Impeding changes to our Health Care system

[TheMercenary]

Originally Posted by Shawnee123

How do you know? Clod just told you that she talked with family friend who is a dentist, and who illustrated the "biggest reason (times 2, even)" many don't want to deal with medicare.

I am not disputing her experience with the one person she had contact with. I fully believe her.

I am talking about the main reason there are so many Docs that do not accept Medicaid, Medicare, Tricare, and a few other state run programs.

[Shawnee123]

*shrugs*

cite

[TheMercenary]

Originally Posted by Shawnee123

*shrugs*

cite

My 30 yrs working in health care. Gimmie a minute and I will pull something out of cyber air.

The primary reason physicians cease to accept new Medicare patients is the rate of payment; secondary reasons include complexity of the Medicare program, intensity of treatment needed for elderly patients, and personal preference.

http://www.unmc.edu/ruprihealth/Pubs/PB2004-5.pdf

"The decline in physicians providing charity care and treating Medicaid patients is a sign of the financial pressures facing physicians," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation. "With substantial pressure on payment rates from private insurers, physicians may place a lower priority on treating the uninsured and Medicaid patients."

http://seniorjournal.com/NEWS/Medica...Physicians.htm

http://pn.psychiatryonline.org/cgi/c.../full/37/22/10

http://www.kevinmd.com/blog/2008/12/...to-accept.html

http://www.physicianspractice.com/in...icleID/369.htm

This study shows that the acceptance had stablized during a 10 period but the threat to declining acceptance was still a threat (in the conclusions).

http://www.hschange.com/CONTENT/811/

Potential Impact of Obama Care

http://online.wsj.com/article/SB124208383695408513.html

I could go on but why...

[Shawnee123]

So I just choose whose first-hand account I most believe?

[TheMercenary]

Look again. But hey, we choose who we want to believe everyday. What eva...

Some numbers on here:

http://www.dcmsonline.org/legislativ...mbursement.pdf

https://texmed.org/Template.aspx?id=7431\

http://www.mcclatchydc.com/173/story/43362.html

Waits in care for Medicaid due to lack of physicians accepting the insurance in the Dallas area (2009)

http://www.dallasnews.com/sharedcont...d.4187740.html

[Shawnee123]

I just thought of my choices in the matter: level-headed Clod, or the guy who so hates the Obama administration that anything and everything even remotely related to anything and everything they do is SUSPECT and EVIL and GOING TO KILL US ALL.

Just sayin'

[TheMercenary]

Originally Posted by Shawnee123

I just thought of my choices in the matter: level-headed Clod, or the guy who so hates the Obama administration that anything and everything even remotely related to anything and everything they do is SUSPECT and EVIL and GOING TO KILL US ALL.

Just sayin'

Hmmmmmm... ok, I find it hard to believe that I ever said anything among the likes of "GOING TO KILL US ALL!"

A bit of an overstatement, but hey, like I said, what eva...

[Shawnee123]

I was employing hyperbole, as I often see in your cited articles.

OK, I'll quit now!

[TheMercenary]

Originally Posted by Shawnee123

I was employing hyperbole, as I often see in your cited articles.

OK, I'll quit now!

Yea, I know that sillyperson. I was giving it back to you...

[TheMercenary]

Some interesting observations about the Calif Insurance Exchange program and the plans that are being proposed in Congress:

http://online.wsj.com/article/SB124925648163600125.html

It will be interesting to see if the legal mandate, as proposed, that every single person enters the exchange if they do not already have insurance, whether or not that will have enough people to support it without the pitfalls that have helped the Calif plan become a complete failure. As usual, there are very little details about how the Federal Health Plan is going to work so we will not know until the law is already passed.

[Clodfobble]

(As a side note, I just realized I've been saying Medicare this whole time, but I meant Medicaid. Poor people, not old people. Old people don't have any teeth left, so they don't need dentists. )

[TheMercenary]

Originally Posted by Clodfobble

(As a side note, I just realized I've been saying Medicare this whole time, but I meant Medicaid. Poor people, not old people. Old people don't have any teeth left, so they don't need dentists. )

I knew that when you were talking about kids, etc.

[TheMercenary]

Another good op ed with some things to think about as Congress rushes through this change.

Obama’s More-for-Less Health Care Doesn’t Add Up: Caroline Baum

Commentary by Caroline Baum

Aug. 3 (Bloomberg) -- President Barack Obama has been exhorting lawmakers to use the August recess to read health- care-reform bills currently before Congress.

In other words, if the president had gotten his way, members would have voted first and read second legislation to revamp one-sixth of the U.S. economy. No wonder public support for both Obama and his health-care plan is eroding, according to recent polls.

Yes, people are resistant to change, as the president noted, especially when it comes to something as important as their doctor. But maybe something else is at play: the growing realization that the numbers don’t add up.

I listened to Obama’s July 29 town hall meeting in Raleigh, North Carolina, hoping to understand how the government plans to deliver more for less, to cover most of the 46 million uninsured Americans while lowering premiums, limiting out-of-pocket expenses and requiring insurance companies to cover preventive care.

I heard Obama say a lot of people will get a lot more without anyone getting less.

I heard him say two-thirds of the cost of covering everyone in America can be paid for “by money that is already in the health-care system.”

I heard him say he favors a public option to increase competition and keep costs down.

I heard him say he “will not sign a health-care bill that is not deficit neutral” and that doesn’t lower health-care inflation over the long term.

Let’s see how some of these claims stack up:

1. Mind Your P’s and Q’s

Obama wants to insure more people and lower the total cost of care. In economic terms, he wants to control price (P) and quantity (Q). What makes Obama think he can repeal the law of supply and demand?

To achieve higher Q and lower P, the supply curve has to shift outward, to the right. How does the government plan to increase the supply of health care? By making it less attractive to young men and women with a passion for medicine and a desire for independence?

Obama says he wants to encourage medical students to become primary-care physicians via financial incentives, reversing the trend toward specialization, which is where the money is.

Easier said than done, says Paul Feldstein, professor of health-care management at the Paul Merage School of Business, University of California, Irvine. “It takes a long time to produce more doctors.”

Once the government starts to dictate budgets and salaries in an effort to control costs, medicine becomes a less attractive profession.

Rationing is inevitable, Feldstein says, and there are only two options: with price and free choice or with regulation. Surely Obama spent enough time at the University of Chicago to understand his P’s and Q’s.

2. Inefficiencies of Scale

Obama says his advisers have identified $500 billion to $600 billion of inefficiencies in the system that would pay for reforms. When was the last time the government wrung inefficiencies out of anything? Medicare is plagued with waste and fraud.

Health-care reform is long overdue. We need a system that offers wider choice, proper incentives (eliminating fee-for- service) and subsidies for those who can’t afford it.

We don’t need something that fails to cut costs and eliminates choice. Plan B anyone?

3. Enhanced Competition

Obama says the government needs to offer a public health- care option to encourage competition. This line of thinking leads “to the uncomfortable conclusion that the government must be a player in every industry,” says Cliff Asness, president of AQR Capital, a hedge fund in Greenwich, Connecticut, who debunks this and other health-care myths in a paper posted on his Web site.

How do other industries manage to be highly competitive without Uncle Sam’s interference?

Unless the public wants health-care outcomes akin to those of the nation’s schools -- another sector offering a “public option,” Asness points out -- Obama needs a better plan and a more convincing argument.

4. Measuring the Right Stuff

Obama has accused opponents of his health-care plan of “scaring everybody” with intimations of rationing. He scared back, telling his Raleigh audience last week that “if we do nothing, I can almost guarantee you your premiums will double.”

The high cost of health care is another myth skewered by Asness, in his paper, and Kenneth Arrow, Nobel Laureate in Economics, in an interview in the Atlantic.

The gist of their arguments: This ain’t your father’s health care. Innovations in diagnostic and surgical procedures cost money but allow for better and less invasive treatment.

What about the accusation that the U.S. spends more money on health care and boasts life-expectancy rates well below those of most developed countries?

A red herring. There’s a big difference between health and health care. If you eat too many Big Macs, smoke and drink, that’s a lifestyle choice.

Once you suffer a heart attack or are diagnosed with cancer, the survival rates in the U.S. -- especially for cancer -- are second to none. For all the hoopla over Canada’s socialized medicine, the cross-border flows aren’t south to north.

“The low longevity ranking of the United States is not likely to be a result of a poorly functioning health-care system,” according to a new study by University of Pennsylvania professors Samuel H. Preston and Jessica Y. Ho.

What’s the prognosis if ObamaCare is enacted?

“People have to get less or pay more,” Feldstein says.

As a group the elderly are the largest consumers of health- care services. If you want to cut costs, you have to go where it’s being spent.

The Eskimos had an efficient way of rationing: in some cases they simply sent the elderly out to sea on an ice floe. It’s not what Gram and Gramps envisioned for their golden years.

http://bloomberg.com/apps/news?pid=2...d=ah.vuAG5B4iU

[TheMercenary]

White House finally confirms it made a back door deal with the Drug Industry over preserving income. Frankly I don't think they should get any "deal" and neither should the Insurance Industry.

August 6, 2009
White House Affirms Deal on Drug Cost
By DAVID D. KIRKPATRICK
WASHINGTON — Pressed by industry lobbyists, White House officials on Wednesday assured drug makers that the administration stood by a behind-the-scenes deal to block any Congressional effort to extract cost savings from them beyond an agreed-upon $80 billion.

Drug industry lobbyists reacted with alarm this week to a House health care overhaul measure that would allow the government to negotiate drug prices and demand additional rebates from drug manufacturers.

In response, the industry successfully demanded that the White House explicitly acknowledge for the first time that it had committed to protect drug makers from bearing further costs in the overhaul. The Obama administration had never spelled out the details of the agreement.

“We were assured: ‘We need somebody to come in first. If you come in first, you will have a rock-solid deal,’ ” Billy Tauzin, the former Republican House member from Louisiana who now leads the pharmaceutical trade group, said Wednesday. “Who is ever going to go into a deal with the White House again if they don’t keep their word? You are just going to duke it out instead.”

A deputy White House chief of staff, Jim Messina, confirmed Mr. Tauzin’s account of the deal in an e-mail message on Wednesday night.

http://www.nytimes.com/2009/08/06/he...ef=todayspaper

[classicman]

the more things change the more they stay the same.