[ETWolverine]

Can anyone explain this Bloomberg article to me?

http://www.bloomberg.com/apps/news?p...d=apv3pcTOWVjk

Because based on my understanding, this plan by Obama would indicate rationing of Medicare.

But that can't be... Obama said there wouldn't be any rationing. And we should all believe Obama.

Right?

Cardiologists Crying Foul Over Obama Medicare Cuts (Update1)



By Alex Nussbaum and Lisa Rapaport

Aug. 28 (Bloomberg) -- An Obama administration plan to cut Medicare payments to heart and cancer doctors by $1.4 billion next year is generating a backlash that's undermining the president's health-care overhaul.

While President Barack Obama and members of Congress have spent August debating health insurance and medical costs at public forums, specialists are waging what one advocate calls a “tooth and nail” fight against a separate initiative to boost the pay of family doctors, and cut fees for cardiologists and oncologists. The specialists, in newspaper columns and meetings with lawmakers, say patients will lose access to life-saving care, from pacemakers to chemotherapy.

The proposal by Medicare, the government insurer for the elderly and disabled, is an effort by Obama to focus U.S. medicine on preventive care. The fight by physicians who work with the most expensive patients is weakening support for Obama's broader goal, legislation to remake the health system, said Mark B. McClellan, 46, a former Medicare chief.
“If you can make the health-care debate all about moving slices of the pie around, it's very easy to generate opposition and very easy to get derailed,” said McClellan, a physician and analyst at the Brookings Institution, a policy research center in Washington, in an interview.
Obama and his allies in Congress are pushing to extend coverage to the 46 million Americans without health insurance, at a potential cost of $1 trillion over a decade. The separate Medicare proposal, announced July 1, slashes projected spending for care by cardiologists and oncologists by more than 10 percent each, while paying family doctors 8 percent more and nurses an additional 7 percent.

'Tooth and Nail'

“Our 37,000 members are fighting tooth and nail on these other issues rather than fighting thoughtfully for expanding access,” said Jack Lewin, 63, chief executive officer of the Washington-based American College of Cardiology.

The cuts could have the unintended consequence of rationing care, especially in rural regions with a large number of Medicare patients, doctors said. In other areas, specialists may decide to pull out of Medicare, or ask patients to make up the difference with higher out-of-pocket payments, said Alfred Bove, president of the American College of Cardiology.

“A fair number of cardiologists are looking at the accounting and saying 'we can't afford it,'” Bove said in a telephone interview.

Some oncologists in rural areas may stop offering chemotherapy in the office, forcing patients to travel to more- distant hospitals, said Allen S. Lichter, 63, CEO of the 27,000- member American Society of Clinical Oncology in Alexandria, Virginia.

Cuts 'Impossible'

The cuts would be “impossible” for some small-town cardiologists who rely on Medicare patients, said Zia Roshandel, a heart doctor in Culpeper, Virginia. The town of 10,000 people is about 60 miles southwest of Washington.

Roshandel and two partners see perhaps 50 patients a day at his practice, the local hospital and a community clinic for the indigent, the 40-year-old said in a telephone interview. Medicare accounts for two-thirds of their clientele, he said.

Already squeezed by government and private insurers, Roshandel said he has cut office hours, forgone paychecks and shifted his 12 workers to a high-deductible insurance plan over the past two years. The latest proposal would push him out of private practice altogether, most likely to a hospital in a larger community less reliant on Medicare, he said.

'Close the Office'

If the proposal stands, “the bottom line is I'm going to close the office,” he said. “This is impossible for me to survive. If my partners and I don't get a salary and run it for free, maybe then we can survive.”
Medicare would reduce reimbursements for some of Roshandel's most common procedures, raising the amount patients will need to pay up front, he said. The government would cut the $251 it pays for an echocardiogram, a sonogram of the heart, by 40 percent, he said. The rate for a cardiac catheterization, another test, would drop by a third to $249.

Those reductions include an additional across-the-board cut of 22 percent for all physicians mandated by federal budget rules. Legislation passed by three committees in the House last month would eliminate that cut, at a cost of $200 billion to U.S. taxpayers. Even so, if Medicare goes ahead with its tilt toward primary care, cardiologists will suffer, Roshandel said.

The Obama administration's plan to raise payment for primary care doctors is intended to encourage more doctors to enter the field. Some 65 million people already live in areas considered by the U.S. Health and Human Services Department to have too few primary care doctors, with less than one practitioner for every 2,000 people, according to department figures as of March 31.

Outnumbered by Specialists

The U.S. has 250,000 primary-care doctors and nurses and about three times as many specialists, said Atul Grover, 39, chief advocacy officer for the Association of American Medical Colleges, a Washington group. The number of medical school graduates in the U.S. entering family medicine fell more than a quarter from 2002 to 2007, according to a study last year by the group and the American Medical Association.

With the number of Americans older than 65 soaring, specialists will be in short supply, Grover said. The Census Bureau projects 81.2 million people in the U.S. will be 65 or older in 2040, from 40.2 million in 2010.

'Silver Tsunami'

“That silver tsunami that represents the baby boomers hitting Medicare age is coming,” Grover said in a telephone interview, referring to the U.S. generation born from 1946 through 1964. “In the next 20 years, we are going to face a physician shortage really across the board.”

Medicare, which covers 45 million people, is expected to spend $503.1 billion this year, accounting for one of every five dollars spent on U.S. health care, the Centers for Medicare and Medicaid Services estimated in February. Spending will reach $931.9 billion in 2018, the agency said.
Without changes, the system is guaranteed “to basically break the federal budget,” Obama said at a White House news conference July 22.

The reimbursements, though, are still a proposal, and may change before a final schedule is adopted Nov. 1, said Ellen Griffith, a spokeswoman for the Centers for Medicare and Medicaid Services, in an e-mail. “All comments that are submitted during the comment period will be given careful consideration,” she said.

Reid Cherlin, an assistant White House press secretary, said the proposal “reflects an effort to pay primary care doctors more appropriately for services to Medicare patients. We have a deep appreciation for the lifesaving work that cardiologists and oncologists do every day, and as part of the rulemaking process CMS has met with groups representing both fields.”

Focus on Results

McClellan, who ran Medicare while George W. Bush was president, said the ultimate solution requires changing how doctors are paid to focus more on results rather than on the number of patient visits.

“My hope is that they'll resolve it in a way that doesn't just move the deck chairs around in a Medicare payment system that's clearly sinking,” he said. “This gets resolved by changing the way that Medicare pays so that both the specialists and the generalists get paid more when they work together and deliver better care.”

McClellan cited Medicare pilot programs in which doctors have formed “accountable care organizations” allowing them to better coordinate patient care. The ACC, the cardiologist group, has pitched another alternative that would use lower co-pays to steer patients to better-performing doctors and give bonuses to physicians and hospitals that cut wasteful spending.

Tensions Rising

Tensions are rising among doctors, said Ted Epperly, 55, president of the American Academy of Family Physicians in Leawood, Kansas, in a telephone interview. Epperly runs a family practice in Boise, Idaho, and teaches at the University of Washington School of Medicine in Seattle.
Specialist colleagues have implied his support for the Medicare changes may cost his students, he said.

While family-care students typically spend parts of their three-year residencies training with specialists, “What I've heard is 'maybe we just won't have time any longer to teach your residents,'” Epperly said.
The ACC is offering a sample letter to patients, asking them to write Congress. “I am concerned that my physician may no longer be able to treat me or other Medicare patients,” the letter says. The campaign has extended to fliers, posters and even the on-hold message the group plays for callers to its Washington office, which asks the public to fight “drastic pay cuts for cardiology.”

The arguments have a familiar ring, McClellan said.

“The usual way that you try to scuttle a health-care reform proposal is by saying whatever it is going to reduce your access to the care that you need,” he said.

Three Years Earlier

Cancer specialists made similar warnings three years ago when reimbursement was cut for the drugs they used, said Nancy M. Kane, a professor at the Harvard School of Public Health in Boston and member of the Medicare Payment Advisory Commission, a panel of outside advisers to Congress.

“As far as I know we have not seen a drop in the number of oncologists since then,” Kane said. “People are not screaming that they don't have access to oncologists.”

The pay shift would help right a financial imbalance that keeps young physicians out of family care, said Epperly, of the family doctors' group.
Average total compensation for family doctors ranged from $150,763 to $204,370 a year, according to a 2008 survey by Modern Healthcare magazine. Cardiologists fetched from $332,900 to $561,875. Radiation oncologists, cancer doctors who specialize in radiation therapy, earned $357,000 to $463,293.

“If we don't invest more in primary care, we won't have the resources to offer more access,” Epperly said. “Our system is very good at getting people to do what they're paid to do. That's why specialists are doing all the things they do, because they're paid gobs of money.”

To contact the reporters on this story: Alex Nussbaum in New York; Lisa Rapaport in New York.

Last Updated: August 28, 2009 09:22 EDT

Am I reading this article correctly?

Is Obama proposing the idea of taking money out of the hands of specialists and putting it into the hands of PCPs and GPs?

Isn't that rationing? Didn't Obama and those on the left promise us that we wouldn't see rationing in Obamacare? That we could increase the number of insured without losing services and without increasing costs?

And none of the people interviewed in this article seem to be denying that rationing is what would be happening. Some try to justify the rationing, some argue against it. But nobody seems to deny that that is what the proposal is. And yet, that seems to be the exact opposite of the promisses coming from the left about how there will be no rationing.

And what of those who NEED specialty care? Are they supposed to make due with PCPs and general medicine practitioners instead? Are we to make due with bandaids and aspirin where the required treatment is heart surgery? Are we to take the "blue pill" when what we really need is an organ transplant? Are we to make due with a GP when what we need is an oncologist? That seems to be what this article is saying will happen under Obama's proposal.

But perhaps those on the left have a better explanation for what this proposal means. Perhaps I'm misinterpreting it.

After all, I'm just a conservative member of the mob and a fear monger. The Libs are SOOOO much smarter than I am. Perhaps they can spin... er... explain this in a way that makes sense.

Elliot

[excon]

After all, I'm just a conservative member of the mob and a fear monger. The Libs are SOOOO much smarter than I am. Perhaps they can spin... er... explain this in a way that makes sense.

Hello El:

I don't know if you're misinterpreting it or not. However, if it were me, and a guy is going to TURN ME DOWN for services, it don't make much difference WHO the guy works for, whether it be the government or a private insurer.

To me, it would be LESS obscene if they did it in the name of insuring EVERYBODY, than if they did it in the name of profit.

However, neither is necessary, and it's only speculation that Obama is going to do it. There's NO speculation, however, about the insurance companies denying service, though. They are, this very day, going to RATION health care to lots of people, some of whom are going to die as a result.

That's an obscenity you're unwilling to cop to.. No matter. WE know it - even if YOU don't.

excon

[spitvenom]

This is kind of off the topic but I have a question. ET you argue that with private insurance if you get denied for care you can simply go find a different insurance company. But if you get denied for care from one insurance company what makes you think another insurance company is going to insure you with a preexisting condition?

[inthebox]

Can anyone explain this Bloomberg article to me?

Cardiologists Crying Foul Over Obama Medicare Cuts (Update1) - Bloomberg.com

Because based on my understanding, this plan by Obama would indicate rationing of Medicare.

But that can't be... Obama said there wouldn't be any rationing. And we should all believe Obama.

Right?



Am I reading this article correctly?

Is Obama proposing the idea of taking money out of the hands of specialists and putting it into the hands of PCPs and GPs?

Isn't that rationing? Didn't Obama and those on the left promise us that we wouldn't see rationing in Obamacare? That we could increase the number of insured without losing services and without increasing costs?

And none of the people interviewed in this article seem to be denying that rationing is what would be happening. Some try to justify the rationing, some argue against it. But nobody seems to deny that that is what the proposal is. And yet, that seems to be the exact opposite of the promisses coming from the left about how there will be no rationing.

And what of those who NEED specialty care? Are they supposed to make due with PCPs and general medicine practitioners instead? Are we to make due with bandaids and aspirin where the required treatment is heart surgery? Are we to take the "blue pill" when what we really need is an organ transplant? Are we to make due with a GP when what we need is an oncologist? That seems to be what this article is saying will happen under Obama's proposal.

But perhaps those on the left have a better explanation for what this proposal means. Perhaps I'm misinterpreting it.

After all, I'm just a conservative member of the mob and a fear monger. The Libs are SOOOO much smarter than I am. Perhaps they can spin... er... explain this in a way that makes sense.

Elliot

There is going to be rationing of healthcare by third party payors [ government and private insurance ] by cost and availability. I think Americans have to acknowledge this fact first. Limited resources just are not going to be "free" or widely available overnight.


The problem is that Obama denies this very fact and has a lot of people drinking the koolaide that healthcare can be free and universal. Obama is not the one taking care of sick people; doctors, nurses, hospitals, physical therapists, receptionists etc... These folks don't work for free, 24 / 7 .


How about tort reform?

How about increasing competition among health insurers, at no cost to the taxpayor?

Oh and another point, even if reimbursement goes up a few percent to primary care, where are all the primary care doctors going to come from? Are future medical students and residents going to be FORCED into a particular field of medicine BY THE GOVERNMENT?
Just because you build a baseball field does not mean there will be enough baseball players.




G&P

[ETWolverine]

Hello El:

I don't know if you're misinterpreting it or not. However, if it were me, and a guy is going to TURN ME DOWN for services, it don't make much difference WHO the guy works for, whether it be the government or a private insurer.

Can you tell me of a single insurance company that has decided to pay GPS more by taking that money away from specialists? Until you can, there's no comparison.

To me, it would be LESS obscene if they did it in the name of insuring EVERYBODY, than if they did it in the name of profit.

That's kind of like saying that it's less obscene if Hitler killed 6 million Jews in the name of making Germany stronger than if he did it in the name of racism and bigotry. I really don't see the difference.

However, like I said, I don't see rationing in private insurance companies. I have never heard of an insurance company telling their service providers that they are going to pay the GPs more by taking money from the specialists.

So your comparison between the insurance companies and the government is somewhat flawed.

However, neither is necessary, and it's only speculation that Obama is going to do it. There's NO speculation, however, about the insurance companies denying service, though. They are, this very day, going to RATION health care to lots of people, some of whom are going to die as a result.

Please prove that. You have SAID it many times, but you have NEVER been able to prove it.

As I have said before, NOBODY in this country has to go without medical care. EVEN if they are denied by an insurance company, there are other options. THAT HAS been proven over and over again.

That's an obscenity you're unwilling to cop to.. No matter. WE know it - even if YOU don't.

Excon

It's a statement you haven't been able to prove. I can't cop to something that isn't true.

But you haven't explained to me how Obama can promise not to ration health care, and yet put forward a plan to ration health care. That's one that you ain't copping to.

So you are not answering the question I posted, AND making statements of "fact" not in evidence.

Elliot

[ETWolverine]

This is kind of off the topic but I have a question. ET you argue that with private insurance if you get denied for care you can simply go find a different insurance company. But if you get denied for care from one insurance company what makes you think another insurance company is going to insure you with a preexisting condition?

Actually, what I argue is that if you get denied, you have MULTIPLE other options.

These include:

1) Finding another insurance company.
2) Paying out of pocket.
3) Free clinics.
4) Obtaining care from charitable organizations.
5) Setting up a long-term payment plan with your provider.
6) PAYING MORE for insurance that does cover you.
7) Purchasing supplemental insurance in addition to your regular insurance to cover what the main policy won't cover.
8) Finding doctors nice enough to donate their time to the indigent.

And others.

My entire point is that there are OPTIONS in a non-government system. If one option doesn't work for you, there are other options that can.

Yes, it is possible that if one insurance company denies you, you might be denied by others. But even if that happens, there are STILL other options.

Not so in a single-payer government-run system. There are no other options if you are denied services under a single-payer system.

My point isn't that some other insurance company will take you. My point is that there are OPTIONS... whatever those options may be for you.

Elliot

[NeedKarma]

Please read:
Twenty-six Lies About H.R. 3200

Twenty-six Lies About H.R. 3200 | FactCheck.org

[ETWolverine]

NK,

This thread has nothing to do with HR 3200. This is about a plan by Obama to make changes within the structure of Medicare.

Would you care to make a RELEVANT post? Or should we just continue to ignore you?

Elliot

[NeedKarma]

You're an angry man aren't you? :)

How nice to have your people under Medicare have to beg for medical procedures, that seems to suit you just fine.

[ETWolverine]

You're an angry man aren't you? :)

Not really. I'm just wondering when you're going to post something both relevant and correct. I haven't seen it happen yet.

How nice to have your people under Medicare have to beg for medical procedures, that seems to suit you just fine.

I'm AGAINST people having to beg the government for medical procedures... remember? That's what being AGAINST government-run health care is all about. I'm in favor of free-market health care that has lots of nice options so that people don't have to beg to the government for their medical care. YOU'RE the one in favor of people having to go to the government for health care.

You seem to be confused about what people's positions are. But no more confused than usual for you.

Elliot

[NeedKarma]

I'm AGAINST people having to beg the government for medical procedures... remember?

Let's look at what you posted earlier when spitvenom asked "But if you get denied for care from one insurance company what makes you think another insurance company is going to insure you with a preexisting condition?"

Actually, what I argue is that if you get denied, you have MULTIPLE other options.

1) Finding another insurance company.
2) Paying out of pocket.
3) Free clinics.
4) Obtaining care from charitable organizations. Begging
5) Setting up a long-term payment plan with your provider. You've been refused!
6) PAYING MORE for insurance that does cover you. Too late, You've been refused!
7) Purchasing supplemental insurance in addition to your regular insurance to cover what the main policy won't cover. After you've been refused???
8) Finding doctors nice enough to donate their time to the indigent. Begging

[tomder55]

[ETWolverine]

Let's look at what you posted earlier when spitvenom asked "But if you get denied for care from one insurance company what makes you think another insurance company is going to insure you with a preexisting condition?"
[/b]

It is obvious that you have no idea how private insurance works. Not surprising, since you live in a country where you have to beg your government for your care.

In this country, paying for MORE insurance means that you get it... even if you were refused for it before. That's why you are paying MORE. The more you pay, the more coverage you get. It's a free-market concept that I wouldn't expect you to understand.

Ditto for buying supplemental insurance. The more you are willing to pay for, the more coverage you are able to get.

Neither of those constitute begging, and neither of them are dependent on whether you have been denied before.

However, in a single payer system, if you are denied, you don't get the option of paying more for more coverage. If you are denied, there is no other solution.

Not to mention that there's a huge difference between begging to the government and begging in the private sector. Governments don't care how much you beg... they're government bureaucrats. But in the private sector, you can usually find someone willing to help you out. I'd rather beg in the free market than beg the government. It's more likely that I'll succeed in getting what I need that way.

But of course, it's likely that I wouldn't have to beg. There are, as I mentioned, other options. Costly, perhaps... but still available.

With the government, if you are denied, all you've got left is begging.

Elliot

[NeedKarma]

That's all you got eh tom? Standard "too long to understand so I'll use the talking point or funny picture that's going around". That seems to be what the far right is doing these days - not engaging in back and forth discussions but putting out "fear and smear" short palatable bursts hoping no one will research the truth behind it.

[NeedKarma]

INot surprising, since you live in a country where you have to beg your government for your care.

Explain that to me please as I've never experienced it.

[ETWolverine]

Explain that to me please as I've never experienced it.

Sure you have... every time you have gone to your government for health coverage. You've just been luckly that you haven't had to beg too hard.

[spitvenom]

So instead of begging you will hope and pray the insurance company who carries you made a big enough profit so your claim won't get denied. Sounds reasonable.

[NeedKarma]

Sure you have... every time you have gone to your government for health coverage. You've just been luckly that you haven't had to beg too hard.

You have absolutely no idea of how it works here do you? So you just spout off crap all the time without a clue.

[ETWolverine]

Tom,

Good photo.

Rush actually had a comment last week about government-run health care.

He said that in the end there would be only two insurance companies left: All-Statist and Statist Farm. And Statist Farm is also going to be the place they put you out to pasture when you're too old to be elligible for health care procedures.

Elliot

[speechlesstx]

That's all you got eh tom? Standard "too long to understand so I'll use the talking point or funny picture that's going around".

I guess you've never seen an editorial cartoon or gag image from a liberal. If you liked that one you'll love this one...

That seems to be what the far right is doing these days - not engaging in back and forth discussions but putting out "fear and smear" short palatable bursts hoping no one will research the truth behind it.

Hasn't that talking point gotten more than a little stale?