Monday, November 22, 2010

Not fixing the Doc Fix

Remember the shenanigans concerning the so-called Doc Fix perpetrated by the Democrats in their efforts to pass ObamaCare? The Democrats needed to do something to fix the Medicare payments to physicians but they didn't want to add the fix to ObamaCare because that would add $250 billion to the cost of the bill and expose the fantasy that ObamaCare would actually save money. So they promised that they'd pass it in a separate bill in order ot win the AMA endorsement for ObamaCare. But then they never got around to passing it. Now they're passing a "fix" that will last only until the end of the year. So they'll dump the whole morass onto the laps of the new Congress.
But Democrats left a permanent fix out of the final ObamaCare bill in order to keep the official price tag below $1 trillion. Democrats planned to pass the $250 billion "doc fix" later in a separate bill, but somehow they never got around to it. Even liberals can't always conjure up a quarter-trillion dollars on demand, and some Democrats wanted the fix "paid for" with other spending cuts, real or invented.

The result has been a string of temporary last-minute reprieves. This will be the fourth this year, which is even worse than the annual "doc fix" fire drill that prevailed under both Democrats and Republicans until ObamaCare sopped up all the easy budget money. The Senate's latest one-month version costs $1 billion and is paid for by claiming to reduce certain outpatient therapy payments by about $100 million each year for the next decade. Anyone willing to bet on whether those cuts will ever happen? We'll take the "no" side of that wager.

In sum, Democrats deceived the AMA about the doc fix and are now deceiving voters about how they'll pay for even this four-week reprieve. And they're dumping the $250 billion bill on Republicans.
Add this unfixed problem to the budget that the Democrats still haven't passed on the list of tasks undone by Democratic Congress. It is well past time for a real fix instead of these month-to-month band-aids.
This doctor-payment charade has served both parties since it was created in 1997 as a palm-greaser for campaign contributions and to disguise the real costs of Medicare as part of the Bill Clinton-Newt Gingrich balanced budget deal. But these Democratic abuses are something else. Three of the four stopgaps this year have passed after the deadline set by the previous stopgap, so for a time Medicare simply stopped paying doctors, causing back-office disruptions nationwide. Imagine if a private insurer pulled these stunts.

A more stable payment system that reflects the real costs of delivering medical care while reining in federal health spending would mean dumping the Medicare price-control model that has led to the current mess. A good place to start are Wisconsin Republican Paul Ryan's Medicare reform ideas, which were endorsed last week by no less than the long-time Democratic budget hand Alice Rivlin. Maybe now that the AMA has been exposed as fools one more time, its new leaders will support genuine reform.
We've been playing games with Medicare payments to doctors for too long. Both parties are guilty. The supposedly comprehensive ObamaCare package ignored the problem. It's time for an adult approach rather than the political pass-the-buck game that is well past its due date.


Rick Caird said...

The games Pelosi, Reid, and the rest of the Democrats have played with Medicare are beyond belief. The very fact the Doc Fix was not included in the health Care bill is just another example of the lies that were used to pass this monstrosity of a bill.

Not only do we have the failure to pass the Doc Fix, we have the double counting of these elusive Medicare "savings" which uses the same money to both pay for coverage for people who do not have coverage and uses the same "savings" to extend Medicare. But, it is all an illusion. Without the "Doc Fix", doctors are being asked to provide services for less than the cost of the service. No one makes a career out of working for free, so expect doctors to stop taking Medicare. Then you will hear the screams.

With Medicare, the government took over all of the over 65 health care market. So, for seniors there will be only two options: pay for it yourself or try to find someone who will take Medicare. That is the kind of "help" we get from Democrats. Never trust government to honor its promises.

Tacitus Voltaire said...

No. Sorry to burst your bubble, but anyone who guarantees that your average stock market return will be 8% is lying to you. Even most of the experts touting that figure are merely repeating the claim made by other experts. Except that it’s not the whole story.

The Average Stock Market Return Depends on the Period
A few years ago, a magazine (probably Money) demonstrated that you can make the average stock market return be any number you want, depending on the period you choose. You could choose a decade with an average 20% return, which would certainly prove that the market is a winner. Some people say 8% since World War II. Many cite 1926-2000. Other cite 1980-2007.

The Average Return Depends on the Stocks
In addition to the chosen period determining the average return, so do the stocks chosen. Some experts cite the S&P 500, others look to the total US market, some include international stocks, too. Whatever number you want, you can find some segment of the market to provide it.

According to Money, the Vanguard Total Stock Market Fund returned 3.5% for the last ten years. The S&P 500 index returned 2.9%, or zero after inflation.

Tacitus Voltaire said...

results of chile's privatization of its social security scheme:

american workers pay 6.2% of their paycheck (up to the first $106,800 of income) into the ss trust fund and get a guaranteed payback that has always paid all promised benefits since the system was inaugurated in the 30s. chilean workers must contribute at least 10%, and this amount may go up depending on when they plan to retire. the unreliability of this system, where as many as 30% of workers didn't have sufficient minimum earnings to contribute enough for a sufficient annuity, have led to revisions as of 2008 that put the system back to a socialized basis, returning it to a state where it resembles the american system

The 2008 reform addressed coverage concerns by introducing a universal pension paid to all Chileans over the age of 65 regardless of their contribution history. In addition, workers with small pensions from their individual accounts will have them topped up by the government.

Tacitus Voltaire said...

With Medicare, the government took over all of the over 65 health care market. So, for seniors there will be only two options: pay for it yourself or try to find someone who will take Medicare.

that's a very "interesting" statement considering that every morning i hear advertisements for supplimental medicare insurance from aarp on t.v.

AARP Medicare Supplement Insurance

Discover more about AARP Medicare Supplement Insurance Plans, insured by UnitedHealthcare Insurance Company. Call toll-free 1-866-438-1538 Code: 3ST or enter your information below to have an information package mailed to you.
Why you may need it:

Medicare doesn’t pay for all of the costs of hospital and medical care. Consider an AARP Medicare Supplement Plan to help pay for some of these costs.

Tacitus Voltaire said...

Not fixing the Doc Fix

what's this? complaining that the government doesn't pay enough socialistic medicare? what about the republicans plan to cut the budget and privatize everything?

seriously, of course this needs to be fixed. i guess meaningful and practical suggestions are okay when it means an opportunity to criticize democrats, even if you have to abandon your budget balancing and free market myths for a few minutes

Rick Caird said...


All those supplemental or Medicare Advantage programs require you to have Medicare first. You cannot go the United Health Care and tell them you are over 65 and want a stand alone health care policy.

Why is that so hard for you understand. Are you just trying to be dense or is that your default position?

My claim stands.

Rick Caird said...

While you are completely off topic, you should note you are confusing a welfare component with socialism. The pension reforms in Chile are designed to increase the tier 1 pensions, but there is nothing that indicates some people's contributions are being taken and given to other people as the US Social Security System actually does.

In the US, the SS returns are only loosely correlated to the contribution. You want to make it even less so by raising the maximums without raising the commensurate benefits. You want socialism. Chile chose welfare.