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"We are in a recovery."Bogus claims that just keep getting repeated
"When a bill lands on my Desk, The American people will have 5 days to review it before I sign it."
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"We are in a recovery."Bogus claims that just keep getting repeated
The Republicans have won PolitiFact's Lie of the Year award two years in a row.
I think they are trying for three.
The Republicans have won PolitiFact's Lie of the Year award two years in a row.
I think they are trying for three.
"Politifact" is a leftwing propaganda organ. It should be called "Politilie."
In other words, you will be regulating private insurers (forcing them to pay on par with medicare).
Is that what you are suggesting ?
ASKED BY A WALL STREET JOURNAL REPORTER to explain how U.S. hospitals price their services, William McGowan, chief financial officer of the University of California, Davis, Health System and thirty-year veteran of hospital financing, responded: "There is no method to this madness. As we went through the years, we had these cockamamie formulas. We multiplied our costs to set our charges."1
Exhibit 1 illustrates his point. Although the list prices reflected in Exhibit 1 vary by only a factor of slightly more than 4, they reportedly vary by as much as seventeenfold across all hospitals in California. However, these "charges" are much higher than the prices U.S. hospitals are actually paid. In 2004, for example, U.S. hospitals were actually paid only about 38 percent of their "charges" by patients or their insurers.2 The actual prices they were paid appear to vary much less than "charges" do, although even that variation is remarkable large. For example, in 2001 the prices hospitals were actually paid by private health insurers serving the Federal Employees Health Benefits Program (FEHBP) varied by "only" 259 percent across the United States.3 [...]
An individual hospital might be paid by a dozen or more distinct third-party payers, each with its own distinct set of rules for and levels of payment, which are negotiated separately with each private insurer once a year. Medicare and Medicaid have their own extensive rules for paying hospitals. Relative to hospitals paid under the much simpler national health insurance schemes in other countries, the contracting and billing departments of U.S. hospitals therefore are huge enterprises, often requiring large cadres of highly skilled workers backed up by sophisticated computer systems that can simulate the revenue implications of the individual contract negotiations.
Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the states spiraling health care costs.
The yearlong investigation, set to be released today, found no evidence that the higher pay was a reward for better quality work or for treating sicker patients. In fact, eight of the 10 best-paid hospitals in one insurers network were community hospitals, which tend to have less complicated cases than teaching hospitals and do not bear the extra cost of training future physicians.
Coakleys staff found that payments were most closely tied to market leverage, with the largest hospitals and physician groups, those with brand-name recognition, and those that are geographically isolated able to demand the most money.
The shift in who holds the upper hand in negotiating paymentsonce held by health insurance plans but now resting with health care providershas had a major impact on California premium trends. According to some survey respondents, the dynamic needs urgent policy attention. I am shocked there isnt an outcry over the fact that our costs are driven out of control, a health plan executive complained. We would like to establish some sort of boundary, beyond which these guys cant go. Wed welcome some regulatory intervention to break up these monopolies, because they are just killing us.
Even some provider respondents are cynical about providers motivation to join or form integrated practices. Coming from Fresno, an area without the kind of integration seen in other California markets, a medical-group physician offered, The good thing about the systems not being highly integrated and coordinated [in Fresno] is that premiums are lower. Why are those hospitals and physicians [integrating]? It wasnt for increased coordination of care, disease management, blah, blah, blahthat was not the primary reason. They wanted more money and market share.
As the interviews document, provider market power is not a phenomenon associated just with integration strategies. A single must-have hospital can develop enough clout to obtain payment rates much higher than Medicares, acknowledging that many providers believe Medicare payments to be inadequate. Indeed, across other markets studied by the Center for Studying Health System Change, providers are developing increased leverage through single-specialty group formation and merger-and-acquisition strategies that do not involve integration.18
Do states need to have an all-payer rate setting system to do what Maryland has done?
I think there are other ways of accomplishing much of what we are able to do, particularly in these highly concentrated markets [where certain providers have very high market share]. Legislation could be established that sets a maximum payment obligation for private payers. That would change the negotiating dynamic instantaneously, and shift the balance of power back to more of an equilibrium. Right now the large hospitals and health systems have all the leverage and people insured with private insurance or self-funded plans are taking it in the throat.
"Politifact" is a leftwing propaganda organ. It should be called "Politilie."
The truth is leftwing to a Republican.
You will win Lie of the Year for three straight years in a row.
My money is on Paul Ryan.