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Senior with empty wallet

It's going to be the battle of the lobbyists when the Super Congress convenes to figure out how to sink American's economic recovery even more deeply, and legislators weigh out where they get a better deal.
The several paths to further deficit reduction mean the political conversation could very well revolve around the topics of entitlement and tax reform for the next year and a half—sucking the oxygen away from other issues. Some lawmakers may end up passing on the super committee's recommendations, believing they can get a better deal down in the next year. That could mean the main forces affected by the potential trigger—the defense lobby and health care industry—will have extra time to engage in a lobbying campaign to ensure that their priorities aren't threatened.

As it stands now, the debt-ceiling deal tasks a bipartisan committee with finding an additional $1.5 trillion in deficit reductions. The committee can do this by looking at both entitlement reform and raising revenue and will have until Nov. 23 to finish its deliberations. If a majority of the 12 committee members vote for a package of recommendations, that package will be sent to both chambers of Congress for passage. No one will be allowed to amend the suggestions offered, nor will a filibuster be permitted. A vote will be held no later than Dec. 23.

The health care industry is gearing up for the fight, and the result could very well be that it's not just provider-side cuts in health programs, but benefits cuts.

"The story isn't over," said Joe Baker, president of the Medicare Rights Center, a New York-based advocacy group. "The future of the programs really hangs in the balance. It could lead to deep cuts and irreversible changes to Medicare and Medicaid that shift costs to beneficiaries."

The hospital industry, which agreed to cuts of $150 billion to help pay for Obama's expansion of coverage to the uninsured, said Monday it's just about had it.

"America's hospitals find it difficult to support a debt ceiling proposal that could negatively affect Medicare for our nation's seniors," American Hospital Association president Rich Umbdenstock said in a statement. "Access to care could be curtailed by further cuts to Medicare funding for hospital care." [...]

"These guys haven't really solved anything — they have only set up a procedure to make cuts," said Robert Laszewski, a health care industry consultant. "We haven't seen the blood on the floor yet."

The White House is emphasizing that Medicaid for the poor and benefits guaranteed to seniors under traditional Medicare would not be touched if automatic reductions become necessary as a backstop.

But the new congressional "supercommittee" created under the deal is under no such restrictions. It can shape its own menu of cuts to Medicare, Medicaid and Obama's health care law, assuming the panel could get the votes to pass a package through Congress and buy-in from the White House.

"Nothing is off limits," said Paul Van de Water, a senior analyst with the Center on Budget and Policy Priorities, which advocates for the poor. "These debates are just going to continue."

What's still out there is the new funding formula for Medicaid the White House proposed in these budget negotiations that could sharply reduce federal contributions to the program. That's in addition to the provider cuts for Medicare already in the works, but also increases in out-of-pocket expenses for beneficiaries, included higher copays and deductibles, as recommended by the Catfood Commission.

Medical providers are nervous, but Medicare and Medicaid patients should be more so. Let's just look at the hierarchy of lobbying efforts that will be at work. The defense industry will reign supreme. Republican Senators Lindsey Graham and Jon Kyl have had absolute hissy fits over defense cuts, and that's just the beginning, before the defense lobby even really has had a chance to gear up. Real defense cuts coming out of the Super Congress is a bad bet.

So they'll turn to health care cuts. There's only so far providers will be willing to bend, and only so far Congress would be willing to go to piss them off. So who ends up bearing the brunt of cuts? You got it. The beneficiaries. That's trickle down for you.

Originally posted to Joan McCarter on Tue Aug 02, 2011 at 11:33 AM PDT.

Also republished by Daily Kos.

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Comment Preferences

    •  Any ideas? (0+ / 0-)

      for protecting beneficiaries?

      Planning a vacation or convention in Arizona? Come to Palm Springs instead! Same desert weather, none of the bigotry.

      by grey skies turning to blue on Tue Aug 02, 2011 at 02:06:29 PM PDT

      [ Parent ]

      •  Nothing in the near term. (0+ / 0-)

        Primary Obama for starters.  I know that means likely ceding the presidency to the 'thugs.

        However, I believe that a Democratic congress (if we hold at least one House!) will fight more effectively against cuts in Social Insurance programs, when same are proposed by rethuglican president.  Witness shrub's attempt to mangle Social Security.

        In short, I don't think a 'thug president can harm us more than Obama has.  The supercongress thing is unbelievable.  He failed with the catfood commission, but has now succeeded beyond his wildest hopes, I reckon.

        Just sayin'.  Others may disagree.  I will not vote for a 'thug president, but I will surely not vote for Obama in 2012.

        The hungry judges soon the sentence sign, And wretches hang, that jurymen may dine.

        by magnetics on Tue Aug 02, 2011 at 03:13:19 PM PDT

        [ Parent ]

        •  Didn't you learn anything from 2010? (1+ / 0-)
          Recommended by:
          grey skies turning to blue
        •  Primaring him would waste Dem money (0+ / 0-)

          and split the party even further.  And it would allow the 'thugs (I like that) to spend less to win.  And it is also the 'thug plan to beat him: beat him so he loses, and beat him so the Democrats are disillusioned.  

          I can't imagine myself not voting Democratic in 2012, even if Obama is the standard bearer.  Of course, the election is a year away, and Obama has plenty of opportunity to grow some balls.

          But right now, appointing a teabagger to a Federal judgeship (MinistryofTruth's diary), he's acting like he did after 2010 and he got whupped.  Like he's been beat, I don't like the implications.

          Planning a vacation or convention in Arizona? Come to Palm Springs instead! Same desert weather, none of the bigotry.

          by grey skies turning to blue on Wed Aug 03, 2011 at 03:42:31 PM PDT

          [ Parent ]

  •  I hope none of you are surprised by this (21+ / 0-)

    The GOP wants to ruin and destroy Obama and the debt ceiling rodeo greatly advanced this agenda, and Dems and Obama helped by capitulating as thy did, and giving them the farm.

    Now McConnell is ALREADY BRAGGING he will do it again BECAUSE IT WORKED SO GODDAMNED WELL!! Bonehead got 98% of what he wanted - we got jack fucking shit.

    And those assholes will do it again and they will win again unless Dems and Obama LEARN.

    Learn that the GOP are motherfuckers and you should treat them with great disgust, just like they treat us.

    Nice is your enemy at this point.

    Hell, I'd rob you if I could at this point - it's pretty fucking easy.

    Quit being easy.

    Quit being nice.

    Forget about "fair" and focus on "WIN". Fair sucks. Nice sucks.

    Losing really, really sucks.

    You SHOULD be dreaming of traumatizing them, not compromising because you're so goddamned scared of them.

    Republicans HATE America. Deal with it. / It's the PLUTONOMY, Stupid!

    by xxdr zombiexx on Tue Aug 02, 2011 at 11:44:26 AM PDT

    •  This gift will keep on giving to GOP through 11/12 (10+ / 0-)

      if not longer.  The dream of universal care is now dead again.  By 2014, we could have individual mandates and an excise tax, but no expansion of availability.

      From a broader perspective, Keynesianism, the glue that held a disparate coalition together for 8 decades, is now dead, too.  It was a nominally Dem WH and far too many Hill Dems who killed it.  I have no clue what themes Dems will run on next year--hell, I don't know what they stand for now.

      At least the kamikaze pilots knew what their mission was.

      Some men see things as they are and ask why. I dream of things that never were and ask why not?

      by RFK Lives on Tue Aug 02, 2011 at 01:19:02 PM PDT

      [ Parent ]

  •  Can someone please explain this to me... (5+ / 0-)

    OK, am I correct that to a person -- every single kossack readily agrees that Part D flawed by the lack of CMS being able to pay drug reimbursement based on bulk pricing, right?

    Any objection to that?  Medicare should get the best deal it can from Big PhRMA?

    Everyone with me?

    Now... explain to me how it is you reconcile that with a completely opposite view on Big Provider...

    You have one set of rules for Pfizer, but a completely opposite set of rules for Columbia/HCA.

    Yes, yes - I am well aware that not all hospitals are privately held.... that's a perfectly good reason for exceptions and digging into the weeds, but it doesn't explain why Medicare should get a better deal on drugs from pharmaceutical companies, but had better just give enormous multinationals like HCA whatever they want.

    Please...

    Someone...

    Help me understand how you logically hold these two completely opposing positions at the same time.

    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 Aug 02, 2011 at 11:54:34 AM PDT

    •  Oh, just for giggles... (2+ / 0-)

      Here's HCA's Q2...  I mean, they are struggling -- Q2 2011 revenue only rose 4% to a mere 8.06 billion, and horror of horrors, EBITDA actually declined 4.7%, so they only made 1.420 billion.

      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 Aug 02, 2011 at 11:59:22 AM PDT

      [ Parent ]

    •  Hospitals are now typically the (5+ / 0-)

      largest employers in town except for maybe the school district.

      •  not after ALEC gets its way... (2+ / 0-)
        Recommended by:
        Ken in MN, 3goldens

        Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

        by a gilas girl on Tue Aug 02, 2011 at 01:14:39 PM PDT

        [ Parent ]

      •  I hate to break it to people (5+ / 0-)

        But cuts to providers will in practice result in cuts in benefits because the money offered won't cover the care, so many physicians will stop seeing medicare patients. How anyone thinks the two aren't linked is living in a fantasy world.

        Just another day in Oceania.

        by drshatterhand on Tue Aug 02, 2011 at 01:50:03 PM PDT

        [ Parent ]

        •  Exactly! (3+ / 0-)
          Recommended by:
          masslib, Pinto Pony, schnecke21

          It's really dishonest for the politicians to infer that cuts to Medicare providers don't affect Medicare patients.  I also think too many people don't understand that cuts to Medicare "providers" doesn't mean just physicians.  It can be nurse practitioners who see patients in areas that can't get a clinic to locate there.  It means businesses that provide home health care aides, for example, will get LESS reimbursement for providing these folks who go into patients homes and provide essential care like showers and other personal cares, for the elderly.  These businesses may close or lay off people because they can't afford to pay them.  And that means seniors not getting the care they need in order to recuperate after a surgery. In addition, the physical therapists and occupational therapists who make home visits to patients following surgery could be cut--meaning more folks would be forced to go to nursing homes (far more expensive) rather than being able to recuperate at home (far less expensive).  And all of this can and will affect Medicare patients, despite what the politicians would like us to believe.  It's disgusting and it's dishonest.

          Objecting to our governor’s policies does not make a citizen of Wisconsin a criminal. Not yet, anyway. ~ nelangst

          by 3goldens on Tue Aug 02, 2011 at 02:05:23 PM PDT

          [ Parent ]

          •  It's no less dishonest (0+ / 0-)

            than pretending that skim, upcoding, and medicare maximization isn't part of the business model of many hospitals.

            I'm all for getting into the weeds and I regularly try to do so whenever these threads come up, yet -- every. damn. time.  the loyal opposition wants to oversimplify things into "provider cuts means benefit cuts!"

            Targeted cuts are needed; badly in many areas.

            I haven't read a single lefty apostate to the standard progressive CW - be it here or elsewhere - who has clamored for blind and universal cuts.

            Yet, far too many insist on becoming the very strawmen that conservatives try to paint liberals as -- i.e., "blind spenders".

            Medicare costs are accelerating at a frightening pace, and a pace that exceeds the mere changing demographics.

            Ever since the 1980s, providers -- especially for-profit providers -- have learned how to game the system.

            Do you think HCA ignore the Medicare GPCI (Geographic Price Cost Index) when they decide to add an additional facility to their existing stable of ~200?  Of course not -- it's part and parcel of corporate planning -- put in a location that will maximize revenue.

            This sort of thinking permeates every layer of hospital financial planning -- directly in the for-profits, but as noted below by the study I cited -- there is lots of evidence that these behaviors trickle down into NfPs.

            Yet-  the progressive line whenever the idea of holding the line on these sorts of things, or even better, reversing them, comes up is an emphatic, reflexive NO!

            It simply cannot continue.

            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 Aug 02, 2011 at 02:17:27 PM PDT

            [ Parent ]

            •  I don't disagree at all that targeted cuts (0+ / 0-)

              are needed to Medicare.  Right now in the area where I live there is a major fight going on between two hospitals as both want to build new hospitals in addition to the two facilities each now runs.    However, WI did at one time have a board (and the name escapes me right now) that oversaw ALL healthcare construction in this state.  Hospitals had to go in front of them to get approval to build a new facility or to add on extensively to a current facility.  That oversight disappeared some years ago.  Are you looking to penalize Medicare participants for the actions of some big organizations that want to grab market share?!  That's ridiculous.

              I notice also you don't mention Medicare Part D and the obscene costs of drugs under that plan.  I go on Medicare as of November 1 this year and I'm scared about what kind of costs I could encounter for prescription drugs.  I take nothing prescription right now---but I know that in time I will.  Why not require the pharmaceuticals to clean up their act?

              Finally, I'm not a clinician but I worked in a 5,000 employee, private, non-profit healthcare system for 21 years.  I was a Management Development professional.  I know for a fact that hospitals are required to provide documentation for ANY charge Medicare wants to question.  The hospital in that system pays a staff of RNs with extensive experience to review EVERY SINGLE CHARGE against Medicare to be sure that the facility is staying within the guidelines for the various procedures covered by Medicare.  Those RNs are there both to ensure compliance with Medicare rules and regs but ALSO to advocate for patients in need of care.  In addition, there's a staff of social workers who HAVE to know the ins and outs of Medicare and Medicaid.  So, please do not imply that hospitals can just run rampant and do as they wish and it's open season on "how to scam Medicare" because in the facility where I worked and knew every single manager, I can guarandamntee you that Medicare scamming was NOT a goal of that hospital.  And hospitals are also accountable to the JCAHO (Joint Commission on the Accredition of Healthcare Organizations) for HOW they operate.

              Medicare is a VERY complex system and IMO no Super Cmte. should be allowed anywhere NEAR changes to that system.  There ARE people like Dr. Donald Berwick, who was nominated to head the Medicare and Medicaid Services, who has studied and worked within the healthcare system, and people like him are the ones who should be hands-on involved in determining changes to these immense systems.  I would also tell you that the institution I worked for participated in a nationwide consortium of top hospitals in the U.S. in how to improve the quality of patient care using the tools of systems thinking and quality improvement to understand the systems and processes they worked within and with the goal of making those systems as flawless and LOW-COST as possible.  Berwick was the Chair of that consortium.  Finally, I think some of your points are vastly unfair and hyperbolic.  NOT ALL CEOs of healthcare institutions are greedy pigs looking to make every dime they can off of government scamming and ripping off patients!  That's just wrong to infer that hospitals are cesspools of greed. The vast majority of people I've encountered in healthcare are pretty damn decent people.

              Objecting to our governor’s policies does not make a citizen of Wisconsin a criminal. Not yet, anyway. ~ nelangst

              by 3goldens on Tue Aug 02, 2011 at 02:42:28 PM PDT

              [ Parent ]

              •  I'm well aware (0+ / 0-)

                of the complexity of Medicare reimbursement -- it's an aspect of my job, too -- and it's also a primary reason that I do have a fair bit of disgust for the industry.

                That doesn't mean I'm unsympathetic to the rural CAH or urban DSH which generally gets undercompensated because they can't afford the profit maximization efforts of other, more well-off providers.  Quite the opposite - it's those facilities and providers that get screwed the most by the current state of affairs.

                However, the fundamental problems is this:

                Are you looking to penalize Medicare participants for the actions of some big organizations that want to grab market share?!

                Those are increasingly one in the same, or at least, the latter is fast becoming a far too powerful subset of the former.

                And... if you'll follow the thread upwards, you'll see that I actually start this particular indent precisely by raising the Part D issue... Certainly I'll accept that the pharmaceutical industry and IPPS industry are not completely analogous -- I said so in my original comment.

                My complaint is that too many progressives refuse to even glance at many of the similarities... and they need to... especially if they're the type of progressives that long for any sort of single payer system.  A single payer system cannot just blindly extend coverage universally without addressing costs and cost control.

                France has to.  England has to.  Germany has to.  Japan has to.  For the US to have any sort of system on par with theirs, we will, too.

                You cannot have it both ways -- and in the here and now, Medicare pays more -- much more, by any metric -- for the same care that other single payer systems pay for.

                I absolutely and completely agree that reimbursement isn't the end of the story... one must ensure that the actual doctors and nurses aren't saddled without enormous educational debt.  one must have a system of billing and coding that isn't a byzantine nightmare of groupers, escalators, and completely "you're on your own" type systems of reporting.

                All these things are necessary... but I cannot see how any rational person, any rational progressive, can continue to essentially mimic AHA press releases in their discussions about Medicare.

                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 Aug 02, 2011 at 02:56:09 PM PDT

                [ Parent ]

        •  100% Agree (0+ / 0-)

          It is akin to cutting out abortions by closing down all of the abortion providers.

    •  18 percent of hospitals are for-profit. (2+ / 0-)
      Recommended by:
      mdmslle, Pinto Pony

      Ideology is an excuse to ignore common sense.

      by Bush Bites on Tue Aug 02, 2011 at 01:09:29 PM PDT

      [ Parent ]

      •  And many of those don't even take Medicare. (0+ / 0-)

        They're mainly for rich old people to dry out or get face lifts or their third bypasses.

        They're boutique hospitals, not community hospitals with emergency rooms and the other expenses that come with serving everybody.

        Ideology is an excuse to ignore common sense.

        by Bush Bites on Tue Aug 02, 2011 at 01:14:45 PM PDT

        [ Parent ]

      •  That's a false flag (1+ / 0-)
        Recommended by:
        chimpy

        First and foremost, that number ignores the growing number of "for-profits in disguise" or "prestige" hospitals -- usually university-run facilities or in some cases, religious-affiliated facilities.  Many (not all, but many) look to maximize revenues (especially from Medicare) in exactly the same manner as hospitals truly classified as "for profit".   This isn't a new concept -- the "for-profits in disguise" was first proposed as a classification in the late 80s, and most scholarly works on health costs acknowledge their existence and classify them as such.

        I was looking for different article that I read late last year, but did run across this study, which makes many of the same points:

        To wit:

        …that hospitals have a strong incentive to report diagnoses in ways
        that result in maximal payment from insurers or Medicare/Medicaid. For-profit
        hospitals are especially susceptible to this incentive, the ultimate result of which
        is increased Medicare reimbursements. Silverman & Skinner (2004) found that between 1989 and 1996 for-profit hospitals exhibited a 23 percentage point increase
        in the percentage of admissions for respiratory disease coded with the most ex-
        pensive [diagnostic related group] DRG" while not-for-profit hospitals increased
        this behavior by only 10 percentage points.

        Nor does this stop at direct reimbursement -- evidence strongly suggests spillover into not-for-profits:

        Additionally, there is empirical evidence that the presence of for-profit hospitals
        in the healthcare market alters the behavior of not-for-profit hospitals. Dug-
        gan (2002) shows that when not-for-profit hospitals must compete with for-profit
        providers they begin to mimic the behavior of the profit-maximizers.

        It's this last point that is critical because the article I was looking for, but cannot locate at the moment -- I do recall pointing that the for-profit share of Medicare reimbursement dollars actually exceeds its share of "beds" (meaning, for-profits take a disproportionate share of Medicare dollars)... but this, perhaps, makes the point even better - because it renders the classification split immaterial:  Doesn't matter the classification -- the for-profits learn how to cream, skim, upcode, and maximize reimbursement first, and then the not-for-profits simply learn to mimic the behavior (indeed, have little choice).

        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 Aug 02, 2011 at 01:45:04 PM PDT

        [ Parent ]

        •  Such a shame you can't prove your accusations n/t (0+ / 0-)

          If it's
          Not your body
          Then it's
          Not your choice
          AND it's
          None of your damn business!

          by TheOtherMaven on Tue Aug 02, 2011 at 02:49:57 PM PDT

          [ Parent ]

          •  The study I cited (0+ / 0-)

            doesn't prove anything?

            What would you consider "proof"?

            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 Aug 02, 2011 at 02:57:36 PM PDT

            [ Parent ]

            •  Referring to articles you "can't find" (0+ / 0-)

              undercuts your argument pretty thoroughly. If you "can't find" the text you want to use, don't refer to it.

              If it's
              Not your body
              Then it's
              Not your choice
              AND it's
              None of your damn business!

              by TheOtherMaven on Tue Aug 02, 2011 at 03:57:10 PM PDT

              [ Parent ]

              •  Did you bother with the study? (0+ / 0-)

                I stopped looking when I ran across and read it because it makes an even stronger point.

                Do you want to nitpick or debate?

                I'm happy to participate in the latter, but I think the former is inevitably a waste of time.

                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 Aug 02, 2011 at 03:59:41 PM PDT

                [ Parent ]

    •  The markets are structured entirely differently. (1+ / 0-)
      Recommended by:
      a gilas girl

      Individual medical providers can simply decide not to "sell" their services to Medicare.

      It's essentially impossible for big pharma not to sell to Medicare customers.

      "[S]ince Obama keeps talking nonsense about economics, at what point do we stop giving him credit for actually knowing better? Maybe at some point we have to accept that he believes what he’s saying." --Paul Krugman

      by GreenSooner on Tue Aug 02, 2011 at 01:12:49 PM PDT

      [ Parent ]

      •  Except they don't generally do that (0+ / 0-)

        Don't confuse individual private practitioners -- who are indeed under-compensated and in many cases, cannot afford to get paid Medicare rates for say, check-ups -- with facilities and hospitals, virtually all of whom love to dip into the Medicare pie.

        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 Aug 02, 2011 at 01:46:28 PM PDT

        [ Parent ]

  •  The European provider rates (3+ / 0-)
    Recommended by:
    zonk, Terra Mystica, chimpy

    are known.

    They are much less.

    Americans providers need to provide at European rates plus 10% or they will probably be replaced.

    The fiscal medicine may taste bitter, but it needs to be swallowed.

    An Army Iraqi Reparations Command can provide a six-year employment opportunitity for a recalicitrant provider.

    The Iraqi government recently declared a heat emergency.

    DOCTOR DRAFT DEFERRAL FORM USA-DDF1
    1. Do you accept Medicare?
    2. Are Medicare patients...

    •  Amen (5+ / 0-)

      There was an excellent diary that went virtually unnoticed yesterday because it was mewling day and mewling is more fun -- but the US spends about 3 times what any other nation does on hospitalization.

      That's a ratio that completely sets aside private insurance skim.... three times:


      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 Aug 02, 2011 at 12:07:27 PM PDT

      [ Parent ]

      •  "mewling day" meme (4+ / 0-)

        Especially given all the whining the this side engages in when their feefees are insulted, I'm sick and tired of the implication that critics of even something as rotten as the debt ceiling deal are just complaining because complaining is "fun."

        If writing "Obots" deserves an HR, surely this does, too (personally, I don't think either does...I'm just saying, what's sauce for the goose should be sauce for the gander).

        "[S]ince Obama keeps talking nonsense about economics, at what point do we stop giving him credit for actually knowing better? Maybe at some point we have to accept that he believes what he’s saying." --Paul Krugman

        by GreenSooner on Tue Aug 02, 2011 at 01:11:11 PM PDT

        [ Parent ]

      •  Can you break down the "hospital" number? (0+ / 0-)

        Does this include physicians, for example? What are elements are in there and in what proportions?

        Obama and strong Democratic majorities in 2012!

        by TRPChicago on Tue Aug 02, 2011 at 01:31:10 PM PDT

        [ Parent ]

        •  It's an OECD table - and I'm afraid (0+ / 0-)

          One can't link directly to a table (they're dynamically generated), but the original source the diarist I noted got this from was Ezra's WaPo blog, and he defined it as "rehabilitative and curative" functions, which I would assume translates into IPPS/Inpatient/true hospitalized care.

          Could be wrong, though, but I think this would exclude (for example) a general practitioner, checkups, and even outpatient care that might be done by a GP.

          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 Aug 02, 2011 at 01:55:06 PM PDT

          [ Parent ]

          •  Thanks, Zonk. (0+ / 0-)

            I'm suspicious of the way hospital accounting works, viewing it somewhat like Hollywood studio accounting in that it is arranged to cover costs and distribute profits in particular ways. This is not necessarily evil, mind you, but if there are several ways to slice up the pie, one can bet the chosen way favors whatever the bean counter's appetite requires.

            That doesn't take anything away from your conclusion on comparisons.

            If health care is going to be the or at least one of the major battle grounds in the next stage of the debt/deficit debacle, we all need to be educated about it.

            Obama and strong Democratic majorities in 2012!

            by TRPChicago on Tue Aug 02, 2011 at 02:20:32 PM PDT

            [ Parent ]

  •  Thanks for fleshing this out. You're right... (4+ / 0-)

    Beneficiaries will be the sure losers.  But Wall Street and Big Insurance can't both be winners.  One of them is going to lose their advantage.  My guess is Wall Street wins.

    The only clear winners are the recipients of massive amounts of campaign contributions as this battle of the Bigs is waged next year.  Add in DefenseCo and Jackpot!

    "Dega dega dega dega. Break up the concrete..." The Pretenders

    by Terra Mystica on Tue Aug 02, 2011 at 11:58:36 AM PDT

  •  We need a plan B (5+ / 0-)

    cause plan A has failed

    Don't just get angry. Get organized. Let's make sure the Bush tax cuts for the rich are ended.

    by Anton Bursch on Tue Aug 02, 2011 at 12:00:46 PM PDT

  •  If the hospitals need help in cutting costs (1+ / 0-)
    Recommended by:
    HoundDog

    federal GS scheduled compensation might be used.

    I'm sure the $600,000/year plus hospital CEO will earn his/her keep to avoid that.

    The GS schedule might top out at around $200,000/year.

    •  Not As Easy As It Looks (0+ / 0-)

      Just what should the salary be for a hospital CEO who is heading up an enterprise employing more than 500 degreed individuals plus many others?  What should the salary for a CEO be when maybe 25% of the employees at the hospital make more than $200K per year, like the doctors.  Trying to set the salary scale at a hospital is more difficult than it might first appear, because of the nature of the staff involved.  It's quite a bit different than running a burger joint, although part of the hospital might be no different than a burger joint (the cafeteria for staff, not the patients food service).  Besides, the GS schedule applies to folks with certain safeguards for dismissal, none of which applies to any hospital CEO answering to some sort of board of directors.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Tue Aug 02, 2011 at 01:23:09 PM PDT

      [ Parent ]

  •  The tale of a doctor in Greece (3+ / 0-)

    who probably is making about $12,000/year at best.

    I'm living in Greece almost 15 years, and working like a pediatrician in one medium size town.

    The Greek Government, and its institutions, never pay ANYONE on time. It is usually "habit" for us to wait up to 2 years to be payed for our services. Despite the cost of the private visit, which is ( listen UK !) - 8E. Yes, every visit on private doctor here is payed by the Greek Government- 8E ( 20E before tax - 12E goes on "taxes"!!!).

    ....in 2011 you must pay 7.000 E, par example, for the years 2000-2007, not because you have committed a tax fraud, or have some kind of tax errors. Simply because they vote for a such thing- 1000E for every year. And this- the socialist parasites call "justice", because according to them, all ( in our case) doctors are "cheaters", and must be punished. Nobody in Europe knows these "practices"... .
    Dishonest, disgrace, third world State... .

    In the small towns, there is not a single doctor exist, which are able to pay taxes, not because we do not want to do. Because we earn so little, than after deduction, almost 60-70% of us are on the month income level of 600-700E and bellow the official line
    ....
    In my small town, of 120.000, there is 80 taxi drivers ( pampered with good wages) and almost 90 cardiologists/ 120 pathologists on private practice
    .
    In 7 mln Greece, there is 4 or 5 Medical Universities, endlessly producing "doctors"....

    on the second page of comments:
    http://www.guardian.co.uk/...

    It's a comment on a very interesting article.

    •  Well, What Is It? (1+ / 0-)
      Recommended by:
      3goldens

      SingleVoter, you advocate earlier that hospital administrators should see reduced salaries while here you argue that doctors should apparently received substantially increased salaries, even though physicians have been about the only group who have real income increases during the last twenty years.  Are we arguing that both groups (doctors and administration) should see reduced income in the US as we move forward?  

      Aren't we seeing the benefits of the free market in Greece with the ready supply of new doctors to the market.  That does not pertain to the US, with the AMA maintaining a strangle-hold around the number of new physicians trained every year.  Besides, if a doctor's compensation was so crappy, as the article describes, why are so many new doctors being minted every year?  If the current doctors are living in penury, it would seem that college graduates would realize that and drift toward other professions, rather than live in poverty.  Somehow, the picture seems a little murky.  How does it get clarified.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Tue Aug 02, 2011 at 01:31:30 PM PDT

      [ Parent ]

      •  The AMA shouldn't have a stranglehold (1+ / 0-)
        Recommended by:
        PrahaPartizan

        Medicare funds more than 90% of GME costs - i.e., residency program costs - in the country.

        Either the profession cedes more control of slotting, or, frankly -- it pays for its apprenticeship and training program (just like any other trade).

        As it stands now, the industry gets to have it both ways...

        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 Aug 02, 2011 at 02:04:30 PM PDT

        [ Parent ]

        •  Ain't The Free Market Grand (0+ / 0-)
          "...As it stands now, the industry gets to have it both ways..."

          Free, as in how much the beneficiaries have to pay for the "privilege."  Yeah, I know how this guild works.  It's a union like any other, only the doctors don't want the public to know that's the scam they got going for fear the populace will want to break them too.

          "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

          by PrahaPartizan on Tue Aug 02, 2011 at 02:13:08 PM PDT

          [ Parent ]

  •  not a joke (13+ / 0-)

    Timothy Geithner holds a debt ceiling passage party with the:

    U.S. Chamber of Commerce,
    American Insurance Association,
    American Council of Life Insurers,

    Financial Services Forum,
    Securities Industry and Financial Markets Association,
    Financial Services Roundtable,
    the National Association of Real Estate Investment Trusts,
    American Bankers Association and the
    National Retail Federation.
    Dr. Evil

    ok, ok, one of those is not correct.

  •  I found this chart from the NYT (2+ / 0-)
    Recommended by:
    HoundDog, Shockwave

    which compares the various options on the table with a timeline, very helpful.  If this has been seen before, I'm sorry for the clutter.  It makes the process more understandable  to me.

    Sausage making....

    Science is hell bent on consensus. Dr. Michael Crichton said “Let’s be clear: The work of science has nothing to do with consensus... which is the business of politics. Science, on the contrary, requires only one investigator who happens to be right,”

    by Regina in a Sears Kit House on Tue Aug 02, 2011 at 01:05:24 PM PDT

  •  i want to tell a joke (23+ / 0-)

    democrats pass a watered down health insurance law that is worse and weaker than anyone could have expected, but its most passionate defenders keep saying once it's established it can be worked on and improved. but once it becomes law, those defenders change their tune and begin telling us how wonderful it is, and forget all about trying to work on it and improve it. and then a year and a half later we get a concocted crisis that is resolved by undermining not only the new health insurance law but old ones as well.

    okay...

    maybe it's not so funny.

    The cold passion for truth hunts in no pack. -Robinson Jeffers

    by Laurence Lewis on Tue Aug 02, 2011 at 01:05:24 PM PDT

    •  Can we all agree this is slink's fault? (13+ / 0-)

      My understanding is that, had slinkerwink clapped loudly enough, the hippies who all voted for the Teaparty out of spite would have delivered even larger majorities for the Democrats in both Houses of Congress last fall.  And in gratitude for the clapping, the Democrats would have then fixed not only ACA, but also FISA, bankruptcy, the USA PATRIOT Act, the Military Commission's Act, the Telecommunications Act of 1996, and Glass-Steagall repeal.  In addition, Ben Bernanke would have resigned his position in favor of Elizabeth Warren.

      But because of slink's criticism, none of this happened and the Democratic Party was forced to behave like Republicans lest the Republicans do it first.

      Or something.

      "[S]ince Obama keeps talking nonsense about economics, at what point do we stop giving him credit for actually knowing better? Maybe at some point we have to accept that he believes what he’s saying." --Paul Krugman

      by GreenSooner on Tue Aug 02, 2011 at 01:18:56 PM PDT

      [ Parent ]

      •  Dang, and I've always been so fond of Slink (0+ / 0-)

        Sounds like we need an intervention.

        Clap, Slink, Clap!

        Or, you might come home soon, and find 300,000 plus Kossacks in your living room, all telling you we love you so much, we're going to have to send you to Adulation Rehab!

        Don't make us come up there!

        Just remember, this hurts us more than it hurts you.

        And, we're only doing this because we love you so much.

        The means is the ends in the process of becoming. - Mahatma Gandhi

        by HoundDog on Tue Aug 02, 2011 at 01:26:39 PM PDT

        [ Parent ]

      •  Speaking as a past and present hippie (1+ / 0-)
        Recommended by:
        3goldens

        I know of absolutely zero hippies who "voted for the Teaparty out of spite."  I know several who stayed home out of disgust with what our "liberal" legislators had wrought, which may have amounted to handing the TP candidates their wins, but no one I know actually voted for any of those crazies.

        "In this world of sin and sorrow there is always something to be thankful for; as for me, I rejoice that I am not a Republican." - H. L. Mencken

        by SueDe on Tue Aug 02, 2011 at 01:30:54 PM PDT

        [ Parent ]

      •  Fucking Slink strikes again! I'm (0+ / 0-)

        getting sick of her.

        "I will be happy to see the Republicans test whether or not I'm itching for a fight on a whole range of issues," President Obama - Liar

        by jec on Tue Aug 02, 2011 at 01:32:06 PM PDT

        [ Parent ]

        •  Ps...I hope Slink realizes that this was snark. (0+ / 0-)

          I'm sure she does as she knows I'm a big fan.

          "I will be happy to see the Republicans test whether or not I'm itching for a fight on a whole range of issues," President Obama - Liar

          by jec on Tue Aug 02, 2011 at 05:26:26 PM PDT

          [ Parent ]

    •  I Know The Punchline! (1+ / 0-)
      Recommended by:
      Laurence Lewis

      LL, your problem is that you have a functioning memory.  You recall all of those incidents which occurred earlier and the arguments advanced.  What you need is another hit of soma and everything will be fine.

      "Love the Truth, defend the Truth, speak the Truth, and hear the Truth" - Jan Hus, d.1415 CE

      by PrahaPartizan on Tue Aug 02, 2011 at 01:36:31 PM PDT

      [ Parent ]

    •  The bigger joke (0+ / 0-)

      Is the complete blindspot that the progressive leading lights on health care reform have for the industry at large.... as if all the ills of the system would be cured by excising private insurance from it.

      But, by all means, keep whistling past the graveyard, comically insisting that "Medicare for all" could be a reality if only the Democrats would stand up to the insurers... blithely ignoring that both the current reimbursement rates and formulas and rate of growth would be completely unsustainable.

      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 Aug 02, 2011 at 02:07:20 PM PDT

      [ Parent ]

  •  The President is drinking a deadly brew. (1+ / 0-)
    Recommended by:
    Shockwave

    Or something.

    Ideology is an excuse to ignore common sense.

    by Bush Bites on Tue Aug 02, 2011 at 01:07:44 PM PDT

  •  Don't you think (2+ / 0-)
    Recommended by:
    Shockwave, worldlotus

    it's just a little bit illogical, that they would prohibit cuts to SS, Medicaid and Medicare benefits (plus VA benefits and programs for the poor) in the trigger, but plan to cut those programs in the committee.  That makes no sense.

    "Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity" - MLK

    by edwardssl on Tue Aug 02, 2011 at 01:10:00 PM PDT

  •  uhm...cough...swallow... (3+ / 0-)
    Recommended by:
    shaharazade, 3goldens, magnetics

    excuse me for asking a dumb question but isn't this:

    The debt ceiling deal will put the big squeeze on health care

    one of the main reasons they had for the whole hostage drama in the first place?

    Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

    by a gilas girl on Tue Aug 02, 2011 at 01:13:39 PM PDT

  •  yanno I really resent having to (5+ / 0-)

    go through this shit all over again in two months. I really do.

  •  Is is possible to still implement our Patient (1+ / 0-)
    Recommended by:
    WheninRome

    Protection Act, given these spending caps?

    My impression is that our new health care bill was going to require substantial federal funding to expand state Medicaid to pick up the expansion of Medicaid coverage to 150% of the poverty level.

    Is it DOA?

    Has nyceve written about this yet.

    Now matter how sad, I'd like to know the real facts, so we can better plan our advocacy, and 2012 election strategies.

    The GOP promised their voters they would kill the PPA.

    Have they just succeeded?

    The means is the ends in the process of becoming. - Mahatma Gandhi

    by HoundDog on Tue Aug 02, 2011 at 01:18:02 PM PDT

    •  That doesn't kick in until 2014. (1+ / 0-)
      Recommended by:
      3goldens

      The key question was if they pass the "stability" clauses or whatever they are calling them now that are supposed to prevent states from gutting their Medicaid programs now prior to the 2014 date of the expansion.

      Those stability guarantees haven't yet been passed.

      Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

      by a gilas girl on Tue Aug 02, 2011 at 01:20:51 PM PDT

      [ Parent ]

      •  I know, but, without expansions to Medicaid it is (0+ / 0-)

        DOA, right?

        It's not a done deal.

        We have to win back the House, and keep the Senate both in 2012, and 2014 to get this accomplished, right?

        Like as in "no Mission Accomplished" banners yet.

        The means is the ends in the process of becoming. - Mahatma Gandhi

        by HoundDog on Tue Aug 02, 2011 at 01:28:40 PM PDT

        [ Parent ]

        •  as I understand it, the expansions are passed. (0+ / 0-)

          but they don't start til 2014.  That gives states time to figure out ways around the expansions, absent these "stability clauses" or whatever they are being called.  Those haven't been passed.  And options abound for states to workaround the already passed expansions, too.  That's where the worries, apparently lie, for folks working to try and implement ACA.  Not so much with the expansions, but with the time gap and with the potential work-arounds.

          I was at a workshop conducted by the Commonwealth Institute in VA about just this issue last week, that's the only reason I have this much "command" (not) of the details. Since VA is one of the states that is challenging ACA via law suit, the folks here working to implement it really have to know their stuff.  The guy leading the workshop is one of the lawyers working to provide briefs against the governor's law suit so I feel pretty confident in his take on it all.

          At least, this is what I took home from the workshop.

          Words can sometimes, in moments of grace, attain the quality of deeds. --Elie Wiesel

          by a gilas girl on Tue Aug 02, 2011 at 05:35:28 PM PDT

          [ Parent ]

  •  The poor and the frail elderly do not have highly (8+ / 0-)

    paid lobbyists, and they will be the ones that are hurt the most by this.

    •  As a person in and out of the hospital (3+ / 0-)
      Recommended by:
      blue jersey mom, 3goldens, jec

      4 different times this past year I can attest to how medicare helped me.  Having medicare kept me from bankruptcy. Lucky for me I have a pittance left in a retirement plan and about $700/month on social security.  For the first time in awhile I am starting to believe I will outlive my money with cuts in ss and medicare as well as a plunging stock market.  It's gonna get ugly for a lot of us.

  •  Joan scores a total bullseye. (3+ / 0-)
    Recommended by:
    HoundDog, cybrestrike, shaharazade
    It's going to be the battle of the lobbyists

    Yep.

  •  Shared Sacrifice (0+ / 0-)

    Just as I expected, Obama and Reid cave.  The wealthy and those who destroyed the economy continue getting tax breaks and sacrifice nothing.  This is the greatest social injustice in history and it was a so called Democratic President and Congress who brought it to us.  Time for primaries, time to run these clowns out of the party.  What does Obama now talk about, further trade deals to move American jobs overseas.

  •  I'm so tired of this. (3+ / 0-)
    Recommended by:
    WheninRome, maryabein, shaharazade

    Clearly, our system is simply incapable of common decency at this point.  All of our elected officials have theirs and they just lack empathy for the rest of us.

    The liberty of democracy is not safe if people tolerate growth of private power to a point where it becomes stronger than their democratic state itself.---FDR

    by masslib on Tue Aug 02, 2011 at 01:23:45 PM PDT

  •  ah decisions decisions (3+ / 0-)
    Recommended by:
    masslib, maryabein, shaharazade

    a family table analogy

    It's difficult to be happy knowing so many suffer. We must unite.

    by War on Error on Tue Aug 02, 2011 at 01:24:34 PM PDT

  •  This may seem a bit picayunish but the (3+ / 0-)
    Recommended by:
    Churchill, maryabein, 3goldens

    cuts to providers will in effect result in benefit cuts. I understand why the Admin and others try to make a distinction but the fact of the matter is that these are benefit cuts, just an attempt to make them stealth.

    "I will be happy to see the Republicans test whether or not I'm itching for a fight on a whole range of issues," President Obama - Liar

    by jec on Tue Aug 02, 2011 at 01:29:01 PM PDT

  •  seniors voted GOP; reap the winds of pain (0+ / 0-)

    So this is what 11th Dimensional Chess is! WOW, we keep losing

    by Churchill on Tue Aug 02, 2011 at 01:30:11 PM PDT

  •  Too late now---you fools..... (1+ / 0-)
    Recommended by:
    Boogalord
    “As the macro data comes out, it seems like we may have more on our hands than just getting the debt ceiling raised,” said Myles Zyblock, chief institutional strategist and managing director of capital markets research at RBC Capital Markets.

    “We get no default, but the bad news is there is a growth trade-off,” he said. “They had to agree on fiscal contraction that would weigh on growth.”

    NYT

  •  If unemployment is as high as reported (1+ / 0-)
    Recommended by:
    3goldens

    And estimates that another 1.2M after the Satan Sandwich... It's already bad, 60M+ uninsured. That's 20% of the population. Catastrophic, chronic and rehabilitative and long term care for the military, and a huge cohort of newly eligible seniors.....it's a powder keg.

    The gov't is killing us from both ends, Wars and lack of access. Industrial Death Complex.

    The climate deniers must be lying and reserving homesteads in the northern latitudes or something. Hoping to "attrition" us for their new Jerusalem.

  •  Is there any way we can influence (0+ / 0-)

    who gets on this commission?

    Democrats build better communities.

    by NCJim on Tue Aug 02, 2011 at 01:38:18 PM PDT

  •  This has been the Tea Potty's plan all along. (2+ / 0-)
    Recommended by:
    nervousnellie, 3goldens

    Make it impossible to fully enact Affordable Healthcare Act in 2014.

    No I didn't misspell TEA POTTY !

    "Now watch what you say or they'll be calling you a radical, a liberal, a fanatical criminal" -- Logical Song -- Rick Davies & Roger Hodgson

    by Over50Lib on Tue Aug 02, 2011 at 01:41:43 PM PDT

  •  More revenue. Period. (0+ / 0-)
  •  I know what to do (0+ / 0-)

    How about letting young people buy into Medicare? The government could make a profit AND still give people a discount over what private insurance is charging. That would relieve pressure on health care AND increase revenues without new taxes.

    Single payer anyone?

    "The avalanche has started, it is too late for the pebbles to vote." Kosh, Believers

    by NuclearJo on Tue Aug 02, 2011 at 01:52:57 PM PDT

  •  The Horror of that elderly gentlemen peering (0+ / 0-)

    befuddledly into that empty billfold will be scalded onto my retinas forever.

    `You needn't go on making remarks like that, ... they're not sensible, and they put me out.'

    by seanwright on Tue Aug 02, 2011 at 01:53:20 PM PDT

  •  The debt ceiling deal will put the big squeeze on (0+ / 0-)

    health care

    Wasn't that the whole fucking point?

  •  Don't be so fast to use the AHA quote (1+ / 0-)
    Recommended by:
    zonk

    The hospitals would like to conflate the cuts to providers as cuts to benefits, but their argument basically boils down to the same garbage we get from corporations (and many of them ARE corporations): "Give us money or we'll take it out on the consumer."

    BS.  As a doc, I can call BS.  I'm more than happy to give up 2% of my billings AND get taxed more in the name of national unity/patriotism/whatever.

    When the amount spent on department chairs, presidents, executives and other top tier administration at even the best non-profit hospitals exceeds the amount of money we're talking about?

    BS.

    For those of you who prefer Bartlett to Obama, re-watch the West Wing. For those who prefer Clinton, re-watch old news videos.

    by Ptolemy on Tue Aug 02, 2011 at 03:22:39 PM PDT

    •  But these are GOOD corporations! (0+ / 0-)

      Those other corporations are BAD corporations!

      ...or something....

      Hey - look over there, it's a clever meme about catfood, satan, and sandwiches!

      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 Aug 02, 2011 at 03:53:06 PM PDT

      [ Parent ]

  •  Didn't Cat Food commission say we need a PuOption? (0+ / 0-)
  •  Sick the market on Medicare (0+ / 0-)

    Cutting payments to providers (i.e. doctors, clinics, and hospitals) is going to make it less likely these people will continue to take Medicare patients. Washington will then throw up it hands, claim the omnipotent Market has spoken and there is nothing they can do about it. It's a force of nature, don't you see, when the Invisible Hand withdraws its blood drenched fingers and lets the elderly die sooner.

    Decisions on spending and tax priorities are ethical choices and Obama had damned well start talking about these issues in those terms or this country may well lose its way for good.

    The Democrats like the Republicans more than they like me. - Christopher Cooper

    by Wahrheit on Tue Aug 02, 2011 at 05:33:19 PM PDT

  •  AUGUST 27, 2011 (0+ / 0-)

    Please join in on the march on Washington.

    http://www.nationalactionnetwork.net/

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