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Thread: Bipartisan support against Obama Death panel

  1. #41
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    [QUOTE=long island leprechaun;4005732]I'm sorry but this is so hypocritical of people like Ryan. He's arguing now that the panel would potentially cut care to seniors... while his plan would do far worse. Also, from what I read, any decision of the panel CAN be overturned by Congress. Also the panel may be appointed by the President but each member has to be approved by Congress. [B]The ENTIRE drive against this is coming from the healthcare industry for obvious reasons [/B]- the panel is pretty much forced by law to look at costs since they can't do much of anything else. Per the NYT:

    "Under the law, [B]the board cannot make recommendations to “ration health care,”[/B] raise revenues or increase beneficiaries’ premiums, deductibles or co-payments. This increases the likelihood that the board will try to save money by trimming Medicare payments to health care providers."

    [/QUOTE]

    My soon-to-be-retired truck-driver father and disabled daughter would disagree with you, rightfully so. I have a horse in this race, and for years I have seen the effects of defunding of Medicaid programs based on budget. That seems to be lost on a few people here. Cutting costs has severe ramifications for the disabled. I have had to contend with over a decade of 0% insurance coverage for someone that is recognized disabled by the City, State and Federal government. And now you want the ONE PROGRAM that does help to be overseen by a panel who will cut funding for the sake of saving money? Do you have any idea how devastating that will be?

    See, I went through something like this last year in NYS. Two competing autism insurance bills went to Albany. The one that we were successful in killing would have had a government appointed panel that would could have denied basic interventions such as speech therapy, physical therapy, occupational therapy, and ABA therapy on the grounds that they are not “evidence based, peer-reviewed and clinically proven.” That's frightening stuff. There are many, many treatments and medicines that don't meet all that criteria, but gubbmint was going to make sure that a new medical standard for treatment of autistics was going to be put in place. Additionally, the panel was going to be in the position to set caps on approved therapies and interventions.

    As for your quote from the horribly partisan Times, the part I bolded is quite misleading. Surprising that such a bastion of journalistic ethics like the Times wouldn't elaborate further.:rolleyes: Sure, the panel can't make those recommendations for rationing, but the cuts they make will force the hand of those that can and will, likely based on the bottom line in addition to examples myself and kenny07 have laid out, the disabled, the end-stage cancer patient etc.
    Last edited by Jetworks; 04-21-2011 at 09:02 AM.

  2. #42
    Obama keeps on complaining about the cost of healthcare costs to the federal govt. I would think he mean federal employees well Mr President make the employees pay more for the benefit or slash the number of employees.
    My deductions have gone up $30 a paycheck this year.

  3. #43
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    [QUOTE=Winstonbiggs;4005734]Reducing payments to providers doesn't cut cost.[/QUOTE]

    I think you need to take a hot shower and rethink that....

  4. #44
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    [QUOTE=Jetworks;4005745]My soon-to-be-retired truck-driver father and disabled daughter would disagree with you, rightfully so. I have a horse in this race, and for years I have seen the effects of defunding of Medicaid programs based on budget. That seems to be lost on a few people here. Cutting costs has severe ramifications for the disabled. I have had to contend with over a decade of 0% insurance coverage for someone that is recognized disabled by the City, State and Federal government. And now you want the ONE PROGRAM that does help to be overseen by a panel who will cut funding for the sake of saving money? Do you have any idea how devastating that will be?

    See, I went through something like this last year in NYS. Two competing autism insurance bills went to Albany. The one that we were successful in killing would have had a government appointed panel that would could have denied basic interventions such as speech therapy, physical therapy, occupational therapy, and ABA therapy on the grounds that they are not “evidence based, peer-reviewed and clinically proven.” That's frightening stuff. There are many, many treatments and medicines that don't meet all that criteria, but gubbmint was going to make sure that a new medical standard for treatment of autistics was going to be put in place. Additionally, the panel was going to be in the position to set caps on approved therapies and interventions.

    As for your quote from the horribly partisan Times, the part I bolded is quite misleading. Surprising that such a bastion of journalistic ethics like the Times wouldn't elaborate further.:rolleyes: Sure, the panel can't make those recommendations for rationing, but the cuts they make will force the hand of those that can and will, likely based on the bottom line in addition to examples myself and kenny07 have laid out, the disabled, the end-stage cancer patient etc.[/QUOTE]

    So if you don't plan to reduce the pricing for procedures, or assess what procedures are necessary to quality, evidence-based healthcare, how will Medicare ever be made fiscally sound? Raise the age and criteria for eligibility? Raise the premiums? Backdoor both by setting up vouchers?

    I should add that the VA does precisely what is recommended for this commission through evidence-based panels, medical cost recovery, and negotiation of medication pricing with big pharma. You could make exactly the same lame-brained argument that they do not have sufficient oversight because every decision they make is not a result of legislation. No government agency could function like that. None. The people arguing against this are not trying to protect medicare recipients, they are trying to protect their prime contributors -- the healthcare industry. Look it up. By the way, if medicare and medicaid set given rates, it will drive the entire healthcare system to adjust. That's the point. Medicaid alone is simply not a sufficiently big player to force that.

  5. #45
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    [QUOTE=MnJetFan;4005749]Obama keeps on complaining about the cost of healthcare costs to the federal govt. I would think he mean federal employees well Mr President make the employees pay more for the benefit or slash the number of employees.
    My deductions have gone up $30 a paycheck this year.[/QUOTE]

    Um, another stupid comment that should have simply been checked. Federal employees have had significant increases in their premiums, just like everybody else. The Federal Health Benefit Plan is exactly the same as private industry... your employer pays a share and the employee pays a contribution. The insurance is private.

  6. #46
    [QUOTE=long island leprechaun;4005780]how will Medicare ever be made fiscally sound? Raise the age and criteria for eligibility? Raise the premiums?[/quote]

    Yes. People are living longer, healthier, than they used to. Many can work longer. And increase int he age of eligibillity (transitioned/grandfathered, of course, over a period of time, as any of these types of changes should be) is one appropriate step.

    Yes. The criteria for non-age-related Medicare qualification can and should be looked at, and in some cases changed to make qualification more difficult for those able-bodied/able-minded.

    Yes. Premiums can and should be raised.

    And Medicaid should be looked at to see who is qualifying for that, and ensure it exists only for the truly poor (below the poverty line), not for others.

  7. #47
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    [QUOTE=long island leprechaun;4005780]So if you don't plan to reduce the pricing for procedures, or assess what procedures are necessary to quality, evidence-based healthcare, how will Medicare ever be made fiscally sound? Raise the age and criteria for eligibility? Raise the premiums? Backdoor both by setting up vouchers?

    I should add that the VA does precisely what is recommended for this commission through evidence-based panels, medical cost recovery, and negotiation of medication pricing with big pharma. You could make exactly the same lame-brained argument that they do not have sufficient oversight because every decision they make is not a result of legislation. No government agency could function like that. None. The people arguing against this are not trying to protect medicare recipients, they are trying to protect their prime contributors -- the healthcare industry. Look it up. By the way, if medicare and medicaid set given rates, it will drive the entire healthcare system to adjust. That's the point. Medicaid alone is simply not a sufficiently big player to force that.[/QUOTE]

    I don't really see where you are getting all this from? I understand what you are saying about the VA (kenny07 mentioned it earlier in the thread) and I think it could work. That is not what I am arguing against, however. I am simply voicing my concern that the disabled population in this country could suffer greatly if there is a panel that determines what is a medical and fiscally viable course of treatment for X. I guess since my family is directly affected by something like that we are a little more tuned in to how things could adversely turn against us.

    Look, if you don't have a disabled kid you'll never understand. This is just one aspect of a landscape (disabilities) that doesn't receive the attention it should (advocacy, legislation, protection) and has in the past been raped when it comes to budget cuts. It's already starting to happen again with some things, so fearing that a program like this would lead to worse outcomes is not totally unfounded. Please recognize and respect that.

    I was trying to find state-by-state expenditures for Medicare vs. Medicaid but I couldn't. I found some interesting stuff on CMS, but nothing that I can readily interpret. Do you have anything I can reference?

    [QUOTE=Warfish;4005842]
    And Medicaid should be looked at to see who is qualifying for that, and ensure it exists only for the truly poor (below the poverty line), not for others.[/QUOTE]

    So the disabled don't qualify for Medicaid? I know, you just overlooked the fact that they receive it, so I am being a bit facetious.;) But it kind of helps to hammer home what I was saying above. Forgotten populations...
    Last edited by Jetworks; 04-21-2011 at 11:40 AM.

  8. #48
    [QUOTE=Jetworks;4005887]So the disabled don't qualify for Medicaid? I know, you just overlooked the fact that they receive it, so I am being a bit facetious.;) But it kind of helps to hammer home what I was saying above. Forgotten populations...[/QUOTE]

    Aye, perhaps I did. I seem to have operated under the misunderstanding that the disabled recieved Medicare, not Medicaid. If I ran the system, thats how it would be, Medicare for the elderly and disabled. Medicaid for the poor.

    Or better yet, one system, Mediwhatever, for all of them that qualify, elderly, disabled, and those below the poverty line. Efficientcy.

    I assure you, the Disabled are not forgotten by me, nor do I have any desire to defund their care. I want to defund alot of other folks who, IMO< should be caring for themselves. Not the disabled.

    Although (and you won't like this), the disabled benefits should be weighted on the wealth of the Guardians (if under age or in some other form disabled to the point of not being personally responsible). This is alos how I'd handle Social Security, with bennies being reduced based on a weighting of personal wealth.

  9. #49
    [QUOTE=long island leprechaun;4005771]I think you need to take a hot shower and rethink that....[/QUOTE]

    Now that I have nothing has changed. Reducing payments to a provider doesn't reduce cost. Think about for awhile.

  10. #50
    [QUOTE=long island leprechaun;4005780]So if you don't plan to reduce the pricing for procedures, or assess what procedures are necessary to quality, evidence-based healthcare, how will Medicare ever be made fiscally sound? Raise the age and criteria for eligibility? Raise the premiums? Backdoor both by setting up vouchers?

    I should add that the VA does precisely what is recommended for this commission through evidence-based panels, medical cost recovery, and negotiation of medication pricing with big pharma. You could make exactly the same lame-brained argument that they do not have sufficient oversight because every decision they make is not a result of legislation. No government agency could function like that. None. The people arguing against this are not trying to protect medicare recipients, they are trying to protect their prime contributors -- the healthcare industry. Look it up. By the way, if medicare and medicaid set given rates, it will drive the entire healthcare system to adjust. That's the point. Medicaid alone is simply not a sufficiently big player to force that.[/QUOTE]

    You are discounting the adjustment that is allready being made. Patient insurance will be dropped or the patient will have to make up the shortfall.

    My wife and I who allready have 8,000 in deductible and essentially use our Insurance company for the ratings have allready seen our providers dump out of our plan and others because of cut reimbursement.

    You are assuming that their is an unending supply of medical care when in fact with an aging population their is going to be increased demand. Cutting benifits will add to shortages, rationing, rising prices and more cost being shifted to the patients who have paid into the Government insurance system for decades.

    Reality is we do have to have an honest debate. We may have to raise premiums, we may have to reduce what is covered, you may not be able to see any doctor you want, we may have to ration procedures. All very reasonable but the President and the Democrats are saying the exact opposite of that.

  11. #51
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    [QUOTE=Winstonbiggs;4005929]Now that I have nothing has changed. Reducing payments to a provider doesn't reduce cost. Think about for awhile.[/QUOTE]

    I believe you're thinking I mean the consumer, when i fact I'm referring to the cost of the Medicare program. If not, I have no idea what you're talking about. Will reducing the payment/reimbursement rate potentially increase cost to the consumer? Yes. It very well could. If it were up to me, I'd move entirely toward a capitation model for Medicare. But this would drive everyone to an HMO style plan. A flat rate would drive the provider to reduce unnecessary procedures to be cost effective. If someone wants to pay per procedure, let them. But let them also pay much higher premiums for the luxury of botique medicine. Americans hate the idea that their healthcare might be rationalized (as opposed to rationed), yet they abhor the costs. Can't have it both ways. Another alternative would be, as I've stated before, to expand the Federal Health Benefits program to anyone who wants to participate and is willing to pay the matching through employer or a COBRA. Let the FHIB negotiate with the participating insurers re eligibility and coverage and negotiate for the entire group with big pharma to reduce medication costs. It would be private but volume discounted. It would work.

  12. #52
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    [QUOTE=Warfish;4005901]
    Although (and you won't like this), the disabled benefits should be weighted on the wealth of the Guardians (if under age or in some other form disabled to the point of not being personally responsible). This is alos how I'd handle Social Security, with bennies being reduced based on a weighting of personal wealth.[/QUOTE]

    Fair enough point, but the only thing that many disabled people get until they are of age is medical benefits, no SSI, and that coverage is supplemental to primary insurance, not in place of it. So what you ask for is pretty much in place already. Truth be told, my daughter wouldn't be such a drain on the Medicaid rolls if there was insurance coverage in NYS for people with her condition.

    I think it's been said already a few times, but a big boost to cleaning this mess up would be insurance and tort reforms.

  13. #53
    [QUOTE=long island leprechaun;4006044]I believe you're thinking I mean the consumer, when i fact I'm referring to the cost of the Medicare program. If not, I have no idea what you're talking about. Will reducing the payment/reimbursement rate potentially increase cost to the consumer? Yes. It very well could. If it were up to me, I'd move entirely toward a capitation model for Medicare. But this would drive everyone to an HMO style plan. A flat rate would drive the provider to reduce unnecessary procedures to be cost effective. If someone wants to pay per procedure, let them. But let them also pay much higher premiums for the luxury of botique medicine. Americans hate the idea that their healthcare might be rationalized (as opposed to rationed), yet they abhor the costs. Can't have it both ways. Another alternative would be, as I've stated before, to expand the Federal Health Benefits program to anyone who wants to participate and is willing to pay the matching through employer or a COBRA. Let the FHIB negotiate with the participating insurers re eligibility and coverage and negotiate for the entire group with big pharma to reduce medication costs. It would be private but volume discounted. It would work.[/QUOTE]

    Good we agree Obama and the Democrats have been BSing the public that nothing is going to change with health care or Medicare.

    This might impact how the public views the social contract of Medicare and SS going forward when they stop reading his lips.

  14. #54
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    [QUOTE=Winstonbiggs;4006121]Good we agree Obama and the Democrats have been BSing the public that nothing is going to change with health care or Medicare.

    This might impact how the public views the social contract of Medicare and SS going forward when they stop reading his lips.[/QUOTE]

    Actually, they're all lying, including that phony, Ryan. What galls me about him is that he tries to hide behind a voucher scam while not touching defense. That is the Republican version of the big lie. The Democrats promise more but don't admit how much it will cost. That's why I actually prefer a commission. At least it will try to address the real issues, even though unpopular. How else can it get done? You sound like you are vested in Medicare so you don't want it to be negatively affected. Well, that's the problem with every program, especially the big ones. Everybody wants to keep feeding at the trough....

  15. #55
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    [QUOTE=Winstonbiggs;4005940]You are discounting the adjustment that is allready being made. Patient insurance will be dropped or the patient will have to make up the shortfall.

    My wife and I who allready have 8,000 in deductible and essentially use our Insurance company for the ratings have allready seen our providers dump out of our plan and others because of cut reimbursement.

    You are assuming that their is an unending supply of medical care when in fact with an aging population their is going to be increased demand. Cutting benifits will add to shortages, rationing, rising prices and more cost being shifted to the patients who have paid into the Government insurance system for decades.

    Reality is we do have to have an honest debate. We may have to raise premiums, we may have to reduce what is covered, you may not be able to see any doctor you want, we may have to ration procedures. All very reasonable but the President and the Democrats are saying the exact opposite of that.[/QUOTE]

    Medicine itself must undgo a change. 90% of medicine is management of very well know disease processes for which the cost of a specialist or even an MD is a waste. We will see many more NP's and PA's assuming the role that PC physicians play today at much better cost differentials and with actually better day to day care. If we try to maintain the extraordinarily costly regime of MD's only, we will be left with no healthcare at all in major areas of the country. Telehealth, and even webhealth will start to emerge as legitimate options. The old fashioned visit to the doctor will be revolutionized, if special interests don't kill it before it's born...

  16. #56
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    Simple question - why can't a panel such as this be comprised of publically elected medically trained experts/officials? Or voted in by Congress? If we made the requirements for the job strictly along medical lines, would that be so horrible?

  17. #57
    [QUOTE=JetPotato;4006997]Simple question - why can't a panel such as this be comprised of publically elected medically trained experts/officials? Or voted in by Congress? If we made the requirements for the job strictly along medical lines, would that be so horrible?[/QUOTE]

    What's the mission? To make sure best practices are followed or to cut the cost of treatment?

  18. #58
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    [QUOTE=Winstonbiggs;4007002]What's the mission? To make sure best practices are followed or to cut the cost of treatment?[/QUOTE]

    If best practices are followed and waste is cut, won't the cost of insurance go down?

  19. #59
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    [QUOTE=Jetworks;4005452]This will likely carry over to Medicaid (disabled) people as well. It's already started with the latest budget with the inclusion of Medicaid block grants.

    Since no one wants to put forth honest discussion here, I will. You know what would help in cost savings, especially when it comes to pharmaceuticals and medical devices? How about eliminating the reps throwing breakfast/lunch/dinners for the entire office/department when "pitching" their product? "That was some goooood chicken primavera. I think We'll go with your SSRI this month". Ethics, much? Eliminating that might make things more affordable and help in the decision-making process of whether a patient warrants the use of that product beyond the cost/worth treating consideration.

    Or maybe doctors could tell their unions to take a hike along with their hundreds of dollars in membership fees requirements, thereby allowing the physicians to roll that into their private practices instead? Seriously, why the hell does the medical community need unions (and no, they're not clubs or fraternal organizations, either)?

    If they really want to effect change, doctors could use their unions and demand better screening by the FDA when it comes to drugs that are put to market with inadequate testing, or maybe insist that the conflict of interest that is PDUFA be eliminated on ethical grounds. Both of these would drive up costs for safety and efficacy testing, but would pale in comparison to the amount of money spent on follow-up care and injury/death settlements that result from drugs that prove to be unsafe.

    There's plenty of good medical people out there, but there are a fair amount that are completely apathetic to what is best for their patient and that is a shame. I can honestly say that in my dealings with healthcare professionals I have been very fortunate, but there have been a few that were clearly nothing more than medical civil servants who made most of their decisions on what the bottom line would be, or worse, consensus.[/QUOTE]

    The anti-corporate attitude towards pharma is dumb - there is some sort of notion (probably orginating in lib academia/media) that pharma shouldn't market their products like other businesses can and do, let alone make profits. Sampling for approved drugs is allowed and regulated, as are advertising and marketing expenses. If a TV ad drives the use of an effective product, where's the harm?

    Most drs wouldnt and dont risk their licenses prescribing drugs solely on Ken & Barbie Sales Rep's say-so - given the limited amount of face time a $30 pizza or hero lunch w/ a 15-30 min marketing pitch to 5 drs and 5 staff in a group practice is informative and efficient - there are no quid pro quos or royalties for Rx written - key opinion leaders and drs involved in research drive the Rx-those are the ones receiviing the big bucks

    The marketing expenses are a drop in the bucket compared to the investment made in developing molecules-drugs don't make it to market if they don't pass clinical trials no matter how much money is spent

    However...thanks to aggressive aggregate spend legislation (VT, MN, MA, ME, PPACA) and concomitant public disclosure of pharma spend drs are reluctant to accept fees and gifts as they did before (even cheapo stuff like pens, coffee cups and other promotional tchotchkes)

    the days of cruises and golf outings are largely a thing of the past

  20. #60
    I am generally quite pro-business, and pro-freespeech.

    But I'm not a fan of Prescription Drug Advertising. I'd bad it, so guess I too am a hypocrite. :dunno:

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