The Conservative Case for Obamacare

[Listening]

Payment and care delivery are closely linked. Reform that doesn't start with changing the way we pay for care isn't reform at all.

Oh that's just a silly assumption. There are any number of ways to reform bad laws that don't involve dictating how people pay for things.

Quite right. One way is to retract "reforms" (i.e. regression) and allow the system to take care of itself. If you withdraw Medicare the way it is currently set up, you'll find that health care costs will go DOWN.

 

[dblack]

Payment and care delivery are closely linked. Reform that doesn't start with changing the way we pay for care isn't reform at all.

Oh that's just a silly assumption. There are any number of ways to reform bad laws that don't involve dictating how people pay for things.

Quite right. One way is to retract "reforms" (i.e. regression) and allow the system to take care of itself. If you withdraw Medicare the way it is currently set up, you'll find that health care costs will go DOWN.

Or remove the incentives that have encouraged people to over-insure, or break up the AMA's monopoly on health care education, or .... etc, etc...

 

[Oddball]

That's not a regulation ???

You're joking...right ?

It's a regulation on CMS telling them how to do business, not a regulation on hospitals. Hospitals can do whatever they like but one of their major payers isn't going to pay for poor service anymore.

it's simple economics. Time to let the market work its magic.

Right...Every market model starts with a central authority telling participants in said market how to do business.

And y'all have the gall to claim that you're not socialists.

 

[Greenbeard]

It's a regulation on CMS telling them how to do business, not a regulation on hospitals.

Right...Every market model starts with a central authority telling participants in said market how to do business.

Every insurance company has policies that govern what it will and won't pay for. CMS is special in that it's the only one of those insurance companies that's owned by the taxpayer. Ergo its internal policies can be changed via legislation, not a Board of Directors meeting.

It is indeed a market participant and it's now sending a strong signal about the quality of services it's interested in buying.

 

[Oddball]

Oh, button it...You've outed yourself yet again, comrade.

 

[Quantum Windbag]

ObamaCare is RomneyCare. Some of us knew that already and that's why I don't expect Romney to move to repeal it if he gets elected.

Both Parties are joined at the hip.

Obama care and Romney care are opposites in that Romney care is one plan for one state and therefore is not a socialist Federal plan for the entire country.

The difference is huge since our country is based on freedom from central government, but not freedom from state government.

I'm sorry, but that's an incredibly convoluted rationalization. The differences are only in scope; the principle is the same. It's fair to say that Obamacare is worse, because it forces Romneycare on the entire country, but the fundamental policies violate individual rights in the same way under both plans.

If my only objection to PPACA was the fact that it's a federal program, your distinction might be meaningful. But I would be just as vehemently opposed to this kind of overreaching government whether it was passed in my state, or county, or hometown. It's wrong because it unnecessarily dictates our personal decisions. Romney doesn't get this. That's why he won't get my vote.

Bingo

 

[Quantum Windbag]

Obama care and Romney care are opposites in that Romney care is one plan for one state and therefore is not a socialist Federal plan for the entire country.

The difference is huge since our country is based on freedom from central government, but not freedom from state government.

I'm sorry, but that's an incredibly convoluted rationalization. The differences are only in scope; the principle is the same. It's fair to say that Obamacare is worse, because it forces Romneycare on the entire country, but the fundamental policies violate individual rights in the same way under both plans.

If my only objection to PPACA was the fact that it's a federal program, your distinction might be meaningful. But I would be just as vehemently opposed to this kind of overreaching government whether it was passed in my state, or county, or hometown. It's wrong because it unnecessarily dictates our personal decisions. Romney doesn't get this. That's why he won't get my vote.

Aren't your rights violated when you have to pay a higher hospital bill to cover those who can't pay?

I have a right to a low hospital bill? Since when?

Besides, I can fix that simply by eliminating the requirement that hospitals treat anyone that shows up, even if they cannot pay. Eliminate the federally mandated driver behind the high cost of health care and we will eliminate the need for a federally mandated solution to the high cost of health care.

 

[Quantum Windbag]

QW's point goes directly the core fault of your beloved regulatory state - it's never about being held accountable for results,

Accountability for results is precisely what this is. Hospital pay in this area will now reflect performance. Avoidable readmissions, which are costly and potential dangerous (bad for the patient, bad for the payer) will no longer be a reliable revenue stream; "righteous readmissions" will not affect reimbursement.

That's not a regulation, it's prudent purchasing. Paying for bad results just gives you bad results.

That's not a regulation ???

You're joking...right ?

Unfortunately, he isn't. He thinks that rules that require all hospitals to pay into a fund that rewards hospitals that do not readmit patients is not a regulation. That, somehow, is actually the government rewarding hospitals that do a good job by not readmitting. whatever happens as a result is obviously not the government's fault.

 

[Quantum Windbag]

That's not a regulation ???

You're joking...right ?

It's a regulation on CMS telling them how to do business, not a regulation on hospitals. Hospitals can do whatever they like but one of their major payers isn't going to pay for poor service anymore.

it's simple economics. Time to let the market work its magic.

Are you ever going to deal with the fact that people who support Obamacare oppose this provision because of its negative impact on safety net hospitals and at risk populations, or are you going to continue to pretend that only assholes who hate Obama are opposed to it?

 

[Quantum Windbag]

And, running that through the patented "Greenbeard Interpreter", we get: "Time to manipulate the economy with coercive government policy!"... Go team!

Economies are based on incentives. Buyers send signals, sellers respond. Is this a new concept?

Can you explain how requiring a seller to pay into a program that is administered by the government to force a result that does not care about market forces in any way represents the process you are describing?

 

[Quantum Windbag]

Obamacare just adds to the confusion. WTF is going on with our government. One bill to correct a problem created by another bill.

Honestly, what is the confusion? What are you finding so baffling? I assume you understand that some proportion of hospital readmissions are unnecessary and can be prevented via some degree of reorganization of care delivery. I assume (perhaps wrongly) that it's also understood that being in a hospital in the United States can be dangerous--people die of or are injured by things they didn't have when they were admitted.

Payment and care delivery are closely linked. Reform that doesn't start with changing the way we pay for care isn't reform at all. This is a bipartisan realization by the way; even Mitt Romney's vacuous bullet points on his campaign issues page recognize this ("Promote alternatives to 'fee for service'").

You assume incorrectly. I have no real evidence that any significant portion of hospital readmissions are unnecessary. Since this program makes a blatant assumption with no underlying data I find myself opposed to it simply because I actually believe that government regulation should be driven by data, not conjecture. Anyone that opposes a data driven approach to regulation also opposes science and might as well demand that schools teach the Bible as science.

 

[Quantum Windbag]

It's a regulation on CMS telling them how to do business, not a regulation on hospitals.

Right...Every market model starts with a central authority telling participants in said market how to do business.

Every insurance company has policies that govern what it will and won't pay for. CMS is special in that it's the only one of those insurance companies that's owned by the taxpayer. Ergo its internal policies can be changed via legislation, not a Board of Directors meeting.

It is indeed a market participant and it's now sending a strong signal about the quality of services it's interested in buying.

If an insurance company tried to implement this policy you would be up in arms and insisting that the federal government prevent them denying coverage based on preexisting conditions.

Damn, you already did that.

 

[Greenbeard]

Are you ever going to deal with the fact that people who support Obamacare oppose this provision because of its negative impact on safety net hospitals and at risk populations, or are you going to continue to pretend that only assholes who hate Obama are opposed to it?

Those with suggested revisions should take them to Congress through MedPAC.

Can you explain how requiring a seller to pay into a program that is administered by the government to force a result that does not care about market forces in any way represents the process you are describing?

Pay into what program? What are you talking about?

You assume incorrectly. I have no real evidence that any significant portion of hospital readmissions are unnecessary. Since this program makes a blatant assumption with no underlying data I find myself opposed to it simply because I actually believe that government regulation should be driven by data, not conjecture. Anyone that opposes a data driven approach to regulation also opposes science and might as well demand that schools teach the Bible as science.

Readmissions are expensive and can be reduced.

http://www.medpac.gov/documents/jun07_entirereport.pdf
Relationship between early physician follow-up and 30-d... [JAMA. 2010] - PubMed - NCBI
Reducing Hospital Readmissions | AcademyHealth
Transitional care of older adults hospitali... [J Am Geriatr Soc. 2004] - PubMed - NCBI
Rehospitalizations among Patients in the Medicare Fee-for-Service Program | NEJM
Contemporary evidence about hospital strat... [J Am Coll Cardiol. 2012] - PubMed - NCBI
A reengineered hospital discharge program to ... [Ann Intern Med. 2009] - PubMed - NCBI
The care transitions intervention: results o... [Arch Intern Med. 2006] - PubMed - NCBI

If an insurance company tried to implement this policy you would be up in arms and insisting that the federal government prevent them denying coverage based on preexisting conditions.

I applaud providers who organize themselves to provide better care delivery, and insurers who reconfigure the financial incentives to make that possible. The problem is that both are too rare these days. That's beginning to change, which is why this is such an exciting time.

 

[dblack]

Those with suggested revisions should take them to Congress through MedPAC.

Yes. We should all plead for reprieve from our benevolent overlords. I'm sure they'll take mercy on us.

Can you explain how requiring a seller to pay into a program that is administered by the government to force a result that does not care about market forces in any way represents the process you are describing?

Pay into what program? What are you talking about?

Taxation? You want to pretend that market manipulation via taxpayer funded 'buying' agencies is somehow an aspect of a free market. It is the opposite.

Readmissions are expensive and can be reduced.

Some are. Some aren't. Some save money by avoiding unnecessary time in the hospital. Once again, you're faced with the fact the the regulatory approach doesn't make this distinction. You should probably just skip this.

 

[Greenbeard]

Readmissions are expensive and can be reduced.

Some are. Some aren't. Some save money by avoiding unnecessary time in the hospital. Once again, you're faced with the fact the the regulatory approach doesn't make this distinction. You should probably just skip this.

Reducing payment for excess readmissions does make that distinction.

I find your dedication to overpaying for poor service delivery puzzling.

 

[dblack]

Readmissions are expensive and can be reduced.

Some are. Some aren't. Some save money by avoiding unnecessary time in the hospital. Once again, you're faced with the fact the the regulatory approach doesn't make this distinction. You should probably just skip this.

Reducing payment for excess readmissions does make that distinction.

Repeating this doesn't make it any more rational. Under the policy in question, "excess" readmissions are established merely by the number of readmissions. It doesn't matter whether they are preventable or unnecessary. Every single readmission a hospital might have could be justifiable but, if the total number exceeded the established maximum, they would still be penalized. That's the blind injustice of such statistical regulations.

What part of that fails to register with you?

 

[Oddball]

Some are. Some aren't. Some save money by avoiding unnecessary time in the hospital. Once again, you're faced with the fact the the regulatory approach doesn't make this distinction. You should probably just skip this.

Reducing payment for excess readmissions does make that distinction.

Repeating this doesn't make it any more rational. "Excess" readmissions are established merely by the number of readmissions. It doesn't matter whether they are preventable or unnecessary. Every single readmission a hospital might have could be justifiable but, if the total number exceeded the established maximum, they would still be penalized regardless. That's the blind injustice of such statistical regulations.

What part of that fails to register with you?

He's the propagandist, you are the subject.

His chickenshit story is supposed to register with you, while you willingly suspend disbelief and anything else remotely resembling common sense, tovarich.

 

[Greenbeard]

Repeating this doesn't make it any more rational. "Excess" readmissions are establish merely by the number of readmissions.

No, they're not. Two hospitals with identical readmissions numbers but different patient mixes don't have the same proportion of excess readmissions.

Though I do enjoy how "Some are. Some aren't." quickly morphed into "Every single readmission a hospital might have could be justifiable."

I retain hope that in the future we can have informed consumers who'll be able to use and interpret publicly reported validated quality indicators to make good decisions when shopping for health care services. But it's conversations like this that make me wonder if that's ever really going to be possible.

 

[Quantum Windbag]

Those with suggested revisions should take them to Congress through MedPAC.

The answer is no then.

On the plus side, you are finally posting something legitimate for the money I am paying you.

Pay into what program? What are you talking about?

Doesn't the CMS withhold a portion of the funds they actually owe hospitals in order to make this work? you might call that market forces at work, I call that the government forcing hospitals to join a program to reach an arbitrary goal.

Readmissions are expensive and can be reduced.

http://www.medpac.gov/documents/jun07_entirereport.pdf
Relationship between early physician follow-up and 30-d... [JAMA. 2010] - PubMed - NCBI
Reducing Hospital Readmissions | AcademyHealth
Transitional care of older adults hospitali... [J Am Geriatr Soc. 2004] - PubMed - NCBI
Rehospitalizations among Patients in the Medicare Fee-for-Service Program | NEJM
Contemporary evidence about hospital strat... [J Am Coll Cardiol. 2012] - PubMed - NCBI
A reengineered hospital discharge program to ... [Ann Intern Med. 2009] - PubMed - NCBI
The care transitions intervention: results o... [Arch Intern Med. 2006] - PubMed - NCBI

Does any of that address the issue I actually raised?

Didn't think so.

I applaud providers who organize themselves to provide better care delivery, and insurers who reconfigure the financial incentives to make that possible. The problem is that both are too rare these days. That's beginning to change, which is why this is such an exciting time.

You applaud providers who deny payment based on the fact that patients who are sick are being admitted to hospitals? Since when?

 

[Quantum Windbag]

Readmissions are expensive and can be reduced.

Some are. Some aren't. Some save money by avoiding unnecessary time in the hospital. Once again, you're faced with the fact the the regulatory approach doesn't make this distinction. You should probably just skip this.

Reducing payment for excess readmissions does make that distinction.

I find your dedication to overpaying for poor service delivery puzzling.

You made that claim before. Strangely enough, despite your access to every government memo ever written, you have provided no actual evidence of that, and many people familiar with the program, and who support Obamacare, have not found it. Perhaps all of this is just an oversight.