since that is about as far as their intellectual capabilities go.
ProSense
(116,464 posts)ProSense
(116,464 posts)BumRushDaShow
(129,096 posts)Edit to add he appears about the 5:45 min. mark
ProSense
(116,464 posts)He repeats his claims from the op-ed. It's a complete mischaracterization of the IPAB.
SunSeeker
(51,571 posts)But Bashir does not challenge him on his claim that IPAB doesn't work, which the LA Times pointed out on Monday is not true. And he even says he wants to get rid of the mandate--which will kill cost control since then only the sickest will get insurance. Again, no challenge from Bashir. I really like Dean, but it is SO disappointing to hear him parrot healthcare industry talking points-- and be a lobbyist for the healthcare industry.
Bashir does not call him on any of that. Pretty softball interview, not Bashir's best work.
LeftyMom
(49,212 posts)ProSense
(116,464 posts)LeftyMom
(49,212 posts)Aside from the whole medical doctor thing, his record on health care policy implementation is excellent.
So yeah, I think he knows more about the reality of health care implementation than you.
You're running out of prominent Democrats who aren't on the enemies list, btw.
ProSense
(116,464 posts)bhikkhu
(10,718 posts)From some points of view, lobbying for corporate interests is the anti-thesis of "Progressive".
In any case, I still like Dean, and I think he is probably speaking from a well informed perspective for the best interests of people in general. It is possible to do that sometimes, even when one has industry ties, conflicts of interest, and monetary incentives.
last1standing
(11,709 posts)or are you saying that you think they're death panels?
Your quotes would lead a reader into believing Dean said this when he absolutely did not. That makes this thread a big lie, doesn't it?
Why are you claiming that Dean said something he didn't? What purpose does that serve other than right wing causes?
ProSense
(116,464 posts)I didn't claim Dean used the term "death panels."
Still, he's using the same line of attack, rationing.
He mentioned the Republican effort to repeal the panel (see the OP).
last1standing
(11,709 posts)Where did you say that Dean wasn't the author of the quote you delivered directly after his name? This makes your OP false and purposefully misleading. That means this OP is a lie and you as its author are propagating lies.
There's a name for those who purposely spread lies but I'll let others come to their own conclusions as to what that name is.
ProSense
(116,464 posts)I'm detecting a bit of desperation in that spin.
last1standing
(11,709 posts)You've posted a bald faced lie. That's desperation.
ProSense
(116,464 posts)SunSeeker
(51,571 posts)From Monday's LA Times editorial:
Former Democratic Party Chairman Howard Dean took to the Journal on Monday to attack the IPAB with the same blatant mischaracterizations that have been the hallmarks of the GOP attacks. The only real difference is that Dean did so after saying there was "much to applaud" in the 2010 law, including its (extremely expensive) push for universal health insurance coverage.
"The IPAB is essentially a healthcare rationing body," Dean blithely writes, despite the fact that the law flatly states the board cannot ration care. Specifically, any proposal the board makes to control Medicare's costs per beneficiary "shall not include any recommendation to ration healthcare, raise revenues or Medicare beneficiary premiums under section 1395i2, 1395i2a, or 1395r of this title, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."
...
The most remarkable -- and remarkably false -- critique in Dean's piece is the statement that the Congressional Budget Office has projected that the IPAB "won't save a single dime before 2021." That's because the CBO projects that Medicare costs per beneficiary will rise so slowly over the coming decade, they won't reach the threshold set in the law for the IPAB to act. It's not that the board will be ineffective, as Dean implies. It's that it won't be activated.
...
http://www.latimes.com/news/opinion/opinion-la/la-ol-howard-dean-obamacare-ipab-wrong-20130729,0,6790127.story
Dean lied about the ACA. Sad.