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Medicare enrollments forms with Social Security card.
It's possible, according to some health care experts and policy advisers, that President Obama will use momentum for Medicare reform for a broader push for further health care reform.
Healthcare experts, including former Obama advisers, say the White House appears to be considering ideas for Medicare, the popular health insurance program for the elderly and disabled, that could become models for the overall health landscape.
And in some good news for Obama, whose 2010 Affordable Care Act has been a lightning rod for Republican opposition, experts also see the political climate brightening for efforts to control the rise in healthcare costs generally.
"My expectation is that the president will offer a mix of ideas on the Medicare program that will not be about middle-income beneficiary cuts," said Neera Tanden, a former Obama healthcare adviser who heads the Center for American Progress, a think tank with strong Democratic Party ties.
If true, huzzah, though it will be difficult to achieve in the ongoing political climate where the austerity fetish demands punishment for people who would dare to get old or sick or lose their jobs without a trust fund as a backup. If it's true, though, we could perhaps start having a conversation once again about what will actually work to drive down costs for Medicare and for the health care system overall.

That would include, has to include, forcing cost reductions on the provider side and on the health care industry, which has for the most part escaped major reforms. For example, allowing Medicare to negotiate for cheaper drug prices could save as much as $200 billion over the next decade. It should also include real consideration of expanding eligibility to Medicare, bringing the age down to 55 or even 50 to enroll a younger, healthier population injecting premium payments into the system.

If the White House truly does try to expand this conversation beyond Medicare reforms to the larger health care system and the critical reforms that still need to be done, then more progressive, and practical, proposals have to be on the table along with benefit cuts. And President Obama needs to be the one to put these options on the table. He's publicly argued for them before, but now it's time to make that rhetoric real in policy proposals.

Originally posted to Joan McCarter on Mon Jan 07, 2013 at 01:45 PM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  And this has been meaningful in what way? (9+ / 0-)
    He's publicly argued for them before,

    "Small Businesses Don't Build Levees" - Melissa Harris Perry

    by justmy2 on Mon Jan 07, 2013 at 01:52:39 PM PST

  •  Lot of qualifiers in there n/t (12+ / 0-)

    One good source - e.g. current as opposed to former adviser would be worth a lot.

    •  The qualifier "middle income" beneficiaries... (0+ / 0-)

      strikes me as pretty telling, too. Means testing should be marginalized and eliminated, not expanded. It doesn't save nearly enough to be worth the political price.

      "The Democratic Party is not our friend: it is the only party we can negotiate with."

      by 2020adam on Mon Jan 07, 2013 at 09:45:09 PM PST

      [ Parent ]

  •  This sounds good and what I hope is another (27+ / 0-)

    step along the way to a form of single payer.

    Analysts guess that Obama could press for more price competition among drug makers, insurers and healthcare providers within Medicare, or for an acceleration of measures adopted as part of the 2010 Act that aim to move the national care delivery system away from its current fee-for-service cost structure.
    http://news.yahoo.com/...

    "Compassion is not weakness, and concern for the unfortunate is not socialism." Hubert H. Humphrey

    by Onomastic on Mon Jan 07, 2013 at 01:55:24 PM PST

  •  if you expand the age, (24+ / 0-)

    might as well lower it to zero and do a universal single-payer system. It will be as difficult to do a partial expansion as a full expansion.

    Obama and the Democrats had a much better chance at fixing health care in 2009 when they had solid majorities in both houses of Congress and Obama's political capital was at its peak. That chance was blown, and quite deliberately so, because they didn't want to upset the powers that be. Now with a divided Congress, it will be far harder to do anything substantial.

    The main priority of this WH seems to be deficit reduction. Obama reiterated this message in his statement on the fiscal cliff deal.

    We know there’s a path forward.  Last year, I signed into law $1.7 trillion in deficit reduction.  This week’s action further reduces the deficit by $737 billion, making it one of the largest deficit reduction bills passed by Congress in over a decade.  And I’m willing to do more...
    That doesn't augur well for any of the things you propose here, some of which might require large government outlays, at least in the short run.

    "In America, the law is king." --Thomas Paine

    by limpidglass on Mon Jan 07, 2013 at 01:58:48 PM PST

    •  medicaid-for-all (6+ / 0-)

      I've been thinking it might be easier to expand medicaid rather than medicare, since medicaid already covers people of all ages. (Plus, you could do it state-by-state.)

      •  As a physician, I say HELL NO to that idea (2+ / 0-)
        Recommended by:
        Timothy J, Creosote

        I will need another career if there is Medicaid for all. Medicaid pays like crapnto providers and providers need to go through the worst bureaucratic nightmare just to get paid for services, 3-6 months after services are provided at best.

        Medicare for all is a much better idea from a physicians standpoint.

        •  Funny. Cdn medicare pays doctors enough, they are (2+ / 0-)
          Recommended by:
          Timothy J, deepeco

          quite happy to get 100% of every bill, paid to them without having an army of accountants on staff and people to deal with a whole host of insurance companies. Their incomes went up after medicare came into effect.  Even Max Baucus once said he was amazed to see a Calgary hospital with an accounting dept. in three rooms, as opposed to a whole floor in a US hospital.

          "...stories of past courage can define that ingredient..... But they cannot supply courage itself. For this each man must look into his own soul." JFK Profiles in Courage " Ontario

          by ontario on Mon Jan 07, 2013 at 08:18:22 PM PST

          [ Parent ]

    •  In response to your comment (7+ / 0-)
      if you expand the age
      might as well lower it to zero and do a universal single-payer system.
      I think that this may not be the best way to go, given the practical realities of this country.

      We might be able to sell allowing those age 55 or 60 buying into medicare due to the high unemployment rate and that allowing these younger healthier people to buy into medicare will lower costs.    Given the Republican attention to the deficit, I think that they would have a hard time opposing if the dems can truly prove that allowing this will reduce the deficit.  

      But if we try to go all the way to zero, it will be difficult if not impossible to pass since Republicans will see this as a public option and/or first step to single payer and will oppose on this basis.

      I think that in an ideal world, yours is the better one, but given the reality we find ourselves in, I think that we are better off trying this one step at a time.  i.e. expanding down to 55 or 60 now and then in a few years reducing the age even more.  

      •  Not to mention (4+ / 0-)
        Recommended by:
        ybruti, night cat, ontario, deepeco

        that there are a lot of people in their late 50's/early 60's that would retire except for the fact that they will lose their health insurance.  So they hang on until 65.  If these people could buy into medicare, it might open up some jobs for others who are currently unemployed.

        “It is the job of the artist to think outside the boundaries of permissible thought and dare say things that no one else will say."—Howard Zinn

        by musiclady on Mon Jan 07, 2013 at 04:48:11 PM PST

        [ Parent ]

    •  Obama, king of austerity (9+ / 0-)

      He really does love the idea of deficit reduction, though he should know it does nothing to stimulate the economy or foster long term economic growth.

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Jan 07, 2013 at 03:21:58 PM PST

      [ Parent ]

  •  asdf ... (8+ / 0-)
    "My expectation is that the president will offer a mix of ideas on the Medicare program that will not be about middle-income beneficiary cuts," said Neera Tanden
    Kinda a low bar on your expectations there, Neera. Particularly in light of this:
    “The median income of the typical Social Security beneficiary is $23,000. So let’s be aware of who we’re talking about here.”
          —Jared Bernstein
    Watchful waiting time continues.

    "George RR Martin is not your bitch" ~~ Neil Gaiman

    by tardis10 on Mon Jan 07, 2013 at 02:05:31 PM PST

  •  It would be excellent if President Obama put the (28+ / 0-)

    ideas of allowing Medicare to negotiate with big pharmaceutical over drug prices, and lower the eligibility age to 55 allowing buy in to Medicare as the public option.

    If we do ever put this out to the public they never learn about it, so it continues to seem out of reach.

    Let sell the idea and compare it to the alternative as massive cuts to Medicare benefits, Medicaid, social programs or even defense spending.

    We need to start focusing attention on the either-or nature of some of these choices.  As in which would you dislike more, this or that?

    How much would extending Medicare to 55 save in ACA and other expenditures.

    Another concept we need to raise public awareness on is cost shifting.  Cutting Medicare doesn't eliminate these expense, just mean someone else has to pay them by giving up food,  or something else, or care is lost.

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

    by HoundDog on Mon Jan 07, 2013 at 02:06:56 PM PST

  •  This is so much more interesting than (17+ / 0-)

    the debt limit. Real potential here for gains. Dropping the age limit would be a huge step in the right direction. And watching GOP heads explode would be a bonus.

    •  Watching the apologist's heads explode, too (3+ / 0-)
      Recommended by:
      Mr MadAsHell, divineorder, ontario

      Suddenly they'd have to cheer clear cut liberal policy on its immediate merits instead of explaining away conservative policy as brilliantly insincere head games, Fabian retreats, forcing the GOP to walk towards a distant light, washing the feet of Jesus, etc.

      "I am confident that we're going to be able to leave the Gulf Coast in better shape than it was before." Barack Obama

      by quagmiremonkey on Mon Jan 07, 2013 at 03:50:35 PM PST

      [ Parent ]

  •  it is an excellent opportunity (12+ / 0-)

    as it has been pointed out that the real budgetary problem is a health care cost one and that it is driven by an aging problem.

    Interestingly Cato Institute came out with a little pamphlet a couple years back talking about our health care problem being one of abundance. Their conclusions were really quite full of shit but they correctly identified several problems. I read it and Howard Dean's book back to back. You can guess which one I agreed with more.

    But the point is that the health care argument can be framed in real financial terms and backed up with solid financial arguments in favor of expanded care, more government involvement and lower costs.

    While I was not crazy about what ACA ended up being I did think that it would lead to improvement over time and if part of that time is now then it is quicker then I expected and for that I am very glad.
     

    "Do what you can with what you have where you are." - Teddy Roosevelt

    by Andrew C White on Mon Jan 07, 2013 at 02:22:38 PM PST

  •  This is not reassuring. Bravo if he takes the left (6+ / 0-)

    of center positions mentioned and actually follows through with rigorous advocacy for them, but I won't be holding my breath.

    I will be absolutely shocked if he does anything like what is mentioned in the diary with respect to negotiation or expansion by lowering the eligibility age. Anything more than misleading and quickly abandoned rhetoric, that is.

  •  The biggest mistake Obama made (4+ / 0-)
    Recommended by:
    ferg, Mr Robert, elwior, deepeco

    was maintaining a narrow menu of what we consider "entitlement reforms". If he put more progressive policies to rein in healthcare costs on the table I don't think the Republicans would just concede but at the very least he could make the reforms a take it all or leave it proposition, I.e.  means testing aong with negotiating drug prices; Chained CPI along with raising the payroll cap. Now we would still come out against these policies but what we'd get along with the cuts would be real reform that prevented a second bite at the benefits apple in the future. Basically, if you're going to put "reform" on the table, put the whole enchelada that allows us to get the progressive reforms we would never otherwise get. Its not too late to reframe the debates on social insurance "reform" and hopefully this article is a positive sign.

  •  I'd like to know how much of our so called (3+ / 0-)
    Recommended by:
    Mr Robert, elwior, blueoasis

    "health care" cost actually goes into profits, overhead, administration and lobbying in the health care and insurance industries.

    I'll bet this is a big reason we pay more per capita for health care and get less for it that anywhere else in the world.

    And it's a major opportunity to fix health care costs.

    In the same article, there was an idea that employee health care benefits might be taxed as income.  I sure as hell don't want to pay income tax on money my employer has to contribute to subsidize insurance and medical profits!!

    •  Gonna be the devil's advocate here (4+ / 0-)

      Let's take two workers.

      Worker A has employer provided coverage. Employer pays Worker A $30,000 in salary, and spends an additional $10,000 on health benefits. Worker A is taxed only the $30K in direct income.

      Worker B is not covered by his employer. However, in recognition of that, and wanting to be competitive for the best skills, the employer pays worker B $40,000. Of this amount, worker B spends about $10,000 on his own health care needs. Worker B is taxed on the entire $40K salary.

      Now, in the interests of fairness - there are two ways to address the imbalance here. One of those is to tax Worker A on both the direct income, and the insurance benefit. The other, of course, is to make Worker B's insurance expense (at least up to some limit) a pre-tax expense.

      "No one life is more important than another. No one voice is more valid than another. Each life is a treasure. Each voice deserves to be heard." Patriot Daily News Clearinghouse & Onomastic

      by Catte Nappe on Mon Jan 07, 2013 at 02:49:59 PM PST

      [ Parent ]

      •  Nice explanation n/t (2+ / 0-)
        Recommended by:
        Catte Nappe, divineorder
      •  I might agree with taxing benefits (1+ / 0-)
        Recommended by:
        Catte Nappe

        once I believe it is in  fact a benefit - but if a significant part of health care cost is in fact overhead and profit, 1) I don't want to pay for it and 2) I certainly don't want to pay tax on what my employer pays for it.

        Depending on the plan, I think that the person in your example who pays for his own insurance can set up an HSA, making his expense pre-tax.  Not sure how that would work with employee benefits.

        The more likely example is that the 2nd company above is not paying benefits in order to be "cost competitive" and isn't worried about being competitive in the job market - especially with unemployment where it is now.  I doubt that companies that don't have benefits actually have premium pay scales.  

        Examples like this help show why tying health care insurance to emloyment is such a bad idea.  We need to find some way to start to separate the two.  Everybody needs affordable insurance - whether or not they are employed and whether or not their employer offers it as a benefit.  And I agree with you that it should be at equal personal cost (maybe risk adjusted in various ways) regardless of employment status.

        All this avoids the big issue - changing who pays for health care doesn't make it cheaper.   We need to control the cost of health care - we pay more per capita and get less for it than anywhere else in the world.  Moving the cost around may "fix" the federal budget - but it doesn't fix the problem.   We don't need to move the cost from employers to employees, or from the federal government to states, or from the government to individuals.  We need to lower the cost, and taxing benefits doesn't do that.

  •  Medicare Part D is a huge savings opportunity..... (10+ / 0-)

    I'm shopping around for a Part D provider and one of the drugs I use is Atorvastatin, the generic for Lipitor.

    Lipitor costs way over $100 for a month's supply, but the generic became available about a year ago, and you can get a month's supply of Atorvastatin in Costco or any of the big box stores for about $17.

    And yet, if you are enrolled in a "money saving" Part D program, it seems you have to pay $45 or more for that same one month's supply. That's because the drug companies and insurance companies negotiate the price for Medicare recipients.

    Why can't those of us about to be on Medicare pay the same price for this cholesterol-lowering drug that the VA pays?

    The answer, of course, goes back to George W. Bush, Billy Tauzin, and Big Pharma. The Bush version of Part D was and is - first and foremost - a huge giveaway to Big Pharma and the insurance companies.

    What benefits the rest of us get are the droplets that trickle down.

  •  This would be such a godsend. (6+ / 0-)

    COBRA is going to drain us; going without coverage is even more of a risk.

  •  Joan, (1+ / 0-)
    Recommended by:
    divineorder

    Where can I look to find out about the $80 billion the drug companies put into the ACA? How long are we bound by that agreement (I assume it had to do with negotiating drug prices)?

  •  I have a hunch that Obama will have a much easier (3+ / 0-)
    Recommended by:
    FiredUpInCA, divineorder, cocinero

    time pushing progressive legislation during his second term.

    Obama - POTUS quondam, POTUS futurus The Once and Future President

    by French Imp on Mon Jan 07, 2013 at 02:58:37 PM PST

  •  Not going to happen (1+ / 0-)
    Recommended by:
    divineorder

    This is just smoke so the admin can get more cover for its coming "grand bargain" on cutting the safety net.

    By allowing this to circulate, Obama apologists can continue to play the "11 Dimensional chess" excuse.

    •  Just out of curiosity, when exactly (6+ / 0-)

      did Obama cut Medicare?  Medicaid?  Social Security?  It appears that the first 2 programs are stronger and reach more people.  Diabolical!  Strengthen the safety net during his first term to make it really easy to cut it in his second term!  How does that work?  I'd really like data from one person who spreads this meme.  Not one of you has responded to my questions.  I'm wondering who's behind the lies and what the payoff is.

      I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

      by I love OCD on Mon Jan 07, 2013 at 03:18:02 PM PST

      [ Parent ]

      •  Your questions assume certain things are true (1+ / 0-)
        Recommended by:
        divineorder

        when in reality they aren't.

        •  Don't be so coy. (2+ / 0-)
          Recommended by:
          Jeff Simpson, I love OCD

          I love OCD asked a straightforward question. Sure, Obama's put stuff "on the table", but that, as far as I can tell, carries no legislative weight. What has Obama done to harm those programs?

        •  like I said, no one has answered my question. (0+ / 0-)

          That's because it's never happened.  No cuts.  Zip.  Zero.  Nada.  The anti-Obama screeds have reached Wayne LaPierre territory- he was just waiting for his second term to come for your guns!!!!!!!  

          No, he has waited for the American people to get smart enough to see your bullshit for what is.  Very much the same tactic he's used on entitlement cuts.  He lays out the bait, they start telling the truth, it hurts them.   They've finally figured that out.  You'll notice they won't say a word about WHAT they want cut?  Here's some entitlements that need cutting:  subsidies and tax cuts for oil and gas companies enjoying record profits; subsidies to factory farms that pollute the water and the soil; tax breaks to companies that outsource jobs; tax breaks to companies that move to your town, provide a few jobs, pay nothing for infrastructure they need; continued payment to defense contractors who miss deadlines and fail to perform; payments to outside contractors who are twice as expensive and half as competent to provide government services.  Short list, there are dozens more.  Obama uses their language, twists it a bit, gets what he wants.  When Progressives miss the big picture and go nuts about his language they reveal an inability to shift to 21st Century politics.  The main complaint I'm reading is he doesn't talk tough enough.  Hmmmm. Maybe people with conviction and a plan don't need to engage in macho bullshit?  Maybe Obama gets it that Americans are sick of posturing and just want action?  Why is that so hard to grasp?

          I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

          by I love OCD on Tue Jan 08, 2013 at 06:51:42 AM PST

          [ Parent ]

  •  ACA already has good cost cutting measures (4+ / 0-)

    better than those in Medicare.  I'd feel a lot more comfortable if he worked on cutting Medicare costs (prescription drug reform) and kept his hands off ACA.

    I'm not sure what he's talking about, but I'd need to see the details.

    Now if he wanted to improve it all by promoting a public option or, even better a Medicare buy in for those under 65, that would be great.

    Somehow I don't see that happening, though, with this WH.

    In spite of everyone calling it Obamacare, ACA was really the work of Dems in the House and, to some degree, Dems in the Senate.  Obama was more of an obstacle in the process.  His WH kept slowing it down and stripping out good cost cutting provisions like the Public Option.

    The only good credit Obama can take for ACA is signing the final bill and not effing it up really badly.

    Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

    by Betty Pinson on Mon Jan 07, 2013 at 03:20:14 PM PST

  •  Let states negotiate prices for their Medicare (0+ / 0-)

    recipients instead of the Federal government. That way Republicans can come out against Federalism too, once Obama supports it.

    -1.63/ -1.49 "Speaking truth to power" (with snark of course)!

    by dopper0189 on Mon Jan 07, 2013 at 03:34:02 PM PST

  •  Allow 50 Year Olds to buy into Medicare (6+ / 0-)

    Better yet, allow 50 month olds to do so.

    Or 50 second olds....

    Drive a stake through the heart of health insurance providers, because they are fucking evil.

    6/24/05: Charlie the Tuna Creator Dies En lieu of flowers, please bring mayonnaise, chopped celery and paprika.

    by LunkHead on Mon Jan 07, 2013 at 03:44:30 PM PST

    •  Thanks for the link. Cenk in high rant dudgeon. (2+ / 0-)
      Recommended by:
      Alice Marshall, tardis10

      Sadly, its hard to know what Obama Admin wants because they ( like many other politicians) prevaricate  so much during campaign season.  

      At any rate, our jobs as progressives is to speak loudly and effectively for  expanding medicare for all.

      Thats what the 18,000 physicians/members of PNHP are doing....

      Here's a fabulous segment with far more facts than the one you link.

      Up with Chris Hayes
      MSNBC
      PNHP's Dr. Claudia Fegan on 'Up with Chris Hayes'

       

      Visit NBCNews.com for breaking news, world news, and news about the economy

      \
      Dr. Claudia Fegan, past president of Physicians for a National Health Program and chief medical officer at John H. Stroger Jr. Hospital of Cook County, appeared on MSNBC's "Up with Chris Hayes" on Nov. 24 as part of a panel that included Dr. Donald Berwick, former administrator of the Centers for Medicare and Medicaid Services; Jacob Hacker, professor at Yale University; Joy Reid, an MSNBC regular contributor; and Josh Barro, a journalist at Bloomberg.com.

      This 3-minute excerpt focuses on the planned expansion of Medicaid coverage under the Affordable Care Act, how the ACA will shift current federal DSH payments now going to safety-net hospitals to individuals enrolled in the Medicaid program, and how some enrollees may have difficulty finding providers willing to take them as patients.

      Later in the program, in a segment on cost control, Dr. Fegan speaks about her skepticism that the ACA will be able to control costs and, by way of contrast, notes the huge administrative savings a single-payer system would yield -- enough to provide quality care to all.
      The full segment is available here.

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Mon Jan 07, 2013 at 04:44:03 PM PST

      [ Parent ]

  •  Health care costs will come down when (2+ / 0-)
    Recommended by:
    whaddaya, divineorder

    we stop the competing factions each trying to get their profit out of the process rather than focus on taking care of people with reasonable and necessary care.  

  •  eliminate Fee for Service (from Howard Dean) (1+ / 0-)
    Recommended by:
    divineorder

    this must be done.

    "The way to see by faith is to shut the eye of reason." - Thomas Paine

    by shrike on Mon Jan 07, 2013 at 03:51:33 PM PST

  •  How Do We Get The Age Lowered To 55 For (1+ / 0-)
    Recommended by:
    divineorder

    being able to get on medicare if the house won't approve it and the senate needs 60 votes?  Is there a way that the president can do an executive order to get it changed?  Also, if the house votes against it, but the senate passes it can it be done by reconciliation?

    "Don't Let Them Catch You With Your Eyes Closed"

    by rssrai on Mon Jan 07, 2013 at 03:53:00 PM PST

  •  Here's a preview (3+ / 0-)
    Recommended by:
    divineorder, Willa Rogers, tardis10

    Following is a link to the Bipartisan Policy Center's (Tom Daschle & Bill Frist) Health Care Cost Driver's Report.

    The kinds of bipartisany "think tanks" run by former senators are just the kind of thing Obama loves.  Let's see what they're putting on our plate:

    Link

    Health Care Financing and Delivery

        Fee-for-Service: Reimbursement under the fee-for-service (FFS) model generates a strong incentive to perform a high volume of tests and services, regardless of whether those services improve quality or contribute to a broader effort to manage care.
        Fragmentation of Care Delivery: Providers are paid for volume rather than patient outcomes, generating little financial incentive to coordinate with others to deliver more efficient care.
        Administrative Burden: Our complex system of payment and delivery leads to increased paperwork and the need for greater administrative resources, raising provider and payer costs.

    ....
    Areas of Focus

    The Initiative will build on the BPC’s Leaders’ Project original four “pillars” of health reform: improving the quality of care, making health insurance affordable, supporting personal responsibility, and developing a sustainable approach to health care financing. This platform will help focus our initiative to tackle the growing costs of health care while preserving the highest quality of care for all Americans and avoiding cost-shifting wherever possible. Specifically, the focus of our work may include but will not necessarily be limited to:

        Payment reform
        New models of care delivery
        Prevention and disease management
        Medicare/Medicaid delivery and design reform
        Administrative simplification
        State flexibility and incentives
        Supply of professionals and services
        Tax reform

    Emphasis mine

    Ok, Medicare and Medicaid are already administered very cheaply, at much lower cost than anything in the private sector.  So there's no savings there, but lots to fark up and lots of middleman profit to be mined by contractors eager to donate to the next political campaign.

    State "flexibility" and "incentives", when it comes to health care, that stuff has always been more expensive, makes the system more complex to administer and oversee and usually results in making a patchwork system that's often unfair to participants and difficult to navigate.

    Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

    by Betty Pinson on Mon Jan 07, 2013 at 03:54:47 PM PST

    •  Here's what Centers for American Progress offers (3+ / 0-)
      Recommended by:
      Losty, Willa Rogers, tardis10

      CAP's report offers the  following;

         Enhance competition based on price and quality
          Increase transparency of price and quality information
          Reform health care delivery to provide better care at lower cost
          Repeal the Sustainable Growth Rate mechanism
          Reform graduate medical education and the workforce
          Reform Medicare premiums and cost-sharing
          Reduce drug costs
          Bring Medicare payments into line with actual costs
          Cut administrative costs and improper payments
          Reduce the costs of defensive medicine
          Reform the tax treatment of health insurance
          Promote better health
      So it doesn't seem like there's any expansion of Medicare on the horizon.

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Jan 07, 2013 at 04:01:18 PM PST

      [ Parent ]

      •  " Reform the tax treatment of health insurance" (1+ / 0-)
        Recommended by:
        tardis10

        Personally, I absolutely can't support this.  This is one of the recommendations in Bowles-Simpson's proposal, The Moment of Truth.

        This will mean that working- and middle-class Americans will have to pay taxes on the portion of their employer-paid premium, that has for decades NOT BEEN counted as "taxable income."
        This is very convenient, since wealthy folks either self-insure, or carry private individual health insurance policies which won't be affected by this "tax treatment."

        Please, folks, let the White House know that this 'regressive' tax reform is not acceptable.

        Mollie

        “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

        by musiccitymollie on Mon Jan 07, 2013 at 05:54:43 PM PST

        [ Parent ]

    •  Great comment, Betty Pinson. Important info. (1+ / 0-)
      Recommended by:
      tardis10

      Absolutely no way I trust Daschle with healthcare policy.

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Mon Jan 07, 2013 at 04:46:22 PM PST

      [ Parent ]

  •  Thanks, I wasn't aware of this (0+ / 0-)

    Often when we think he's fighting yesterday's battles Obama comes up with a compromise or accommodation that is actually something we've been trying to do for a long time.

    With twice the cost for substandard care there has to be a lot of low hanging fruit left on the old health care tree.

    How big is your personal carbon footprint?

    by ban nock on Mon Jan 07, 2013 at 03:57:53 PM PST

  •  If they cut provider pay too much, will this not (1+ / 0-)
    Recommended by:
    tardis10

    make it very hard for seniors to find a provider?  Basically, wouldn't providers just stop accepting Medicare and only accept private insurance?  

    I see this as an issue.

  •  Allowing 50-and-older to buy in.... (5+ / 0-)

    ... and pay premiums... to Medicare would be a tremendous boon to small businesses (and even larger ones).  

    Health insurance costs start really going up for employees over 50, and those costs are still rising by leaps and bounds on an annual basis.  The small company I work for has to research and renegotiate this every year -- and a number of us, including owners, their spouses and employees, are now over that magic age, so those increases really hurt (and they really do try to get the best insurance they can for us, too).

    Having the option of being able to buy into Medicare for older employees, and having that cost be PREDICTABLE and relatively stable from year to year, would be a huge help to small and medium businesses -- for whom health benefits are a huge expense.

    And on the average, most people in that age group are still pretty healthy, so that's money going IN to Medicare.  

    Come up with a fair premium, it's still likely to be less than what private insurers want, AND it won't jump by 20% or more every year, which is good news for businesses.

  •  Obama has already proposed (0+ / 0-)

    that Medicare adopt the Medicaid formula for prescription drug prices. That was included in his first "fiscal cliff" proposal. The savings were about $350 billion, iirc.

    That last link in the post goes to a really outdated HealthBeat article, April 15, 2011.

    For example, allowing Medicare to negotiate for cheaper drug prices could save as much as $200 billion over the next decade.

    The sh*t those people [republicans] say just makes me weep for humanity! - Woody Harrelson

    by SoCalSal on Mon Jan 07, 2013 at 04:06:31 PM PST

    •  But the change hasn't been adopted (0+ / 0-)

      Correct?  If it has, please provide a link. That would be great news.

      Democratic Leaders must be very clear they stand with the working class of our country. Democrats must hold the line in demanding that deficit reduction is done fairly -- not on the backs of the elderly, the sick, children and the poor.

      by Betty Pinson on Mon Jan 07, 2013 at 04:19:10 PM PST

      [ Parent ]

      •  No, not adopted. yet. (1+ / 0-)
        Recommended by:
        tardis10

        Probably I read about that at Wonkblog, but it could have been another site. Right now some kids demand my time and attention, but I'll search later and send you the link.

        The sh*t those people [republicans] say just makes me weep for humanity! - Woody Harrelson

        by SoCalSal on Mon Jan 07, 2013 at 04:39:48 PM PST

        [ Parent ]

  •  So, which policies will be ripped from right-wing (0+ / 0-)

    think tanks this time?

    Obama: self-described moderate Republican

    by The Dead Man on Mon Jan 07, 2013 at 04:15:39 PM PST

  •  Enhanced Medicare for all! (3+ / 0-)

    (i.e. Single Payer)

    Daily Kos an oasis of truth. Truth that leads to action.

    by Shockwave on Mon Jan 07, 2013 at 04:17:36 PM PST

  •  Steve King introduced a bill last week (0+ / 0-)

    to repeal the Affordable Care Act. He's a slow learner.

  •  Oky, doky. Full speed ahead. Keep an eye on them (0+ / 0-)

    Joan.  And let us know how we can help.  :)

  •  This is the President I elected! (0+ / 0-)

    yes yes yes.

  •  Does this mean they are leaving the door open on (1+ / 0-)
    Recommended by:
    tardis10

    means testing?

    not be about middle-income beneficiary cuts

    "I cannot live without books" -- Thomas Jefferson, 1815

    by Susan Grigsby on Mon Jan 07, 2013 at 05:11:25 PM PST

    •  I'd say so. (1+ / 0-)
      Recommended by:
      Susan from 29

      But how broadly and how much deeper they are considering is unknown,I think.

      "George RR Martin is not your bitch" ~~ Neil Gaiman

      by tardis10 on Mon Jan 07, 2013 at 06:56:19 PM PST

      [ Parent ]

    •  Susan, here's piece about means testing Medicare. (1+ / 0-)
      Recommended by:
      Susan from 29

      Here's a Kaiser Health News piece, "Affluent Seniors Could Take A Hit On Medicare."

      This article is very worrisome.  Here's an excerpt and the link to the piece.

         . . . House Minority Leader Nancy Pelosi, D-Calif., has left the door open to asking wealthy seniors to pay more, and public opinion polls show support for the idea.

      . . . "When you’re talking about seniors, the definition of wealthy seems to be a whole lot lower than when you’re talking about younger people," said Maria Freese, director of government relations and policy at the National Committee to Preserve Social Security and Medicare. "Just because they’re retired, it doesn’t mean their expenses are much lower."

      Current law already requires seniors with annual incomes of $85,000 and above ($170,000 for couples) to pay more than others for Medicare Part B, . . .

      Premiums for wealthier seniors will range from $139.90 to $319.70 per month.

      About 5 percent of seniors fall into the higher-premium group now. President Barack Obama wants the share of beneficiaries paying more for their coverage to grow over time to one quarter of all beneficiaries.  If that were the case today, people with incomes as low as $40,000 a year would be paying higher Medicare premiums, according to Tricia Neuman, senior vice president of the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

      Under Obama's proposal, more people will fall into the higher-paying category over time because the trigger levels wouldn’t be adjusted for inflation until that one-quarter target is reached. While the threshold would still be $85,000 for an individual, that would buy a lot less in the future than it does today, and tomorrow's seniors would likely have higher nominal incomes than today’s retirees when they first go onto the Medicare rolls.

      Obama's proposal also would boost the premiums paid by everyone in the higher-income group by 15 percent, with no one paying more than 90 percent of the cost of their coverage.  The White House estimates that Obama’s proposal would save approximately $20 billion over 10 years.

      My concern is the old "slippery slope" theory.  Once the door is opened (which it already has been, I believe under Bush), where does it stop?  As this article points out, if this policy was expanded to the top 25 percent today, it would hit seniors with annual income as low as approximately $40,000.

      I hope that we can figure out a way to stop this trend.  And because of "semantics"--the use of words such as 'the wealthy,' a lot of people won't mind, and therefore won't pay much attention to the details.

      As as they say, "the Devil's in the details."

      [Italics and boldface print are my emphasis.]

      Mollie

      “If a dog won’t come to you after having looked you in the face, you should go home and examine your conscience.” -- Woodrow Wilson

      by musiccitymollie on Mon Jan 07, 2013 at 07:42:39 PM PST

      [ Parent ]

  •  We'll see how it works out (0+ / 0-)

    Lots of docs here are starting to close their practices to new patients ahead of the Medicare cuts

    •  Private practices are going to be rare soon anyway (0+ / 0-)

      Docs are all getting jobs with health care systems cos they can't afford electronic medical records.

      "Michael Moore, who was filming a movie about corporate welfare called 'Capitalism: A Love Story,' sought and received incentives."

      by Bush Bites on Mon Jan 07, 2013 at 05:37:02 PM PST

      [ Parent ]

  •  So far the only proposal we've seen from Obama (0+ / 0-)

    during the last two years was his offer to raise the Medicare age, which was documented in the Woodward memo.

    By all means, let's discuss progressive solutions for lowering health care costs. Put them on the table.

    However, let's not kid ourselves. The GOP is not concerned with lowering Medicare costs -- it only wants benefit cuts and privatization.

    Finding "common ground" with Republicans is a fantasy, unless it involves benefit cuts and privatization. Obama was willing to go down that road in 2011, when he offered to raise the Medicare eligibility age.

    Sure, it would be absolutely wonderful if Obama instead publicly argued for progressive ideas, like lowering the Medicare age. But do I expect him to do so? No.

  •  Talk is cheap. (0+ / 0-)

    I want action.

    "Michael Moore, who was filming a movie about corporate welfare called 'Capitalism: A Love Story,' sought and received incentives."

    by Bush Bites on Mon Jan 07, 2013 at 05:34:13 PM PST

  •  No austerity for drug companies and corporate... (0+ / 0-)

    hospital chains.  They don't need to share in the suffering.  Only seniors and workers need suffer in America.

    Republican ideology isn't about deficits.  We know that.  It's not about spending either, just look at defense boondoggles.

    So, what is it about?

    It's about keeping the vast majority desperate.  Willing to go into a mine for a few bucks a day.  Without health care or a pension.

    It's about keeping us desperate.  Willing to work more hours for less pay and LESS SECURITY.  Always fearful, instead of hopeful.

    In that environment, they win.

  •  it does not matter if true or not (0+ / 0-)

    on this site you'll get ripped for stating anything in a positive light.

    me? just gonna read and take occasional potshots at the naysayers and "real" democrats.....heckuva lot more productive and fun.

    mittens=edsel. no matter how much money is spent to promote it, if the product sucks, no one will buy it.

    by wewantthetruth on Mon Jan 07, 2013 at 07:09:23 PM PST

  •  UK targets high drug costs (0+ / 0-)

    Just for international reference, this report on UK initiatives to knock millions off the prescription drugs bill.

    (Source The  Independent 31 December 2012)

    Doctors who unnecessarily prescribe expensive branded drugs to patients when cheaper alternatives are available are facing a crackdown as the NHS attempts to reduce its annual £8bn family medicine bill....

    GPs will be forced to justify their prescription costs against newly published data, allowing managers to identify those doctors who continue to prescribe expensive branded drugs rather than their generic alternatives. The move comes after a study, backed by the new NHS Commissioning Board, found the NHS was wasting £33m a month on unnecessary expenditure on two branded heart drugs alone.

    (GPs are General Practicioners, basically Doctors working outside hospitals.)

    Note that this 'justification' could actually lead to clinical benefits, as it may be that some more expensive varieties  of a drug have specific advantages in terms of side effects for some patients.

    Violence is the last refuge of the incompetent.

    by saugatojas on Tue Jan 08, 2013 at 04:57:37 AM PST

  •  This is a Big Issue.....but..... (0+ / 0-)

    The following people would be real happy NOT to carry around their Medicare Card.....

    Dick Armey
    Most of Congress
    The Older Woman down the street from me
    worth about $7 Million living on her dead husband's
    trust money.

    If we can just MEANS TEST IT, we can leave the age alone and I know people right now who needed a F/U Mammogram, and other health issues waiting for Medicare, making anywhere between $14K and $23K a year.  How sad  and disgusting is that....when Taiwan offers a better healthcare system than we do?

  •  We could save a trillion $/year (0+ / 0-)

    That's hundreds of billions more/yr than our entire military budget, simply by adopting the healthcare system of any other advanced nation.  
    Any Other Advanced Nation's Healthcare System

    •  Meanwhile under ACA, Aetna CEO says (0+ / 0-)

      ...our premiums will double.

      ACA will double premiums  

      This article neglects to point out that CBO estimates ACA will only cover roughly half, not all (or 30 million of our projected 60 million uninsured by the time it is fully implemented), leaving 30 million still completely uninsured.  So that's double the premiums to cover half of our uninsured under forced privatization. Yay.

      What if we don't trust "what we have" as far as we can spit (for extremely good reasons)?

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