Tying Medicare Payment to Quality

[Greenbeard]

This does get to the core of things, maybe even to an interesting discussion. The core philosophical difference is in our assumptions about the purpose of government. You pretty consistently stand up for the idea that it's government's job to decide what we should do and force us to do it. I prefer a government that preserves our freedom to pursue our own visions of the good life.

It's Medicare's job to spend the taxpayers' money wisely, which means directing more of it to care that improves health and less to care that doesn't. Hospitals that aren't clearing basic quality bars should not be reimbursed as much as those that are.

Paying them for showing up isn't enough anymore. It's time to pay them for the quality of their product.

 

[uscitizen]

Greenbeard, you really put out the fool attractor in this thread.

 

[dblack]

This does get to the core of things, maybe even to an interesting discussion. The core philosophical difference is in our assumptions about the purpose of government. You pretty consistently stand up for the idea that it's government's job to decide what we should do and force us to do it. I prefer a government that preserves our freedom to pursue our own visions of the good life.

It's Medicare's job to spend the taxpayers' money wisely, which means directing more of it to care that improves health and less to care that doesn't. Hospitals that aren't clearing basic quality bars should not be reimbursed as much as those that are.

Paying them for showing up isn't enough anymore. It's time to pay them for the quality of their product.

Right, which is exactly why many of us oppose programs like Medicare in the first place. It's not, as you often insinuate, that we are steel-hearted social Darwinists. The problem is that these kinds of state programs are inevitably used as you are advocating here, as a tool for controlling people. In this case, the aim is to use the significant "buying power" of the Medicare program to manipulate the health care market.

This kind of government is called corporatism and I believe it's paving the way (worldwide) for another ugly round of fascism.

 

[CrusaderFrank]

This does get to the core of things, maybe even to an interesting discussion. The core philosophical difference is in our assumptions about the purpose of government. You pretty consistently stand up for the idea that it's government's job to decide what we should do and force us to do it. I prefer a government that preserves our freedom to pursue our own visions of the good life.

Greenbeard is a Party insider who is paid to post here and disseminate false information.

I have no idea what the motivation is. I suppose that if the Party sees these message boards as influential it might be worth a few bucks to spam us. It's also possible he's just a die hard cheerleader for the authoritarian state. In either case, I don't really think he's posting false information. Outside the overly optimistic predictions of the law's impact, most of what GB posts is factually correct. There's plenty of spin and demagoguery thrown in for good measure, but that's hardly uncommon around here.

Oh, no. He knows these great ideas always fail and end up with the worst of Eastern European Communism. He's just playing a tune so the useful idiots can dance along.

When it all goes to hell, the idiots will say, "But Greenbeard, I thought you said we'd be OK" and his response will be, "No, I said I'd be OK"

I spotted him as a paid Party apparatchik from his first post.

 

[CrusaderFrank]

Real life communist countries have dropped Greenbeards central planning as a total guaranteed failure and they're laughing at how stupid the American Left is for embracing an admittedly failed system

 

[dblack]

Real life communist countries have dropped Greenbeards central planning as a total guaranteed failure and they're laughing at how stupid the American Left is for embracing an admittedly failed system

They have? From what I've seen they're moving more or less toward the same end we are. Arguably, they are approaching it from the other 'direction', but the goal seems to be the same.

 

[Greenbeard]

Greenbeard, you really put out the fool attractor in this thread.

When they find out Medicare is currently the most sustainable component of the U.S. health care system--and improving every month!--it literally makes them sick.

It's Medicare's job to spend the taxpayers' money wisely, which means directing more of it to care that improves health and less to care that doesn't. Hospitals that aren't clearing basic quality bars should not be reimbursed as much as those that are.

Paying them for showing up isn't enough anymore. It's time to pay them for the quality of their product.

Right, which is exactly why many of us oppose programs like Medicare in the first place.

Live in the now. Medicare exists and isn't going away. Which means watching its cost growth slow as it starts to pay for performance and not meaningless widgets is a good thing.

But I'm sure your friendly local hospital conglomerate appreciates your concern. No one wants a revenue stream conditional on them doing a good job if they can get the same revenue doing a poor job.

 

[dblack]

No one wants a revenue stream conditional on them doing a good job if they can get the same revenue doing a poor job.

Which is, of course, why we've been saddled PPACA in the first place. Insurance companies don't want to earn our business. And now they don't have to thanks to corporatist state intervention. Not all of us are eager to become slaves.

 

[Oddball]

This does get to the core of things, maybe even to an interesting discussion. The core philosophical difference is in our assumptions about the purpose of government. You pretty consistently stand up for the idea that it's government's job to decide what we should do and force us to do it. I prefer a government that preserves our freedom to pursue our own visions of the good life.

It's Medicare's job to spend the taxpayers' money wisely, which means directing more of it to care that improves health and less to care that doesn't. Hospitals that aren't clearing basic quality bars should not be reimbursed as much as those that are.

Paying them for showing up isn't enough anymore. It's time to pay them for the quality of their product.

No, it's Medicare's job to make sure its bureaucrats have nice upper-middle class jobs and benefits for life.

 

[dblack]

I've posted this before, but for a little more insight into the heart and soul of PPACA, check this out:

Obamacare architect leaves White House for pharmaceutical industry job | Glenn Greenwald | Comment is free | guardian.co.uk

Greenwald nails it:

This is precisely the behavior which, quite rationally, makes the citizenry so jaded about Washington. It's what ensures that the interests of the same permanent power factions are served regardless of election outcomes. It's what makes a complete mockery out of claims of democracy. And it's what demonstrates that corporatism and oligarchy are the dominant forms of government in the US.

 

[CrusaderFrank]

Greenbeard lives outside of the free market, everything he has comes from the government so the idea of getting value for your dollar is new and alien to him

 

[Greenbeard]

No one wants a revenue stream conditional on them doing a good job if they can get the same revenue doing a poor job.

Which is, of course, why we've been saddled PPACA in the first place. Insurance companies don't want to earn our business. And now they don't have to thanks to corporatist state intervention. Not all of us are eager to become slaves.

That's interesting, but this isn't about insurance. It's about the quality of hospital care--actual health care delivery. Insurance markets are a different beast than delivery systems.

 

[dblack]

No one wants a revenue stream conditional on them doing a good job if they can get the same revenue doing a poor job.

Which is, of course, why we've been saddled PPACA in the first place. Insurance companies don't want to earn our business. And now they don't have to thanks to corporatist state intervention. Not all of us are eager to become slaves.

That's interesting, but this isn't about insurance. It's about the quality of hospital care--actual health care delivery. Insurance markets are a different beast than delivery systems.

Yes. I'm making an analogy... The very same desire to avoid doing a good job that you're worried about in the one case, you happily disregard in the other. The common characteristic is that in both scenarios you want to protect the corporations from consumer demand, supplanting it with state command.

 

[boedicca]

No one wants a revenue stream conditional on them doing a good job if they can get the same revenue doing a poor job.

Which is, of course, why we've been saddled PPACA in the first place. Insurance companies don't want to earn our business. And now they don't have to thanks to corporatist state intervention. Not all of us are eager to become slaves.

That's interesting, but this isn't about insurance. It's about the quality of hospital care--actual health care delivery. Insurance markets are a different beast than delivery systems.

If you understand that, then why do you support ObamaCare - which is just a massive takeover of health insurance and does NOTHING to improve delivery systems?

 

[Greenbeard]

Yes. I'm making an analogy... The very same desire to avoid doing a good job that you're worried about in the one case, you happily disregard in the other.

Not so. When it comes to insurers, I want quality indicators on their performance to be publicly reported and easily accessible to buyers at the point of purchase, for easy comparison with competitors. That's the point of an exchange: making comparative decision-making for complex financial products intuitive and easy for the consumer.

Similarly, I'm more than happy for hospital quality metrics to be readily available (as they are on Hospital Compare). But, shockingly, consumers don't necessarily check to see how hospitals compare with peers on quality indicators before they end up in the hospital. Some may well do that and they certainly could theoretically, in some circumstances, vote with their feet by choosing hospitals less likely to harm them and more likely to heal them. But in reality, it's the responsibility of payers to hold hospitals accountable for the quality of care provided.

And no, that responsibility doesn't just fall to "the state," although in its capacity as a payer it should act in the interest of patients when signing the checks. It's a key responsibility of the commercial payers, too. I've been very happy and impressed with some of the moves some of them are making (BCBS of Massachusetts is one of the more prominent examples at present).

 

[dblack]

Yes. I'm making an analogy... The very same desire to avoid doing a good job that you're worried about in the one case, you happily disregard in the other.

Not so.

Sure it is. You go on to describe exactly what I'm talking about:

When it comes to insurers, I want quality indicators on their performance to be publicly reported and easily accessible to buyers at the point of purchase, for easy comparison with competitors. That's the point of an exchange: making comparative decision-making for complex financial products intuitive and easy for the consumer.

The point of the exchange, and the accompanying mandate, is to preserve a defunct insurance industry at the expense of our liberty. PPACA takes away the most fundamental right a consumer has: the right to say "no". It compensates the loss of our consumer rights with oversight of state authority. Which is what I was talking about. It protects the insurance industry's interests by forcing us to pay them for something we don't want, and likewise forces them to give us the level of service the government regulators think we should get.

 

[Greenbeard]

]If you understand that, then why do you support ObamaCare - which is just a massive takeover of health insurance and does NOTHING to improve delivery systems?

Is this a joke?

PPACA takes away the most fundamental right a consumer has: the right to say "no".

You're going to say "no" to a hospital the next time you have a heart attack to make some point? Sounds like a Darwin Award in the making.

 

[dblack]

You're going to say "no" to a hospital the next time you have a heart attack to make some point? Sounds like a Darwin Award in the making.

Don't be coy. This is about insurance, not health care itself. Insurance is one way to finance health care. I my view, and in the view of a growing number of people, it's a spectacularly bad way that has done more harm to the health care market than good. PPACA targets those of us who have had enough of the insurance scam and scapegoats us into keeping the insurance industry afloat by mandatory payments.

Bill Moyers Essay: Washington's Revolving Door | Moyers & Company | BillMoyers.com


http://www.salon.com/2012/12/19/capitol_hill_belongs_to_lobbyists/

I'd like to hear your excuses for the corruption Moyers discusses here.

 

[Greenbeard]

Don't be coy. This is about insurance, not health care itself.

As already explained to you, no it isn't. This thread is about hospital care and value-based purchasing. You had some analogy to make which has since deteriorated into your standard irrelevant rants about the individual mandate.

If you want to talk about something else, start a new thread.

 

[CrusaderFrank]

Cass, er I mean Green, is "value-based purchasing" supposed to be a new and novel idea to "Bend down the cost curve"?