Cut Medicare or Reward Wealthy...Duh...

[ClosedCaption]

Interesting so far the most popular response to the OP from the opposing side is "You're stupid!".

Persuasive argument sir, well played.

 

[Greenbeard]

Ryan's plan calls for those who reach 65 on or after 2022 to receive a tax credit of up to $15,000 to buy health insurance if they want to, from private insurers in an exchange.

According to CBO, "The payment for 65-year-olds in 2022 is specified to be $8,000, on average."

Moreover, come 2022, that 65-year-old is paying about 2.25 times what he would be under traditional Medicare, yet he's in a private plan 1) whose costs are growing more quickly than they would be under traditional Medicare ("CBO projects that total health care spending for a typical beneficiary covered by the standardized benefit under the proposal would grow faster than such spending for the same beneficiary in traditional Medicare under either of CBO’s longterm scenarios") and 2) is going to offer less care ("First, private health insurers would probably impose greater utilization management than occurs in Medicare. Second, private plans might restrict enrollees’ ability to purchase supplemental insurance plans; enrollees would thus face higher out-of-pocket costs than they do in Medicare, and that increased cost sharing would encourage lower utilization.")

So, to reiterate, he's paying significantly more for a plan that's offering less care and whose costs are growing more quickly. The reason being that Medicare, the public payer and the defined health benefit associated with it, are eliminated. What a deal.

To be clear, lowering utilization is, in many cases, a worthy goal. But there's a significant difference between lowering utilization by meeting health needs more efficiently and lowering utilization by indiscriminately saying no more.

Plus his plan provides block grants to the states for Medicaid, and lets them tailor their needs to their unique needs.

Can you elaborate on what kind of additional flexibility you'd like to see states have when it comes to using their current federal contribution toward their Medicaid programs?

The Obama plan on the other hand is all about price controls. Many doctors and providers have already said they will not accept new Medicare patients at a time when we have millions of baby boomers who will need more care. Price controls have never worked - never.

Value-based purchasing is not a price control. The President's apparent call the other day for even more expansive and explicit value-based insurance design is not a price control. Incentives for accountable care are not price controls. One of the largest patient safety initiatives in recent memory, aimed at curbing unnecessary expenditures due to preventable errors and hospital-acquired conditions, is not a price control. Financial incentives for Medicare and Medicaid providers who adopt electronic health records with clinical support tools and quality measurement capabilities are not price controls. Seeding models of advanced primary care aimed specifically at high-utilization, high-cost beneficiaries is not a price control. Payment reforms to discourage unnecessary spending are not price controls. Improved care coordination, particularly for those needing the most complex and expensive care regimes (and thus likely to benefit the most from it) is not a price control. Transitioning enrollees from institution-based long-term care to community-based care where possible is not a price control. Learning which treatments are the most effective and using that knowledge is not a price control. A body dedicated to testing payment and delivery system innovations to determine which ones improve quality an reduce costs, and a mechanism for using that knowledge are not price controls.

What these have in common is a shift toward what the IOM calls a learning health system, and a health system in which value is emphasized, demanded, and paid for. A higher-value health system is a worthy goal and one of the more humane ways to pursue long-term cost control.

So, neither plan is all that great but at least the Ryan plan will be less costly in the long run.

There's a difference between costs and federal spending. Ryan's plan raises costs but it reduces federal spending (by pushing those costs on to the elderly, the poor, state government, providers, etc).

 

[Avatar4321]

Interesting so far the most popular response to the OP from the opposing side is "You're stupid!".

Persuasive argument sir, well played.

If you guys wants better responses stop saying stupid things

 

[Avatar4321]

BTW, why was this moved to the media forum?

 

[Quantum Windbag]

According to CBO, "The payment for 65-year-olds in 2022 is specified to be $8,000, on average."

Do you understand the difference between "on average" and "up to"?

Moreover, come 2022, that 65-year-old is paying about 2.25 times what he would be under traditional Medicare, yet he's in a private plan 1) whose costs are growing more quickly than they would be under traditional Medicare ("CBO projects that total health care spending for a typical beneficiary covered by the standardized benefit under the proposal would grow faster than such spending for the same beneficiary in traditional Medicare under either of CBO’s longterm scenarios") and 2) is going to offer less care ("First, private health insurers would probably impose greater utilization management than occurs in Medicare. Second, private plans might restrict enrollees’ ability to purchase supplemental insurance plans; enrollees would thus face higher out-of-pocket costs than they do in Medicare, and that increased cost sharing would encourage lower utilization.")

Hmm.

How is that going to work out differently than Obama's plan to control Medicare spending by having a commission set reimbursement rates?

So, to reiterate, he's paying significantly more for a plan that's offering less care and whose costs are growing more quickly. The reason being that Medicare, the public payer and the defined health benefit associated with it, are eliminated. What a deal.

Or he isn't. CBO projections are consistent for how wrong they are, especially when projecting the private sector.

To be clear, lowering utilization is, in many cases, a worthy goal. But there's a significant difference between lowering utilization by meeting health needs more efficiently and lowering utilization by indiscriminately saying no more.

And, again, what is the difference with the goals Obama proposed in his speech?

Value-based purchasing is not a price control. The President's apparent call the other day for even more expansive and explicit value-based insurance design is not a price control. Incentives for accountable care are not price controls. One of the largest patient safety initiatives in recent memory, aimed at curbing unnecessary expenditures due to preventable errors and hospital-acquired conditions, is not a price control. Financial incentives for Medicare and Medicaid providers who adopt electronic health records with clinical support tools and quality measurement capabilities are not price controls. Seeding models of advanced primary care aimed specifically at high-utilization, high-cost beneficiaries is not a price control. Payment reforms to discourage unnecessary spending are not price controls. Improved care coordination, particularly for those needing the most complex and expensive care regimes (and thus likely to benefit the most from it) is not a price control. Transitioning enrollees from institution-based long-term care to community-based care where possible is not a price control. Learning which treatments are the most effective and using that knowledge is not a price control. A body dedicated to testing payment and delivery system innovations to determine which ones improve quality an reduce costs, and a mechanism for using that knowledge are not price controls.

And unicorn farts make rainbows.

What these have in common is a shift toward what the IOM calls a learning health system, and a health system in which value is emphasized, demanded, and paid for. A higher-value health system is a worthy goal and one of the more humane ways to pursue long-term cost control.

Systems do not learn.

There's a difference between costs and federal spending. Ryan's plan raises costs but it reduces federal spending (by pushing those costs on to the elderly, the poor, state government, providers, etc).

Since the major problem we currently have is that the government cannot sustain its involvement in Medicare how is cutting the cost to the government a bad thing?

Maybe you should get out of the basement of the HHS a bit more often, you might see what actual liberals that understand a little about economics think about what Ryan proposed as opposed to what Obama proposed in his speech. As this guy also happens to know about Obamacare, which is mostly irrelevant to the Medicare and budget debate we are trying to have, maybe you should think about what he says.

In his speech on our nation's long-term budget crisis Wednesday, President Barack Obama identified the problem, but he failed to provide concrete solutions. Indeed, when it came to describing how he would fix federal health care spending, Obama stayed pretty close to his budget document in which he said that Medicare and Medicaid costs would come down because they'd come down and, if they didn't, a panel of experts would tell Congress to lower them.
Give us a break. This is simply a continuation of kick-the-can down the road, which leaves ever larger government bills for our kids to pay.
To be clear, the president is absolutely right that the Bush administration made the fiscal situation much much worse. Indeed, President George W. Bush's administration is arguably the most fiscally profligate in our nation's history. And Obama is also right that high-income households can and must make a much larger tax contribution to help get our nation's finances in order.
But Obama's speech made no effort to find common ground with House Budget Chairman Paul Ryan's plan to address Medicare and Medicare. Ryan was brave enough to say exactly what he thinks needs to be done with these programs.
If you read his Medicare plan carefully, you'll see that it's highly progressive because the size of each Medicare participant's voucher is based on his/her pre-existing health conditions, and poor participants have worse health status, on average, than rich participants.

Obama kicks budget can down the road - CNN.com

We are discussing the budget deficit here, try to stay on topic in the future.

 

[JimH52]

BTW, why was this moved to the media forum?

Have a problem with the staff, take it to PMs or to the Admins.

~Oddball

 

[code1211]

<snip>

Plus his plan provides block grants to the states for Medicaid, and lets them tailor their needs to their unique needs.

Can you elaborate on what kind of additional flexibility you'd like to see states have when it comes to using their current federal contribution toward their Medicaid programs?

).

That is one of the most intriguing parts of the plan. There would be 50 opportunities for experimentation.

We know for certain that the current process will collapse under its own weight in the near future. We also know that large and remotely controlled government programs have a tendency to grow into areas not anticipated.

Giving block grants removes the Federal control, opens the possiblity of greater creativity through greater diversity of think tanks and brings control of care programs closer to those for whom care is provided.

Transferring power OUT of Washington is needed to accomplish this and is a bonus of the idea.

 

[Greenbeard]

That is one of the most intriguing parts of the plan. There would be 50 opportunities for experimentation.

That's my point. "Medicaid" does not refer to a single program, it refers to 50+ unique programs that generally begin with the same root federal guidance and then innovate from there. There is already a huge amount of experimentation going on in state Medicaid programs. Indiana built a Medicaid coverage expansion based on HSAs. Oklahoma reconfigured its entire program around the patient-centered medical home model two years ago. Tennessee put its entire Medicaid population into a managed care delivery system nearly two decades ago.

In fact, there are multiple avenues for innovation built into the system, the most prominent and broadest being Section 1115 research and demonstration projects. There are currently 66 of those in operation in 41 jurisdictions right now (for example, Mitch Daniels' Medicaid HSA experiment is authorized under 1115).

So what I'm asking is: what experiments--for which there is no existing avenue for execution--do conservatives seek to try in their Medicaid programs? There's a lot of generic talk in this vein, which leads me to believe that many of those repeating it are under the impression that no state-level variation exists in Medicaid and no avenues exist for states to try out innovations they've come up with. In reality, nothing could be further from the truth.

In fact, so far all I've heard is references to "flexibility" used as a euphemism for slashing coverage. Creative perhaps, but unimpressive. So I'm very interested in hearing someone pitch these brilliant innovations that states are leaving on the shelf because they can't implement them now using policy levers in their state Medicaid programs.

Transferring power OUT of Washington is needed to accomplish this and is a bonus of the idea.

If we were talking about Medicare, these kinds of statements would be make more sense. But we're talking about Medicaid.

 

[code1211]

That is one of the most intriguing parts of the plan. There would be 50 opportunities for experimentation.

That's my point. "Medicaid" does not refer to a single program, it refers to 50+ unique programs that generally begin with the same root federal guidance and then innovate from there. There is already a huge amount of experimentation going on in state Medicaid programs. Indiana built a Medicaid coverage expansion based on HSAs. Oklahoma reconfigured its entire program around the patient-centered medical home model two years ago. Tennessee put its entire Medicaid population into a managed care delivery system nearly two decades ago.

In fact, there are multiple avenues for innovation built into the system, the most prominent and broadest being Section 1115 research and demonstration projects. There are currently 66 of those in operation in 41 jurisdictions right now (for example, Mitch Daniels' Medicaid HSA experiment is authorized under 1115).

So what I'm asking is: what experiments--for which there is no existing avenue for execution--do conservatives seek to try in their Medicaid programs? There's a lot of generic talk in this vein, which leads me to believe that many of those repeating it are under the impression that no state-level variation exists in Medicaid and no avenues exist for states to try out innovations they've come up with. In reality, nothing could be further from the truth.

In fact, so far all I've heard is references to "flexibility" used as a euphemism for slashing coverage. Creative perhaps, but unimpressive. So I'm very interested in hearing someone pitch these brilliant innovations that states are leaving on the shelf because they can't implement them now using policy levers in their state Medicaid programs.

Transferring power OUT of Washington is needed to accomplish this and is a bonus of the idea.

If we were talking about Medicare, these kinds of statements would be make more sense. But we're talking about Medicaid.

There probably needs to be an authorization for MSA's similar to Roth 401's that allows for a fund to be built up over a working life time to pay for post retirement insurance coverage.

An example of innovation near where I live is that a local hospital in Indianapolis, the one that I am aware of, is opening a walk in clinic in a strip mall. Lord knows there are plenty of vacant store fronts right now.

Taken to the next step, these could be in Home Depots, WalMarts, the Food Courts of the local Mall and just about any higher traffic area. These could be staffed by nursing level professionals with ready access to Doctors electronically when needed. Certain prescriptions could be written and non invasive care given.

Blood taking, blood pressure and smears of various varities are easily accomplished and the lab testing does not necessarily demand an MD be involved before the results are known. Much of face to face medical assessment is temperature, color of eyes, skin condition and so on that the MD needn't be present to accomplish unless a problem is noted.

Flu shots are already dispensed in drug stores. CVS already has simple, on-site medical prodedures under way right now.

Medical care is evolving. The answers are coming from all over and the federal government does not seem to be leading the way. That is the point. The monolith preserves the monolithic while the innovations are everywhere.

Maybe in Indianapolis, the best new venues are the vacant store fronts. Maybe in Minneapolis, that option is unavailable or unwise. Maybe in San Francisco, the right options are different than Billings. Salt Lake City might have different needs and opportunities than Miami Beach.

If your only tool is a hammer, every problem starts to look like a nail. Let's be open to use as many tools as we can.