Fundamental Differences

[Eidolon Faer]

Lurker...

Instead of finding the CPT code, I found a .PDF of a report ISSUED BY THE CBO, which says THE SAME THING I HAVE BEEN SAYING.

Are they 'arguing by anecdote' as well? The piece of the .PDF I quoted can be found on Page 3 of the report.

Basically, the report talks about the Sustainable Growth Rate Formula, a particularly-dumb law Congress enacted in 1998. Basically, if the Medicare spending budget goes up, Medicare just pays Health Care providers less to compensate. It's an automatic calculation, with no regard to what the procedures actually cost.

The past two years now, Congress has had to pass special exemptions from this rule to prevent the whole system from crashing down around their ears, but they haven't repealed the rule.

Tell your landlord "Gee, my cost of living has grown faster than my salary, so I'm only going to pay 75% of my rent this year." Let me know how that goes.

[Lurker]

I wasn't disregarding your CBO link, I was just talking about the specific test you mentioned because it's an interesting side issue.

And yeah, SGR has to go away. I talked about it last month and the reform bill in the House ends the practice. As I said, the reforms on the table address your concerns with Medicare. There's no reason to worry that the public option would emulate Medicare as it is now because Medicare will not be as it is now.

[Eidolon Faer]

And Ddrak...

You're right, an Appendectomy gets reimbursed the same amount no matter whether the Doctor is the best surgeon in the state, or a putz who graduated from Joe's Medical School last week. The way the Government tries to ensure quality is through a process of accreditation and inspection, similar to the way Health Inspectors monitor restaurants. (Nervous yet?)

This combination of fixed compensation and inspector-based quality assurance leads to a least-common-denominator approach to running hospitals that is extremely pernicious. It's not "what is the best way to do this?" but "what can we get away with?"

Congress has recently been toying with plans to incent quality in other ways, and the idea they've come up with can best be summarized by the line "the beatings will continue until morale improves." (link is to an editorial from the New England Journal of Medicine, and NOT a .PDF)

[Eidolon Faer]

Then Lurker...

WHEN Medicare is miraculously transformed by all these proposals grinding through Congressional Subcommittees into something other than a grinding, inexorable force of despair and destruction, THEN I will revise my opinion of its' value.

I am talking about what CURRENTLY EXISTS. The future has not been determined yet, and I find your childlike trust in the all-knowing benevolence of Congress to be deeply unsettling. They are, after all, the individuals who gave us our current Medicare reality. Also, Medicare is one of those "third rail" political entitlements. Anything that smacks of a real fundamental overhaul is going to need some very careful selling to the AARP crowd, as well as more political cojones than I would believe exist in all of DC.

[Lurker]

WHEN Medicare is miraculously transformed by all these proposals grinding through Congressional Subcommittees into something other than a grinding, inexorable force of despair and destruction, THEN I will revise my opinion of its' value.

Fair enough. Just be a little more honest about who recognizes the problems and what they are doing to address them.

AARP and the AMA have endorsed the House bill from the Tricomm committee. It's going to be tough to get a good bill through the Senate but it will be improved in conference committee. The biggest obstacle to a good reform bill are the people who want no reform bill at all. Why not direct a little anger their way.

[Eidolon Faer]

...which brings us back to the original point of this thread...

Several individuals on this board have characterized anyone who expresses doubt about the eventual outcome of the Health-Care Reform bandwagon as:

--Having been deceived by a vast Right-Wing Conspiracy
--Being MEMBERS of a Vast Right-Wing Conspiracy
--Being evil and wanting people to suffer
--Worshipping Richard Nixon's brain, which is being kept alive in a jar at the local Masonic Lodge

You get the idea.

In fact, earlier in this very thread, Lurker was getting quite testy with me when I dared to point out that Medicare, as it currently exists, is deeply flawed. He seemed outraged that I was willfully ignoring how great their cost savings were and how happy the patient satisfaction surveys were. (Wal-Mart also has low prices and happy customers.)


IF you are aware of the structural problems with Medicare (which have not been a deep dark secret if you work in health care or talk to someone who does) and you're familiar with Congress' track record on entitlement programs in general, you don't need to be chanting hymns to Nixon at the Masonic Temple to harbor severe doubts as to the eventual outcome of all this Health Care mania.

Especially if you weren't aware of the advice coming from institutions like the Mayo Clinic, or if some of this stuff is over your head.

And, if you harbor severe doubts about an uncertain future, the conservative mindset instinctively wants to make change slowly, carefully, in a stepwise fashion, testing outcomes and revising plans at each step of the way. Better no change at all, than a catastrophically bad one.

[Lurker]

Did I seem outraged? I wasn't.

And the goal of the "conservatives" in this instance isn't to move slowly; it's to kill health care reform. And they aren't above lying to do it.

Conservatives have no problem proposing and making drastic, radical, untested changes to things when it fits their ideological vision. Hell, they take policies that are proven failures and suggest we do the same thing only bigger as solutions for a range of issues. I don't see any slow, careful, stepwise fashion, testing outcomes and revising plans out of the Republican party going back decades. Where did you come up with that one?

[Eidolon Faer]

And the goal of the "conservatives" in this instance isn't to move slowly; it's to kill health care reform. And they aren't above lying to do it.

All Hail Nixon. I'll leave it to the readers to judge your intent, if and when they bother to scroll up. And Liberals want to expand all kinds of proven failures that fit their idealogy as well.

If you want to sell this to conservative voters, I've just handed you a roadmap as to how to do it. Acknowledge Medicare's issues, explain how you're addressing the issues in terms the average voter can wrap his head around, and take it in stages.

All this "subcommittee this" and "alphabet-soup-commission that" sounds great to a process-oriented liberal mindset, but to a conservative who's more interested in outcomes all that BS gets filtered down to "Obama says the way to fix all the problems with Wal-Mart is to make it EVEN BIGGER!"

[Eidolon Faer]

I don't see any slow, careful, stepwise fashion, testing outcomes and revising plans out of the Republican party going back decades. Where did you come up with that one?

Republican != Conservative

[Lurker]

We have to get bills out of committee before we can sell them to the public.

Do you agree that Obama has spoken out against fee-for-service and wants to emulate places with proven track records, like the Mayo Clinic? Do you agree that the bills in committee recognize and address some major issues with Medicare? Do you agree that the Republicans and anti-reform groups are using demonstrable lies, not concern about outcome but lies about what's being proposed, to speak out against reform?

Republican != Conservative

Republicans are what we're stuck with.

[Eidolon Faer]

So far, yes, the blather coming out of DC has been uncommonly reasonable, sane, and hopeful. The only relevant item, however, is the text of the bill that gets put in front of Obama for his signature.

Congress still has plenty of chances to fuck this up.

And, I agree that being stuck with Republicans is unfortunate. Come to think of it, you have my sympathies for being stuck with Democrats as well.

[Lurker]

I'll trade you Harry Reid for just about anyone.

The problem with the Democrats on the health reform issue is that they are likely to cave just enough to the people who want no reform whatsoever that we end up with a bad bill. I do trust Obama and he is saying the right things on the reform issue. I think we'll get a good bill out of conference committee after the House and Senate pass their versions. As I said, the biggest obstacle to that are Dems caving to the anti-reform crowd but still passing a bill.

[Eidolon Faer]

As I said, Congress still has plenty of chances to fuck this up.

In fact, from a Game-Theory point of view, fucked-up outcomes are the odds-on favorite.

You see, if one "team" is going to get credit for a bill, it's in the other team's interest to poison that bill. If they can't stop it, they can tack on changes that turn it into an unmitigated disaster. Then they say "look at how bad that bill (other team) passed two years ago has turned into a disaster! Vote us!"

And, if you're honest, you'll see that both parties do this.

[Eidolon Faer]

Speaking of which, I live in Minnesota.

Do you think we could talk to Iran and give them Al Franken in exchange for Ahmedinijad?

[Eidolon Faer]

Another possible outcome is that all this ends with a fizzle.

Dems deliberately allow the bill to fail, then say "We tried, but those evil big oil insurance types were just too powerful and evil. Vote us!" It might be a hard sell with a filibuster-proof supermajority, but nobody ever went broke underestimating voter intelligence.

[Embar Angylwrath]

Another possible outcome is that all this ends with a fizzle.

Dems deliberately allow the bill to fail, then say "We tried, but those evil big oil insurance types were just too powerful and evil. Vote us!" It might be a hard sell with a filibuster-proof supermajority, but nobody ever went broke underestimating voter intelligence.

Personally, I think this is where its headed. There will be no substantive change. The Dems have already backed off off two key Obama positions: Protecting employee health benefits is no longer sacrosanct and 2) they seem to be abandoning the public option

[Partha]

And, if you harbor severe doubts about an uncertain future, the conservative mindset instinctively wants to make change slowly, carefully, in a stepwise fashion, testing outcomes and revising plans at each step of the way.

Like the Iraq War. Righto.

[Eidolon Faer]

Personally, I think this is where its headed. There will be no substantive change. The Dems have already backed off off two key Obama positions: Protecting employee health benefits is no longer sacrosanct and 2) they seem to be abandoning the public option

What makes me think this is likely: are the Democrat mouthpieces trying to make their case to the voters about the reality of the plan, or are they screaming about how the evil right-ringers are opposing them? Are they setting themselves up to succeed or to fail?

Partha gets his opinions beamed into his empty skull every night by the DNC satellites. Let's ask him.

[Lurker]

The Democratic plans coming out of the committees are "uncommonly reasonable, sane, and hopeful", and yes, they are doing their best to inform people about the plans in the face of a neverending stream of moronic misinformation like, "Obama wants to kill grandma!!!"

[Eidolon Faer]

You're not reassuring me, Lurker.