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Stethoscope on $100 bills.
We've heard this one before: "Efforts to finally get rid of that dreaded Medicare payment formula could see smoother sailing [...]"

A year ago there were hopeful signs that a permanent fix would be done in the payroll tax cut extension. Didn't happen. A permanent fix for this problem in the payment formula pops up at least once a year, when it comes time to legislate a temporary fix. It's been that way since the 1990s, when Congress passed a payment formula that set what doctors and other providers would get in reimbursement for caring for Medicare patients. But that formula quickly proved to be too stingy, and didn't keep up with rising health care costs on the provider side, so every year it has to be adjusted. It's an annual event because, so far, legislators haven't been able to agree to a way to pay for permanently repealing the formula.

And lately, it's been a popular hostage for Republicans to take. They know the fix has to be done to keep doctors and seniors on Medicare placated and to keep the program running smoothly. So they hold their breath and refuse to fix it until Democrats give in on something, usually tax hikes for people or corporations who could certainly afford to pay just a little bit more for the common good.

But now there's new hope in the CBO having given permanently fixing the formula a much smaller price tag than before. Last year's estimate for repealing the formula was $243.7 billion. Now it's $138.3 billion, thanks to much lower actual spending in Medicare than projected spending. In the past three years actual Medicare spending has slowed drastically, in anticipation of the reforms coming under the Affordable Care Act. (Yes, would-be Medicare "reformers," Obamacare is working to reduce spending in the program.)

There are a few proposals percolating in the House to make this fix permanent, but whether any one of them actually succeeds is really going to depend on whether House Republicans are willing to give up this very handy potential hostage.

Originally posted to Joan McCarter on Thu Feb 07, 2013 at 10:16 AM PST.

Also republished by Daily Kos.

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Comment Preferences

  •  Tip Jar (16+ / 0-)

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

    by Joan McCarter on Thu Feb 07, 2013 at 10:16:23 AM PST

  •  I have a dream (4+ / 0-)

    I dream of a congress that carefully considers legislation in committees comprised of members who are proficient in their committee's functions - and then passes on their recommendations to the full congress with their carefully crafted recommendations!

    I have a dream!

    Self-described political "centrists" believe the best policy is halfway between right and wrong. — @RBReich via web

    by BentLiberal on Fri Feb 08, 2013 at 07:22:15 PM PST

    •  Do you mean a dream (0+ / 0-)

      of a Congress w/sane republicans?  If only.

      Perhaps we would feed the hungry, care for the sick, not go into unnecessary wars, not give billionaires more of everything, etc.

      Republican mental illness is the number one problem facing America.  
      And, we're not supposed to talk about it.

      "If you want to make G-D smile, tell him your plans." Vin Scully

      by BrianParker14 on Fri Feb 08, 2013 at 07:50:11 PM PST

      [ Parent ]

      •  Modern Republicanism isn't a mental illness, (0+ / 0-)

        its just greed and selfishness a la Ayn Rand. Mental illness, on the other hand, is a genuine medical condition.

        •  Voting to deprive the hungry of food, (0+ / 0-)

          the sick of medical care and sending the unemployed to fight unnecessary wars is a mental illness.  I've read much of Ayn Rand, she was mentally ill.  Living off the the back of society and hating the society she used, she was mentally ill.  Setting up circumstances to kill those of lesser means is a mental illness.  Is bigotry a mental illness?  Knowingly passing/voting for laws that hurt or kill those who don't have the means to defend themselves is  a mental illness.

          "If you want to make G-D smile, tell him your plans." Vin Scully

          by BrianParker14 on Sat Feb 09, 2013 at 05:24:56 PM PST

          [ Parent ]

  •  Here's How to Fix the Docs (4+ / 0-)

    With apologies to docs, of course.

    The way to fix all this is to replace our current, ugly healthcare smattering with a uniform, publicly-funded healthcare system. That would be where all essential healthcare is paid for by the federal government out of a progressive tax.

    We could fix the total compensation at 15% of GDP. That would stop run-away healthcare costs. We would save hundreds of billions of dollars because we would end profits and other waste in the for-profit health insurance business (by, essentially, nationalizing it).

    Poor people would not be excluded or forced to pick up the tab.

    Or we can limp along with the current way of doing business, as is appropriate for a nation without adequate healthcare.

    •  Hear, Hear! LT N/T (1+ / 0-)
      Recommended by:
      Liberal Thinking

      Mollie

      "Only he who can see the invisible, can do the impossible." --Frank L. Gaines

      "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 Fri Feb 08, 2013 at 07:46:16 PM PST

      [ Parent ]

    •  Actually, since Congress issues the currency, (1+ / 0-)
      Recommended by:
      a2nite

      it doesn't have to collect taxes to pay for necessary services.

      So why does it engage in this charade that sets up the Federal Reserve and the banks as money distributing middlemen? Because the Congress has long sought to shirk obligations and to retain the capacity to reward supporters and penalize critics by controlling where the resources go. In the past, when there were still lots of natural resources to dole out, this behavior was less obvious. Who knew to whom all the oil drilling rights were allocated?
      What's different now is that this system of rewards and punishments to keep themselves in power has devolved mostly to handing out or withholding (sequestering) money. To sequester is another word for hoard.

      Anyway, the concept I'd like to introduce into the discussion is that the hoarding of money and the threat of depriving payment to medical personnel are both examples of triangulation -- of doing one thing or injuring one person in order to affect the behavior of another. Triangulation is the hallmark of the kidnapper and the terrorist. It has the advantage of exploiting people's sympathies, picking on innocent bystanders as victims and making it difficult to identify who's actually responsible. To effect indirectly is the coward's choice because it makes revenge difficult.

      It seems strange that binary thinkers are resorting to indirection, that black/white thinkers should triangulate, but I think it's instinctive and surfaces out of that gap represented by the slash. Think of the Father and the Son and the Holy Spirit, the active agent, as the slash. Binary thinkers are in a triangle of which they are not aware. They act indirectly without thinking--directed by ulterior motives against unknown enemies. Perhaps they aren't even aware of being antagonistic.

      We organize governments to deliver services and prevent abuse.

      by hannah on Sat Feb 09, 2013 at 12:32:56 AM PST

      [ Parent ]

      •  Once more again (2+ / 0-)
        Recommended by:
        Liberal Thinking, nextstep

        Issuing currency does not create either value or valuable pieces of paper—external, market-based judgments are the final arbiters. I really would like to see this pernicious notion, which seems to be becoming ever more present here on DKOS, once and for all given the burial it deserves. It forms no part of the science of economics, left or right, and is just wishful thinking of the beggars/horses variety.

        This is not a new notion—it has a rich and dismal, even tragic, history. For a clear explanation, Amazon offers a free Kindle download of Andrew Dickson White's short essay, Fiat Money Inflation in France. Nothing significant has changed since it first appeared in 1896, and it ought to be required reading for anyone who imagines that economic salvation comes from a supply of paper and ink.

        http://www.amazon.com/...

  •  With each passing year Obamacare looks better (3+ / 0-)
    Recommended by:
    Tom Anderson, a2nite, mudfud27
    In the past three years actual Medicare spending has slowed drastically, in anticipation of the reforms coming under the Affordable Care Act. (Yes, would-be Medicare "reformers," Obamacare is working to reduce spending in the program.)
    Especially in contrast with the GOP voucher-care alternative.
  •  Help me understand why doctors and the (2+ / 0-)
    Recommended by:
    blugrlnrdst, Tom Anderson

    AMA routinely support GOPers, even when the Rethugs are willing to physicians hostage while they screw over health care and the nation.  Oh, and did I mention that they're willing to screw the doctor, too?

    Round these parts, physicians are pretty much 90% GOPer and they write the checks to prove it.

    •  Because. . . (2+ / 0-)
      Recommended by:
      mudfud27, Rube Goldberg

      1) They don't know.
      2) In general, they aren't trained #s people and so some are having difficulty figuring out how the ACA will affect their practices.
      3) Doctors are a group that includes diverse people from diverse backgrounds and this affects their voting behavior as much as "doctor stuff."   Some are evangelical social conservatives, others are communal oriented activists.  Some experienced heart-breaking bigotry in discrimination in their lives, others coasted through prep school and an Ivy League college on a smooth path laid out by wealthy and powerful parents.  Some are so busy juggling work, marriage, kids, and aging parents that they haven't sat through a whole evening news cast in years, others run for and win political office.  And on and on.

      As for the AMA, the huge majority of physicians are NOT members.  So while "AMA approved" may still mean something to the general public, it means nothing to most docs.  Most are members of their specialty society like the American Academy of Pediatrics, the American College of Cardiology, the American Society of Anesthesiologists, etc.  They will rely on these organizations to interpret changes in Medicare, ACA implementation, etc.

    •  A decent article addressing that issue (2+ / 0-)
      Recommended by:
      Tom Anderson, Rube Goldberg

      http://www.nytimes.com/...

      FWIW, I myself and the vast majority of physicians I know are quite anti-Republican, but we are mostly academic docs. And as already mentioned, the AMA represents only a small fraction of physicians (and even they supported Obamacare).

  •  Just to keep track (0+ / 0-)

    A $138.3 bn addition to last week's new! rosy! CBO deficit projection raises it to $983+ bn, still also assuming the entire sequester is maintained untouched. Which reminds me that I have to track down my copy of Boorstin's The Image: A Guide to Pseudo-events in America.

  •  What (or who) is the problem? (0+ / 0-)

    First of all, most Medicare patients have a secondary insurance that covers the balance of the reimbursement.  Also, Medicare patients are required to sign an ABN which guarantees that the doctor will get paid by the patient directly if insurance doesn't pay.  Monthly installment plans are common.  If all else fails, doctors can write off much of the bad debt at tax time.  Second, reimbursement rates, and the accompanying diagnosis codes, are set by Medicare, and further refined by individual insurance companies.  An example would be if a doctor suspects high cholesterol and orders a blood test, the insurer can refuse to pay unless the patient meets all of the criteria set up by the company.  In other words, only people who are morbidly obese can have high cholesterol.  The whole idea of government-driven death panels is a joke; the death panels exist exclusively in the insurance companies and doctors are powerless to stop them.  Third, the AMA rant about not taking Medicare patients has no basis in reality.  I'm very sure that no thinking person would dismiss the largest source of income in the country: the baby boomers. Last, single payer Medicare is the only answer.  Medicare is a well-managed, cost-efficient agency unlike its industry counterparts.  In my opinion, there is no valid argument against it.  Resistance consists solely of smokescreens and sound bytes designed to further uninform the uninformed.

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