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Thread: CBO deals new blow to health plan

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    Re: CBO deals new blow to health plan

    Quote Originally Posted by jackalope View Post
    Yup. It will force inefficient states to compete with efficient states, or pay for the excesses themselves. Currently bloated inefficient states are paid more, because they are inefficient. Lower cost, efficient states get paid less, because they worked to control costs. Makes NO sense at all.

    And, if everything costs more in NYC and LA, well that's a problem they'll have to work out themselves, because they didn't PAY any more into the system than low-cost states did. NYC doesn't pay Medicare at a higher percentage, no reason to collect it.
    No one on Medicare now has payed enough in to collect what they are getting now, by that line of reasoning we should cut all Medicare payments everywhere.
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    Re: CBO deals new blow to health plan

    Quote Originally Posted by RightinNYC View Post
    Are you seriously arguing that the reason things cost more in NYC or LA is because NYC and LA are "less efficient" than MN or IA?



    Do you really think we should shift to a system where federal money is distributed based on what areas pay in more? I can guarantee you that if we do, it won't be NYC or LA that loses out.

    The rich (and high COL) areas in this country subsidize the **** out of the poor (and low COL) areas of this country.

    I think unless efficiencies are forced into the system, they will not happen.
    Also, I find it interesting that you side with the liberal Democrats on this issue. They are opposed to this, and were not in favor of the deal.

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    Re: CBO deals new blow to health plan

    Quote Originally Posted by jackalope View Post
    No, it did not. Just as profit does not equal sales; neither does the cost of this program equal only expenses. Thought you said you put in two decades with P&Ls? This is accounting 101, you don't even need a fancy report to get that.
    Profit, grasshopper, is Revenues less Expenses (which are also known as costs).

    Per the CBO, HR3200 will cost $1042 Billion, of which $583 Billion is offset by new government revenue streams (which are also known as taxes), and another $219 Billion is offset by Medicare/Medicaid "savings" of $219 Billion (also known as not paying the bill), for a net cost of $239 Billion (also known as IOUs shipped off to China).

    http://www.cbo.gov/ftpdocs/104xx/doc10464/hr3200.pdf

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    Re: CBO deals new blow to health plan

    Quote Originally Posted by jackalope View Post
    I think unless efficiencies are forced into the system, they will not happen.
    And I think that this is an absolutely moronic place to try to find an "efficiency." If we proposed to cut all payments to doctors whose last names started with "M," that would be an efficiency as well. Why don't we just do that?

    Also, I find it interesting that you side with the liberal Democrats on this issue. They are opposed to this, and were not in favor of the deal.
    If you find that interesting, you haven't read many of the things that I've argued for.
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    Re: CBO deals new blow to health plan

    Quote Originally Posted by Harry Guerrilla View Post
    No one on Medicare now has payed enough in to collect what they are getting now, by that line of reasoning we should cut all Medicare payments everywhere.

    That's true, but nonetheless, Medicare paots are per recipient. NYC and LA are not paying into the system at a higher rate than citizens in other states, no reason for them to collect at a higher rate.

    If they cannot contain the costs, and compete with more efficient states, then they'll have to charge an add'l tax to cover it.

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    Re: CBO deals new blow to health plan

    Quote Originally Posted by jackalope View Post
    Yup. It will force inefficient states to compete with efficient states, or pay for the excesses themselves. Currently bloated inefficient states are paid more, because they are inefficient. Lower cost, efficient states get paid less, because they worked to control costs. Makes NO sense at all.
    Medicare payments are styled as "reimbursements"--meaning they are presumed to be covering actual costs. Why should Maine get paid more than they spend on Medicare? (Assuming of, course, Maine is one of the efficient states, which begs the question of why Maine needs other states to pay for its health care)

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    Re: CBO deals new blow to health plan

    Quote Originally Posted by RightinNYC View Post
    And I think that this is an absolutely moronic place to try to find an "efficiency." If we proposed to cut all payments to doctors whose last names started with "M," that would be an efficiency as well. Why don't we just do that?



    If you find that interesting, you haven't read many of the things that I've argued for.

    That's true! I don't claim to know you at all, that's why I said it was interesting! I didn't mean it as a dig, but as a statement of expression. I always find it interesting when people have complex positions, and not party-line positions. Sorry if you read it as a dig, I didn't intend it that way.


    However, back to your first statement, I don't find it moronic at all. Things must change. Efficiencies must be forced into the system. What exists now is unsustainable. But, cutting pmts to people with initials obviously is ridiculous.

    If your contention is that NYC just costs more, than NYC should charge more.

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    Re: CBO deals new blow to health plan

    Quote Originally Posted by jackalope View Post
    That's true, but nonetheless, Medicare paots are per recipient. NYC and LA are not paying into the system at a higher rate than citizens in other states, no reason for them to collect at a higher rate.

    If they cannot contain the costs, and compete with more efficient states, then they'll have to charge an add'l tax to cover it.
    TaxProf Blog: Red States Feed at Federal Trough, Blue States Supply the Feed

    States Receiving Most in Federal Spending Per Dollar of Federal Taxes Paid:

    1. D.C. ($6.17)
    2. North Dakota ($2.03)
    3. New Mexico ($1.89)
    4. Mississippi ($1.84)
    5. Alaska ($1.82)
    6. West Virginia ($1.74)
    7. Montana ($1.64)
    8. Alabama ($1.61)
    9. South Dakota ($1.59)
    10. Arkansas ($1.53)

    States Receiving Least in Federal Spending Per Dollar of Federal Taxes Paid:

    1. New Jersey ($0.62)
    2. Connecticut ($0.64)
    3. New Hampshire ($0.68)
    4. Nevada ($0.73)
    5. Illinois ($0.77)
    6. Minnesota ($0.77)
    7. Colorado ($0.79)
    8. Massachusetts ($0.79)
    9. California ($0.81)
    10. New York ($0.81)
    By your logic, we should level this out to $1 per state across the board. I'm 100% in favor of that.

    That's true! I don't claim to know you at all, that's why I said it was interesting! I didn't mean it as a dig, but as a statement of expression. I always find it interesting when people have complex positions, and not party-line positions. Sorry if you read it as a dig, I didn't intend it that way.
    No worries.


    However, back to your first statement, I don't find it moronic at all. Things must change. Efficiencies must be forced into the system. What exists now is unsustainable. But, cutting pmts to people with initials obviously is ridiculous.
    I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.
    Last edited by RightinNYC; 07-25-09 at 08:43 PM.
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    Re: CBO deals new blow to health plan

    Quote Originally Posted by RightinNYC View Post
    I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.
    I'm sure there will likely emerge a condition that doctors will not be able to refuse service, and they will just have to take the reimbursement rate and like it, even if its at a level lower than the cost of medical care provided. But its ok, if the government lowballs a doctor, because thats part of "efficiency". When an insurance company does it, its "greed".
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    Re: CBO deals new blow to health plan

    Quote Originally Posted by RightinNYC View Post
    I find this equally ridiculous, because the payments are based on an eminently rational factor - how much doctors will need to be paid in order to keep them in the system. If they cut reimbursement rates in NYC, tons of doctors will stop serving these patients.
    Which makes one wonder why folks think that a public plan that locks in those cut back Medicare reimbursement rates to doctors is a good idea--and that is exactly what HR3200 does.

    http://www.cbo.gov/ftpdocs/104xx/doc...tee-Rangel.pdf

    The proposal would also establish a “public plan” available only through the insurance exchanges. That plan would be set up and run by the Secretary of Health and Human Services (HHS). On average, it would pay Medicare rates plus 5 percent to physicians and other practitioners (and those rates would not be determined by the sustainable growth rate formula that is used to set rates for physicians in Medicare but instead would be increased over time using an index of physicians’ input costs). On average, the public plan would pay Medicare rates for hospital and other services and supplies on fee schedules, and negotiated rates for drugs or other items or services not on a fee schedule. Providers would not be required to participate in the public plan in order to participate in Medicare. (A more detailed summary of the proposal’s key provisions is attached.)

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