Just heard something disturbing about the progressive causus demand for public option

[HamdenRice]

Generally, I agree with them that they should not vote for any bill without a p.o. They have the power to draw a line in the sand.

But what I don't get is the part of the demand that the p.o. be based on Medicare reimbursement schedules.

Why is that a critical part of the po? By being flexible on the reimbursement schedules, doesn't that split the health providers from the insurance lobby? Isn't the main objection of the providers that Medicare reimbursement is too low, forcing them to subsidize Medicare patients with private insurance patients? I mean, in the long term, they have to use Medicare and p.o. reimbursement schedules to bring down health care costs, but do they have to fight that fight right now???

[kristopher]

1. Buying power, duplicate bureacracies, fragmented standards.

My opinion...

[HamdenRice]

3. I agree with the buying power argument, but politically ...

do they have to fight that fight now? Wouldn't it be better to have p.o. have its own schedule to be decided later by a bureaucracy, and then have that bureaucracy come up with a schedule that's miraculously a lot like Medicare?

As I understand it the providers' lobbies are not dead set against p.o., but mainly concerned with the schedule.

Do we need to piss them off now?

[kristopher]

7. Not if you want a good score from the CBO.

And a good score by the CBO is only going to happen if you piss off the people who want to maintain high prices.

I believe that a good CBO score for Weiner's amendment is going to be the single payer rabbit that Obama pulls out of his hat at the speech. The Republican's are rock solid in basing their objections on the cost and in using the CBO analysis as an authoritative benchmark. They've allowed a nebulous "public option" to take all the flak while setting up a series of objections that are best answered by "Medicare for All".

That hinges on a CBO score that says the plan will trim 1/2 trillion in costs over the next 5 years. To do that you have to have the bargaining power and other savings now, not later.

[HamdenRice]

9. So are you saying the Medicare schedule is to get the CBO score for po? OK. nt

[Phoebe Loosinhouse]

2. Because that will provide the benchmark the private insurers will need to meet

in order to stay competitive. It should cause all insurance costs to decrease because the privates will need to cut into their (gasp!) profits. Why put off something so basic for a later fight?

[napi21]

4. I'm going to guess here, but a close friend of mine is the

finance director of a very large hospital system, and she told me "medicare reimbursements are barely enough to cover costs, but you should seee how bad the Medicaid ones are! They don't even come close to covering 1/2 our cost to admin. preceedures!" Sje's always been straight with me, and she'd like to strangle the ins. cos. too. I suspect that is at least one of the reasons they put that "Medicare Schedule" in the ir demands. BTW, the HC System where she works IS non-profit.

[HamdenRice]

5. So I've got it backwards?

By saying that it will be based on Medicare, they are saying it won't be as bad as Medicaid, and therefore win over the providers?

[napi21]

6. Yes. Again, I'm guessing about this, but it makes sense to me

that, especially non-profit institutions can't be expected to support a program that could insure 20-40 million people or more and have them actually losing money on every treatment! We've all heard the fears that a gov't run plan would put everyoopne out of business because the gov't can just say "that's all we're paying!"

[HamdenRice]

8. Thanks. I was feeling like Rachel Maddow when she says, "talk me down"!

Makes sense, but I still think it might be better politically if the progressive caucus didn't include this in their line in the sand. It doesn't seem like a make or break thing because we all know that a p.o. will put downward pressure on prices even if it's not exactly in sinc with Medicare.

[dmosh42]

10. C-Span had a good question & answer thing on these ...

medical centers. They questioned the doctor-director for A Virginia medical center, and he pretty much said all these centers want to have the latest diagnostic machines & the supporting technology, which is enormously expensive. So, in the DC area alone, you might have many of the devices duplicated, rather than some kind of specialized service for each location. So they need to keep them busy, so they can 'make the payments'. The answer isn't to step up the schedules of payment amounts, but a reorganization of priorities by the hospitals to lower cost.

[napi21]

12. That's very true, however, when I said my friend works for a

large hosp system, I meant HUGH SYSTEM! Over the last 20+ years they have bought/taken over almost every hospital within 100 mi. radious of a large city. They have designated certain hospitals for each specialty (heart, transplant, neurology, etc) and therefore have eliminated much of the duplication of equipment. That diagnostic equip. IS extremely expensive, and you're right...the practioners always cry for the newest technolgy!

[dmosh42]

18. Ok, thanks for reply. Glad some are catching on! n/t

[Junkdrawer]

11. House bill is Medicare + 5% ... Senate HELP bill is Medicare + 10% BUT

neither bill mandates hospitals to accept this "insurance" so both are feel-good shams.

see:

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=389&topic_id=6449079&mesg_id=6449079

[napi21]

15. Do you know if either bill contains anything about the

impact of a gov't option on the currenty uninsured and how everyone handles covering what are now unpaid ER costs? Depending on location, that is a HUGH expense for most hospitals right now. My thoughts have been, if somehow this HC Reform would significantly reduce the # of uninsureds, it would automatically reduce everybody's bottom line costs that are now built into ins. premiums, your copays, and everythings else!

[Junkdrawer]

16. Here are links to the CBO analysis of both bills:

House:
http://www.cbo.gov/ftpdocs/104xx/doc10430/House_Tri-Committee-Rangel.pdf

Senate:
http://www.cbo.gov/ftpdocs/104xx/doc10431/07-02-HELPltr.pdf

[cutlassmama]

17. You're right.

That is it exactly.

Also, the main problem hasn't been that hospitals/doctors are making money it's been that private insurance companies are making outrageous profits.

[TankLV]

13. It's only "disturbing" to those who don't "get it" that the "Public Option" IS the "compromise"

position!!!

Get a fucking clue already!

I TOTALLY SUPPORT THE PROGRESSIVE CAUCUS!!!

Get on board or get out of the way!!!

[HamdenRice]

14. huh? I think it's you who doesn't get the point.

The question isn't the p.o. itself, it's about the reimbursement schedule -- whether the reimbursement schedule is a make or break issue.

As several have pointed out, the houses haven't yet agreed on the relationship between the p.o. and Medicare reimbursement schedule.

[TankLV]

19. Oh WE KNOW - and you can stop with the BULLSHIT - it ain't working!