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.

"Politifact" is a leftwing propaganda organ. It should be called "Politilie."
 
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."

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.
 
In the spring of 2009, a Republican strategist settled on a brilliant and powerful attack line for President Barack Obama's ambitious plan to overhaul America's health insurance system. Frank Luntz, a consultant famous for his phraseology, urged GOP leaders to call it a "government takeover."

"Takeovers are like coups," Luntz wrote in a 28-page memo. "They both lead to dictators and a loss of freedom."

The line stuck. By the time the health care bill was headed toward passage in early 2010, Obama and congressional Democrats had sanded down their program, dropping the "public option" concept that was derided as too much government intrusion. The law passed in March, with new regulations, but no government-run plan.

But as Republicans smelled serious opportunity in the midterm elections, they didn't let facts get in the way of a great punchline. And few in the press challenged their frequent assertion that under Obama, the government was going to take over the health care industry.

PolitiFact editors and reporters have chosen "government takeover of health care" as the 2010 Lie of the Year. Uttered by dozens of politicians and pundits, it played an important role in shaping public opinion about the health care plan and was a significant factor in the Democrats' shellacking in the November elections.

Readers of PolitiFact, the St. Petersburg Times' independent fact-checking website, also chose it as the year's most significant falsehood by an overwhelming margin. (Their second-place choice was Rep. Michele Bachmann's claim that Obama was going to spend $200 million a day on a trip to India, a falsity that still sprouts.)

By selecting "government takeover' as Lie of the Year, PolitiFact is not making a judgment on whether the health care law is good policy.

The phrase is simply not true.

PolitiFact | PolitiFact's Lie of the Year: 'A government takeover of health care'
 
In other words, you will be regulating private insurers (forcing them to pay on par with medicare).

Is that what you are suggesting ?

No. The reason I include so many links is that, on the off chance that someone is actually interested in something (unlikely, I know), they can pursue it. What I'm talking about here is addressing the extreme price discrimination hospitals practice between payers, which is closely connected to their ability to use market clout to decouple prices from actual value and costs. Believe it or not, health insurers aren't the bad guys in this story.

If you want a look at how hospital services get priced, read The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy :
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.

The results of this situation in states with concentrated provider markets is not only prices that keep going up dramatically but prices that vary widely between payers for no apparent reason, as in Massachusetts:
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 state’s 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 insurer’s 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.

Coakley’s 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.

A similar story can be told about California:
The shift in who holds the upper hand in negotiating payments—once held by health insurance plans but now resting with health care providers—has had a major impact on California premium trends. According to some survey respondents, the dynamic needs urgent policy attention. “I am shocked there isn’t 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 can’t go. We’d 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 wasn’t for increased coordination of care, disease management, blah, blah, blah—that 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 Medicare’s, 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

If you're hearing this as something about regulating insurers, then you're hearing wrong. Insurance market regulations are designed to make sure that insurance market functions well for customers; some basic baseline rules of the road are generally enough to line up the incentives correctly for that.

But what I'm talking about here is how increasingly concentrated provider markets are distortionary. These are the facilities that are actually offering the health services you buy health insurance to get in the first place.

What I'd like to see certain states (particularly those with the most concentrated provider markets) do is experiment with different models of all-payer systems (or potentially even similar systems that still allow value-based variations between payers at a given hospital). There are more market-based approaches to this and more administrative ones (like Maryland's). There are other possible ways to approach this problem. This is what the defeated public option concept was for, and you can see that in that Maryland article Robert Murray (who used to run Maryland's system) suggests an alternative:

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.

So, no, this isn't about going after payers, it's about going after the providers who are using market clout to drive up health spending. A number of the bulleted changes I said I'd like to see are beginning (slowly) and I suspect several of them are ultimately going to do a decent job of increasing value in the health sector and starting to bend the cost curve. My concern (and the source of the all-payer rates bullet) is that as care becomes less costly to deliver, it's not clear to me how much of that benefits just providers, given their price-setting abilities in many markets, and how much of that will benefit everyone. That's something I'd like to see states thinking about, as well.
 

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