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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.
The goal of Obamacare is also simple, to cap the expenses of the government. Some people want to argue that it will do this by controlling costs, but have put forth nothing but sound bites to explain how that works. Instead they point to a list of items that will supposedly accomplish miracles that have never before been possible in the history of the universe.
- 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.
Just like that.
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.
I would be more likely to agree with this if the administration would explain exactly what the process is, who is eligible, and the reason for denying waivers when they do. Can you point to where they are doing that?
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.
The idea behind the Ryan plan is to make the patient into the payer.
The goal of Obamacare is also simple, to cap the expenses of the government. Some people want to argue that it will do this by controlling costs, but have put forth nothing but sound bites to explain how that works. Instead they point to a list of items that will supposedly accomplish miracles that have never before been possible in the history of the universe.
No, it isn't. It simply pushes them into the arms of private payers (you understand they get a voucher to purchase private insurance, right?).
It would certainly make sense to set a cost growth target and then include no attempts to address the cost drivers in our system, ensuring that the targets can't be met. I can understand why Ryan's your man.
Good luck with that.
The idea behind the Ryan plan is to make the patient into the payer.
Yes, I do. The idea is to make that insurance more responsive to the needs of the individual, not to simply provide a one size fits all answer.
Ryan is not my man, I have serious problems with his plan. I do, however, see the advantages it has over Obamacare.
BTW, I notice you did not provide any link showing what criteria the administration is using to grant, or deny, waivers. Why is that?
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.
I understand math quite well, which is why I understand that taxing the rich will not solve the problems. The only way to pay for everything is by taxing the middle class. If you want to be taken seriously you should at least be honest about it.
By the way, how is giving seniors a grant to purchase health insurance not putting the money in the hands of the people that need it?
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.
Yes, you want to turn medicare into a giant HMO, we covered that before. I don't recall you answering why HMOs are bad unless it is run by the government, but I have given up expecting answers.
Yes, I do. The idea is to make that insurance more responsive to the needs of the individual, not to simply provide a one size fits all answer.
That doesn't "make the patient into the payer." You're not making any sense.
Nor is it clear that current Medicare recipients are demanding some change in the benefit structure of the program because it isn't responsive to their needs. In fact, as I recall the primary selling point being used is that the Republican proposal doesn't touch Medicare for those currently receiving it (false, but a telling argument).
Ryan is not my man, I have serious problems with his plan. I do, however, see the advantages it has over Obamacare.
Yes, namely that it was proposed by House Republicans. Strong case.
The fact is, the ACA contains cost controls. The Republican budget does not. The ACA retains Medicare as a payer for the medical services consumed by the nation's elderly. The Republican budget does not.
BTW, I notice you did not provide any link showing what criteria the administration is using to grant, or deny, waivers. Why is that?
If you want to know how a state goes about getting a Medicaid waiver, I suggest you head over to the CMS website.
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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.
Yes.
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.
Did we spend a trillion dollars or is that a projected cost over the next 20 years?
You know, I like the left. They come up with plans to try things. Try to make things work. Try to help the average American. Try to support the elderly.
What is the right wing plan? Die? Throw a few bucks at old people and tell them, "Sorry grandma, you're on your own. We just don't care about you. We have an oil company we have to subsidize". Is that the plan? Because if it isn't, then tell us, what is it?
Nothing like saying, "Here is a plan. Show us something better".
So there you go. Put up, or shut the fuck up. The right wing has been challenged. "DO SOMETHING". Show us what you've got.
Yes, I do. The idea is to make that insurance more responsive to the needs of the individual, not to simply provide a one size fits all answer.
That doesn't "make the patient into the payer." You're not making any sense.
Nor is it clear that current Medicare recipients are demanding some change in the benefit structure of the program because it isn't responsive to their needs. In fact, as I recall the primary selling point being used is that the Republican proposal doesn't touch Medicare for those currently receiving it (false, but a telling argument).
Yes, namely that it was proposed by House Republicans. Strong case.Ryan is not my man, I have serious problems with his plan. I do, however, see the advantages it has over Obamacare.
The fact is, the ACA contains cost controls. The Republican budget does not. The ACA retains Medicare as a payer for the medical services consumed by the nation's elderly. The Republican budget does not.
If you want to know how a state goes about getting a Medicaid waiver, I suggest you head over to the CMS website.BTW, I notice you did not provide any link showing what criteria the administration is using to grant, or deny, waivers. Why is that?
I understand math quite well, which is why I understand that taxing the rich will not solve the problems. The only way to pay for everything is by taxing the middle class. If you want to be taken seriously you should at least be honest about it.
The same way you wouldn't be addressing need if you took my house, then gave me a $400 voucher to use toward rent.
I haven't seen you ask that question. My response is that I don't think HMOs are bad.
Yes.
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.
Did we spend a trillion dollars or is that a projected cost over the next 20 years?
You know, I like the left. They come up with plans to try things. Try to make things work. Try to help the average American. Try to support the elderly.
What is the right wing plan? Die? Throw a few bucks at old people and tell them, "Sorry grandma, you're on your own. We just don't care about you. We have an oil company we have to subsidize". Is that the plan? Because if it isn't, then tell us, what is it?
Nothing like saying, "Here is a plan. Show us something better".
So there you go. Put up, or shut the fuck up. The right wing has been challenged. "DO SOMETHING". Show us what you've got.
Nothing like saying, "Here is a plan. Show us something better".
So there you go. Put up, or shut the fuck up. The right wing has been challenged. "DO SOMETHING". Show us what you've got.
I asked for a link to how the administration determines Obamacare waivers. not Medicaid. They are two separate things.
Since I never stated "taxing the rich" would pay for it, looks like you've got...
Aren't you the one that brought up tax cuts for millionaires?
http://imageshack.usThe same way you wouldn't be addressing need if you took my house, then gave me a $400 voucher to use toward rent.
Except that Medicare is not a house, it is government spending taxpayer money to provide health insurance for seniors. Who is using a strawman now?
I haven't seen you ask that question. My response is that I don't think HMOs are bad.
If you have no problems with HMOs reducing costs by restricting access to services why do you think we need Obamacare in the first place?
I asked for a link to how the administration determines Obamacare waivers. not Medicaid. They are two separate things.
Apologies, I thought you were asking something germane to the conversation into which you inserted yourself (existing Medicaid waiver authority that allows for block grants to states); I forgot who I was talking to.
The proposed process for submission and review of ACA state innovation waiver applications was posted for public comment in March.
Yes, because that's what Ryan's budget uses the savings on. That's not even remotely similar to saying we pay for everything on the table by solely taxing the wealthy.
I guess you're not very good with analogies, so I'll state it more directly. Under the current system, the cost of health care for seniors beyond a certain amount is covered. Under the Ryan plan, they get a coupon for a few bucks off and then the sky is the limit for cost they will bare.
To directly provide for the millions that lacked coverage (instead of paying through it via the backdoor of ER visits) and so those with pre-existing conditions could be covered.
The idea behind the Ryan plan is to make the patient into the payer.
No, it isn't. It simply pushes them into the arms of private payers (you understand they get a voucher to purchase private insurance, right?).
The goal of Obamacare is also simple, to cap the expenses of the government. Some people want to argue that it will do this by controlling costs, but have put forth nothing but sound bites to explain how that works. Instead they point to a list of items that will supposedly accomplish miracles that have never before been possible in the history of the universe.
It would certainly make sense to set a cost growth target and then include no attempts to address the cost drivers in our system, ensuring that the targets can't be met. I can understand why Ryan's your man.
Good luck with that.
$0.00
The real difference between the Ryan plan and the Big 0's plan is that the Big 0 relies on government officials to do the work while we sufer or reap the effects of their efforts.
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.
No matter how many government officials are at work doing the planning, they will not be able to equal the combined efforts of every single Senior and their families researching every nuance of their conditions and the available options for insurance and care.
Ryan's plan endorses the capability of the end users while the Obamacare option denies the capability and the wisdom of the end user. The Obamacare approach asserts that we are all helpless idiots who need care and guidance, not able free agents who need reasonable options.
Obamacare is the typical Liberal approach that has to be interpreted as an insult to any thinking individual.
From the article:
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.
On the other hand, PTP places control in the hands of seniors. Retirees under PTP will be incentivized to reduce wasteful health spending by shopping for insurance plans that contain the benefits they most want. This patient-centered approach is far more appealing.
That's cute rhetoric. Too bad it doesn't work out in reality.
