<p>^^spoken like a lawyer. :)</p>
<p>If a cost reduction is only a figment of Congress’s imagination is it REAL? If it reduces costs of hundreds of items a few pennies while raising the the total costs by billions, is that (true) cost-control? Puhleeze…</p>
<p>The bill will 1.) cut some costs, 2.) raise revenue, 3.) raise other costs.</p>
<p>CBO’s best judgment is that 1 + 2 > 3. If CBO proves correct, then the bill will have actually lowered the deficit, albeit partly by raising taxes.</p>
<p>I happen to think this judgment is pretty severely naive. But it is wrong to say that cost reduction is “only a figment of Congress’s imagination,” or that it will only reduce costs “a few pennies.” Cost reduction in this bill is real and genuine, and CBO actually thinks it’s larger than the spending increases.</p>
<p>Again, I disagree with CBO on this point. But there’s no sense getting caught up in heated rhetoric about “zero” and “figment of imagination” and “pennies.”</p>
<p>Fair enough. “Heated rhetoric” was not my intent. </p>
<p>But each and every year Congress passes a total Medicare budget with significant doc cuts in it ($500xx), and then each and every year Congress passes a separate bill to over-ride those cuts. So in that sense, the cuts in the first bill are “real” and become law (if only for a short time), but they truly are only a figment of anyone’s imagination bcos everyone “knows” that Congress will then over-ride that cut later. And Congress does. </p>
<p>Of course, those same “cuts” to providers, primarily docs, are in the current health care bill that was signed into law. For their support, the AMA got a ‘wink and a nod’ that Congress would eliminate those “cuts” later. So, yes, the cuts are there and they are real – for a short time, but if it walks like a duck and quacks like a duck…the point is that no one in DC believes that such cut will remain. They will be over-ridden; they have to (or docs will refuse to take on government-sponsored patients).</p>
<p>Even the head of the CBO said that he did not think it was likely that such cuts would remain. But, his marching orders were to use that assumption and they did. Thus, you are not really disagreeing with CBO, but the assumptions that Congress mandated that they use. </p>
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<p>I haven’s seen any real, practical evidence to assume that to be true. (Is that less heated?)</p>
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<p>fwiw: our California state-approved insurance costs show a 6.5:1 ratio in age-based pricing (60+ vs a 24 year-old). Obviously, any blended rate is going to significantly increase the price to the soon-to-be college grads.</p>
<p>These are all fair points. Even if the cuts as listed remain in place – and actually I do not think they are part of this bill; I believe they’re part of the Medicare schedule, which would be separate – I still don’t think the bill will actually be deficit reducing.</p>
<p>In other words, I think CBO is wrong on the merits, not just using faulty assumptions. Faulty instructions, of course, would compound the problem.</p>
<p>The government forcing people to buy auto insurance is my analogy, not the prof’s analogy. And I have not taken a course on macro economics in college :D</p>
<p>^Pretty sure the states require people to buy car insurance if you are driving, not the federal government.</p>
<p>Fair point. That’s a fourth difference. (4) The mandate is enforced by states, not the IRS.</p>
<p>It seems to me this bill, although not perfect, is better than the status quo. A lot of the posters in this thread seem to agree. Why then, is there such widespread opposition to healthcare reform from physicians?</p>
<p>I think an SDN poll, though I’m too lazy to pull it up, showed that most members of the forum disagreed with the current healthcare reform.</p>
<p>Well, the American public in general was very against it. And then it passed and about 15% of the American public decided that they were actually for it. So now public opinion is roughly split, if memory serves.</p>
<p>The bill received a lot of attention at the same time as Obama began talking about fee cuts to physicians. So a lot of people think those fee cuts are part of the bill, which (so far as I can tell) they aren’t.</p>
<p>More rationally, physicians in general fear the expansion of government power, and the fee cuts are part of the reason why. This bill most certainly does expand government power – exchanges, mandates, and a Medicaid expansion.</p>
<p>On the other hand, a rise in the number of insureds should increase demand for physicians’ services, so this should be good for business.</p>
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<p>Finally, do remember that the AMA actually did support the bill. So it’s not as if that many physicians were against it.</p>
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Won’t it increase patient load at a time when there are already too many patients for not enough reimbursement? The picture of the overworked PCP comes to mind.</p>
<p>I let my mind slip back into a normal market economy. You’re right – it’s not as if high demand actually brings in more revenue in this world.</p>
<p>The one thing it does is it reduces the number of uninsured patients who simply don’t pay at all.</p>
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The AMA only represents a minority (22%) of physicians in the US. Approximately 30% of the AMA membership is made up of students, residents and fellows; Only 50% of the AMA members are practicing physicians.</p>
<p>Most practicing physicians oppose the bill.</p>
<p>[Obama-care</a> Means 1/3 Fewer Doctors?](<a href=“http://sweetness-light.com/archive/obama-care-to-mean-13rd-fewer-doctors]Obama-care”>sweetness-light.com)</p>
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<p>Not a physician, but I predict a definite reduction in physician’s salaries over the next decade or so. It will HAVE to happen. Medicaid/Medicare will both continue to reduce their costs over time and the only two ways to accomplish that is to reduce/limit/cap coverage (whatever term is not heated), and/or reduce/limit/cap reimbursement rates. Of course both methods hit the physicians in the pocketbook.</p>
<p>bluebayou</p>
<p>Medicare and medicaid reimbursement rates for physicians are already poor - that’s why physicians limit the number of medicare and medicaid patients they see. Some large insurance programs base their reimbursement on the Medicare pay scale, so low Medicare rates affect total compensation in a disproportionate fashion. Finally, although Federal law mandates medicaid coverage and eligibility, state governments must finance the a substantantial fraction of medicaid spending. Since the state governments are strapped for cash, the only way to cover larger medicaid rolls is to shave reimbursement to physicians.</p>
<p>See [Medicaid’s</a> Continuing Crunch In a Recession: A Mid-Year Update for State FY 2010 and Preview for FY 2011 - Kaiser Family Foundation](<a href=“http://www.kff.org/medicaid/8049.cfm]Medicaid’s”>Medicaid's Continuing Crunch In a Recession: A Mid-Year Update for State FY 2010 and Preview for FY 2011 | KFF)</p>
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<p>Yeah, I know all that – (I spent 20+ years in health care finance). I purposely included the word “continuing” in my statement bcos, IMO, the “poor” reimbursement rates will only continue to get worse. And future MD’s ought be wary.</p>
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<p>[New</a> York an Insurance Lab on Skyrocketing Rates - NYTimes.com](<a href=“http://www.nytimes.com/2010/04/18/nyregion/18insure.html?hp]New”>http://www.nytimes.com/2010/04/18/nyregion/18insure.html?hp)</p>
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[Short-Term</a> Medicaid Rate Hike Breeds Long-Term Concerns The Washington Independent](<a href=“http://washingtonindependent.com/81144/short-term-medicaid-rate-hike-breeds-long-term-concerns]Short-Term”>http://washingtonindependent.com/81144/short-term-medicaid-rate-hike-breeds-long-term-concerns)</p>
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<p>Hi Bayou – I’m fully in agreement with your analysis here. I’m trying to write it up as part of a research paper as we speak. Do you happen to have any good citations?</p>
<p>Particularly useful would be:
(1) Examples of these cuts happening in the past,
(2) A statement from the AMA implying that these cuts were not credible,
(3) Elmendorf (head of CBO) giving the statement you’re referring to.</p>
<p>I read the official CBO report and it seems to hint strongly about #3 – strongly enough that I could probably use that, actually. But do you happen to have any explicit statements from Elmendorf to this effect?</p>
<p>medicare cuts for oncologists:</p>
<p>[Grin</a> and bear it: Oncologists find reason to smile about Medicare cuts - Cancer Network](<a href=“http://www.cancernetwork.com/news/display/article/10165/1492337]Grin”>http://www.cancernetwork.com/news/display/article/10165/1492337)</p>
<p>doc fix, or lack thereof – been around since '87.</p>
<p>"The Sustainable Growth Rate imposes automatic cuts in Medicare payment rates to doctors.</p>
<p>For several years, fearing a revolt by doctors — and seniors — Congress has suspended those cuts." </p>
<p>[Medicare</a> Doctors Feeling Pressured To Support Overhaul - IBD - Investors.com](<a href=“http://www.investors.com/NewsAndAnalysis/Article.aspx?id=526948&Ntt=doc+fix+david]Medicare”>http://www.investors.com/NewsAndAnalysis/Article.aspx?id=526948&Ntt=doc+fix+david)</p>
<p><a href=“http://www.washingtonexaminer.com/opinion/blogs/beltway-confidential/With-Doc-Fix-Dems-health-plan-would-increase-deficit-by-59-billion---88720687.html[/url]”>http://www.washingtonexaminer.com/opinion/blogs/beltway-confidential/With-Doc-Fix-Dems-health-plan-would-increase-deficit-by-59-billion---88720687.html</a></p>
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<p><a href=“http://money.cnn.com/2010/03/12/news/economy/debt_health_care.fortune/index.htm[/url]”>http://money.cnn.com/2010/03/12/news/economy/debt_health_care.fortune/index.htm</a></p>
<p>I want to know why the government isn’t planning on subsidizing medical education and malpractice and other costs that physicians incur by practicing if they’re cutting salaries. Why yes I suppose that would raise costs for them, but by cutting payments to physicians and not subsidizing the education they have to repay, then they’re essentially putting an extra portion of the burden on the physicians ON TOP of the tax and insurance premium increases they’re going to undergo along with everyone else.</p>
<p>I personally think a good salary is something a physician deserves. They’ve worked really hard, gone way in to debt (usually) for their education, and they work a difficult job. A lot of people argue that physicians over in Europe don’t earn what American doctors earn, but I also believe they get more in terms of things like subsidized malpractice insurance and cheaper schooling. I’m not certain about those things, so someone should correct me if need be, but I believe it’s true to some extent.</p>
<p>While this may be good for improving the health of Americans short and medium term, I think it’s going to devastate the profession in the long term unless some concessions are made. Becoming (and being) a doctor is already daunting as it is. If you screw physicians over even more, then you’re just going to lower the quality of care in the long run.</p>