1

Hey, they're trying to save the world, so shut the fuck up.

2

Our new toltalitarian government, wake the fuck up people

Car czar:  will tell us what cars to buy

Health czar:  ration healthcare

Food czar:  tied to health czar, you want healthcare?...Eat what we tell you to eat.  And, no more wine, coffee, pork products for you! 

Pay czar:  Will tell you how much your getting, after we take most of it.

This shit is getting really scary. 

3

these "scoreable" shorter-term cuts include

reducing overpayments to Medicare Advantage private insurers; strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud and abuse

What this translates to is more gov't bureaucrats cutting the amount of money going to health care providers. They may very well cut some waste, but there will be unintended consequences (in addition to the intended consequence of more gov't workers). Doctors will give up and stop practising due to paperwork overload, some hospitals on the edge may shut down.

steps such as health IT, research into what works and what doesn’t, prevention and wellness, and changes in incentives so that Americans get the best care not just more care. 

As if this hasn't been going on for a long time. How can you suddenly jump it forward except by spending a lot of money?

4 It's not about fixing things as they exist, it's about creating new things that will advance an agenda. Why put people under house arrest (Medicare) when you can put them in supermax (socialized health care)?

5

Funny, but this kind of shit is the same kind of shit in Goldberg's book on Liberal Fascism.

Go figure, I woulda NEVER fuckin guessed this would happen in the Barry Era, never.

6 This Medicare savings idea is the biggest crock of shit ever.  From what I've read, Mr. Orszag and his staff of geniuses have determined that some states spend alot more on Medicare than other states, so why not just make them be as efficient as, oh, say a state like Wyoming.  Then grab up all that saved money and use it to pay for Universal Health Care. 

Except the states that spend a lot more on Medicare are the states that have a lot more older people and retirees or that have large regional health care institutions or both.  Like New York, Texas and Florida.  And Medicare is for people over 65 and all.  And the largest health care expenditure that most individuals make is in the last year of their life.

And not a word from the MSM on how Obama is going to tinker with Medicare.  Old people should be afraid.  This time it's real.

7 Obama doesnt want reform, he and the Dems want to get their hands on the funds.

8

It's not about fixing things as they exist, it's about creating new things that will advance an agenda.

Hey, I didn't go all-in with this goon for nothing.

9 Why does BHO want to drag us down to the same poor health care that the rest of the EU has? Does he hate the U.S. that much? Does BHO even know what he is doing. He most likely is clueless. All he knows is how to read a speach really well, and take his daily ride in AIR FORCE ONE.

10

@3 - I wonder if they are referring to Bush's Deficit Reduction Act 2005 & the Medicare RACs (onsite audits to determine medical neccessity and appropriate payment based on coding and physician documentation)?  Of course, this bill passed four years ago and the government's RAC contractors are just now getting out of DC and into your neighborhood hospitals.  Also the repayment money they recieve from these audits will only be a onetime deal.  It will not be addressing the bigger problem that is Medicare. 

I am an RN and work from home auditing medical claims against documentation and coding.  Medicare/Medicaid rules are so complex that I wonder how hospitals and physicians stay in business.  Plus most private payors follow these Medicare rules at least in some degree.  Medicare needs to be fixed first, imho. 

 

11 Because only Barry's genius can fix healthcare. Look at the great job he's already done with funemployment.

12  All he knows is how to read a speach really well, and take his daily ride in AIR FORCE ONE.

Spurwing Plover, is that you?

13

Why does BHO want to drag us down to the same poor health care that the rest of the EU has?

Because he's never actually earned a dollar?  Because his mushy, molly-coddled little ass has been protected and pushed along by a combination of richy-rich grandparents, corrupt political machinations, and institutionalized racism during his entire accomplishment-free life?

A guy who has done nothing gets a huge advance to have a domestic terrorist write a memoir describing that nothing in endless streams of purple prose, and you're expecting him to have some perspective and, dare I say, humility when approaching one-seventh of the world's largest economy?

He doesn't care.  He's a weak-minded, self-righteous, amoral fool without a single original thought to his name.  Tan Caligula and the First Sasquatch have never wanted for anything, nor will they no matter how much more ruination they inflict on this nation they so clearly detest.

Happy Quatro de Cinco!

14

He does promise further "dialog," though.

In other words, he and the MSM need to re-calibrate on the lies to be told.

15

Government will never fix anything because it works better, from a certain perspective, when it is actually broken.

16

Because he's never actually earned a dollar?  Because his mushy, molly-coddled little ass has been protected and pushed along by a combination of richy-rich grandparents, corrupt political machinations, and institutionalized racism during his entire accomplishment-free life?

A guy who has done nothing gets a huge advance to have a domestic terrorist write a memoir describing that nothing in endless streams of purple prose, and you're expecting him to have some perspective and, dare I say, humility when approaching one-seventh of the world's largest economy?

He doesn't care.  He's a weak-minded, self-righteous, amoral fool without a single original thought to his name.  Tan Caligula and the First Sasquatch have never wanted for anything, nor will they no matter how much more ruination they inflict on this nation they so clearly detest.

Happy Quatro de Cinco!

Posted by: VJay at June 10, 2009 03:10 PM (gQ+XA)

 

That gets a standing ovation from me. Well put.

17

***--The "game changers," as described by Orszag, include

steps such as health IT, research into what works and what doesn’t, prevention and wellness, and changes in incentives so that Americans get the best care not just more care.

So let's see...

Health IT?  We already have that.

"Research into what works and what doesn't"?  Hell we have a gigantic federal agency (National Institutes of Health) which already does this.  We don't need no stinkin' socialized medicine to get more research.

"Prevention and wellness"?  Private health insurers already incentivize this.

"Changes in incentives"?  Now there's the Orwellian part.  You vill put down ze cheeseburger and eat ze apple or you vill face ze consequences!

So if I understand Mr. Orszag correctly, the real "game-changing" part of socialized medicine will be for the government to use health care as a carrot to change people's behavior.  It will be the nanny state run amok.

18 Reform and change are all the same words to BHO. He said it himself .Words, just Words.

19 I'm a R.N. who works in a hospital who went to all electronic records about a year and a half ago (we were trying to stay ahead of the curve because our administration could see how reimbursement could be tied to utilizing this technology).  The process has been painful and very expensive.  We use a system called EPIC which is a very bad platform for charting in the O.R. where I work.  Basically, the circulator nurse (the non sterile person who isn't scrubbed in at the field) who is responsible for all the documentation and taking care of the patient and the team and providing them with all the supplies etc they need is now focused on a computer instead of the patient.  Previously, the O.R. used electronic charting that had been created specifically for that area and it was very simple and intuitive.  Because we all need to be in the same system, we are using something that may be fine in other areas but is cumbersome and tedious for our application.  I hate when Obama and other Democrats tout the great benefits of electronic charting and bogus stats about how much money it saves.  These systems are very expensive and it takes an act of God to get things changed to facilitate ease of use. 

20

here is how to defeat proposed socialized medicine.  talk about it in terms of breast cancer.

our country has the best detection, treatment & cure rates, far & away better than all the other developed nations who, by the way, have some form of socialized medicine.

this will get out the women to protest against nationalized medicine.

if this sounds like exploitation, i'm sorry.  so far, i'm the only woman in my family who has Not had breast cancer & if i get it, i want the best treatment.

21

encouraging physicians to form "accountable care organizations" to improve the quality of care for Medicare patients ....

 

And not a goddam word about tort reform. Eat me, Barry.

22 I feal real sorry for any service person who needs any special care in the national health care of BHO. By the way, how is V.A.  doing lately?

23 I posted this on an earlier thread about this Health Care reform shit and did not get an answer - anyone have any ideas:

If single payer is the godsend of administrative savings, cannot the same savings be achieved by granting the insurers an anti-trust exemption to integrate their various front end mechanisms to the providers.  Congress would still get to play around with the edges of the system due to the need to reauthorize the waiver, but the executive branch would be SOL.

24 The Federal Government has been running both Medicare for the elderly and Medicaid for the poor for fifty (50) years.  Both programs are riddled with waste and fraud from top to bottom.  Physician nationwide often refuse to take Medicare or Medicaid patients specifically because these programs pay far less than other insurance and often take more than an entire year to pay the bill. 

I ask you:  if the government cannot manage the health care programs that it already runs efficiently, how on earth can we possibly believe that giving them total control of the health care industry - more than 17% of our nation's economy - will make them more efficient managers?

Say NO to government run health care!

25 @23 Jean

Nearly all of the "problems" with our healthcare system are the behavioral, moral-hazard problems you get when transactions are done with other people's money.

The remainder of the "problems" are covered by the fact that the power to regulate is the power to enrich through graft.  What you call "play[ing] around the edges" can more accurately be described as either selling influence or buying votes.  It is not just the federal government that regulates insurance--the states have their own thumbs in the pie.

Single-payer is in the opposite direction of where we need to go.  The administrative costs argument is specious.  Even if a single entity--either the government or your proposed trust--were in charge of delivering all care, there would still need to be an accounting of every transaction that occurs or else the amount of theft from the system would be epic.

26 I guess that you have to get better with one advil or you too get tossed under the obamabus and left to die, that sort of Joe Stalin policy would do the trick for him.

27 "He does promise further "dialog," though."

Like Kerry promised to release "all" his military records?  Like Chris Dodd promised to release "all" his mortagage information?  Like Nancy Pelosi promised "the most open, the most honest, the most ethical Congress, evah?  Like all the things Obama promised (sorry have lost track of all of them, including the one's thrown under the bus.

Was it that kind of promise?  I'll hold my breath while I wait.

28

MikeO

I agree the supply/demand disconnect is significant.
But, every Liberal talking head seems to hold out adminstrativ
e savings as the solution.

I was not proposing a trust, but a commercial joint venture that would reduce duplicity and provider costs. Industry could do it faster and cheaper then Uncle Sugar.
Then worry about correcting the psyche.

29 @28 Jean

I understand what you are asking and suggesting.  My response is that the administrative costs argument is total crap for two reasons:

1.  It doesn't address the real problem rooted in moral hazard

2.  No matter what, there has to be an accounting because the alternative is that the public will be robbed blind

I think the left advances the argument because it is a seductive form of the fallacy of composition in the sense that it pinches-off an ostensibly facile piece of a very complex subject and puts it in terms that any casual observer can understand.  I intend no offense to you whatsoever when I say this next part:  This is akin to flattery in that the observer will congratulate himself over his mastery of the diversionary argument and will need to force himself from the comfort of that mastery to explore other areas of the subject about which he may not be so certain. 

30 @28 Jean,

Also, I don't think the psyches need to be corrected. 

We need to stop doing the things we do that pervert the incentives.

31
MikeO

I don't disagree with you. But, can industry make a counter-proposal that disarms the Left. Achieve the savings they extol, while avoiding the morass of Government administration.

32 Jean,

No.  In my opinion, countering that argument on the fallacious terms is wasted effort.

The administrative overhead "nightmare" stems mostly from the regulations that are the flip-side of the Medicare/Medicaid coin.

The correct response to this fallacy is this:

What is the nature of this administrative overhead nightmare? 

The nature of the administrative overhead nightmare is the paperwork needed to make sure that the i's are dotted and the t's crossed.

Is it a good idea not to have the controls in place to make sure that the i's are dotted and the t's crossed?

No.  If we don't dot the i's and cross the t's, then either the care will be done wrong, or fraud will rob the system blind.

Now that we've established that the administrative overhead nightmare is necessary to the function of the system, does any lefty honestly believe that the for-profit insurers and providers that the left so loves to characterize as greedy, heartless capitalist pigs would be so inefficient as to waste money on any paper-shuffling that could be avoided?

33 Jean,

Nuts!  I just realized that I am not addressing what you are saying.  Sorry.

I don't think that there is any meaningful benefit from consolidating the administrative infrastructure across insurers and providers.  I believe this to be the case because I think that the nature of the administrative overhead is driven by the incidence of patient visits and the discrete events that comprise the delivery of care.

34 MikeO,

It doesn't matter if they (the providers and insurers) can actually save money, they have to fight the perception created by the Left that money can be saved in Administrative and IT solutions.  If they can implement "Single Payer" independent of the Government, then house of cards comes crashing down.

The real numbers are too complex for the public to digest.  [This is a function of the current system in which price (value information) is separated from the incurring of the cost.] The perception of hundreds of forms and all of those letters from your insurer for $5 co-pays creates a strong impression.  Add to that the AMA saying it matters, and you have a "crisis" that can be exploited. 

I want to de-link the paperwork "crisis" and the un-insured "crisis".

The other meme I think that can be attacked is the number of uninsured.  The tactic would be to understate the cost burden by insisting on the use of the real number of uninsured.  The Left would be arguing for a vastly larger number or have to accept the reduced "need" for coverage.  Add to that the question of coverage for illegals and you have a powerful message.

35 BTW, I have a little periphery experience in this having been associated with an attempt to implement an EDI X12 interface back in the 90's.  The private business case was just too complex back then; but the specter of Uncle Sam stepping in could be enough to get the insurers to play nice.

36
If they can implement "Single Payer" independent of the Government, then house of cards comes crashing down.

Jean,

IF single-payer could actually work, I'm afraid that I would be on the side of nationalizing healthcare.  I'm sorry, but it would be a no-brainer, and I would be evil or stupid not to get on board with the idea.

But it won't work, and I know why it won't work.  It actually magnifies the moral hazard effects that we have now until whatever jury-rigged controls we enact to control it lead to rationing.

If Obama wants us all to board a bus so that he can drive us over a cliff, jumping into my car to drive myself over the cliff first is not the proper response.

The administrative overhead fallacy may seem reasonable, but it is not.  It is a diversion, and it needs to be ridiculed.

If you want to attack some memes, then ask why it is that there is so much paperwork involved with the forms and the co-pay notices.  Would they rather that everything be played fast-and-loose and have somebody else making claims for care under their names?  Unfortunately, the moral hazard of spending other people's money probably makes them not care that much.

Another approach is to counter with a class-warfare argument of your own by asking people directly whether their own coverage is acceptable.  If it is, then what in the hell are they worried about?

My coverage has always been better than acceptable, and I spent many years paying for it out of my own pocket since I've been self-employed for the last fifteen years.  Though I am fortunate not to have had to use my coverage, I have never not been covered, and going without was never an option for me even when I was young and single.

So, somebody please remind me why it is that a couple of deadbeat artsy types who own a building in Baltimore should be allowed to raid my earnings to pay for SCHIP to cover their children's care?

37 @35 Jean,

Heh.  That's funny.

I'm a computer guy, and data integration work is my bread-and-butter.

As much as everyone hated EDI, all this (tongue-in-cheek) newfangled stuff is worse because it gives people the flexibility to pull stuff out of their backsides and call it a masterpiece.

In case you can't guess, my roots involved JCL.

38 MikeO,

I was integrating instrumentation directly to the billing system; basically giving machines a structured admin interface.  What we would now do in XML.

I not sure I understand why a single payer system, essentially a back office clearing house for claims paperwork would effect the moral implications of customers not paying for the value they receive.  It may provide more transparency, but it is essentially invisible to the consumers of healthcare.

Single payer has two important constituencies; the general political class (voters and the chattering class) who perceive it as saving money and the providers - specifically the AMA.  If you want to fight socialized medicine, you need the AMA on your side.  And the AMA wants to reduce administrative burdens on the providers; both to save costs and improve the quality of care.

I want to take away their carrot, so in this debate they are all stick.

39 My technical roots are in BTOS/CTOS systems with controlled, audited messaging systems. 

I ran without Health Care for a while because my work made me uninsurable: overseas shitholes + explosives + organophosphate exposure = laughing insurance guy; but otherwise have been paying my own way with catastrophic coverage. Only thing I can say is that dental bills have far outstripped medical at this point and paying cash overseas can get you taking care of.  (Wife and kids have their own policy, employer paid.)

40 Jean,

The big effect of arguing the savings of paperwork reduction is that we are both sitting on this dead thread, nitpicking the details of possibly pinching pennies that may need to be spent anyway without paying enough attention to the elephant in the room that is government entitlement/health maintenance/non-catastrophic insurance.

The argument the left--including the AMA--is making about administrative savings is a diversion, and they are lying when they suggest that the potential savings from administrative streamlining is within even three orders of magnitude of the direct liabilities of medical entitlements.  I don't think it's possible to estimate the indirect costs of these entitlements.

If you "win" this argument by saving every last cent that could be saved by streamlining, they'll just shift the argument to something else.

41 @37:

You've called it. The more flexibility that gets added to a standard, the more likely you are to find people that abuse that flexibility by implementing procedures like "Put the blood test results in the comments because I forget how to do it the right way."* Just like that, *POOF*, your "savings" from electronic records have just disappeared.

/begin rant:
Very few proponents of single-payer actually understand _why_ our current healthcare system is so out of whack. It's not just who pays for the coverage. It's a metric boatload of circumstances that we don't share with other single-payer countries:

1) We demand our doctors have a gold-plated education. Furthermore, we punish them while they are in training, forcing long hours and low wages on them, guaranteeing that anyone who signs up for the deal is going to feel they are owed payback for same.
1a) Most single-payer countries subsidize college education for everyone. This doesn't make it any cheaper to train doctors, but it does change the label on the bucket that provides the money.
2) We allow the AMA to monopolize treatment. There's no reason why much of the day-to-day stuff that you see a doctor for can't be handled by a nurse.
3) Baumol's disease, coupled with fantastic productivity increases in other sectors guarantees that the wages we pay medical professionals are going to be higher than other countries.
4) Crazy tort environment. Remind me again how many single-payer countries don't have "loser pays"?
5) Lack of primary care providers means health care consumers focus on the micro by going to specialists when they'd be better served by having a professional orchestrate their care. See also, moral hazard.
6) The American over-reliance on "silver bullets" means we'd rather have something convenient than something that's low cost and effective. Diet and exercise are cheap, statins are not.
/end rant

*I'm not digging on medical professionals here. I'm just calling this out as a standard response when management rolls out an overly-complex system that doesn't really address how work gets done, or doesn't spend the time to train people how to use the system.

42 MikeO,  I don't care how much money is really saved and neither do they.  They need to be denied the cover it provides.  Without the illusion of offsetting "savings" - their version of healthcare is DOA.   I also wouldn't characterize the AMA as on the "Left."  They have their own agenda, and being minions to a Government beaurcracy isn't on it.

43

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44 Jean,

I agree with you on several of your points, but I think it's futile to chase the administrative savings argument down the rabbit hole.  I also think that the AMA is as much a part of the collectivist left as the NEA/AFT or the SEIU.

If the AMA and the rest of the left are going to lie about this, then what really can we do?

I knew that TARP was a bum deal, but there were many on the right who argued that it was necessary.  The jury will likely be out on TARP for at least five more years, but I am pretty sure that it was the wrong thing to do, and I think Paulson was lying his ass off to President Bush, the Congress, and all of America to get some money shoveled-off to his Goldman-Sachs buddies since he knew it was all going to come crashing-down anyway.

I knew that porkulus would make matters worse, and that brilliant chart we keep seeing from Geoff at InnocentBystanders shows that Romer, Goolsbee, and all the other jackasses in the administration were talking out their asses when they did their unemployment projections.

They lied.  They lied their asses off to get money or to get power.  If the people can't or won't see it, there really isn't much that we can do about it.

I know that the savings to be had from administrative streamlining isn't even a hill of beans compared to the horrendous distortions caused by third-party payment schemes.  Should the industry ever prove that it can wring-out every last cent of savings to be had, these power-hungry marxists are going to switch to a different fallacious argument.

This is why I am sure that we are doomed.  I used to think that there were three levels for political discourse.  The ideal is rational and logical argument.  The middle ground is where emotionalism may sometimes trump facts and reason.  The low end is violence and civil war.

I was wrong.  There are only two levels:  rational/logical argument and everything else.

45 Anybody else think we should turn the whole decision process about saving medical care costs for govt over to MikeO and Jean?  They've clearly got the experience and they're not politicians or political appointees.

Unfortunately, logic and efficiency are at the bottom of the list of goals in Barry's "sweeping reform" of our nation's medical care system.  As others have commented, the real goal is power and control.  And with both houses of congress firmly under Dem control, whatever those bastards want, they'll get.

Which raises one faint, last-ditch hope to defeat this obamanation:  EVERY republican at all levels needs to start saying--constantly, at every speaking opportunity--that
    "We see *huge* problems with the president's takeover of America's medical care system, but we simply don't have the votes to block it.  The congress is firmly in Democrat control, so if they want to pass it, there's nothing we can do."
    "So if the Dems pass this monstrously expensive, probably unconstitutional abortion of a bill, the outcome is entirely their doing.  We believe this will be a disaster, and we want to make sure the American people are crystal clear, without a shadow of a doubt, as to who will be *totally* to blame:  the Democrats, the Democrats, the Democrats."

The question is, how many Dem rank-and-file congresscritters are *so sure* this is a great idea that they're willing to have people blaming them for ten or twenty years if it goes sour--as we're convinced it must?

46 @41

Yes.  All that Lane Meyer said, except that I would once again point to the elephant in the room:  If more people were paying for care with their own money instead of out of some funny money account made possible by premiums their employers mostly cover of which they are made aware only during benefits election season, then they might actually care what stuff costs.

I would go so far as to say that even the Baumol Effect is dwarfed by the perverse incentives of third-party payment.

47 @45 sf

The question is, how many Dem rank-and-file congresscritters are *so sure* this is a great idea that they're willing to have people blaming them for ten or twenty years if it goes sour--as we're convinced it must?

Yeah, but. . .  it's not so much that I capitulate as it is that I would like to see this settled by other means such that it is unmistakable that porkulus, the GM/MOPAR takeovers, and healthfail were nothing more than fascist power-grabs.  Otherwise, we're back at it again in another fifteen years.

48 The PROBLEM: Americans can't afford to pay for doctors, hospitals, and medicine.

The SOLUTION: Force Americans to pay for doctors, hospitals, medicine, and a huge government bureaucracy.

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50 All that Lane Meyer said, except that I would once again point to the elephant in the room:  If more people were paying for care with their own money instead of out of some funny money account made possible by premiums their employers mostly cover of which they are made aware only during benefits election season, then they might actually care what stuff costs.

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