If the Medicare cuts of 21% go through with a Democratic majority...

[madfloridian]

we are the ones who will be blamed. NOT Jim Bunning, not the Republicans....but us. The Democrats have been pussy-footing around this issue and playing political games with it.

If those cuts remain, we will lose our majority this year.

Those are payments to doctors, who get very little from Medicare as it is.

The fact this was allowed to happen shows a mindset in both parties of a lack of concern for the elderly.

We already knew that Obama was calling for huge cuts to Medicare.

Reporting from Washington -- Under pressure to pay for his ambitious reshaping of the nation's healthcare system, President Obama today will outline $313 billion in Medicare and Medicaid spending cuts over the next decade to help cover the cost of expanding coverage to tens of millions of America's uninsured.

Among the proposed policy changes outlined by the president are:

* Reductions in payments to providers to reflect increased efficiencies in the system, which the White House estimates could save $110 billion over the next decade.

* Cuts in federal subsidies to hospitals that treat large populations of uninsured patients, estimated to save $106 billion over the next decade.

* Cuts in how much the federal government pays pharmaceutical companies to provide prescription drugs to seniors and others, estimated to save $75 billion over the next decade.

We already knew that one of Obama's main advisors on health care, Dr. Ezekiel Emanuel, brother of Rahm, wants to phase out Medicare and put everyone gradually on vouchers for health care.

Zeke Emanuel is a health care advisor to Obama. Wants to phase out Medicare and Medicaid.

The Guaranteed Healthcare Access Plan will be administered by a National Health Board and regional boards modeled on the Federal Reserve System with fiscal, administrative, and political independence to make tough decisions based on the merits, not special interest lobbying. There will also be an Institute for Technology and Outcomes Assessment to assess the effectiveness of new drugs, devices, procedures, and other interventions. It will also assess and make publicly available data on the clinical outcomes of patients in different insurance companies. This will permit comparative shopping based on real quality results.

No one (I think he means to say "anyone") receiving Medicare, Medicaid, or any other government program will not be forced out, but there will be no new enrollees. People who turn 65 will simply stay in the Guaranteed Healthcare Access Plan. The special tax benefits related to employer based coverage will be eliminated and most employers will stop offering health insurance.

No new enrollees under his plan.

Did the planned cuts for cardiovascular treatments go through as planned? Anyone have a cardiac problem, or parents with a cardiac problem? Any thoughts on the payments being cut 50%?

Payments for cardiovascular Medicare patients may go down by 50% under HHS new rules on January 1.

On Jan. 1, Medicare patients across the state of Florida will confront a new reality in cardiovascular care. The Obama administration released the final 2010 Physician Fee Schedule on Nov. 1, severely cutting cardiovascular payments for Medicare patients - some by as much as 50 percent. These cuts have nothing to do with the battle over health care reform currently taking place in Congress.

This new rule has taken place without public debate or approval. The cuts have been mandated by the Centers for Medicare and Medicaid Services under the direction of Health and Human Services Secretary Kathleen Sebelius. These are the primary tools for early diagnosis and treatment of cardiovascular disease. Many of the tests will now be done in a hospital where the costs (and co-pays) are higher.

Such drastic cuts will inevitably force some cardiology offices to close because the cost of equipment, supplies, and salaries for office staff cannot be sustained.

And now a Democratic majority is blaming one man for a severe cut of 21% in payments to doctors??

Spare me the excuses. Fix the Senate, do what must be done.

People are not going to blame Jim Bunning or the Republicans. I don't blame them myself. There has been too much game playing by politicians over a program that allows seniors to have decent medical care.

Take the approximately 1000 dollars that goes to Medicare Advantage private plans for each patient they snag...last I saw at the AMA site it was a 922 dollar subsidy to private companies for each patient they snag. Take that and give it to the doctors.

Stop the 21% cut in payments to doctors or we WILL lose in November.

[madfloridian]

1. And we will be saving even more money than ever...

trying to make a difference politically.

Fed up.

[L0oniX]

65. Oh ...pffft ...they are just trying to save more money for military use...

...got to pay for all those wonderful military jobs that everyone is signing up for ...and the people here cheer them on.

[WinkyDink]

76. JOBS?? Try weaponry.

[luckyleftyme2]

2. why we will lose in nov.

We will lose many more seats in congress as we did in 1994 if we again walk away from healthcare reform. I for one don't buy all the bullshit the right is spewing. nor do I like the money that the health industry and insurance companies are spending to defeat the progress of healthcare reform. this money should be used for patient care.
So stop playing the rights game and play ours the majority and frig the republicans!

[madfloridian]

12. You want ME to stop playing the "rights'" games? Really?

[ooglymoogly]

41. The reason Brown won in MA, that is being swept under the rug,

Was for a very simple reason. The elderly are an important part of every demographic; The one thing they are tuned into like war families listening to the news, above all else, is Medicare, Medicaid and healthcare; It is life and death. They, we, do not buy this dangerous and reckless approach by O. I network with a lot of elderlies; Most did not vote this time round because we saw a dino being stuffed down our throats and some voted for Brown just in spite for the flim flam O and the DLC pulled, and is pulling on all of us. He is playing fast and loose with our lives.

[PDJane]

3. And that's a demonstration of really skewed priorities.

Bring the troops home. Close bases. Stop trying to rule the world, and see how much easier things become for the people of the country. Devise a manufacturing and renewable resource system and see how much better lives become. This is insane.

[Faygo Kid]

4. Obama is NOT calling for "huge cuts in Medicare."

He is calling for cuts in the Medicare Advantage program, which goes to private insurers. Medicare Advantage was set up to show that private insurers can outperform the government; instead, Medicare Advantage costs 14% more than traditional Medicare - and that's not fair to those paying into the system. That's where the cuts come. If the private sector wants to compete, let's level the playing field and let them compete, not pay them fat extra subsidies.

I agree that physicians need to be paid fairly, and we are totally on the same page there; the bill needs to pass. But quit scaring people about the Medicare "cuts." This is DU.

[luckyleftyme2]

5. I agree with you

this whole thread is to capture the uninformed to turn against healthcare;
instead turn against the rights lies and move foward!

[madfloridian]

7. He has not been clear on the cuts...not at all. Don't call what I write "crap"

The GOP is out messaging us big time.

Bill Nelson of FL is working FOR keeping the Medicare Advantage plans, the private ones.

No one is being honest with us about what they are doing.

The public will not blame Jim Bunning, trust me.

I do not appreciate your calling my post crap.

[Change Happens]

31. Please calm down, I understand perfectly that Advantage Plans need to be cut!!!

Billions wasted for no reason...

Obama is indeed FIXING Medicare.

[madfloridian]

35. Don't condescend to me. He is not fixing Medicare, he is cutting benefits.

[ooglymoogly]

43. To some; Cutting half a trillion dollars, half the medicare budget,

from a program they depend on is pretty damn reckless and short sighted. It shows a lack of good judgment without common sense. Many of us who pounded the pavement, phone banked, gave money and ran ourselves ragged for this prez. may just work our harts out for something better next time round.

Brown-Coakley proved that in no uncertain terms. We are tired of a crooked bill of goods. Watching astronomical amounts money go carelessly down the drain right and left on programs for corporate welfare and greed wars, to provide trillion dollar parachutes for the rich, while cutting programs for those who depend on them to keep them alive, is criminally negligent if not totally insane.

[backtomn]

64. I agree....

but the amount of the Medicare savings is supposed to be $400-$500 billion. That is a bit more than Medicare Advantage. I believe that the concensus is for health care reform, but perhaps not this particular provision......at least I hope not.

[drm604]

8. Thank you. n/t

[madfloridian]

9. Crap? Really?

Let's wait and see until the Dems get their message act together. Dean once said it was the advantage plans they were cutting, but I never heard those in power say it.

[Faygo Kid]

13. Guess you're not happy about that. OK, I take it back. You're just wrong.

Will edit to make that happen. But that tactic is still unworthy of the good, long-time DUer you are whose posts I enjoy.

I have a tendency to call them as I see them. But your posts deserve that respect, so the change will be made.

[madfloridian]

14. We have a majority. We allowed a 21% cut to go through.

Now tell me where I am wrong.

[Faygo Kid]

20. Already have. The 21% is the reimbursement rate. I favor - strongly - restoring that.

Medicare Advantage? Make them compete. As intended.

[CreekDog]

55. My congressperson, Jackie Speier said the Medicare Advantage plans would get cut

not Medicare itself.

she said the Advantage plans were far more costly than traditional Medicare.

not only that, cutting the Advantage plans frees up money to reduce out of pocket expenses for Medicare Prescription drug benefits.

the thing I really dislike about your post is that you don't seem to understand what's being cut, why it's being cut and where the money is going. your message seems to be all about optics.

but optics or not, the bill is going to have to work and raising 50 billion more per year or spending 50 billion less is going to mean the bill cannot do things for people that it needs to and for what benefit? so certain Medicare beneficiaries using private plans instead of traditional Medicare can keep their non-Medicare benefits.

lousy trade.

[madfloridian]

11. "* Reductions in payments to providers "...his own words.

Please find a link where he says it is Medicare Advantage loudly and clearly.

[inna]

73. Cuts to Medicare Advantage constitute only about a third of total cuts to Medicare.

The rest comes from eliminating fraud and "wasteful spending".

[deaniac21]

79. Plus AARP is an Obama supporter.

[deaniac21]

80. Plus AARP is an Obama supporter.

[RC]

6. Why do we keep thinking Democrats are something more that the Left wing of the Republican party?

The truth is "We the people..." really have very few representatives in Washington, in any of the 3 branches. Most have be bought by big business.
Our news is infomercials and propaganda.

[L0oniX]

10. Why does this country hate the elderly? Does everyone hate their parents?

WTF ...we're a bunch of animals.

[eShirl]

48. and the disabled, many of whom are not elderly

[WinkyDink]

81. Are you kidding? You should try being a woman over 60 in this country. Even young WOMEN hate us.

[Zynx]

15. Where'd that 21% figure come from?

[madfloridian]

16. Link: starts tomorrow.

http://topnews.us/content/212053-doctors-term-medicare-cuts-threat-southwest-florida

There are many other links as well.

[madfloridian]

17. More at this link.

http://topnews.us/content/212016-congress-slammed-cma-over-failure-stop-cuts-medicare-doctors

"On Friday, the California Medical Association said that it is calling on Congress in order to "act immediately" to try and stop deep Medicare cuts are that are scheduled to take effect from Monday, stressing that 21% cuts to doctors' reimbursement in the Federal program might end up hampering "senior citizens' access to care and force physicians to contemplate turning away patients or dropping out of the program altogether".

The Congress, however, is adjourned for the weekend, so an immediate response is highly unlikely. Although the House of Representatives has passed the bill to block these cuts, the US Senate has not. CMA, based in Sacramento, stressed that the imminent 21% pull back in doctors' Medicare pays, put forward with the aim to try and keep the overall system solvent for a long period, is "unconscionable".

The group joined hands with the American Medical Association, AARP and others who represent seniors and physicians to fight the pending cuts, and is encouraging its 35,000 physician members in the Golden State to get in touch with U. S. Sens. Barbara Boxer and Dianne Feinstein and their congressional representatives about the issue.

"It’s unconscionable that Congress has not intervened to prevent this coming train wreck. Sadly, if these cuts take effect, senior citizens will have a tougher time getting access to a doctor because many physicians will not be able to afford to deliver care under Medicare", said Dr. Brennan Cassidy, the state medical association’s President."

[RB TexLa]

18. 21% is a good start. Many people have had cuts of that or greater in income

The doctors and hospital administrators can scale back their lifestyles, they can get a loan modification, they can get an apartment with a roommate.

If the government sticks to and increases the cuts in payments private insurance will follow with cuts in what they pay. And we have leverage. If a doctor wants to stop accepting federally insured patients and has a federally backed student loan they are paying off they can get a notice of accelerated collections letter. They can also come to realize how many doctors around the world would love to come work here. I bet the first hour of a congressional hearing on removing the cap for visas for doctors would shut the American doctors up pretty quick.

[cornermouse]

22. Insourcing instead of outsourcing?

Next time you see a doctor tell him/her that you consider their lifestyle to be wildly lavish and that they need a comeuppance.

:eyes:

[madfloridian]

23. Oh, well, then let's hurt our seniors to make a point. Way to go.

Updating list.

[Elwood P Dowd]

24. This poster is a huge fan of "the race to the bottom"

when it comes to trade, outsourcing, importing foreign workers to replace American workers, and now health care. I can figure out why he is still here.

[madfloridian]

26. Well, I don't have to see it anymore.

Cause I updated my list. :)

I have little patience left for stuff like that.

[Hawkeye-X]

28. I wouldn't worry about RB

He's a stealth Rethuglican pretending to be a Democrat to post here.

I've already ignored his stupidity a long ago.

[Sgent]

62. That's 21% of what practices are paid

considering most practices run at least 50%, and many 70-80% overhead, that's equivalent to a 42% to 100% (or loss) pay cut.

[WinkyDink]

77. Who else will work to save your very life?? Doctors deserve every penny. (Not one, nor am married to

one, nor am I the daughter of a doctor.)

[bjjblackbelt]

19. ...

More money for the war machine and the banks. Both parties are rotten to the core.

[LWolf]

21. My mother is a cardiac medicare patient.

This matters to me. Not that it wouldn't matter just as much if it weren't personal, of course.

[SlingBlade]

25. Thank You madfloridian once again for ... REALITY !

Ms. Pelosi says Democrats will retain a majority in the House, Regardless of what
the outcome may be of Health Care Reform and all that goes with it which now in my
mind seems to be nothing more than a corporate sell out.

Public Option and Single Payer as WE ALL KNOW is the only true reform for Health Care
Yet this Administration with the nodding consent of this Congress have killed it.

This is NOT what you have worked for all of these years nor I.
Thinking back to the deepest darkest years of the Bush Administration
and their smirking disregard for all things truly good about this country
only sickens me to think now, today, It is US Democrats who now snicker while
pointing to the Bad Cop Republicans as all that is evil.

Pelosi talks about the Republicans Hi-Jacking the Tea Party !
Who the hell Hi-Jacked the Democratic Party, That's what I want to know
To hell with the Republicans.

My God, What the hell happened ?

K&R for your insight and honesty.

Added to my, Health Reform Greatest Hits Threads
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x7764365

[Sgent]

27. The cardiac cuts

are not part of this round of cuts.

Every few years Medicare analyzes the costs of providing various services (imaging, surgery, office visits, etc), and ranks them using a system called Relative Value Units. Due to decreasing costs of equipment, and much higher than anticipated usage, the RVU's for certain cardiac imaging services were reduced, thus reducing the reimbursement.

On the other hand, payments were increased to primary care physicians and others according to that system. Medicare part B is a fixed pot of money, so any decrease in one medical service will go to others (in regards to RVU calculations).

Now, the 21% cut is a cut that reduces the reimbursement per RVU, rather than a reassignment of RVU's.

[madfloridian]

29. Looks like the cardiac cuts already happened.

"On Jan. 1, Medicare patients across the state of Florida will confront a new reality in cardiovascular care. The Obama administration released the final 2010 Physician Fee Schedule on Nov. 1, severely cutting cardiovascular payments for Medicare patients - some by as much as 50 percent. These cuts have nothing to do with the battle over health care reform currently taking place in Congress."

From my link.

[WinkyDink]

82. IMO, and I don't really care what others perceive, Obama has a very, very cold heart.

PARTICULARLY towards the elderly (though he has cavalierly mentioned that a child with asthma ought not go to the Emergency Ward).

[Change Happens]

30. The 21% cut will not be effective tomorrow, fixes are coming...Medicare has 14 (or 29) days

To make changes if any are implemented.

Congress is stupid and very slow fix this, I agree with that.

[madfloridian]

34. This says tomorrow. They have played games with this fix for ages.

It is time to stand up for seniors and do what is right.

http://topnews.us/content/212053-doctors-term-medicare-cuts-threat-southwest-florida

[Change Happens]

36. Yes, but Medicare has 14 days to process electronic claims and 29 days for paper claims

So nothing is going to be done between tomorrow and the 14th, if there is no fix, claims will be released on the 15th and paid at the lower rate.

[madfloridian]

37. That answer does nothing to respond to my topic.

Which is that Democrats allowed this to happen under their watch.

There is no excuse at all.

[Change Happens]

38. Nothing happened yet...

[madfloridian]

39. Due tomorrow. Scheduled since 2003. AMA tells doctors how to get out of Medicare program.

http://blogs.wsj.com/health/2010/02/26/tick-tock-medicare-payment-cuts-for-docs-due-to-start-monday/

"The clock is running out before a 21% cut in Medicare payments to doctors kicks in. Plans to block the reductions have gotten hung up in Congress.

In response, the AMA is telling its members what they can do about the lower payments, including closing their doors to new Medicare patients, CNN reports. “To our physicians, we are providing information on their Medicare participation options, including how to remove themselves from the Medicare program,” AMA President James Rohack told the cable channel.

There’s nothing new about these cuts — they have been scheduled to go into effect regularly since 2003. Congress has blinked with a temporary reprieve each time in the past, but hasn’t done so yet this time with the cuts slated to begin Monday. Here’s why:

The House yesterday adopted a one-month delay in the cuts as part of a $10 billion employment bill with various other health provisions. “The legislation, which the Senate may take up next week, would give lawmakers more time to debate the fee cuts,” Bloomberg reported today.

But there could be a big hangup in getting that bill through the Senate in a hurry because Republican Sen. Jim Bunning of Kentucky wants to delay any swift action. That runs counter to what Senate leaders on both sides of the aisle had in mind, but senators can do"

You need to be honest when you post. It happens tomorrow, the impact will be doctors getting out of Medicare.

If you keep saying this is not happening, you can argue with yourself. I am done. I believe in being honest and not putting forth specious arguments.

[Change Happens]

40. Please see # 30...And try to stay calm, nt

[madfloridian]

42. I am updating my list.

I find it rude and inappropriate for someone to keep saying "try to stay calm." Those words are meant to talk down to someone like they are small children. I find it offensive.

This is twice. There will be no more.

[flyarm]

44. Madfloridian..that crap keeps being done to me as well..the stay colam crap..it is a ploy

by those that i believe may be working with a corp tied to AHIP or Pharma or Rahms rovers..or whatever you want to call them..and if you remember ( which i am sure you do) the same damn ploys were employed by bushbots..same MO..same crap...they are selling propaganda..of some sort.

I just freaking ignore them now..I won't even reply to them. Save yourself the headache. They have an agenda..and it sure as hell isn't a democratic agenda of truth or helping those that need help.

What many of "the new democrats " don't understand is ..many of us have been working for a lifetime to see to it others in our society get the care they need..not to have it robbed from them by nefarious groups or politicians.

[madfloridian]

46. Telling someone to "stay calm" is meant as a slam at their intelligence.

I despise it.

That condescending attitude is making my list grow fast.

:hi:

[flyarm]

47. excuse my typo..i am on meds ...and i just noticed I had a typo..too late to correct!

yes it is condescending..many of those around these parts lately..and it should be despised. But i noticed when you put them on ignore..they do worse and you can not stop them because you can't see it.

Now i just alert on them, and often.

:hi: :thumbsup:

[Biker13]

68. In Idaho...

I'm DESPERATELY trying to find a doctor who will accept new medicare patients! The caps are intentional! So far, no luck!

Welcome to the future.

[luckyleftyme2]

88. this is in reponse to your spiel

you obviously must be a republican in the closet!
Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector. Health insurance is primarily provided by the private sector, with the exception of programs such as Medicare, Medicaid, the Children's Health Insurance Program and the Veterans Health Administration.

At least 15% of the population is completely uninsured,<1><2><3> and a substantial additional portion of the population is "underinsured", or less than fully insured for medical costs they might incur.<4><5> More money per person is spent on health care in the United States than in any other nation in the world,<6><7> and a greater percentage of total income in the nation is spent on health care in the U.S. than in any United Nations member state except for East Timor.<7> Despite the fact that not all citizens are covered, the United States has the third highest public healthcare expenditure per capita.<8><9> A 2001 study in five states found that Medical debt contributed to 62% of all personal bankruptcies.<10> Since then, health costs and the numbers of uninsured and underinsured have increased.

Active debate about health care reform in the United States concerns questions of a right to health care, access, fairness, efficiency, cost, and quality. Many have argued that the system does not deliver equivalent value for the money spent. The US pays twice as much yet lags behind other wealthy nations in such measures as infant mortality and life expectancy, though the relation between these statistics to the system itself is debated. Currently, the U.S. has a higher infant mortality rate than most of the world's industrialized nations.<11> The USA's life expectancy lags 42nd in the world, after most rich nations, lagging last of the G5 (Japan, France, Germany, UK, USA) and just after Chile (35th) and Cuba (37th).<12><13><14> The USA's life expectancy is ranked 50th in the world after the European Union (40th).<15><16> The World Health Organization (WHO), in 2000, ranked the U.S. health care system as the highest in cost, first in responsiveness, 37th in overall performance, and 72nd by overall level of health (among 191 member nations included in the study).<17><18> A 2008 report by the Commonwealth Fund ranked the United States last in the quality of health care among the 19 compared countries.<19>

According to the Institute of Medicine of the National Academy of Sciences, the United States is the "only wealthy, industrialized nation that does not ensure that all citizens have coverage" (i.e. some kind of insurance).<20><21> The same Institute of Medicine report notes that "Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States." <20> while a 2009 Harvard study published in the American Journal of Public Health found a much higher figure of more than 44,800 excess deaths annually in the United States due to Americans lacking health insurance.<22><23> More broadly, the total number of people in the United States, whether insured or uninsured, who die because of lack of medical care was estimated in a 1997 analysis to be nearly 100,000 per year.
we need reform now-if we just passed a law that all health care insurance companies had to be non- profit we would save a minimum of 1800 a year per family policy!
your idea is bankrupting the country!

[flyarm]

32. My sister in law does billing for numerous Cardiac docs..and just before New Years

she was working big time over time to correct billings because a huge change was coming in pricing..I know she was bitching about it and the Dems.. when she was coming home late during the holidays..and she was saying..she voted democratic only to see the dems screw people even worse than Bush and the repukes..her words not mine. She was damn angry. She has a huge number of cardiac docs as clients, doing the medicare and medicaide billing for all the top cardiac docs in a major hospital in Northern Calif.

She had her own business doing this medicare billing for doctors..a big thriving business..but she said she was closing it up because the government just screwed the people and the doc's now are all going to be dropping medicare patients...after the new year. ( being now this year) She said it was like a 50% cut..

But sorry , I didn't listen to all the details..it was the holidays and well I just didn't pay that much attention because I thought it was mostly Calif medicare and medicaide and I don't live in Calif. any longer. I wasn't realizing this was across the board and across the nation ..at the time.

[madfloridian]

33. It's across the board.

She's right, we assumed Democrats would save the Medicare system.

[flyarm]

45. yeah..i sadly understand that now...unfreaking believable..this will effect so many in our state of

Florida..it makes me sick beyond words.

[madfloridian]

49. Anyone who supports cutting Medicare....be willing to pay your parents' medical bills.

And take care of them yourself.

I think too many younger people have no clue about Medicare and Medicaid and the differences.

Too many brainwashed by the ridiculous right wing, not aware that without Medicare the burden of their parents' medical care would fall completely on them.

It's scary how few understand it.

[madfloridian]

50. "Democratic attempts to blame this on Senate procedure will ring utterly hollow"

This blogger at MyDD gets it.

The Democrats are in charge, and they will be blamed.

Democrats did not have to adjourn. They could have kept fighting Bunning.

Quoting Chris Bowers:

Democrats are in charge, and they are going to get blamed for this. Democratic attempts to blame this on Senate procedure will ring utterly hollow. Not only do people not understand, or care about, those rules, but it simply sounds wimpy and pathetic for the people running the United States Government to throw their hands up in the air and say "our procedural rules prevented us from doing anything to solve this huge problem. Sorry."

Democrats did not have to adjourn. They could have kept fighting Bunning. Further, they all agreed to the rules under which the Senate operates, and most of them are still defending those rules. Blaming Senate procedure is not going to extend anyone's unemployment or COBRA benefits, and its not going to win many hearts around the country.

Sure, Jim Bunning is currently the biggest asshole in the country right now. However, if you think that procedure is a problem, then start working to change the procedure. If you think that unemployment benefits need to be extended, then don't adjourn for the weekend when those benefits are slated to run out.

Amen to that.

[SanchoPanza]

51. Some clarifications.

The cuts to hospitals for emergency room services coincide with the increase in the number of insured due to reduced insurance costs. The only reason why these subsidies exist is because people without insurance rely on emergency room care. Reduce the number of uninsured and the subsidies become less necessary.

The efficiency savings have to do with things like record portability and provider screening, and shouldn't really be considered controversial.

The savings in Medicare D will come from a reduction in the subsidies to individuals/couples making above 85,000/170,000 a year. That savings is in large part going toward filling the Part D coverage gap (aka the "Donut Hole").

If you want someone to blame for the conversion rate cuts for cardiovascular imaging services, look no further than the CMS. They wanted to reconstitute the fee schedules to provide more reimbursements for primary and preventive care. Since everything they do has to be budget neutral, they commissioned a study to find inefficiencies in specialty care services. It has nothing to do Congress or the President.

The general cuts, or rather the threat of general cuts, happens every year due to a change made to the reimbursement schedule back in 1997. They happen like clockwork, and get avoided like clockwork.

[Change Happens]

52. Thank you for this...I wish some people would just calm down and think and about what

they are saying.

[Change Happens]

96. To all the professional hyperventilators! There was NO 21% cut afterall, it passed

with the bill last night.

See, staying calm and collected is all you needed to do.

[cornermouse]

53. Record portability is still a mirage.

Provider screening? A general purpose, nonspecific term. To what are you referring; their credentials or the patient attempting to research the doctor?

Reduced insurance costs? :rofl: :rofl: :rofl: For whom?

I would give this post a "D" for being long on fluff and soothing sounds but short on facts.

[SanchoPanza]

69. More clarifications.

It has to do with credentials. Medicare does an abysmal job weeding out fraudulent providers. Back in 2008 the FBI set up a bunch of fake DME firms that were easily able to get clearance from CMS. Two years before that, the Office of the Inspector General uncovered 500 bogus providers in South Florida, bilking over a billion dollars out of the system on an annual basis. A lot of money can be saved by having a more robust provider screening system.

Record portability isn't necessarily a mirage. The VistA system in use by the VA is very robust, for instance. But this type of thing is expensive (and not open-source), so while it might save the system money over time, the cost for individual users is very high. Availability is the problem, and putting all the up-front costs onto providers doesn't help that. There's been around $20 billion allocated to provider incentives through ARRA to help address this, but more is needed.

Finally, insurance cost reductions won't be uniform. The legislation will effect the nongroup market the largest, followed by the small group and the large group markets. CBO did the analysis back in November: http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf#nameddest=Table1

Didn't think it was necessary to elaborate on some of this stuff because a lot of the questions were implicit in Madfloridian's OP, and the information's been out for a while. If you wanted me to elaborate, you could have asked nicely instead of acting like a presumptuous asshole.

[cornermouse]

84. corrections indeed.

Hospitals have entire departments that check credentials of doctors, nurses, etc. They have to follow laws and guidelines set up be federal, state, and voluntary institutions. If they fail to meet the standards they are punished. It looks like your fraud is based on clinics opened by criminals "The partners' infusion treatments, purportedly administered intravenously, were neither prescribed by doctors nor provided to patients, Stumphauzer said." which doesn't appear to have a doctor anywhere near it. I would suggest credentialing was not the problem with this one at least. Your argument is incorrect.

Record portability is a mirage. The software for the various systems available to hospitals, clinics, and public company offerings are much more likely to be incompatible than compatible with each other.

You're dreaming about insurance reductions. If reductions were what we could expect I wouldn't have had to pay the equivalent of 2/3 of my monthly car payments for car insurance and I don't have any strikes against my driving record. Health insurance isn't going to go down any more than car insurance did when they made it mandatory. I should know. I'm old enough to have been paying car insurance when they passed the law and watched my car insurance skyrocket.

[SanchoPanza]

85. Not so.

There's a difference between providers checking the credentials of those that work for them and CMS checking the credentials of providers. Where screening fails is when a provider is adequately credentialed but engages in identity theft, as an example (and probably the most common one), to file false claims. Those cases will largely be handled by requiring providers/suppliers to implement mandatory compliance programs. And Miami-Dade will probably be the first area put on the enhanced oversight list.

The current software is largely incompatible because such a system needs modularity, so it can be customized to suit a particular medical environment, and most of the modules in systems like VistA are proprietary and not open-source. Which is why current successes with EHRs have been limited to large provider networks (VA, Kaiser, etc), because they can impose that modularity from the top down without having to worry about problems inherent with customization. Non-networked providers can't do this because it has, like I said, a lot of upfront costs attached to it and little in terms of exclusive benefits. It's like asking one ship to pay for the entire cost of a lighthouse, which benefits every other ship. The federal spending has largely gone toward reducing those costs.

Car insurance was never subject to the kind of national regulations that health insurance will be subject to in a few years. And even at the state level, there is no such thing as community rating for car insurance. Apples and oranges.

[cornermouse]

86. Even the clinics have to meet standards of some sort.

I would argue that these clinics were not even part of the medical system. I would also point out the fact that you have no idea what you're talking about on this subject. These clinics were a bunch of store fronts operated by crooks and thieves.

The software argument? Wrong again. It took Kaiser 7 years to make their system work after they installed it. Look it up. Modularity from the top down is a lot like record portability. Its a fantasy. It simply does not exist.

Health insurance not like car insurance? rofl Yeah. Right.

[SanchoPanza]

87. No they don't.

CMS does not effectively evaluate Medicare provider/supplier applications before billing privileges are granted. Changing this framework is what provider screening means in the Medicare context. Read the 2008 GAO Report here: http://www.gao.gov/new.items/d08955.pdf

I have no idea why you keep sidestepping this point with meaningless red herrings. CMS does not have the infrastructure, or even the legal authority, to do the necessary screenings. They don't even check to see if the name on the application matches any convictions for fraud in Federal databases.

HealthConnect had a non-simultaneous deployment schedule. Not every system went up at once in every region, since the logistics of such an effort would be too overwhelming for anyone outside the public sector. I'm not sure if you're trying to make the case that they completely set up HealthConnect, and all its modules, nationwide in 2003 and it's been a buggy lump of garbage ever since, but if you are then the history of the program doesn't bear that out.

And VistA totally demolishes the notion that modularity can't exist in a diverse provider network: the system is running in over 160 hospitals and 800 clinics around the country, and will likely be exported (in one of its open-source variants, like WorldVistA EHR) to dozens of other countries in the near future. The technical limitations aren't really there, since most open-source EHR systems are based off of VistA so there would be limited compatibility issues, and there's been a pilot program to connect HealthConnect (the only other major EHR system) with VistA since last November. The issue is creating open-source alternatives for VistA's modules, and these are in development.

Health insurance is absolutely not like car insurance, for a variety of reasons. Apportionment of risk, levels of adverse selection in their respective markets, positive and negative externalities, etc. The reason why there's no community rating (or guaranteed issue) for car insurance is because of these factors. Not to mention the fact that insurance mandates serve entirely different functions within each risk pool, and there are too many variables to assume that a health insurance mandate would have the same effect as an auto insurance mandate. And that's assuming the reason for your individual premium increases is even tangentially related to the auto insurance mandate.

[cornermouse]

90. Congratulations.

You've proved definitively and without a doubt that you know nothing at all about this subject.

[SanchoPanza]

93. Uninteresting cop-out is uninteresting

I'll give it a "D" and follow up with some insipid smilies in a smug effort to make me look superior.

:rofl: :rofl: :rofl:

[cornermouse]

92. One more thing.

Next time Obama tries to take credit for making medical records electronic, keep in mind that Kaiser was working on it while he was still a state senator in Chicago.

[SanchoPanza]

94. I'll give you a better one.

The Public Health Service started working on their EHR system for the Department of Veterans Affairs, what would eventually become VistA, before Obama entered High School.

ZING!!!

[madfloridian]

56. No, not the 21% rate cut. Not every year. This is devastating.

[SanchoPanza]

71. True.

In previous years, it hasn't been this large. But my point was that these cuts are built into the system and have been occurring for years. The Republican solution has been to simply delay the cuts through deficit spending, while the Democrats want to get the system reformed so that they no longer occur. Bunning's simply thrown a wrench into the gears because he's apparently opposing both methods, (falsely) claiming that the money can be taken out of ARRA.

Problem is everything but a temporary delay has to be passed through regular order, not a unanimous consent request. In other words, you need a quorum (60 votes) to even consider any other option.

[DisgustedInMN]

54. Yep...

... the Overwhelming Minority strikes again, and the pouty, whining Dems are powerless to stop them... 'cuz "They are going to say mean things about us!" :sarcasm:

:banghead:

[madfloridian]

58. Yep...the "overwhelming minority"....true words.

:hi:

[madfloridian]

57. Doctors say Medicare's pay cuts are killing their practices

http://www.tennessean.com/article/20100301/BUSINESS01/3010332/2047/business

"Uncertainty about reimbursements from payers, including Medicare and private insurers, is a lingering issue for many doctors. They face a 21 percent overall cut in Medicare reimbursements that becomes effective today. It could still be averted by a monthlong stay that the U.S. House passed on Thursday; action is pending in the Senate. Many doctors, meanwhile, are holding out hope for a "permanent fix" to how physicians are paid.

In the interim, more doctor practices are considering not accepting new Medicare patients. Many other doctors are seeking employment at hospitals. And others are focusing more on patients who pay out of pocket and ending ties with insurers that cut rates. If the Senate passes the temporary fix that's expected to stave off the 21 percent cut, it would be the latest in a series of patches that have become a near-annual ritual in Congress since 2003.

Under the formula by which doctors are paid by Medicare, growth in total payments to physicians can't exceed annual growth in the nation's gross domestic product. As the U.S. population ages, doctors are serving more patients, and they're using more costly treatments and tests amid advances in technology. As a result, doctors are requesting reimbursements that exceed GDP growth, which has averaged about 3 percent. Medicare is required to ensure that total payments don't exceed budget.

Lobbyists for doctors, including their trade group American Medical Association, have played the lead role in persuading Congress to keep the rate cuts from going into effect. If the rate cut goes into effect, doctors will feel the impact beyond Medicare. Many private insurers factor the Medicare rate into setting their own rates."


Well, well, looks like the lobbyists for doctors got beat big time by the other lobbyists.

[apples and oranges]

59. don't you think those same doctors would be furious if we got single payer?

:shrug:

[madfloridian]

60. That is not my topic. I am writing about destroying Medicare.

I would have been for single payer until the groups started pushing against a public option, hurting all of us.

But that is not what my post is about at all.

[madfloridian]

61. Two things Democratic forums care little about: Medicare and education..

and the privatization thereof.

Those who post about education here are mostly treated casually or with scorn.

The Democrats are playing Medicare games and too many don't understand how lives of seniors will be affected.

http://blog.newsweek.com/blogs/thegaggle/archive/2010/03/01/congress-cuts-medicare-payouts-medicare-says-oh-no-you-don-t.aspx

"That's essentially what happened in Washington over the weekend regarding the 21.2 percent Medicare pay cut for doctors. Instead of delaying the cut (as it's done every year since 2001, and as the House did late last week), the Senate failed to do anything about it and adjourned for the weekend early. That means the cut technically went into effect today.

But the Centers for Medicare and Medicaid Services, playing the part of the guy from payroll, has stepped in. It's refusing to process any of its biweekly payments to doctors over the next ten days. That gives the Senate more time to act before the pay cut actually starts hitting doctors' wallets. Maybe it'll use these ten days to repeal the cut and convince the House to do likewise, making a lot of doctors happy. More likely, it'll just use this brief, artificial reprieve to buy itself even more time."

So they are getting 10 days to play more games with Medicare like they have for years.

[backtomn]

63. The worst part is......

that the savings are not used to keep Medicare solvent and available in the future, but to make the healthcare bill look cheaper. I realize that 70 or 80% of all healthcare dollars are spent in the last year of a person's life (and this generally means the elderly), but simply reducing payments to doctors is not going to help anything. This is not a viable, long-term solution to this issue......it is simplistic, callous, and ultimately, stupid. I think that a reliably Democratic vote understands this.

[madfloridian]

66. I agree.

Cutting Medicare to build a new health care plan that caters to insurance companies.

Not a very good idea.

[county worker]

67. This one is really bad.

Cuts in federal subsidies to hospitals that treat large populations of uninsured patients, estimated to save $106 billion over the next decade.


The payments are called "disproportionate share payments." It gives hospitals who have a disproportionate share of indigent patients some extra money in the form of cash payments through out the year.

It isn't really enough to make up for the loss of revenue for caring for people who cannot pay and have no insurance. Every year the share if indigent patients at these hospitals increases. The cost of treating them increases too.

[closeupready]

70. ANYTHING but raise taxes on the wealthy.

Why is that?

[inna]

72. Because the rich own the country and the government?...

:shrug:


Another kick for the OP, anyway.

[Name removed]

89. Deleted message

Message removed by moderator. Click here to review the message board rules.

[Jakes Progress]

74. Another chance blown.

Instead of losing senior support, which we will do, we could have made inroads into the republican bastion of the medical profession. Let them hear republicans calling for cutting their pay while giving millions to insurance companies and we would have had a supportive following. Instead, we just shoot ourselves again and again.

I'm already dreading the slog that the next presidential campaign will be. How will I be able to sit in those living rooms and stand in those halls and defend this crap. You can't win an election by telling people that your crap isn't quite as nasty as the other guy's crap. Brain dead washingtonions.

[backtomn]

95. Excellent Point !!!

I would add that we appear to be willing to "cut off our nose to spite our face". We are so pissed at anyone that makes money (insurance companies, doctors, corporations, etc.) that we are willing to let Medicare recipients suffer just to stick it to them. Unfortuanately for us, those Medicare recipients are going to be pissed and they vote. Being morally superior is going to bite us in the a**.

[WinkyDink]

75. We will DESERVE to lose!!

[deaniac21]

78. Hip Hip Hooray. Dean would never have let this happen.

[xchrom]

83. Kick

[luckyleftyme2]

91. lets make this thread honest

what I see is a thread that is full of crap from the git go! blaming the left for the rights lockstepping is getting common inn here! I think we got alot of people passing themselves off as democrats but are really closet repukes!
Senate gridlock triggers cut to doctors
By RICARDO ALONSO-ZALDIVAR (AP) – 14 hours ago

WASHINGTON — Political gridlock in the Senate triggered a legal requirement Monday for a 21 percent cut in Medicare fees to doctors, who warned they may have to limit care for seniors unless the reductions are reversed.

Hoping the Senate will act soon to stave off the cuts, the Obama administration directed Medicare billing contractors to hold off processing claims for 10 business days. Medicare normally takes 14 days to pay doctors, so there would be no reduction in reimbursement if lawmakers move quickly.

"Our No. 1 goal is to avoid disrupting payments to physicians during this time," said Jonathan Blum, who directs the Medicare division that handles payments to providers.

But the American Medical Association assailed lawmakers for allowing the cuts to go through, saying it shows the political system is failing to address manageable problems with health care, let alone big challenges like covering the uninsured and trying to slow rising costs.

"Our message to the U.S. Senate is to stop playing games with Medicare patients and the physicians who care for them," said Dr. James Rohack, president of the doctors' group.

Funding to temporarily stave off the cuts was part of a bill passed last week by the House. But the Senate failed to act on the one-month fix because Republican Sen. Jim Bunning of Kentucky objected that the $10 billion measure would add to the deficit.

The Medicare cuts are the consequence of a 1990s deficit reduction measure that Congress has routinely waived for years. But every time the cuts are postponed, they only get bigger in percentage terms, making a permanent fix more costly and difficult.

Republican leaders in Congress have pledged to help pass legislation to temporarily restore the funding. But there's no consensus on a long-term solution. The Obama administration and most Democrats favor repealing the 1990s law that called for the cuts to doctors, arguing that it never worked in the first place.

The AMA's Rohack said the instability is damaging the popular health insurance program for seniors — and is a harbinger of bigger problems, if Congress fails to act this year on a health care overhaul. The doctor cuts are a prime example of why postponing action won't work when it comes to medical costs and the uninsured.

Coincidentally, the Medicare cuts come as the doctors' group opens a major issue advocacy conference in Washington this week. Health and Human Services Secretary Kathleen Sebelius is scheduled to address the AMA on Tuesday.

Copyright © 2010 The Associated Press. All rights reserved.
if you read this madfloridaian it mutes evewry response you have given!
sorry but I think you speak with little facts to back it!
lmao at a red herring!