Impeding changes to our Health Care system

[TheMercenary]

More great news for your guys plan from the NYTimes....

September 23, 2009, 4:10 pm Medicare Advantage: Suddenly a Battle With Three Fronts
By David M. Herszenhorn
Three related issues consumed lawmakers on the Senate Finance Committee as they debated major health care legislation on Wednesday afternoon, but connecting the dots from one controversy to the next isn’t easy.

Here’s the back story:

The health care bill proposed by Senator Max Baucus, Democrat of Montana and the committee chairman, seeks to cut $123 billion in payments to private insurance plans that administer health benefits for roughly 10 million Medicare beneficiaries.

The private insurance plans, known as Medicare Advantage, were originally intended to save money, and the government initially paid them 95 percent of the projected cost of enrollees in traditional Medicare.

But in recent years, spending on Medicare Advantage has soared, in part because the federal government offered incentives to the private insurers to offer coverage in underserved regions, including many rural areas.

Studies show that the private plans now cost about 14 percent more than traditional Medicare, and many Democrats say insurance companies are profiting excessively from them.

To attract customers, Medicare Advantage plans typically offer enhanced benefits compared to traditional Medicare, including vision and dental benefits and, in some cases, gym memberships. The added perks make Medicare Advantage popular among beneficiaries, and the proposal by Mr. Baucus to reduce payments to them has stirred opposition, particularly in Florida, where about 1 million people are covered by the plans.

As a result, Senator Bill Nelson, Democrat of Florida, has proposed an amendment to the health care legislation that would protect Medicare Advantage plans in areas where they are more cost-efficient than traditional Medicare, like Florida. (Big surprise.)

Now that proposal has set off at least three related controversies on the Finance Committee.
First, lawmakers in rural states are furious at the idea of protecting Medicare Advantage plans only where they are cheaper than traditional Medicare, because that’s typically true only in higher-cost regions like Mr. Nelson’s home state.

Second, to cover the cost of protecting some existing Medicare Advantage plans, Mr. Nelson has proposed extracting at least $86 billion more in savings over 10 years from drug manufacturers, potentially upending a deal between the pharmaceutical industry and the Obama administration.

And third, Republicans are furious that the federal Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services, has warned private insurers not to lobby customers over the health care legislation.

That last fight stems from a letter sent by Humana, one of the largest providers of Medicare Advantage coverage, to Medicare beneficiaries warning of potential cuts in benefits.

The Senate Republican leader, Mitch McConnell of Kentucky, has accused Democrats and the Obama administration of trying to muzzle critics of the legislation.

So as the Finance Committee debate shifted into high gear, Senator Orrin G. Hatch, Republican of Utah, proposed an amendment seeking to shield all Medicare Advantage plans from reduced payments. Mr. Hatch’s amendment was rejected by a vote of 14 to 9, with Senator Olympia J. Snowe, Republican of Maine, joining all of the Democrats on the committee to defeat it.

Senator Jon Kyl, Republican of Arizona, has offered an amendment seeking to protect the First Amendment rights of private insurers who might want to criticize the proposed health care legislation.

Mr. Baucus fired back at Mr. Kyl, saying Humana had overstepped its bounds and had frightened American seniors by warning them that their benefits would be cut. “There is no First Amendment right to lie,” Mr. Baucus said. “There is no First Amendment right to mislead.”

Some Republicans said Mr. Kyl’s amendment was valid even if Humana had made misstatements. “You have a right to be wrong,” said Senator Pat Roberts, Republican of Kansas. Mr. Kyl’s amendment was defeated 13 to 10, with all Democrats opposed and all Republicans in favor.

In an appearance in Maryland on Wednesday, Vice President Joseph R. Biden Jr. sought to refute the Republican assertions about cuts to Medicare Advantage. “Here’s the truth — you’ll continue to be able to get Medicare Advantage if that’s what you choose,” Mr. Biden said.

Mr. Biden said that less than a quarter of those eligible choose Medicare Advantage, “but those of you who have it, you’ll be able to get it.”

“All we’re doing,” the vice president said, “is just cutting the padding out of the subsidies that insurance companies are already getting.”

But some health insurance industry experts say that the proposed cuts in payments to Medicare Advantage plans will mean that insurers either have to reduce benefits or cancel their plans altogether.

Senators on the Finance Committee will be debating that point in the hours ahead.

http://prescriptions.blogs.nytimes.c...-three-fronts/

[TheMercenary]

Go ahead Redux, defend it....

You can't....

Are we done yet?

[TheMercenary]

Sure, you can't defend the cuts. I am done if you can't defend the cut to the elderly who in the end are going to be royally fucked by the Demoncratic plan.

[TheMercenary]

Well it has been 10 minutes. I guess you can't defend the cuts to the elderly. No biggie. I will wait for Pelosi and Reid to feed us their bullshit on why it is ok. Make it a great day Redux...

Originally Posted by TheMercenary

Sure, you can't defend the cuts. I am done if you can't defend the cut to the elderly who in the end are going to be royally fucked by the Demoncratic plan.

Merc...I am very comfortable with the clear and concise response I provided in my own words:

....the plan will take money out of the pockets of the insurance providers (add: who have been overcharging for years) with tighter requirements in the bidding process (including holding patients harmless as much as possible), not the patients...and that is why the Republicans and the insurance industry have opposed it and vilify it and are scaring seniors.

If you want to post more partisan editorials, that is your choice.

The folks following this discussion (sic) can decide for themselves, as will the voters.

[TheMercenary]

That is your defense!?!?! Holy crap your guys are in trouble.

BTW, I do not now nor have I ever supported the insurance industry in any issue of healthcare reform.

Fail.

Again.

[TheMercenary]

Imagine that.....

CBO says Medicare Advantage seniors WILL suffer from lower benefits, to say nothing of the higher premiums, and the departure of their carriers from the market that will also result from the cut:

"However, the director of the Congressional Budget Office, Douglas Elmendorf, in testimony before Baucus’s own Senate Finance Committee, said, in fact, the cuts in Medicare Advantage would result in a loss of benefits and lower enrollment.

'The effect of the original chairman’s mark on Medicare Advantage enrollment in 2019, would be a reduction of roughly 2.7 million people or 20 percent of the enrollment,' Elmendorf said Tuesday. '[T]he competitive bidding process would reduce the extra benefits that would be made available to beneficiaries through Medicare Advantage plans.'

Elmendorf said that, by 2019, the value of extra benefits provided by private insurers but not by the government, would be cut in half if health reform is passed.

'The additional benefits would be smaller: $42 in additional benefits per month in 2019, and it’s a little less than half of what we would project under current law,' he said."

http://bubbanear.blogspot.com/2009/0...advantage.html


Redux, can you defend the cuts?

[TheMercenary]

Come on Redux. All I am asking you to do is to defend taking away a benefit from the elderly to pay for other's healthcare. This is not difficult. Can you defend it?

Originally Posted by TheMercenary

Come on Redux. All I am asking you to do is to defend taking away a benefit from the elderly to pay for other's healthcare. This is not difficult. Can you defend it?

Merc..in a post earlier today, you discount the CBO because you dont like the numbers.

Now you find a statement from the CBO that you do like...even if it is several weeks old and addressing the original "mark" and does not apply to the final Senate Finance bill that was crafted over the last week (that added protections to Medicare patients in the final version).

You cant have it both ways, Merc.

[TheMercenary]

The Baucus Bill: An October Trick
By Diana Furchtgott-Roth

WASHINGTON--It's October, the month of trick or treat, and Congress is trying to come up with a trick. The Congressional Budget Office's estimate of Senate Finance Chairman Max Baucus's health reform bill makes it looks like a treat-it's projected to reduce the federal deficit by $81 billion over the next 10 years-but in reality it's a Nightmare on Pennsylvania Avenue.

Yesterday CBO came out with its second estimate of the Baucus bill, reflecting the original bill together with amendments that have been hammered out over the past three weeks in committee deliberations. Only in government accounting could an additional 29 million people receive new health coverage with a savings of $81 billion. By this congressional logic, America could insure all 6 billion people in the world at a savings of trillions of dollars.

CBO estimates that the $829 billion bill (over ten years) would be paid for partly with additional taxes-on expensive health insurance plans, on employers who do not provide the right kind of health insurance, and on people who do not sign up for insurance-and partly through savings in Medicare and Medicaid.

The Baucus bill would require everyone to purchase health insurance or face penalties. Americans with incomes up to 300% of the poverty line (currently $66,000 for a family of four) who are not covered by an employer plan would receive tax credits to purchase health insurance plans in an "exchange."

Plans purchased in the exchange would be Cadillac plans, with generous coverage and no lifetime or annual limits on any benefits. Only Americans under 25 would be allowed to purchase "young invincible" plans, catastrophic insurance against major accidents. Most Americans would have to pay a far higher cost for health insurance, since plans would have to accept everyone, regardless of health or pre-existing conditions.

The Baucus bill would be paid for in two major ways-an excise tax on expensive plans and savings from Medicare. CBO underestimates the true cost of both components.

Take the excise tax increase, for instance. The more expensive health care plans would face an excise tax of 40% on premiums above $8,000 for singles and $21,000 for families, bringing in $201 billion from 2013 through 2019. Today health insurance premiums cost on average $4,824 for singles and $13,375 for families.

What CBO doesn't tell Americans is that their health insurance premiums would increase substantially in the decades ahead. The level of health insurance premiums does not have to be incorporated in CBO estimates, because it is not a tax and it is not paid by the federal government. In 2019, in addition to $46 billion in excise taxes, Americans would be paying over $100 billion in higher premiums.

Since CBO forecasts increases in excise tax revenues of 10% to 15% annually after 2019, health insurance premiums must also rise by the same percent annually. This government mandate will amount to a steady drain on Americans' pocketbooks, a tax under another name.

Turning from taxes to savings, nearly 90% of the $404 billion Medicare and Medicaid savings would be from Medicare in the period 2013 to 2019. Thereafter, savings would be expected to continue at the rate of 10% to 15%. Of all demographic groups in America, the elderly would be the biggest losers under the Baucus plan.

CBO estimates that Medicare Advantage plans, popular bundled health maintenance organizations serving 20% of Medicare patients, would be cut by $117 billion.

Under "Ensuring Medicare Sustainability," more than $200 billion would be cut from payments to hospitals, elder care, doctors, and hospices. Payments to Medicare doctors would be cut by 25% in 2011.

Another $55 billion would be saved by "Improving Payment Accuracy," as if one can magically reduce government spending by increasing accuracy. A Medicare Commission would propose further cuts.

The government would persuade doctors to cut Medicare costs by associating more tests with lower reimbursements. Ranked in order of spending per patient, every year the top 10% of physicians would have their reimbursements cut. Since by definition there would always be 10% of physicians in the top 10%, they would have an incentive to avoid the sickest patients or the specialties with the most tests.

America's elderly might soon discover that if they were sick they would be shunned by many doctors, if the bill operated as planned.

But it's more likely that the $360 billion of Medicare savings would not materialize, and that the Baucus bill would add to the deficit rather than reducing it. After all, Congress regularly overrides an existing law requiring Medicare payments to doctors to be cut when the program is in deficit, as it is today. Why should the new law be any different?

As CBO director Douglas Elmendorf so aptly wrote in his letter to Mr. Baucus yesterday, the "mechanism governing Medicare's payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments...The long-term budgetary impact could be quite different if those provisions were ultimately changed and or not fully implemented."

Should some version of the Baucus bill pass, Medicare spending could decline as projected, with catastrophic consequences for seniors' health care. Or, Congress could back away from cuts as it has in the past, with catastrophic consequences for the deficit. Either way, it's no treat for America.

http://www.realclearmarkets.com/arti...ick_97444.html

[TheMercenary]

Originally Posted by Redux

Merc..in a post earlier today, you discount the CBO because you dont like the numbers.

Now you find a statement from the CBO that is several weeks old that does not apply to the final Senate Finance bill that was crafted over the last week (that added protections to Medicare patients in the final version).

You cant have it both ways, Merc.

No, I did not say I did not "like" the numbers. I stated that the calculations were going to be faulty and they did not take in to account many unintended consequences such as employers accepting the penalty over paying for insurance. Among other things.

Oh good...another partisan editorial. Does that make 4 or 5 in the last hour?

Honestly, I dont bother to read them...others may.

Seriously if you want to keep posting editorials, go for it, and maybe you will change some minds here.

I've had my say.

Good luck!

[TheMercenary]

Originally Posted by Redux

Now you find a statement from the CBO that you do like...even if it is several weeks old and addressing the original "mark" and does not apply to the final Senate Finance bill that was crafted over the last week (that added protections to Medicare patients in the final version).

You cant have it both ways, Merc.

None of that changes the planned cuts in Medicare Advantage.

[TheMercenary]

Originally Posted by Redux

Oh good...another partisan editorial. Does that make 4 or 5 in the last hour?

Honestly, I dont bother to read them...others may.

Again, feel free to keep posting them and maybe you will change some minds.

Good luck!

Either way you still cannot defend the facts as presented. I am ok with that. The burden is on you, the defender of the Demoncratic Plan.

All I am asking you to do, as a supporter, is to defend the cuts. Can you?