The difference between Ryan's Medicare spending and Obamacare's

[8537]

]\

So we passed a trillion dollar law that anyone can get a waiver for?!

Yes.

I'm not exactly seeing the logic behind this. If Obama just wanted to push states to enact their own healthcare reforms, I'm sure there are cheaper and more constitutional ways to do it.

The point is to allow states who wish to do so to create their own plans, serving as labs for potential reform efforts.

 

[Trajan]

Obama's plan:

Insures millions more Americans and children.

Ryan's plan:

I don't see any wheelchairs, wtf?

 

[8537]

I don't see any wheelchairs, wtf?

Damn folks, that shit was funny!

 

[Trajan]

Wouldn't the best idea be, then, to set up 5 trial US states to use the Ryan plan and see how it goes? Lets say, just for argument, Wisconsin (I think he's from WI), Louisiana, Arizona, Kentucky, and Georgia.

Lets see how much money it saves in practice.

Any thoughts?

Better yet, block grant the cash to the states and let each state, all 50, develop and deploy a plan and a program. What might work even better is to not ever send the cash to Washington and let the States take care of it.

In that way the Feds woldn't have to take their cut at all.

That's already part of Obama's plan. Any state that can prove they can insure more people for less money can apply for an exemption. Seriously, I thought everyone knew that.

thats not what he said, but anywayI can ask for permission not to breath....then what?


so how many have asked? how many states have been given the medicaid block grant waiver, aside from RI?

 

[Quantum Windbag]

That's false.

No it is not.

If we implement the Medicare savings in Obamacare the government will end up spending exactly what they would under the Ryan plan.

Are Paul Ryan’s Medicare Spending Targets Impossible? - Avik Roy - The Apothecary - Forbes

The real difference is that the Ryan plan will actually preserve Medicare and make it fiscally viable, while Obamacare just pretends that it will.

The Ryan plan will "make it fiscally viable" by taking the cost off the government ledger and pushing them on the backs of seniors.

And yes, Ryan's belief you can hold the rate of growth to the rate of growth is completely unrealistic.

So? Why is asking people to pay for more coverage if they want it a bad thing? Why should the government supply everyone with unlimited coverage including long term care in residential facilities just because someone is old enough? What makes you think that there is any way to make that economically viable by reducing fraud and abuse?

By the way, I agree with you about keeping the rate of growth down, which is why I know Obamacare is a complete joke in its projections about the rate of growth. Why do you support one projection and reject the other one, especially since the Obamacre predictions rely on much more rosy assumptions about the rate of growth?

 

[The T]

No it is not.

If we implement the Medicare savings in Obamacare the government will end up spending exactly what they would under the Ryan plan.

Are Paul Ryan’s Medicare Spending Targets Impossible? - Avik Roy - The Apothecary - Forbes

The real difference is that the Ryan plan will actually preserve Medicare and make it fiscally viable, while Obamacare just pretends that it will.

The Ryan plan will "make it fiscally viable" by taking the cost off the government ledger and pushing them on the backs of seniors.

And yes, Ryan's belief you can hold the rate of growth to the rate of growth is completely unrealistic.

So? Why is asking people to pay for more coverage if they want it a bad thing? Why should the government supply everyone with unlimited coverage including long term care in residential facilities just because someone is old enough? What makes you think that there is any way to make that economically viable by reducing fraud and abuse?

By the way, I agree with you about keeping the rate of growth down, which is why I know Obamacare is a complete joke in its projections about the rate of growth. Why do you support one projection and reject the other one, especially since the Obamacre predictions rely on much more rosy assumptions about the rate of growth?

Especially seeing Obama is doing everything he can to tinker with 'growth'?

 

[The T]

Better yet, block grant the cash to the states and let each state, all 50, develop and deploy a plan and a program. What might work even better is to not ever send the cash to Washington and let the States take care of it.

In that way the Feds woldn't have to take their cut at all.

That's already part of Obama's plan. Any state that can prove they can insure more people for less money can apply for an exemption. Seriously, I thought everyone knew that.

thats not what he said, but anywayI can ask for permission not to breath....then what?


so how many have asked? how many states have been given the medicaid block grant waiver, aside from RI?

Then compare that to how many Entities as Unions (that endorsed this garbage) have been granted waivers? They're dancing on a double-edged sword imho...

 

[Quantum Windbag]

Befrore the Congress passed and President Obama signed new health care legislation, the costs for medical to individuals, counties and states continued to rise every year for decades. Sadly, when the deal was done, we got a camel. I suppose everyone knows that's what our Congress usually produces: "A camel is a horse designed by committee".

Part of the problem is that those who benefitted from the former system demagogued the issue, others played the emotion card, branding those who supported a form of universal preventative and single payer health care as, "communists, socialists, marxists and un-American". The elected representatives of the Republican party joined the effort to kill reform in mass their effort funded by the special interests.

Now the New Right wants to kill Medicare, Medicade and while their at it Social Security and Supplemental Security Income. They hope to kill the ability (the right) for workers to organize and negotiate salary and benefits, and to pit working man v. working man in compitition, while business and industry continue to merge creating a climate where cartels can flourish and competition is nil.

It is the goal of the New Right leadership to fundamentally to change our economic system into a Plutocracy. They oppose abortion not out of moral outrage, but by recognizing that a greater population creates competition for jobs, and a greater supply of cheap labor is a benefit to business & industry. They have allowed greater influence of money into our political system (Citizens United v. FEC) knowing the masses are easily led by hate and fear & such rhetoric which beats reasoned arguments everytime.

The NR accuses anyone who disagrees with them of using tactics which they themselves employ, it is a propaganda machine which speaks in one voice from thousands of mouths, using the same message which changes from week to week and day to day; it is always the same, always focued on the next election and uses any opportunity to demagogue, accuse, exploit, embarrass or abuse those whose opinions and ideas are different than their own.

No, this is not a conspiracy theory, and any effort to label it so is dishonest and partisan. Defending the NR and the hard right turn of the GOP is in fact UN-American. For nothing they have offered will benefit 'We the People'. The effort by the NR and the Republican leadership is evil to those of us who support the ideal of representative government.

How typically trite. The problem is we spend to much money, and your solution is to spend more money.

 

[8537]

Better yet, block grant the cash to the states and let each state, all 50, develop and deploy a plan and a program. What might work even better is to not ever send the cash to Washington and let the States take care of it.

In that way the Feds woldn't have to take their cut at all.

That's already part of Obama's plan. Any state that can prove they can insure more people for less money can apply for an exemption. Seriously, I thought everyone knew that.

thats not what he said, but anywayI can ask for permission not to breath....then what?


so how many have asked? how many states have been given the medicaid block grant waiver, aside from RI?

Vermont has a Medicaid block grant with five years of pre-determined federal payments to the state instead of the usual matching payments. Not sure if that's the same as Rhode Island.

The basic impact is to:
(A) give the federal government cost certainty.
(B) give the state an incentive to reduce costs because we get to keep any realized savings below the federal commitment.

 

[Trajan]

That's already part of Obama's plan. Any state that can prove they can insure more people for less money can apply for an exemption. Seriously, I thought everyone knew that.

thats not what he said, but anywayI can ask for permission not to breath....then what?


so how many have asked? how many states have been given the medicaid block grant waiver, aside from RI?

Vermont has a Medicaid block grant with five years of pre-determined federal payments to the state instead of the usual matching payments. Not sure if that's the same as Rhode Island.

The basic impact is to:
(A) give the federal government cost certainty.
(B) give the state an incentive to reduce costs because we get to keep any realized savings below the federal commitment.

do you agree that this is a path we should explore more?

 

[8537]

thats not what he said, but anywayI can ask for permission not to breath....then what?


so how many have asked? how many states have been given the medicaid block grant waiver, aside from RI?

Vermont has a Medicaid block grant with five years of pre-determined federal payments to the state instead of the usual matching payments. Not sure if that's the same as Rhode Island.

The basic impact is to:
(A) give the federal government cost certainty.
(B) give the state an incentive to reduce costs because we get to keep any realized savings below the federal commitment.

do you agree that this is a path we should explore more?

I'm torn. I like the idea of allowing states to be "lab rats" for reforms, and VT is serving that role both under the Medicaid plan and our seeking a HCR waiver. On the other hand, I have reservations about each state cooking up their own solution and creating a race to the bottom (though I'm not sure that would be the result).

 

[Polk]

No it is not.

If we implement the Medicare savings in Obamacare the government will end up spending exactly what they would under the Ryan plan.

Are Paul Ryan’s Medicare Spending Targets Impossible? - Avik Roy - The Apothecary - Forbes

The real difference is that the Ryan plan will actually preserve Medicare and make it fiscally viable, while Obamacare just pretends that it will.

The Ryan plan will "make it fiscally viable" by taking the cost off the government ledger and pushing them on the backs of seniors.

And yes, Ryan's belief you can hold the rate of growth to the rate of growth is completely unrealistic.

So? Why is asking people to pay for more coverage if they want it a bad thing? Why should the government supply everyone with unlimited coverage including long term care in residential facilities just because someone is old enough? What makes you think that there is any way to make that economically viable by reducing fraud and abuse?

By the way, I agree with you about keeping the rate of growth down, which is why I know Obamacare is a complete joke in its projections about the rate of growth. Why do you support one projection and reject the other one, especially since the Obamacre predictions rely on much more rosy assumptions about the rate of growth?

I think most people would have a moral problem with condemning the elderly to death sentences. You don't seem to suffer from that problem.

As for the "much more rosy assumptions", how is GDP + 1 a more rosy assumption that GDP?

 

[Trajan]

The Ryan plan will "make it fiscally viable" by taking the cost off the government ledger and pushing them on the backs of seniors.

And yes, Ryan's belief you can hold the rate of growth to the rate of growth is completely unrealistic.

So? Why is asking people to pay for more coverage if they want it a bad thing? Why should the government supply everyone with unlimited coverage including long term care in residential facilities just because someone is old enough? What makes you think that there is any way to make that economically viable by reducing fraud and abuse?

By the way, I agree with you about keeping the rate of growth down, which is why I know Obamacare is a complete joke in its projections about the rate of growth. Why do you support one projection and reject the other one, especially since the Obamacre predictions rely on much more rosy assumptions about the rate of growth?

I think most people would have a moral problem with condemning the elderly to death sentences. You don't seem to suffer from that problem.

As for the "much more rosy assumptions", how is GDP + 1 a more rosy assumption that GDP?

death sentences, you didn't disappoint, unfortunately.....

 

[Trajan]

Vermont has a Medicaid block grant with five years of pre-determined federal payments to the state instead of the usual matching payments. Not sure if that's the same as Rhode Island.

The basic impact is to:
(A) give the federal government cost certainty.
(B) give the state an incentive to reduce costs because we get to keep any realized savings below the federal commitment.

do you agree that this is a path we should explore more?

I'm torn. I like the idea of allowing states to be "lab rats" for reforms, and VT is serving that role both under the Medicaid plan and our seeking a HCR waiver. On the other hand, I have reservations about each state cooking up their own solution and creating a race to the bottom (though I'm not sure that would be the result).

rhode island has had their medicaid blocked granted since 08 I think, I won't post any article becasue I won't want to be accused of bias, so, if you feel, its out there , read a few , it seems, seems being the operative word, that its 'working'.

 

[Greenbeard]

The Ryan plan puts the decision making in the hands of the Seniors. When this approach has been used before, it has worked and worked very well to improve the options, coverages and cost factors.

You make the same mistake here that liberals often do: taking the patient-payer relationship as the fundamental unit of analysis in understanding health costs, instead of the payer-provider relationship and, to some extent, the patient-provider relationship. There are some gains to be had from ordering an insurance market and prompting insurers to compete on price and quality (which, incidentally, doesn't mean an incomprehensible market that aims at infinitely customizable insurance products, but rather one that features variation within standardized categories).

But more important is the structure of the system that actually delivers care and the influence payers have over providers. Simply giving seniors a choice between private insurers is not a panacea--they already have the choice of competing private insurers if they prefer that to traditional Medicare. Yet the partially privatized portion of Medicare has turned out to be more expensive than traditional Medicare, despite precious little of that extra spending trickling down into additional consumer surplus for seniors.

The goal of the Republican plan is very simple: cap what the feds spend on health, and let somebody else worry about it. If the goal is simply to get the feds off the hook for paying for seniors' medical expenses, the Republican budget would (theoretically) achieve that, since it ends Medicare's role as a payer for health services on behalf of the elderly. Most folks, however, don't seem to believe that's the primary goal we should be pursuing.

A key difference between PPACA and PTP is the method by which each reduces Medicare spending. PPACA cuts payments to hospitals and doctors, which will force many doctors out of the health care system, reducing access to care for seniors in much the same way that Medicaid does.

Missing the mark a bit on that one. The groundwork for getting a handle on Medicare costs is laid in a number of ways:

• Value-based purchasing in Medicare.
• In the vein of paying for value, building on quality measure advancement begun for children two years ago under CHIPRA by extending it to adults and expanding public reporting on quality.
• Incentives for accountable care.
• Upping AHRQ's role in health care delivery system research and building technical assistance capacity to assist providers in implementing them.
• 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.
• Supporting community-based prevention efforts, particularly those aimed at chronic illness (one of the big cost drivers in our system).
• Financial incentives for Medicare and Medicaid providers who adopt electronic health records with clinical support tools and quality measurement capabilities.
• Seeding models of advanced primary care aimed specifically at high-utilization, high-cost beneficiaries.
• Payment reforms to discourage unnecessary spending.
• Improved care coordination, particularly for those needing the most complex and expensive care regimes (and thus likely to benefit the most from it).
• Transitioning enrollees from institution-based long-term care to community-based care where possible.
• Determining which treatments are the most effective.
• 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.

I'm torn. I like the idea of allowing states to be "lab rats" for reforms, and VT is serving that role both under the Medicaid plan and our seeking a HCR waiver. On the other hand, I have reservations about each state cooking up their own solution and creating a race to the bottom (though I'm not sure that would be the result).

There's nothing wrong with using the existing waiver processes in federal level (waivers are extremely common within Medicaid), if that's what a state decides is the best course of action. Flexibility, within limits (i.e. preventing the race to the bottom you're talking about), is desirable. Pushing every state into a block grant that they could already seek through the normal 1115 waiver process if they wanted one, on the other hand, goes beyond letting the states decide what system works best for them.

 

[Trajan]

what is chirpa? re-tasked schip?

Greenbeard said-

The goal of the Republican plan is very simple: cap what the feds spend on health, and let somebody else worry about it.

trajan says-

The goal of the Democratic plan is very simple: cap what the feds spend on health, and let somebody else worry about it.

 

[The T]

The Ryan plan puts the decision making in the hands of the Seniors. When this approach has been used before, it has worked and worked very well to improve the options, coverages and cost factors.

You make the same mistake here that liberals often do: taking the patient-payer relationship as the fundamental unit of analysis in understanding health costs, instead of the payer-provider relationship and, to some extent, the patient-provider relationship. There are some gains to be had from ordering an insurance market and prompting insurers to compete on price and quality (which, incidentally, doesn't mean an incomprehensible market that aims at infinitely customizable insurance products, but rather one that features variation within standardized categories).

But more important is the structure of the system that actually delivers care and the influence payers have over providers. Simply giving seniors a choice between private insurers is not a panacea--they already have the choice of competing private insurers if they prefer that to traditional Medicare. Yet the partially privatized portion of Medicare has turned out to be more expensive than traditional Medicare, despite precious little of that extra spending trickling down into additional consumer surplus for seniors.

The goal of the Republican plan is very simple: cap what the feds spend on health, and let somebody else worry about it. If the goal is simply to get the feds off the hook for paying for seniors' medical expenses, the Republican budget would (theoretically) achieve that, since it ends Medicare's role as a payer for health services on behalf of the elderly. Most folks, however, don't seem to believe that's the primary goal we should be pursuing.

A key difference between PPACA and PTP is the method by which each reduces Medicare spending. PPACA cuts payments to hospitals and doctors, which will force many doctors out of the health care system, reducing access to care for seniors in much the same way that Medicaid does.

Missing the mark a bit on that one. The groundwork for getting a handle on Medicare costs is laid in a number of ways:

• Value-based purchasing in Medicare.
• In the vein of paying for value, building on quality measure advancement begun for children two years ago under CHIPRA by extending it to adults and expanding public reporting on quality.
• Incentives for accountable care.
• Upping AHRQ's role in health care delivery system research and building technical assistance capacity to assist providers in implementing them.
• 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.
• Supporting community-based prevention efforts, particularly those aimed at chronic illness (one of the big cost drivers in our system).
• Financial incentives for Medicare and Medicaid providers who adopt electronic health records with clinical support tools and quality measurement capabilities.
• Seeding models of advanced primary care aimed specifically at high-utilization, high-cost beneficiaries.
• Payment reforms to discourage unnecessary spending.
• Improved care coordination, particularly for those needing the most complex and expensive care regimes (and thus likely to benefit the most from it).
• Transitioning enrollees from institution-based long-term care to community-based care where possible.
• Determining which treatments are the most effective.
• 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.

I'm torn. I like the idea of allowing states to be "lab rats" for reforms, and VT is serving that role both under the Medicaid plan and our seeking a HCR waiver. On the other hand, I have reservations about each state cooking up their own solution and creating a race to the bottom (though I'm not sure that would be the result).

There's nothing wrong with using the existing waiver processes in federal level (waivers are extremely common within Medicaid), if that's what a state decides is the best course of action. Flexibility, within limits (i.e. preventing the race to the bottom you're talking about), is desirable. Pushing every state into a block grant that they could already seek through the normal 1115 waiver process if they wanted one, on the other hand, goes beyond letting the states decide what system works best for them.

WHOM is paying you to be here Greenboy?

 

[Wacky Quacky]

]\

So we passed a trillion dollar law that anyone can get a waiver for?!

Yes.

I'm not exactly seeing the logic behind this. If Obama just wanted to push states to enact their own healthcare reforms, I'm sure there are cheaper and more constitutional ways to do it.

The point is to allow states who wish to do so to create their own plans, serving as labs for potential reform efforts.

Then why did we just spend a trillion dollars? It makes a lot more sense to have allowed these healthcare experiments to occur before we spent a trillion dollars on a nation-wide plan.

 

[Quantum Windbag]

The Ryan plan will "make it fiscally viable" by taking the cost off the government ledger and pushing them on the backs of seniors.

And yes, Ryan's belief you can hold the rate of growth to the rate of growth is completely unrealistic.

So? Why is asking people to pay for more coverage if they want it a bad thing? Why should the government supply everyone with unlimited coverage including long term care in residential facilities just because someone is old enough? What makes you think that there is any way to make that economically viable by reducing fraud and abuse?

By the way, I agree with you about keeping the rate of growth down, which is why I know Obamacare is a complete joke in its projections about the rate of growth. Why do you support one projection and reject the other one, especially since the Obamacre predictions rely on much more rosy assumptions about the rate of growth?

I think most people would have a moral problem with condemning the elderly to death sentences. You don't seem to suffer from that problem.

As for the "much more rosy assumptions", how is GDP + 1 a more rosy assumption that GDP?

Here is the problem. What we are doing is unsustainable. What Obamacre plans to do is cut Medicare spending to the exact same levels as Ryan, without putting that money in the hands of the people who actually needing it. You can twist that to me not caring about seniors if you want, but the truth of the matter is that the position you are defending here is less viable than the one you are attacking.

What is the historical rate of growth of Medicare? How does Obamacare plan to control that growth?

 

[Polk]

So? Why is asking people to pay for more coverage if they want it a bad thing? Why should the government supply everyone with unlimited coverage including long term care in residential facilities just because someone is old enough? What makes you think that there is any way to make that economically viable by reducing fraud and abuse?

By the way, I agree with you about keeping the rate of growth down, which is why I know Obamacare is a complete joke in its projections about the rate of growth. Why do you support one projection and reject the other one, especially since the Obamacre predictions rely on much more rosy assumptions about the rate of growth?

I think most people would have a moral problem with condemning the elderly to death sentences. You don't seem to suffer from that problem.

As for the "much more rosy assumptions", how is GDP + 1 a more rosy assumption that GDP?

Here is the problem. What we are doing is unsustainable. What Obamacre plans to do is cut Medicare spending to the exact same levels as Ryan, without putting that money in the hands of the people who actually needing it. You can twist that to me not caring about seniors if you want, but the truth of the matter is that the position you are defending here is less viable than the one you are attacking.

What is the historical rate of growth of Medicare? How does Obamacare plan to control that growth?

The first problem is you don't understand basic math. X and X + 1 are not the same thing. And Ryan's plan doesn't "put the money in the hands of people who actually need it". Ryan uses the money to fund another route of tax cuts for millionaires.

As for cost control proposals in the health care bill, they've been listed too many times to count, but here's a refresher...

Some of them have already been passed in to law. The Affordable Care Act included full coverage for annual wellness screenings (it's cheaper to treat something if you catch it early), a shift toward accountable care organizations (which ties pay to ability to reduce total costs), financial incentives for hospitals to reduce readmission rates, and provisions to align Medicare cost growth more closely with overall cost growth (IPAB).

Some of the proposals that haven't been passed, but have been discussed are increasing the rate of cost growth acceptable during IPAB, and increasing funding for comparative effectiveness research.