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Pipe dream? Obamacare
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techno900



Joined: 28 Mar 2001
Posts: 1349

PostPosted: Sat Nov 23, 2013 9:33 am    Post subject: Reply with quote

Mac said:
Quote:
You always reveal how poorly read you are, and how when talk radio says jump, you say "How high?"


As expected, you just can make a post without some sort of ridicule or personal jab. Why not stick to open debate, and if you find fault with things that others post, just provide contradictory evidence to support your views and leave it at that. I kind of feel sorry for you.

And if you think the ACA is the answer to all our healthcare issues, so be it. Time will tell, but so far, there is little about the program that suggests any kind of future success, but there is a truck load of evidence that suggests that it may be a complete failure.
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techno900



Joined: 28 Mar 2001
Posts: 1349

PostPosted: Sat Nov 23, 2013 9:49 am    Post subject: Reply with quote

swchandler said:
Quote:
Am I wrong when I suggested "that you wouldn't be a participant in either program if the government wasn't requiring it by law"? You never touched on that.

If I had had the option, I would not have participated in SS. If there had been an "opt out" option for the general public, it would have made no sense because the average Joe citizen would have probably opted out, not saved for retirement and now be on the street or totally dependent on government assistance.

Therefore, I understand the nature of the program and the required participation, but saying that I could have done better on my own is not contradiction. I can't make it any more clear than that.

Medicare, I would have participated as required by law, because it's more of a gamble than managing finances.
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isobars



Joined: 12 Dec 1999
Posts: 13286

PostPosted: Sat Nov 23, 2013 9:56 am    Post subject: Reply with quote

Especially now that Obama has unfettered authority to appoint any unvetted loon he wants to the panels that decide which patients and which treatments it will allow. It already curtails my knee rehab PT very significantly, and that will get much worse when the IPAB and its counterparts get packed with political appointees rather than practicing physicians.
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youwindsurf



Joined: 18 Aug 2012
Posts: 331
Location: North Shore High School

PostPosted: Sat Nov 23, 2013 10:04 am    Post subject: Reply with quote

IPAB was created as a strengthened version of the Medicare Payment Advisory Commission (MedPAC), a body with no regulatory power that solely advises Congress, but can not enact regulations in and of itself. Since 1997, MedPAC had recommended cuts totaling "hundreds of billions of dollars" to Medicare that were ignored by Congress. Also, Congress has pressured Medicare administrators to cover "ineffective or needlessly costly methods of care", while Medicare's founding legislation says "Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine". Henry J. Aaron, a health care expert at the Brookings Institution, says that many observers see that some in Congress are "in thrall to campaign contributors and producers and suppliers of medical services" and most are not well enough informed to wisely use Medicare's buying power to reform health care. The idea behind the IPAB was to take power away from Congress (and special interests) in order to give it to those knowledgeable in health care policy.

On June 25, 2009, Senator Jay Rockefeller introduced the Medicare Payment Advisory Commission Reform Act of 2009, which would have changed MedPAC into an executive branch agency. On July 17, 2009, the Obama administration submitted to Congress a similar proposal called the Independent Medicare Advisory Council Act, which would have created an independent five-member executive council to make recommendations to the president. From June 17 to September 14, 2009, three Democratic and three Republican Senate Finance Committee members met for a series of thirty one meetings to discuss the development of a health care reform bill. During this period, Senators Max Baucus (D-Montana), Chuck Grassley (R-Iowa), Kent Conrad (D-North Dakota), Olympia Snowe (R-Maine), Jeff Bingaman (D-New Mexico), and Mike Enzi (R-Wyoming), met for more than sixty hours, and their discussions established the principles upon which the health care reform legislation that later passed was based. The Finance Committee included a provision establishing an independent Medicare advisory board in its health reform legislation, which passed the Senate on December 24, 2009.

IPAB is tasked with developing specific proposals to bring the net growth in Medicare spending back to target levels if the Medicare Actuary determines that net spending is forecast to exceed target levels, beginning in 2015.

With regard to IPAB's recommendations, the law says "The proposal shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums under section 1818, 1818A, or 1839, increase Medicare beneficiary cost sharing (including deductibles, coinsurance, and co-payments), or otherwise restrict benefits or modify eligibility criteria." The Department of Health and Human Services (HHS) must implement these proposals unless Congress adopts equally effective alternatives. The board is also required to submit to Congress annual reports on health care costs, access, quality, and utilization. IPAB must submit to Congress recommendations on how to slow the growth in total private health care expenditures.

Every year on September 1, IPAB must submit a draft proposal to the Secretary of Health and Human Services. On January 15 of the next year IPAB must submit a proposal to Congress. If IPAB fails to meet this deadline, the HHS must create its own proposal. Congress must consider this proposal under special rules. Congress cannot consider any amendment to the proposal that does not achieve similar cost reductions unless both houses of Congress, including a three-fifths super majority in the Senate, vote to waive this requirement. If Congress fails to adopt a substitute provision by August 15, HHS must implement the proposal as originally submitted to Congress.

A 2009 Kaiser Health News article predicted primary care doctors would likely see benefits from an "independent Medicare commission because the panel would be more likely to increase their fees and lower specialists' rates". While payment cuts to hospitals and hospices are off-limits until 2020, and clinical laboratories are off limits until 2016, physician fees may be cut unless a doc fix to Medicare's sustainable growth rate formula makes those cuts off limits. Other "savings would have to be found in private Medicare Advantage plans, Medicare’s Part D prescription-drug program, or spending on skilled-nursing facilities, home-based health care, dialysis, durable medical equipment, ambulance services, and services of ambulatory surgical centers". According to the New England Journal of Medicine, holding off creation of accountable care organizations (ACOs) is likely to be a bad long term strategy for physicians.

Critics of IPAB have charged that the board's cost-cutting mandate will inevitably bring about a reduction in care, despite the anti-rationing language in the bill. Congressman Phil Roe from Tennessee, a medical doctor, warned that IPAB will ration care through payment policy. American Medical News charged that the bill gives IPAB "unprecedented, dangerous authority to cut Medicare pay rates and strangle access to care." IPAB has frequently been denounced by its critics as a death panel.

IPAB is composed of fifteen members appointed by the President, subject to Senate confirmation. The Secretary of HHS, the Administrator of the Center for Medicare and Medicaid Services, and the Administrator of the Health Resources and Services Administration serve ex officio as nonvoting members. In making the appointments, the President consults with the Majority Leader of the Senate concerning the appointment of three members; the Speaker of the House of Representatives concerning the appointment of three members, the Minority Leader of the Senate concerning the appointment of three members, and the Minority Leader of the House of Representatives concerning the appointment of three members.

The first members appointed to the Board will be divided into three staggered classes in order to ensure that their terms do not expire simultaneously. Five will be appointed for a term of one year, five will be appointed for a term of three years, and five will be appointed for a term of six years. All subsequent appointments will be made for six years. A member may not serve more than two full consecutive terms. Individuals who are directly involved in providing or managing the delivery of Medicare items and services may not constitute a majority of IPAB’s membership.

The President of the United States must establish a system for public disclosure by IPAB members of any financial and other potential conflicts of interest. As it currently stands, no IPAB member may be engaged in any other business, vocation or employment.

Members will be paid at a rate described in Level III of the Executive Schedule that determines pay for senior executive branch officials. As of 2010 this is $165,300 per year.


Last edited by youwindsurf on Sat Nov 23, 2013 10:55 am; edited 1 time in total
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isobars



Joined: 12 Dec 1999
Posts: 13286

PostPosted: Sat Nov 23, 2013 10:28 am    Post subject: Reply with quote

Not now that Obama can appoint anyone he wants to ration health care.
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youwindsurf



Joined: 18 Aug 2012
Posts: 331
Location: North Shore High School

PostPosted: Sat Nov 23, 2013 12:06 pm    Post subject: Reply with quote

isobars wrote:
Not now that Obama can appoint anyone he wants to ration health care.


LIE!

http://www.ama-assn.org/ama/pub/advocacy/topics/independent-payment-advisory-board.page?

The IPAB members are to include:

15 members appointed by the President, by and with the advice and consent of the Senate. In selecting individuals for nominations for appointments to the Board, the President shall consult with: (i) the majority leader of the Senate concerning the appointment of 3 members; (ii) the Speaker of the House of Representatives concerning the appointment of 3 members; (iii) the minority leader of the Senate concerning the appointment of 3 members; and (iv) the minority leader of the House of Representatives concerning the appointment of 3 members;
The HHS Secretary, the Administrator of CMS, and the Administrator of the Health Resources and Services Administration (all of whom will serve ex officio as nonvoting members of the Board).

Qualifications/Requirements for IPAB Members:
Appointed members of the IPAB will include individuals with national recognition for their expertise in health finance and economics, actuarial science, health facility management, health plans and integrated delivery systems, health facilities reimbursement, allopathic and osteopathic physicians, other providers of health services, and other related fields who provide a mix of professionals, broad geographic representation, and balance between urban and rural areas.

IPAB members must include (but not be limited to) physicians and other health professionals, experts in the area of pharmaco-economics or prescription drug benefit programs, employers, third-party payers, individuals skilled in the conduct and interpretation of biomedical, health services, and health economics research, and expertise in outcomes and effectiveness research and technology assessment. Members must also include individuals representing consumers and the elderly.

Individuals who are directly involved in providing or managing the delivery of Medicare items and services may not constitute a majority of IPAB’s membership.

The President must establish a system for public disclosure by IPAB members of any financial and other potential conflicts of interest.

No IPAB member may be engaged in any other business, vocation, or employment.
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swchandler



Joined: 08 Nov 1993
Posts: 5448

PostPosted: Sat Nov 23, 2013 1:20 pm    Post subject: Reply with quote

Thanks youwindsurf for the clarity and factual background pertaining to the IPAB.

No worries about isobars. As we've found over time, all he can offer is the repetition of nihilistic nonsense being promoted by talk radio and other highly questionable sources. Just look at his last two vacant posts. When it comes down to offering real ideas or any meaningful contribution to the debate, he's hopelessly incapable and lost.
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keycocker



Joined: 10 Jul 2005
Posts: 3021

PostPosted: Sat Nov 23, 2013 1:39 pm    Post subject: Reply with quote

Techno,
Does anyone think that the ACA is the solution to all our healthcare problems?
That is first time a conservative has ascribed that foolish idea to liberals as far as I know.

Did you think of that silly opinion yourself? Libs didn't.
You object to libs here misrepresenting your opinions and so do I.
Do you regularly do the same without realizing it?
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mac



Joined: 07 Mar 1999
Posts: 4651

PostPosted: Sat Nov 23, 2013 3:04 pm    Post subject: Reply with quote

But Techno, you always reveal how poorly read you are. You post some right wing talk radio blather about social security and Medicare going broke, the Democrats having no solutions, and privatizing social security is the answer. All of those are factually wrong--and, as usual, you demonstrate no grasp of the actual complexities of the issues, or that there might be different opinions, and underlying facts. You keep screeching that you have set a high tone here with your relentless attacks (without facts and reasoning they cannot be called criticisms) on Obama and Democrats and thus should be immune from insults. Also wrong--your tone in defines the tone in response.

There are a number of different academic studies of Social Security. Depending on assumptions, it can be spun to have fiscal issues in about twenty years--or be sound forever. Projecting out beyond ten years, on fiscal and climate issues, is risky. Here's just one bit of analysis from outside the bubble, which puts your argument into the ash bin:

Quote:
Republican claims that Social Security is going broke were dealt a blow by the latest Social Security trustees report, which found that the program will be able to pay every benefit until 2033.

The report echoed the same tone as last year. Social Security is fine for the next twenty years. The report also contained good news for Medicare, as it is now projected to be solvent until 2026. In a statement, Sen. Bernie Sanders stressed that these findings confirmed what the reality based political world already knew. Sen. Sanders said, “The report from the Social Security trustees confirms what many of us have known, that Social Security is not ‘going broke,’ that it can pay every benefit owed to every eligible American for the next 20 years and that after 2033 there is enough in reserve to pay three-quarters of future benefits.”

Republicans have been claiming that Social Security is going broke for years in order to justify the privatization of the program. The right has also argued that Medicare needs to be replaced with a voucher system because it is going broke. It turns out that both of these claims are absurdly false. While this report is bad news for those Republicans who are trying to sell privatization, it is also bad news for President Obama. The president has made the argument in the past that cost of living adjustments need to be cut by moving to a chained CPI. Today’s report illustrates that there is no need for impulsive steps in the name of getting a deal on entitlements.


Same bs with the claims on Medicare: Of course, you ignore the well documented $550 billion donut hole left by Bush's Part D benefit.
http://useconomy.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=useconomy&cdn=newsissues&tm=107&f=00&tt=65&bt=0&bts=0&zu=http%3A//www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/downloads/tr2009.pdf

Quote:
7:10 AM - September 11, 2012
Medicare ‘bankruptcy’: CNN gets it right
The network fact-checks a frequent talking point, and does it well

By Trudy LiebermanFacebookTwitterEmailPrint One Page
Hooray for CNN.com, for fact checking the often-heard claim of Medicare’s “impending” bankruptcy. CNN’s contribution sets a high bar, and the network also distinguishes itself from the over-the-top fact checking that has cropped up lately, as pointed out recently by my colleague Brendan Nyhan.

The “bankruptcy” language comes up a lot. In his convention speech last week, for example, former president Bill Clinton declared that Mitt Romney’s goal to repeal the Affordable Care Act (ACA), presumably along with its provisions that prolong the Medicare Hospital Trust Fund, would make “Medicare go broke in 2016.” And on Thursday, vice president Joe Biden said that Romney’s plan “would cause Medicare to go bankrupt by 2016.”

The word “bankrupt” is high on Romney’s list of talking points, too. A Romney spokesperson told CNN, when it asked for a response to Clinton’s charges, “Medicare will go bankrupt in 2024.” That’s when Medicare trustees now say the hospital trust fund will have a money shortfall.

But is Medicare really going bankrupt? Definitely not, says CNN. The network is correct, and the point is crucial.

How did CNN pull away from the fact-checking pack on this one? It did some old-fashioned reporting, read some financial reports, and found sources that could really give the financial skinny on Medicare. And it didn’t go for that “mostly true” or “partly misleading” stuff that some other fact checking pieces resort to, which can confuse readers more than it enlightens them.


And then there is the privatization piece. I have a chunk of money and it is managed by a professional who is better at it than I am. He is well paid for what he does--and he takes risks according to my general direction. It is my opinion (now here we can distinguish between fact and opinion) that the main purpose of Bush and Republican policies is to steer more business to financial advisors--and campaign contributions back to Republicans. Risk be damned.

Hard to find overwhelming evidence because contributions to private "think tanks" like the Cato Institute are impossible to track. But this provides the other side of the issue:

Quote:
By DON McINTOSH, Associate Editor

President George W. Bush visited South Bend, Indiana, March 4, and in front of a cheering throng of 6,000 mostly Republicans, he presented his ideas for privatization of Social Security.

In the audience, University of Notre Dame economics professor Teresa Ghilarducci, former assistant director of the AFL-CIO’s Department of Employee Benefits, knew something didn’t add up.

Bush talked about a predicted shortfall in Social Security, and then called for a shift to a system of private accounts.

If the problem is solvency, why would Bush advocate taking money out of Social Security to put it in private accounts? That would make the solvency problem worse, a fact even Federal Reserve Chair Alan Greenspan, the Republican economic superstar, acknowledges.

So what’s the motive for such a major overhaul? What constituency has been clamoring for Social Security privatization — an issue that was on no one’s mind a year ago, and was barely mentioned in the election campaign?

The answer: The campaign was generated by an alliance of right-wing thinkers and top-tier bankers that have waged a two-and-a-half-decade-long campaign to undermine Social Security.



Enter The Ideologues

For a generation, privatizing Social Security has been the objective of the Cato Institute. Cato is a key player in a network of conservative organizations (think tanks, legal foundations, publishers, political organizations) funded and coordinated by a small but wealthy group of conservative foundations.

Cato describes itself as libertarian, espousing principles of limited government, free markets, individual liberty and peace.

Rob Levine describes Cato in less flattering terms. Levine is the founder of MediaTransparency.org, which publicizes the interlocking links of the right-wing network. “It’s libertarian — for corporations,” Levine said. “They argue for things that would benefit them as rich people.”

Cato’s very first hardcover book, published in 1980, was a template for privatization of Social Security. In Social Security: The Inherent Contradiction, author Peter J. Ferrara argued that workers should be allowed to invest part, and eventually all, of the money they now pay into Social Security, in return for a corresponding reduction in their


You want to have a higher tone of debate? Set it. You want to avoid criticism as poorly read? Read.
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keycocker



Joined: 10 Jul 2005
Posts: 3021

PostPosted: Sat Nov 23, 2013 3:12 pm    Post subject: Reply with quote

This is an interesting factual take on these entitlements future.
I learned something from it. Thanks Mac.
I regret that such missives often come with a session of slapping someone around.
Along with Techno , I thought these programs were going broke too.
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