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  • Libertarian: End All Entitlements

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    4 23.53%
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Thread: Between the Medicare Cutters

  1. #31
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    Re: Between the Medicare Cutters

    Quote Originally Posted by Catawba View Post
    I choose other. The majority of Americans are opposed to cuts in medicare.

    New Poll Show Americans Oppose Cuts To Medicare, Medicaid - Kaiser Health News
    yeah, the American people also tend to think that we can solve the debt crises by cutting foreign aid (which they tend to place at about 27% of the federal budget) and pork barrel spending (which they also way overestimate).

    but i'm not sure that we should put our personal opinions in the service of the general populaces' misimpressions.

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    Re: Between the Medicare Cutters

    Quote Originally Posted by Kandahar View Post
    Because their own decisions may or may not be cost-effective from the government's perspective
    but since the money they are recieving is fixed; then it makes no difference to the government whatsoever if their chosen cuts are cost-effective.

    and since the primary goal is to control the cost of health care, the government absolutely has an interest in regulating the way it allocates its scarce health care funds.
    ...but the CBO scored the IPAB as saving no money; and Ryan's plan as saving lots of money; and the method of payment continues to drive up the cost of healthcare, while Ryan's method of payment is designed to drive down the cost of healthcare....


    this is why I don't get your vote; your own stated opinions seem to drive you into the Republican's camp on this one, but given the actual choice.... you stick with the Dems. I don't get it.

  3. #33
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    Re: Between the Medicare Cutters

    Quote Originally Posted by chevydriver1123 View Post
    All the cuts do is continue to kick the can down the road. The welfare state can no longer be sustained, Im tired of being stolen from for services Ill never end up using. Its way overdue to get rid of them and let private charity take over.
    .... or make the system self-sustaining, as Harry Guerrilla and I have proposed.

  4. #34
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    Re: Between the Medicare Cutters

    Quote Originally Posted by cpwill View Post
    but since the money they are recieving is fixed; then it makes no difference to the government whatsoever if their chosen cuts are cost-effective.
    The government wants to limit costs, but it also wants to provide the best quality care possible. For evidence of this, I present the Medicare program itself. If the government was solely interested in its balance sheet, it never would have created the program.

    Quote Originally Posted by cpwill
    but the CBO scored the IPAB as saving no money;
    Let's be clear about how CBO scoring actually works. It looks at the baseline numbers (i.e. what our national finances would look like without any further action, or in this case, what it would look like if there was no IPAB and everything else stayed the same) and compares them to the numbers of the policy in question. The other provisions of the Affordable Care Act, for example, are not included in the CBO's calculations for the IPAB because it's already a law and therefore part of the baseline.

    Furthermore, the CBO tends to score proposals under the most pessimistic approach that's reasonable. That's not necessarily a bad thing and in no way discounts the work that the CBO does, but we have to remember that when discussing policy. For example, if you have a bill with hundreds of mechanisms to reduce costs but the scope of the reductions is unclear (like, say, the ACA) the CBO will tend to score them ALL as low as possible. That's fine for individual mechanisms, but in the aggregate it creates a distorted picture of how much money would be saved.

    As for the IPAB specifically: It's a fundamentally sound idea to pay hospitals for results rather than procedures. By analyzing what works and what doesn't, the IPAB can allocate the government's resources more efficiently. The problem with IPAB (and the reason why the CBO is unsure if it will actually save money) is that Congress tied its hands in the ACA because they didn't like the idea of giving up their own power to an executive agency. For example, many Medicare operations are explicitly exempted from review by IPAB, and IPAB will not be able to use any cost-sharing or care-rationing mechanisms that could substantially reduce costs. These could be some of the best weapons in IPAB's arsenal for containing costs, if they were allowed to use them.

    Quote Originally Posted by cpwill
    and Ryan's plan as saving lots of money;
    That depends what you define as "saving" money, and I think is the fundamental problem I have with the Ryan approach. Many conservatives believe that the main problem with health care is the rising cost that ends up on the government's budget. I believe that the main problem with health care is the rising cost, period. Ryan's plan "saves" money by removing the costs from the government and transferring them to the private sector. This doesn't do anything to correct the fundamental problem, which is that health care costs are eating up a larger and larger fraction of the economy and the end result will be to limit access to health care if nothing is done to stop it.

    Quote Originally Posted by cpwill
    and the method of payment continues to drive up the cost of healthcare,
    The problem with payment methods - whether public or private - is that the patient doesn't see enough of the cost. I support high deductible coverage plans (subsidized for low-income patients), so that people are protected in the event of a catastrophe and have access to care when they get sick, but have to pay for at least some of their own procedures. This is true whether the plans in question are public or private. From an economic standpoint, a consumer doesn't care whether the entity paying for his health care is Medicare or a private insurer, as long as it isn't him. There's no fundamental reason that the private sector should necessarily do a better job than the government, if it's not the consumer who is paying for the service in either case.

    Quote Originally Posted by cpwill
    while Ryan's method of payment is designed to drive down the cost of healthcare
    It's designed to drive down the cost of health care for the government, by indiscriminately slashing costs and transferring them to patients. For example, the CBO estimated that Ryan's plan would increase total health care costs for seniors (relative to the baseline) by 25%.
    http://cbo.gov/ftpdocs/121xx/doc1212...yan_Letter.pdf
    Last edited by Kandahar; 04-25-11 at 07:51 PM.
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    Re: Between the Medicare Cutters

    Quote Originally Posted by cpwill View Post
    .... or make the system self-sustaining, as Harry Guerrilla and I have proposed.
    Maybe some of us are tired of getting stolen from, you may like getting your check raped by entitlement bull**** but I dont.
    Jackboots always come in matched pairs, a left boot and a right boot.

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    Re: Between the Medicare Cutters

    Quote Originally Posted by Kandahar View Post
    The government wants to limit costs, but it also wants to provide the best quality care possible. For evidence of this, I present the Medicare program itself. If the government was solely interested in its balance sheet, it never would have created the program.
    politicians want to claim credit for providing the best quality care possible while limiting costs; but government programs have repeatedly proven inneffective at doing so, and those running the actual programs themselves have no strong incentives to do either. Medicare (like the NHS) was originally sold on the notion that if you provide people with an entitlement, they won't need it or use it, and so costs will actually fall as time goes by. The House Ways and Means Committee projected Medicares' costs (allowing for inflation) out to 1990, and claimed that Medicare that year would cost $12 Bn - it cost almost ten times that much. That's for a number of reasons, not least that Medicare has driven up the price of healthcare - the estimates I've seen tend to estimate that about half the growth in healthcare costs since its' inception are generally the result of Medicares' effect on the market. If we want to reduce long term growth in costs, then it seems we have to address that issue; if Medicare, as it's currently structured, drives costs up, then we should look into changing it's structure to allow it to drive costs down. A good lesson here is Medicare D - which functioned very similar to the Ryan plan. Medicare D came in 40% UNDER estimates. That's pretty huge, considering the kinds of reductions in expenditures we are looking for. When Indiana moved a portion of their public employees to HSA's (which also utilize market pressure on healthcare prices), they saw costs to the state drop by 11% in just a couple of years - even as prices were skyrocketing across the nation. So while Ryan's plan reduces expenditures statically scored (which is how the CBO scores), there is excellent reason to suppose that it will reduce healthcare prices across the board.

    Let's be clear about how CBO scoring actually works. It looks at the baseline numbers (i.e. what our national finances would look like without any further action, or in this case, what it would look like if there was no IPAB and everything else stayed the same) and compares them to the numbers of the policy in question. The other provisions of the Affordable Care Act, for example, are not included in the CBO's calculations for the IPAB because it's already a law and therefore part of the baseline.
    well you bring up a good point that the IPAB is already law, and thus part of the baseline. But what I got from the President's speech is that he somehow thought they were going to be increasing the amount they cut from Medicare off of $500 Billion. Now the economics of the ACA are bunk; you and I are both smart enough to know that you can't double-count money (as the ACA does), and the addition of another entitlement at the same time that our current ones are threatning us with bankruptcy isn't going to reduce the deficit. In particular the pretense that we wouldn't pass the "doc fix" is ridiculous.

    and that is what makes the IPAB ridiculous, but we'll get into that in a minute.

    Furthermore, the CBO tends to score proposals under the most pessimistic approach that's reasonable
    well it might be worth noting that the CBO was downgrading the savings from an earlier "more optimistic" figure that we would save $28 Billion over the next 10 years. yeah, that's good. that will solve our exploding entitlement costs.

    it's also worth noting that Medicare's Chief Actuary has stated that the effect of the ACA (current law position) will increase Medicare's costs, not decrease them.

    ...[url=http://online.wsj.com/article/SB10001424052748703309704575413263344491010.html]Mr. Foster has been Medicare's chief actuary for 15 years, and as such he is required to evaluate the law as written. But as he notes in his appendix, the law as written bears little if any relation to the real world—and thus, he says, the trustee estimates "do not represent a reasonable expectation for actual program operations in either the short range . . . or the long range." In an unprecedented move, he directs readers to a separate "alternative scenario" that his office drew up using more realistic assumptions.

    Mr. Foster shows that the Medicare "cuts" that Democrats wrote into ObamaCare exist only on paper and were written so they could pretend to reduce the deficit and perform the miracles the trustees dutifully outlined. With the exception of cuts in Medicare Advantage, those reductions will never happen in practice.

    One of the fictions Mr. Foster highlights is the 30% cut in physician payments over the next three years that Democrats have already promised to disallow. Republicans would do the same, we hasten to add.

    Another chunk of ObamaCare "savings" are due to cranking down Medicare's price controls for hospitals and other providers that Mr. Foster says are also "extremely unlikely to occur." In the absence of "substantial and transformational changes in health-care practices"—in other words, a productivity revolution in medicine that has never happened—costs will simply rise for private patients, or hospitals will refuse to treat seniors insured by Medicare. Congress will never allow that to happen either.

    In other words, under ObamaCare the "cost curve" will not be bent as the White House has advertised.

    Under his more plausible outlook, Mr. Foster notes that Medicare's share of the economy will rise 60% between now and 2040, while under the trustees report that Democrats are crowing about it would "only" rise by 35%...


    That's not necessarily a bad thing and in no way discounts the work that the CBO does, but we have to remember that when discussing policy. For example, if you have a bill with hundreds of mechanisms to reduce costs but the scope of the reductions is unclear (like, say, the ACA) the CBO will tend to score them ALL as low as possible
    unless of course (as in the case of the ACA) it's ordered not to. unless it's ordered to assume that you can spend the same $500 Bn twice. Unless it's ordered to assume that the Doc Fix will pass and we will overnight slash our reimbursement rates down below the ability of hospitals and doctors to continue to provide Medicare patients with care...

    As for the IPAB specifically: It's a fundamentally sound idea to pay hospitals for results rather than procedures
    that's not true. the "let's try to pay for results instead of procedures" was a vague idea, thrown out by the president, who has no idea (nor does anyone else) how we would actually go about enacting it. the IPAB functions by slashing reimbursement rates and by choosing procedures and medications which it deems not cost effective, and having the government enforce that one-size-fits-all approach to America's retirees. it's the American N.I.C.E.; the much-ballyhood and aggrandized "death panels" (and even Paul Krugman agrees that they are, that that's how they function, and that that's how you save money with IPAB).

    But the experience of N.I.C.E. and like programs (and this is where they deserve comparison to the history of market-based reforms as mentioned above) is that they do not reduce costs over time - they just produce increasing lists of care which can no longer be afforded.

    which is to expected because:

    By analyzing what works and what doesn't, the IPAB can allocate the government's resources more efficiently.
    you are depending on a government bureacracy to be effecient at making one-size-fits-all economic decisions, and your claim that it is superior to the Rayn plan seems dependent on the assumption that they will be more effecient than the private market. If that doesn't make you sit back and go "huh", then I don't know what will. Deciding to go with the awesome superior efficiency of a government bureacracy over that of the free market is one of history's most dependably losing bets.

    The problem with IPAB (and the reason why the CBO is unsure if it will actually save money) is that Congress tied its hands in the ACA because they didn't like the idea of giving up their own power to an executive agency. For example, many Medicare operations are explicitly exempted from review by IPAB, and IPAB will not be able to use any cost-sharing or care-rationing mechanisms that could substantially reduce costs
    to the contrary, under current law, IPAB recommendations for care-rationing requires a supermajority of Congress to overturn.

    That depends what you define as "saving" money
    from the government's side, simple reduction in expenditures.

    and I think is the fundamental problem I have with the Ryan approach. Many conservatives believe that the main problem with health care is the rising cost that ends up on the government's budget.
    that's the debt crises problem. it's part and parcel of our general healthcare costs problem, but it's the part and parcel that helps to bankrupt our government. and that's what we're trying to fix here. In realityland, if we wanted to reduce healthcare costs there are a number of basic steps that would allow us to do so by applying market pressure and some basic tort, state border, and licensing reforms.

    I believe that the main problem with health care is the rising cost, period.
    then you should be excited about the ability to put into the largest healthcare system in the country reforms that have already been proven to reduce healthcare prices, and eager to leave behind a system that has been demonstrated to have no effect whatsoever on healthcare prices other than to continue to allow them to rise.

    Ryan's plan "saves" money by removing the costs from the government and transferring them to the private sector.

    This doesn't do anything to correct the fundamental problem, which is that health care costs are eating up a larger and larger fraction of the economy and the end result will be to limit access to health care if nothing is done to stop it.
    on the contrary, utilizing market pressure (as Ryan's plan does) has been proven on multiple occasions to achieve precisely that happy result. it is increasing state control (current law) that has repeatedly and dramatically failed to do so.

    The problem with payment methods - whether public or private - is that the patient doesn't see enough of the cost.
    see, this is why i don't get you. you say this - which is correct - but then you fail to apply it above.

    I support high deductible coverage plans (subsidized for low-income patients), so that people are protected in the event of a catastrophe and have access to care when they get sick, but have to pay for at least some of their own procedures
    Gosh, you mean sort of like how the Ryan plan functions?

    This is true whether the plans in question are public or private. From an economic standpoint, a consumer doesn't care whether the entity paying for his health care is Medicare or a private insurer, as long as it isn't him. There's no fundamental reason that the private sector should necessarily do a better job than the government, if it's not the consumer who is paying for the service in either case.
    exactly and THAT is behind our spiking healthcare prices and so that is what must be fixed.

    [i]yet when we move to do so, you complain that "Ryan's plan "saves" money by removing the costs from the government and transferring them to the private sector." that "private sector"? it's the consumer. that's why Medicare D came in so far below estimates, that's why HSA's reduce costs. because we are utilizing market pressure.

    and instead you support a plan that IS THE PRECISE OPPOSITE OF WHAT YOU YOURSELF SAY IS NEEDED.

    It's designed to drive down the cost of health care for the government, by indiscriminately slashing costs and transferring them to patients. For example, the CBO estimated that Ryan's plan would increase total health care costs for seniors (relative to the baseline) by 25%.
    http://cbo.gov/ftpdocs/121xx/doc1212...yan_Letter.pdf
    eh, it's means-tested, so that number deserves to be given on a scale.

    BUT THAT IS EXACTLY WHAT YOU JUST SAID WE SHOULD BE DOING!.

    have you recently ceased some kind of medication for schizophrenia?

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    Re: Between the Medicare Cutters

    Quote Originally Posted by Zyphlin View Post
    yes, shocking I know, the majority of Americans want a cut in spending, want to get the debt under control, but don't want cuts taken out of some of the largest expenditures the government has...oh, and they don't want their own taxes raised.

    So obviously, we should bow the desires of the people who refuse to give up stuff they're getting or give up any of their money by taking from the "greedy" rich.
    Or, we can do what the We the People decide is important. 30 years of tax cuts to the rich have not helped the middle class improve their lot. It just increased the public debt which the middle class and their heirs are now on the hook for. The other big issue is unnaffordable health care costs, it is one of the issues that swept Obama into office. The GOP comes down on the wrong side of both of these issues from the perspective of the middle class.
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    Re: Between the Medicare Cutters

    Quote Originally Posted by chevydriver1123 View Post
    Maybe some of us are tired of getting stolen from, you may like getting your check raped by entitlement bull**** but I dont.
    which is why we want you to keep that, we want you to own it.

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    Re: Between the Medicare Cutters

    Quote Originally Posted by Catawba View Post
    Or, we can do what the We the People decide is important. 30 years of tax cuts to the rich have not helped the middle class improve their lot. It just increased the public debt which the middle class and their heirs are now on the hook for. The other big issue is unnaffordable health care costs, it is one of the issues that swept Obama into office. The GOP comes down on the wrong side of both of these issues from the perspective of the middle class.
    The tax cuts of the past 30 years have helped the middle class. It has reduced their tax burden and allowed for more individuals within the middle class to move up into the upper middle class or hire. A legitiamte argument can be made that they've helped "the rich" far more than the middle class, and that would be a logical and common sense notion since the Rich was taxed significantly higher than the middle class and thus would feel the affect of a tax cut far more. But the middle class not being helped as much by tax cuts is not the same as not being helped at all.

    You can try the "We the People" line with me all you want Glenn Beck, but sorry...you're not going to sway me. "We the People" as a collective are, looking at nothing else, human and thus generally a selfish lot worried primarily about what benefits us in the short term. Its why we're a Republic and not a Direct Democracy. We are not, and should never be, a country governed by polls telling us what "We the People" want. Somehow I don't imagine you standing here talking about doing what "We the People" wanted when they said to repeal Obama's Health Care law. We'd have invaded Iraq in 2001, when a majority of "We the People" favored that. "We the People" decided that at one point George Bush was the most approved of President of all time. "We the People" have stated gays shouldn't be legally allowed to marry. "We the People" are more pro-life than pro-choice, so perhaps we should ban abortion since all you care about is "we the people's" polling data. "We the People" favored extending ALL the tax cuts in December of 2010, I guess you believe that was right as well.

    I wouldn't be shocked that if Gallup asked a poll if people would be in favor of everyone but the top 1% of the country getting a $3000 tax refund back from the government to "stimulate" our economy that "We the People" would probably largely be in favor of slapping on a near 1 trillion dollars worth of spending onto the debt because...hey, they're getting money.

    We definitely need to listen to the citizens of this country, unquestionably. But what they're saying can only be one factor in regards to how our representitives should be acting. And its foolish, in any walk of life, in any situation, to absolutely ignore all surrounding context.

    "We the People" are screaming to reduce the deficit, cut spending, and pay down the debt. "We the People" are also saying don't cut any of our social programs, don't cut any of our entitlement programs, and you have a 1% swing arguing about defense spending. At the same time "We the People" are saying tax the rich over cutting social programs while saying extend the tax cuts for everyone. "We the People" by and large elected in representitives to the part of congress that starts budgetary things, largely based on fiscal conservatism, and yet then we're told "we the People" are not wanting fiscal conservatism.

    The blatant and obvious cherry picking you're doing to validate your point of view by not even applying your own extremely narrow and childish view of the situation in an even way is decisively dishonest in method. "We the People" need to be heard, but need to have all they say taken into account, and need to be looked at realistically, and need to be balanced against the interests of "They, the next group of People" and the needs of the country.

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    Re: Between the Medicare Cutters

    Quote Originally Posted by sazerac View Post
    Orr we could seize the oil revenues from Iraq and Afghanistan that are owed for saving their sorry asses and give our seniors better wheel chairs and bingo boards.
    any chance of a serious contribution?

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