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At Think Progress, Igor Volsky has an important reminder for policymakers eyeing Medicare for cost savings in debt ceiling and deficit negotations: the plans under consideration just shift costs, they don't actually reduce them.
Rep. Paul Ryan’s (R-WI) budget would find savings in the Medicare program by shifting a greater share of its costs to beneficiaries, who would receive a fixed "premium support" credit to go out and purchase health care in an exchange of private health care plans.[...]

Ryan’s isn’t the only proposal to lower the growth in Medicare spending that’s asking seniors to pay more, and that’s precisely what has health care advocates so concerned. They point out that nearly “half of Medicare recipients have incomes at or below 200 percent of poverty—$21,780 for an individual, $29,420 for a couple” and that many simply can’t afford to spend more on health insurance:

Only 5 percent of Medicare beneficiaries have incomes of $80,000 or above, a figure that includes any income from a spouse. As for the 47 percent who are at or close to poverty, on average they are already spending nearly a fourth of their budgets on health care, according to an analysis of Medicare survey data by the Kaiser Family Foundation.[...]

Last week, the LA Times’ Noam Levey observed that saving costs by shifting them from the federal government to beneficiaries—once seen as taboo—has become all the rage in Washington, with pundits eagerly applauding the bold “leadership” and “tough decisions” of such proposals.

It's not bold or tough to make the beneficiaries of these programs pay more. What would be bold and tough would be to take on the big health care industry special interests to force cost reductions in things like pharmaceuticals and medical equipment and devices. There's cost savings to be had in the program itself in addressing the actual costs of care. Those are what policymakers should be looking for instead of just passing the buck on to America's seniors.

Originally posted to Joan McCarter on Tue Jul 19, 2011 at 12:59 PM PDT.

Also republished by Daily Kos.

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Comment Preferences

  •  It's sad that it's always about money. (19+ / 0-)

    Everybody is going to need health care. The question is how do you pay for it?

    1. National single payer (Medicare for all) with a less than 5% overhead
    2. Private health insurance with a 15-25% overhead.

    Why does the DC beltway pick the second choice? Because that 15-25% overhead includes lots of profit for private companies.

    •  Yep (6+ / 0-)

      as much good as the Affordable Care Act does do, it doesn't do as much as we really need for cutting costs. It'll help, but doesn't get to much of the systemic problems.

      And if Medicaid really does get slashed in the debt ceiling/deficit package, it'll hurt the ACA, too, by increasing the ranks of the unemployed and increasing costs for subsidies there.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Tue Jul 19, 2011 at 01:11:39 PM PDT

      [ Parent ]

      •  I agree with your diary, Joan, but (2+ / 0-)
        Recommended by:
        tardis10, Into The Woods

        not so much with this comment. ACA isn't given credit for setting the table with proposals and ideas (through the Center for Medicaid and Medicare) that get to the kind of problem you are attempting to address in your diary.

        The Affordable Care Act:
           • Establishes a Center for Medicare and Medicaid Innovation. This center will aggregate known nationwide health care delivery improvements and offer incentives for other health care providers to implement and improve on these best practices.
           • Recognizes that our current system is fragmented, which leads to inefficiencies. The ACA, through several proposals, seeks to provide more coordination among providers.
           • Provides incentives and resources to build a computerized medical record.
           • Establishes patient-centered models of delivery through mechanisms like medical homes and accountable care organizations.
           • Recognizes that Medicare hospital readmissions is a significant driver of expenses so establishes a Community Care Transition Program to ensure that patient post-discharge needs are adequately met.
           • Establishes the Community First Choice option, which seeks to move patients from a costly nursing home setting to the home.
           • Creates programs to increase the primary care workforce and provides for increase in primary care payments.  
           Dr. Donald Berwick, the administrator for the Center for Medicare and Medicaid, asserts that many significant improvements to health care delivery are occurring throughout the country, and that a policy goal should be to “scale up those efficiencies.” The example he uses is the infection that sometimes results from a central line venous catheter. He points out that several hospitals have found ways to eliminate those infections, leading to thousands of dollars in savings. This can be replicated throughout the system.

        •  But the states are dismantling Medicaid (10+ / 0-)

          as fast as they can.

          And there is a clause in the ACA that allows them to do so, and if they aren't happy with the results in 2014, they can roll back eligibility to what it is currently. In other words: still no coverage for childless adults, no matter what level of income they have.

          All these pretty words about what Medicaid is going to cover seem to ignore the fact that nobody in MY state legislature (Texas) is going to allow one more person on the rolls than they can help. They have no fear about losing federal money -- they don't care. They are hell bent on cutting poor people off the government health care lists, and they will refuse federal money to do it.

          If they aren't participating, the feds can't tell them who they have to cover.

          "The difference between the right word and the almost-right word is like the difference between lightning and the lightning bug." -- Mark Twain

          by Brooke In Seattle on Wed Jul 20, 2011 at 08:08:31 AM PDT

          [ Parent ]

          •  Agree that ACA is imperfect vehicle (1+ / 0-)
            Recommended by:
            Mr MadAsHell

            but ACA does address the issue of improving health care delivery, improving efficiency, and methodically reducing costs.

          •  Cost Shifts in Future Include Those to States (0+ / 0-)

            Just as the cuts to federal Medicare spending only shift costs to the beneficiaries (on top of the already significant amount many already pay), the cap/cuts to federal Medicaid spending shift costs to beneficiaries and State budgets.  

            Severe restraints on State budgets and unwillingness to shift costs to the wealthiest through increased taxes has resulted and will increasingly result in shifting costs to the people least able to afford it - the non-elderly poor and disabled and the nursing-home poor.

            Increased co-pays, cut-backs in covered services (i.e. increased out-of-pocket costs) and more restrictive eligibility standards (i.e. rationing of services forcing increased individual payments and increased out-of-pocket spending) are all embedded into the Ryan budget cuts and many of the proposals currently circulating from the GOP and GOS (gang-o-six).  

            We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

            by Into The Woods on Wed Jul 20, 2011 at 11:31:41 AM PDT

            [ Parent ]

      •  The Gang of Six called for provider cuts (3+ / 0-)
        Recommended by:
        mmacdDE, WillR, Into The Woods

        They called for changes in payments while guaranteeing the benefits Seniors rely on.  They were concerned with provider cuts.  True, increasing efficiency and reducing ineffective end-of-life care is in a way a cut in benefits but this is absolutely necessary if we are going to control costs.  We need serious changes  in how the medical profession and society deal with  death in the elderly, moving toward palliative care more than reflexively "trying everything" because someone can't let go or Drs see death as  a defeat rather than the inevitable consequence of  life.

        I agree about Medicaid, because it is incredibly efficient, but Medicare needs some real changes in payment incentives and procedures.

        The scientific uncertainty doesn't mean that climate change isn't actually happening.

        by Mimikatz on Wed Jul 20, 2011 at 08:23:07 AM PDT

        [ Parent ]

    •  It's also sad that it is always about appeasing (4+ / 0-)

      the "independents" who are probably right wing partisans. Chipping away at social programs will be the beginning of the end for the brand of the Democratic Party, it used to be what defined us.

    •  tiny little Costa Rica provides health care to all (4+ / 0-)

      of its citizens.

      If they can afford to, I'm pretty sure we can too.  We're a zillion times richer than they are.

      •  they have no Army (2+ / 0-)
        Recommended by:
        Mr MadAsHell, wsexson

        ... food for thought?

        It's not a fake orgasm; it's a real yawn.

        by sayitaintso on Wed Jul 20, 2011 at 08:26:30 AM PDT

        [ Parent ]

        •  indeed that was the key to their social programs (0+ / 0-)

          but not for fiscal reasons.  In every other Latin American country, the army was the primary tool used by the wealthy to impose whatever economic conditions they wanted onto the large mass of poor. When Costa Rica abolished its army, they took away that weapon and forced the elite to make peace with the poor on terms that everyone accepted -- or else.  

      •  Lots of fresh fruit and fish in Ticolandia (1+ / 0-)
        Recommended by:
        sarahdillingham

        No government subsidies for high fructose corn syrup.  Gas is expensive there; so more people walk or ride bikes.

        Ticos also don't invade countries with nonexistent weapons of mass destruction to create no-bid contracts for politicians' campaign contributors.  So with the money they save, they can provide health care.

        But doctors don't make 6-figure salaries in Costa Rica.

  •  We can't keep ignoring (7+ / 0-)
    What would be bold and tough would be to take on the big health care industry special interests to force cost reductions in things like pharmaceuticals and medical equipment and devices.

    The fact that a lot of specialized surgical procedures belong in that same list... Our shortage of primary care physicians and GPs is likewise tied to the out of control reimbursement of high-end procedures.  The health care industry goes where the money is - and the money is in specialized procedures.

    Rather than keep kicking the silly 90s "doctor fix" down the road, it's to actually properly fix it -- remove the across-the-board nature of the cuts, exempt check-ups and other primary care activities from it -- and then let it stand and actually happen for high-end procedures.

    Full Disclosure: I am an unpaid shill for every paranoid delusion that lurks under your bed - but more than willing to cash any checks sent my way

    by zonk on Tue Jul 19, 2011 at 01:08:13 PM PDT

    •  All true (9+ / 0-)

      But things like competition between local hospital systems is problematic. Like why do the two main hospitals in my city, Boise, each have to have all the latest, most expensive equipment? It could be shared in a community of this size.

      "There’s class warfare, all right, but it’s my class, the rich class, that’s making war, and we’re winning." —Warren Buffett

      by Joan McCarter on Tue Jul 19, 2011 at 01:13:42 PM PDT

      [ Parent ]

      •  Because hospital systems make money running (1+ / 0-)
        Recommended by:
        Book of Hearts

        tests that you don't need.

      •  Very true (0+ / 0-)

        DE is close to Johns Hopkins and Philly hospitals, as well as DC and S. Jersey.

        Of course we still need local hospitals - but those local hospitals also have every device known to man.

        And there are stand alone clinics that do MRI (at least 3 I can think of - in a town of 20k), every hospital has a cardiac unit, a neonatal unit. They don't necessarily have a cancer unit though - which doesn't make a lot of sense to me.

        Lots of places for dialysis, orthopedic surgery - but few OB-GYNs.

        Everything is skewed, just like most places.

      •  They compete for patients and Drs., but to do so (0+ / 0-)

        end up making capital expenditures that keep them at the forfront of diagnostic and treatment technology.

        Unfortunately, the utilization rates necessary to recoup those costs are often below what is reasonably necessary given the duplication of such capacities within the local market.  

        This puts pressure on the providers to either increase utilzation on that equipment or cross-subsidize it by pushing their margin or utilization in other areas (ie. $5 pill of Aspirin.)  

        The deregulation of healthcare expenditure controls (such as 'certificate of need' programs that required evidence of need before capacity increases were approved) placed this aspect of health care at the mercies of the market forces.

        But given the truncated and blended character of the 'market's' influence on health care it just does not work the way they fantasized it would.  

        We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

        by Into The Woods on Wed Jul 20, 2011 at 11:42:58 AM PDT

        [ Parent ]

  •  So far, common sense is off the table. (8+ / 0-)

    It is not "Serious" to reduce profits...

    What would be bold and tough would be to take on the big health care industry special interests to force cost reductions in things like pharmaceuticals and medical equipment and devices.

    It is only acceptable to skin the marks and create the new feudalism.

  •  It's not health care spending (16+ / 0-)

    in general that anybody in government is concerned about. Obama's health care bill does nothing about the cost of care, it just throws more money to the insurers by mandate - politicians love it when their corporate benefactors make more money. It's the job they are in government to do.

    This cost-shifting is all about lowering the amount government and insurers have to spend on health care, that's all.

    •  "wealth creation" (sic) (5+ / 0-)

      Sorry, I  mean "sick".

      Antemedius | Liberally Critical Thinking

      by Edger on Tue Jul 19, 2011 at 02:08:03 PM PDT

      [ Parent ]

    •  The ACA does a lot about cost control. (1+ / 0-)
      Recommended by:
      Into The Woods

      It does a lot of things about cost control.

      It sets a maximum level of profit and overhead (no more than 15% of premiums).

      It sets up boards to study and implement methods of cost-savings within Medicare and overall, by studying health care outcomes of different treatment methods.  (You know, "death panels.")

      It sets up a system for sharing those results with doctors, so they can cut out unnecessary procedures that are a waste of time and money and know better what to concentrate one - a win for efficiency and quality.

      It cracks down on fraud.

      It expands the number of Americans in more-efficient government programs (mainly Medicare) by millions.

      Art is the handmaid of human good.

      by joe from Lowell on Wed Jul 20, 2011 at 08:23:53 AM PDT

      [ Parent ]

      •  Which is why the GOP hates it and the GOS (0+ / 0-)

        is at best tepid on it so far (with some exceptions.)

        Even after adjusting for special payments and levels of illness, the wide unjustifiable disparity in the costs-per-Medicare recipient between different markets - sometimes even within the same state - discussed here provide a fat target for the independent cost-containment panels (assuming they are independent and assuming they survive to do their job).  

        Increasingly analysis is showing that savings could come from better utilization levels not only by weeding out the unnecessary care (driven more heavily by desire for profit than fear of lawsuit) but by avoiding the costly side-effects of such unnecessary tests and procedures.

        We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

        by Into The Woods on Wed Jul 20, 2011 at 03:16:08 PM PDT

        [ Parent ]

  •  I'm Pretty Sure It Does Lower Spending, That It's (4+ / 0-)

    doing right now in private health care as premiums and copays have risen.

    I'm almost certain I saw it cited as causing people to get less treatment and as part of why insurance company profits are up this year.

    Well absolute spending is probably still rising but making "consumers" more "responsible" for their "behavior" suppresses the growth of their "shopping."

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Tue Jul 19, 2011 at 01:53:44 PM PDT

    •  Whenever I hear these "shopping around" argumetns (8+ / 0-)

      about health care, I picture some guy missing a leg in a car accident sipping a martini in the back of the ambulance while blithely directing the ambulance driver to stop at the various hospitals for a quote.

    •  The real question... (3+ / 0-)

      is whether it lowers spending while also ensuring that people get the care they need. That is something that I highly doubt about the Ryan plan or any other plan that shifts costs onto patients, such as high-deductible health insurance. The idea that patients are going to "shop around" for the best price on their medical care is fundamentally absurd, and therefore any argument that it's going to lower costs via free market pixie dust is delusional.

      For one thing, patients don't have access to adequate pricing information in order to do that. It's nearly impossible to get doctors and hospitals to even tell you how much something is going to cost in advance. But even if we could somehow magically change that situation, patients can't just buy their medical care piecemeal wherever is cheapest. A hospital stay typically involves goods and services provided by a wide variety of different people and organizations (doctors, lab work, medicines, medical supplies, food, etc), but you can't really "unbundle" those services because you don't like the pricing on one particular thing. It would be crazy for people to try to shop around for a better price on the hospital food or the labwork, or whatever, because it would be massively dysfunctional and inefficient. The whole thing is an integrated system that just can't be broken up like that.

      Further, it's not like most patients are actually educated enough about healthcare to judge whether a) they really need some particular piece of healthcare or not, or b) educated enough to judge whether the quoted costs are fair. If my doctor charges me, say, $1200 for a scope procedure, how should I know whether that's a reasonable price or not? I have no idea, because I don't deal with it every day. How should I know whether I really need to be sedated for that procedure? If we leave these decisions to patients rather than doctors, then you will inevitably get people making decisions based on personal ignorance rather than informed decision-making. That's not a recipe for good healthcare. And actually, studies have already proven that I'm correct about this: people who are on high-deductible insurance plans are less likely to follow medical recommendations on things like vaccination, Pap smears, and so on, unless the policy specifically excludes those things from the deductible.

      Plus, most of the costs in our system are for things like chronic disease care and catastrophic illness or injury. Care for those kinds of things are non-optional, and so even the theoretical savings associated with reducing overuse of healthcare are very limited. All you do to those people by shifting costs onto them is increase their financial burden, since they can't choose to use less healthcare and save money.

      If you give people a strong financial incentive to not use health care, they won't use as much health care. But that doesn't mean they'll be better off for it.

  •  This is hideous, also... (9+ / 0-)

    trying to find a Doctor that will accept Medicare will be a nightmare.

    You can bet the Doctors are in the cross hairs too for Medicare reimbursement. This is so convoluted~!  

    The domino effect that assures the patient of more stress emotionally and financially.

    And of Medicaid?  I don't recognize this country anymore.

  •  Although I recced, the sad truth is that it WILL (9+ / 0-)

    lower health care spending, by shifting cost off onto those who can't afford to pay for it.  So as Grayson pointed out, the only option left to them is 'die quickly'.

    •  Depends though (5+ / 0-)

      if they end up in ERs more frequently, the costs will go up - and hospitals will go under.

    •  Federal Health Care Spending will be lowered (0+ / 0-)

      by shifting the costs to individuals and states.

      Total health care spending will likely increase, because instead of seeking the kind of testing, diagnostics and early treatment that can identify and resolve issues early, people will postpone their Dr visits - resulting in higher costs down the line.  

      It's been shown over and over again.  

      This is cost shifting in the short-term to individuals and cost-shifting that avoids some costs now but adds higher costs a few years from now.  

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Wed Jul 20, 2011 at 03:20:05 PM PDT

      [ Parent ]

  •  Sure it does. (3+ / 0-)

    The theory -- and I think the reality as well -- is that if you have to pay more of the cost yourself, you will think twice or three times before going in for that test or procedure. I know that's true for me, and I'm not in the position of having to trade it off against groceries or rent. (Would I have just had foot surgery if I'd had to pay 20% of it out of pocket? Or just lived with the pain and reduced mobility? I'm not sure but it would have been a lot harder decision.)
    That doesn't mean this is good policy -- it keeps people from getting the care they really need, as well as what's less essential. We'd just be sicker and suffering. But it likely would reduce the total health care cost.

    •  Externalities put the lie to that justification (1+ / 0-)
      Recommended by:
      Brooke In Seattle

      E.g. lowered productivity due to untreated health problems, so your employer ends up paying for the foot problem you couldn't afford to have treated.

      No one is arguing that government should anticipate and take care of every little problem that people encounter in life. But there are certain ones that, even if they only directly affect individual people, indirectly but meaningfully affect many more people, often in a negative way, that government would do well to get involved in. People arguing against that are doing so from a moral, not practical viewpoint. And their moral system is too simplistic (not to mention cruel) to be compatible with the modern world (or decent human society). They are either too dumb to understand reality, or too infantile to care. We should just ignore them.

      "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

      by kovie on Wed Jul 20, 2011 at 08:41:58 AM PDT

      [ Parent ]

    •  Not fixing the roof saves money 'today', not in (0+ / 0-)

      long run.

      Same with many health issues.

      Catch and address them early, it costs less and you have a better chance and more quickly returning to your highest possible functional level.

      Wait until you just can't stand it anymore (or you're unconscious and someone's taking you to the ER) and costs skyrocket, chances for higher-cost intervention being required go way up and chances for best-possible and soonest-possible recovery go down.

      Better to spend the money today to fix the roof by repairing it before you have to replace it and half the interior as well.

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Wed Jul 20, 2011 at 03:24:28 PM PDT

      [ Parent ]

  •  Many who have Medicare can't afford to use it. (13+ / 0-)

    There still is a monthly premium for part B.  After you spend I think it's $140 to begin with at the doctor's office at the beginning of the year, then Medicare pays 80% of the office visit, treatment.  Meds are extra and the RX plans are for you to pick and pay and then you have to pay for your meds.  The problem is the plan requires Medicare to buy the meds at their highest and not at the discounted price the military gets.

    I know people who have Medicare A and B that still can't afford to use it.  Fixed income is tough.

    •  Medicare Advantage was created (1+ / 0-)
      Recommended by:
      Into The Woods

      to deal with precisely this problem, and it's a great deal for members, but a horrible one for taxpayers because it's fiscally inefficient. It's a textbook example of the sort of "wasteful government spending" that the GOP loves to rail against even as it itself creates it to please its corporate owners.

      "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

      by kovie on Wed Jul 20, 2011 at 08:44:21 AM PDT

      [ Parent ]

  •  Since when is lowering costs the goal? (0+ / 0-)

    The cost issue doesn't have the leverage that it should, just at it didn't with the public option question.

    Wonder what the means.

    What do we want? Compromise! When do we want it? Now!

    by itswhatson on Wed Jul 20, 2011 at 08:13:00 AM PDT

  •  SOMEONE EXPLAIN to me (4+ / 0-)

    Great Diary, healthcare cost are the issue and they are not being talked about.  My father had to go to the hospital ER for stomach pain, I figured it was just another kidney stone in a sensitive area again.  So anyway.

    Take him in, he is there for hours, get seen, get an xray,  and then gets a ct scan, stays the night, gets some painkillers, nothing special, stays the night.  All in all there for less than 24 hours.  Bill over 22,ooo DOLLARS.

    Yeah, how is that possible. I laughed and said I could of sent him on a around the world cruise for that price.

    In the end all they said was, have your specialist look at the xrays etc, we dont see anything, and take these pills for the pain.  whoppdee freaking doo.  22 Grand.

    WHo what where why.  I would love to see the break down.  How is it even possible?

    I mean I got my dog xray at the vet last week it cost 100 bucks.  How is that any different.    Next time maybe I just have to dress my  dad up as a giant poodle?

    Pain pills we got are nothing special, 20 to 30 bucks max at cvs.  SO again.  where is the 22k?  That , that is the question.  That is what needs to be addressed, and of course it is not.

    Its just like the jobs debate, jobs are DIRECTLY tied to trade agreements and tariffs yet do you EVER hear them being discussed in the same conversation.

    This country and its leaders arent serious about any of this.

    Bad is never good until worse happens

    by dark daze on Wed Jul 20, 2011 at 08:14:20 AM PDT

    •  That's what happens in a fee-for-service (2+ / 0-)
      Recommended by:
      dark daze, Brooke In Seattle

      based system, as opposed to a flat fee system where hospitals and providers get compensated annually for doing what they're supposed to do as is the case in virtually every other industry. You're also subsidizing all the ER patients they're required to see regardless of ability or intention to pay, as well as, I'm guessing, their yacht-owning star doctors and overpaid administrators.

      The medical industry is an underregulated mess.

      "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

      by kovie on Wed Jul 20, 2011 at 08:33:18 AM PDT

      [ Parent ]

    •  And now imagine an elderly frail person (0+ / 0-)

      who spends a fair share of her time in the hospital (be it just for observation) along with a few transports by ambulance. Who is footing the bill?

      This industry is a giant racket.

      We don't inherit the world from the past. We borrow it from the future.

      by minorityusa on Wed Jul 20, 2011 at 09:47:58 AM PDT

      [ Parent ]

  •  a great comment (1+ / 0-)
    Recommended by:
    sarahdillingham

    in a great diary here.

    opening our eyes wider and wider.

    The Addington perpwalk is the trailhead for accountability in this wound on our national psyche. [...you know: Dick Cheney's "top" lawyer.] --Sachem

    by greenbird on Wed Jul 20, 2011 at 08:16:28 AM PDT

  •  imo the only thing that comes out of DC pols... (0+ / 0-)

    healthcare plans seems to be big profit increases for pharma and health insurance companies. we can all expect to pay much much more, get a hell of a lot less and we better be happy we got anything ................wtf

  •  I'll disagree a little bit (0+ / 0-)

    My mom works in a dermatology office as a nurse.  Most derm cases are minor.  They see lots of Medicaid and Medicare patients who have no copay and come in to have them look at the stupidest things.  A 90 year old lady with age spots probably doesn't need to see a doctor.  A kid on Medicaid who isn't taking his acne medicine is surprised when it doesn't work.  I feel like if there was a copay that might make these people think about going to the doctor, it would be useful.

    •  There are always fools and ... (1+ / 0-)
      Recommended by:
      Brooke In Seattle

      connivers, as well as lonely people who go to the doctor because they want someone to talk to.  I'm not sure how you eliminate them except on a case by case basis.  You do have a point though.

      However, do we eliminate bakers because some adulterate bread?  Or bankers because some steal from their costumers? Heck, we can't even prosecute the worst offenders among bankers.  Steal millions or billions and go free to do it again!

      That does not mean that we have to put up with fraud, only that we can't generalize that all or even most Medicare recipients are perpetuating fraud.  

    •  The Skin Cancer that is not caught early (0+ / 0-)

      how many really short, really straightforward office visits can be covered by the difference in costs between "caught it earlly" and "this far progressed requires intense and prolonged treatment with reduced chances of survival".

      What other mechanisms could be used to allow people to check on what worries them without a full blown Dr visit or tests?  

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Wed Jul 20, 2011 at 03:29:28 PM PDT

      [ Parent ]

  •  Spread the Word That (1+ / 0-)
    Recommended by:
    sarahdillingham

    The Republicans have no credibility on deficits. The last Democratic president balanced the budget, while the last three Republican presidents successively outdid each other in creating record deficits. The Republicans have no credibility on deficits.

    Far and Wide...

    The man who knows and knows he knows not is a wise man

    by OpherGopher on Wed Jul 20, 2011 at 08:26:12 AM PDT

  •  "Cost shifting" is a tax by another name (4+ / 0-)

    A regressive tax, of course. Repubs obviously can't lower taxes, because being an advanced society with certain unavoidable collective and individual needs that we have to pay for to get, we still have to pay for these things. They're just trying to shift the effective tax burden from the upper ends of the wealth and income scale to the lower ones. They're engaged in tax shifting, not reduction.

    Or, as they would put it, they're liberating grandma from the burden of having someone more deserving pay for her hip replacement surgery. FreeDumb!

    "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

    by kovie on Wed Jul 20, 2011 at 08:26:37 AM PDT

    •  But...but... (0+ / 0-)

      it doesn't count when it's a private corporation doing it! Only government taxation is tyranny and theft! Private corporations stealing your money are just the invisible hand of capitalism at work improving your life.

      /snark, as if I needed to point it out here. On a conservative blog, on the other hand...

      •  They take the part of Jefferson that they like (0+ / 0-)

        and conveniently dismiss the part that they don't. He railed against both government AND corporate tyranny. But they do like quoting him, don't they?

        "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

        by kovie on Wed Jul 20, 2011 at 08:56:49 AM PDT

        [ Parent ]

    •  right, new and higher fees (1+ / 0-)
      Recommended by:
      Into The Woods

      for any possible service imaginable is fine, but tax rates are too high. I get mad at all these day use fees now in National Forest and National Recreation areas. They keep going up all the time. Charges for some primitive campgrounds are ridiculous (and a lot of them have gone to the reservation model where you pay another fee just for the reservation). This is just an example where Republicans have no problem with charging people more for something you are already funding supposedly via taxes.

      We don't inherit the world from the past. We borrow it from the future.

      by minorityusa on Wed Jul 20, 2011 at 09:53:57 AM PDT

      [ Parent ]

      •  It's regressive taxation by another name (1+ / 0-)
        Recommended by:
        Into The Woods

        Anyone claims otherwise is a liar.

        "Liberty without virtue would be no blessing to us" - Benjamin Rush, 1777

        by kovie on Wed Jul 20, 2011 at 09:58:02 AM PDT

        [ Parent ]

      •  Every $ Shifted Away from Progressive Income Tax (0+ / 0-)

        falls more heavily on the middle and lower income categories.

        Every $ that is shifted from the federal to the state/local level immediately and inevitably becomes not just 'less progressive' but regressive due to the state/local regressive tax systems that exist in essentially every single state.  

        We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

        by Into The Woods on Wed Jul 20, 2011 at 03:41:10 PM PDT

        [ Parent ]

    •  It's not either/or it's both/and. (0+ / 0-)
      Repubs obviously can't lower taxes,

      Unless you count the GOP budget proposal passed by the House and supported by the GOP members of the Senate that included tax cuts only for the wealthy and for corporations (90% of stocks, bonds and business equity is owned by the richest 10% of Americans.)  

      But in addition to that proposal, and in addition to the $1 Trillion in taxes they've already shifted down onto the middle and lower income workers since the 1980s by tricking them into paying to build up a $2.5 Trillion Soc Sec reserve that the Fed Govt borrowed to avoid taxing the rich's income - a debt the Republicans say now means nothing, they are also shifting the health care costs from the rich to the poor, from the govt to the individual, from the country to the states and from today to a few years down the line when they will have increased not only due to inflation but due to neglect and lack of early identification and treatment (with the resulting increased loss in productivity and lifespan.)

      We'd rather dream the American Dream than fight to live it or to give it to our kids. What a shame. What an awful, awful shame.

      by Into The Woods on Wed Jul 20, 2011 at 03:38:46 PM PDT

      [ Parent ]

  •  It is never a tough decision to .. (0+ / 0-)

    cut other people's benefits.

    This reminds me of the logic of certain racists that while they would like all people to be truly equal, it was obvious from (insert scientific study or theological dogma) that such and such a group (not that of the speaker) are inferior.  It makes them sad, but what can they do?

    Such crocodile tears are pretty much worthless.

  •  Amazing how health care reform (4+ / 0-)

    got virtually nowhere since 2008.  And now we're deep into cutting/shifting health care costs, with obvious lethal consequences imminent.  What happened to simply improving health care?

    Sunday mornings are more beautiful without Meet the Press.

    by deben on Wed Jul 20, 2011 at 08:34:27 AM PDT

  •  Sanders talks about Obama's dangerous plan (0+ / 0-)
  •  Big bills on Medicare prove this point (1+ / 0-)
    Recommended by:
    Into The Woods

    I am retired and on Medicare and have more experience with doctors, hospitalization and the rest.

    I had and have private BC/BS which covers my wife and acts as a supplement to Medicare. It's expensive.

    Try being hospitalized for surgery and look closely at the bills that  come. Two nights of hospitalization for a major surgical procedure. I held the cost down because I didn't want to stay the third night authorized.

    Those two nights came to $90,000 which wrapped in the bed (1 night in ICU), the surgical suite, assorted odds and ends including some surgical staff and equipment. Anesthesia was extra, 16,000, on a separate bill.

    Medicare reduced that $90,000 to $16,000 and the $16,000 to 2600. There were some other bills but offhand don't remember them. Before Medicare I would have paid a larger part of that. And without insurance, they would have billed the full amount and haggled it down to what they thought they could get out of me, up to and including legal process.

    I don't know yet what the two neurosurgeons charged. We received a check for one who does not accept assignment. The lead surgeon does. But both no doubt represent a markdown from list price.

    A few weeks ago, I saw one of my other specialist who said he was retiring at the end of the month. We talked about things as old friends and he questioned a rheumatologist who had dropped me and other Medicare patients.

    in time Medicare does okay, he said, and in any event, it's what sets the pattern for private insurance for the most part. It keeps things like hospital bills from going throught the roof. It's not just Medicare patients who benefit, he said, it's everyone.

    He doesn't have any objection to making good money. He'll live well in retirement. But he thought the system was fair and that he didn't choose medicine as a career for the money, but had no complaints.

    It could do with a a good bit less politics in his opinion in which the system is yanked around constantly. He also noted that some doctors who left the system had come back to it, even some who had made a lot more money out of it for a time.

    This man was approaching his mid70s and created one of the most prestigious multi-discipline practices around, accepting not just great doctors, but those with a record of accomplishment including advanced study, an indication it's something more than a living.

    Across the board my doctors believe in the system. One of my other specialists is not accepting new Medicare patients. He's just tired of the congressional yo-yo every year.

    FWIW, none of my doctors has a nurse. All of them block time to see me and I'm rarely stacked up for hours waiting to see one. Most spend a full half hour or close.

    Beneficiaries of Medicare should not bear the burden of paying  for the debt they didn't incur. Everyone should pay some small percentage more, but Medicare should be extended to more people, not cut back.

    I can't go along with increasing the cost of Medicare through a means tested user's fee, but not so oddly I don't object to a higher tax on income that might or might not apply to me just as the user's fee.

    Cost of Social benefits should be shared across the board. I financed my Social Security in advance and paid heavily at times for Medicare. Now I think it's time for those who are working who have more to pay more.

    It's ludicrous that my wife paid more Medicare tax in a single year from severance pay for 30 years than a hedge fund manager who made $40 billion last year will in his lifetime.

    I think that the people with the means should continue to pay what they do, but there is a great social and business value in having a secure old age without having to deal with a rat's warren of new taxes hidden as user fee's because the Republicans don't have the balls to tell themselves the truth, much less the rest of America. And if they don't, they're too crazy and too stupid to realize they have NO business in public life.

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