Where is all the CPI buzz coming from??

[Peacetrain]

I am listening to the Wolf Blitzer interview with the President repeat on CNN.. and he asked him two or three times if he was going to change CPI.. and what he said is that he is looking at changes on what providers would get so that beneficiaries would not end up with a decreasing benefit..

So I went and pulled the text to read it for myself.

http://cnnpressroom.blogs.cnn.com/2011/08/16/pres-obama-ultimately-the-buck-stops-with-me-im-going-to-be-accountable/


"You, yourself, have said you support modest modifications in Medicare. Give me specifics.

OBAMA: Well, what I'm going do - I'm not going to make news here, Wolf, in terms of what a comprehensive plan would look like - but what's I've consistently said is that Medicare, health - and health care costs generally are out of control. That the health reforms that we initiated are starting to reduce those costs, but we're going to have to do more, particularly around Medicare and Medicaid.

BLITZER: Changing the cost of living index - ?

OBAMA: What we - what we –

BLITZER: - which would reduce the amount of money for Medicare, Social Security recipients?

OBAMA: As much as possible, what we'd like to do is actually reduce the cost of health care, as opposed to just shifting the cost from the government to seniors. That - that –

(CROSSTALK)

BLITZER: But a change in the cost of living, is that something you're open to?

OBAMA: The problem with some of the proposals we've seen, including some of the proposals coming out of the House of Representatives and the Republicans there, is they don't really address what they - what it takes to reduce costs.

What they say is, senior citizens, we're going to voucherize it, and whatever inflation there is you're going to have to cover out of pocket. So seniors might have to spend $6,000 more.

What we say is are there modifications that can change the delivery system and how health care is delivered so that you don't have to take five tests, you take one; so that providers are not ordering unnecessary procedures, but focusing on what actually works.

The more we can do those kinds of changes - and, in some cases, you know, that involves empowering consumers to make better choices, then we can hopefully control these costs without seeing any radical change to the basic structure of Medicare.

[MannyGoldstein]

1. "As much as possible..."

I think we know how that ends up for Democrats!!

[Peacetrain]

2. Manny you have had a wild hair for weeks now..

And been going on about CPI.. and where Manny... where are you getting this. Blitzer asked him stone cold and they are looking at the providers ..

[madfloridian]

5. Obama did not give a straight answer on CPI

[Peacetrain]

7. Did you listen to the interview Mad?

I listened to it.. and he backed Wolf down..

[elleng]

9. THANKS, Peace!

[Peacetrain]

10. Hey ellen!

I am glad I got a chance to actually hear the interview..

[elleng]

11. 'True facts' are useful, eh? Too bad many don't bother/not interested, just spout off.

[madfloridian]

22. I hate it when you guys talk like that, like we are not here...like behind our backs.

I read the part that was posted as text, and in that part he did not give a direct answer on chained cpi

[elleng]

26. Peace said she'd LISTENED to the interview,

which confirms my suspicion, based on the transcript, that President Obama had NOT said he was planning to/hoping to change the CPI. Right, in the transcript he did not give a direct answer; blitzer did not allow him to do so.

'BLITZER: Changing the cost of living index - ?

OBAMA: What we - what we –

BLITZER: - which would reduce the amount of money for Medicare, Social Security recipients?

OBAMA: As much as possible, what we'd like to do is actually reduce the cost of health care, as opposed to just shifting the cost from the government to seniors. That - that –'

As far as 'talking behind your backs,' sounds pretty silly; there's no 'sub rosa' here, ya know!

[MannyGoldstein]

15. Where did Obama deny that they were looking at cutting CPI?

My big beef is on Social Security. There are zero problems with it, so any attempts to cut benefits are pure theft, totally black and white. Obama has been working hard to slash Social Security, and that's awful, awful stuff:

http://www.handsoffss.org/what-is-the-deficit-commission-why-did-it-recommend-deep-cuts-in-social-security.html
http://www.handsoffss.org/hasnrsquot-president-obama-pledged-to-fight-against-social-security-cuts.html
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=439x1631283

Medicare is trickier, because that actually will become unaffordable, and (as Obama said) the reason is because costs are too high. We pay far more for health care than does any other country, twice (as a percentage of GDP) what the average industrialized country pays, and our medical outcomes are, at best, no better than average. Single payer health care could have fixed that, but it was off the table - apparently it's OK for those 65 and over in the US, but not for the rest of us.

If we allow Obama and others to continue with their weasel words (http://www.csmonitor.com/USA/Politics/The-Vote/2011/0707/Briefing-room-word-games-What-s-a-slash-versus-a-cut-in-Social-Security">here's my favorite), we'll wake up one day and seniors will have their Medicare and Social Security cut. We must protect these programs aggressively.

[madfloridian]

23. I don't see it either.

:shrug:

[woo me with science]

Not to mention that he *already* put CPI on the table, just a few weeks ago.

That in itself is a very good indication that it remains one of the most likely options on the table as the Super Congress convenes to discuss options.

[truedelphi]

3. The Republicans know that all they have to do is push hard for

Something and then they will get it.

Prsident Collusionary doesn't have the ability to negotiate himself out of a big paper bag.

[karynnj]

4. Blitzer has conflated two things and is not really listening to the President

He seems to be speaking of the chained CPI that some have proposed for social security. The President is speaking of things that are being considered to lower the rising medical costs. (Consider there are ways to do that - such as the trial to pay doctors based on what they are treating and outcome rather than on the basis of tests and procedures done.)

[elleng]

8. Exactly. Thanks

[DURHAM D]

12. Obama should have looked at Wolf and said

"That is a stupid question and you don't understand the basics." However, what I really don't understand is why Obama tried to answer it.

[LiberalFighter]

35. yes

[PoliticAverse]

28. Right, Obama keeps talking about Medicare and Wolf keeps talking about SS COLA. n/t

[elleng]

6. Its coming from nay-sayers' imaginations, of course.

'actually reduce the cost of health care, as opposed to just shifting the cost'
'modifications that can change the delivery system'

[DURHAM D]

13. My take on the last paragraph -

Medicare clients will have co-pays for every single procedure/test. If its just $5 or $10 people will push back and ask why they need it. It would slow down the train.

[MannyGoldstein]

16. Other industrialized countries don't have co-pays, yet

health care costs half what it does in the US, and medical outcomes are at least as good.

Let's stop picking on seniors and start solving the real problems.

[DURHAM D]

17. Ok Manny - How do you propose to cut medical costs?

For the time being leave the private health insurance companies out of the conversation. Also, leave out prescriptions for the moment.

[MannyGoldstein]

18. Every other industrialized country in the world has far lower costs

We can study what any one of them does and copy it - they range from fully-socialized medicine (e.g., England, Spain) to mandatory private plans that are extraordinary tightly regulated (e.g., Netherlands, Switzerland). There's no shortage of ways to do it: rather, there's a shortage of desire to have some rich folks eat their peas. Eating peas seems to be only for the 99%.

[DURHAM D]

19. This is not a helpful response.

Especially the last two sentences.

I know you are mad but I thought maybe you could provide a road map of the way forward. We have an entrenched mess that is our reality. How do you turn this glacier around?

[MannyGoldstein]

20. Medicare for all

Is my favorite candidate. People already know Medicare, and they like it. If everyone was on Medicare, whether the government paid or individuals paid, it would have the leverage to drive costs down, and would slash overhead. Overhead for Medicare is about 5%, vs 20%+ for private insurers.

But there are many ways that have been proven to work, while ours has proven to fail.

[DURHAM D]

21. Ok - So here is what I take from that.

1) You want single payer (US government issued check)

2) You said you don't care who pays - government or individuals. Medicare is funded by individuals through payroll deductions. In my case over a work life of 45 years. However, the government writes the check. I don't see anyway to set up a single payer/Medicare type program where individuals write the checks. Do you?

3) You state it will drive down the cost. I assume you mean the actual cost of the health care? Is that what you mean? Or, did you mean the cost of medical insurance?

4) You stated it will drive down overhead. Won't it raise the government's overhead?

The place to start with Medicare is on the payroll deduction. It has not been raised in over 25 years. The second problem is that doctors and hospitals run every test they can think of when the get a Medicare patient in the office - they treat us like cattle. In part, because they know they will actually be reimbursed. Myself and my sister made a career out of chasing down charges and asking "Why" for every test my parent's doctor ran or wanted to run. Why did we do that? Because my parents taught us to as they pushed back on the fluff for the first 25 years they were on Medicare. When we had to take over we continued to do what they had done. Now I push back.

Today when you are in a large clinic you can see that pretty much everyone in the waiting room is a senior (no matter the specialty) and it is easy to see that we are the cash cows. If more seniors asked more questions about tests, procedures, etc. Medicare costs would go down. One way seniors would be motivated to ask those questions is if they had to make a small co-pay for every test. The co-pay should be on a sliding scale - income tested. Medicare is already income tested in that seniors who make more money pay more for their monthly Part B. Use that or a similar scale for the co-pay sliding amount.

So, I am for a single payer government written check to the providers but how do you begin? Get rid of the current payroll deductions that fund the program and just put in its place a standard fee for each family member? Would the employer be required to pay 50% of the amount? 20%? 0%?
Or, should the fee be based on your age and depend on how much you have already contributed?

Currently Medicare does not pay any attention to how much you have paid in over your work life. Do they need to? If you are single and have worked 40 quarters you are eligible for Part A and provided an opportunity to get part B if you are willing to pay for it. Should people (like spouses) who have never worked be eligible for Part A for free or does that need to change? Should people who have paid in a lot over their work life be allowed to buy Part B (currently $115) for a lesser amount? Do you think the current Medicare program which is an 80/20 needs to be changed to a 90/10 or 100/0? Or maybe go the other way - make it a 70/30 (private insurance companies will still get to write the medigap/supplement policies). At the end of the day Medicare coverage is far from perfect and not that fair and needs to be tweaked in several areas, including figuring out a way for seniors to stop be the doctor's guinea pigs cause they want the $$$.

[MannyGoldstein]

29. I want anything that has been proven to work - answers below

>>I don't see anyway to set up a single payer/Medicare type program where individuals write the checks. Do you?
Yes, the way to do it is by having individuals write the checks. There was a movement to do just that in Congress towards the end of the healthcare reform debate, and 59 Senators were in favor of http://www.huffingtonpost.com/2009/12/08/medicare-buy-in-proposal_n_384591.html">allowing individuals 55-64 to buy into Medicare - then the proposal disappeared when the pharmacomedical establishment weighed in against it.

The problem that you point to of overutilized tests and procedures is because, as you say, docs make money per procedure - so it's in their best interest to order stuff that makes as much money for them as possible rather than what's cost-effective, or even just effective (most of the money spent in medicine today is on stuff that's not been demonstrated to improve medical outcomes).

You might like the way things are done in the UK - docs are on government salary, and the government is very good about setting guidelines for how medicine should be practiced. They do FANTASTIC research to find what actually works, and what does not. They negotiate aggressively with drug companies and other vendors. As a result, patients get great medicine at low cost.

I agree that Medicare for all is imperfect - but it's far, far better than what we have now, and probably pretty easy to achieve because everyone already knows it and likes it (except the pharmacomedical establishment). Proposing something different, like UK-style socialized medicine, will scare a lot of people.

[Recursion]

25. Every time somebody tries to solve the real problem the left and/or right start screaming

The simple fact is national single payer would bankrupt us all if we can't control provider costs. So will private insurance. We're screwed either way as long as providers make as much as they do now.

[MannyGoldstein]

30. But national single payer would at least be able to control costs

And it would immediately cut the cost of care by cutting overhead costs - Medicare's are 5% vs 30%+ for private insurers.

But you're right, if there's not a lot else that can be done without the will to miff the wealthy.

[bornskeptic]

34. Of course other countries have copays.

They couldn't keep their costs down if they didn't.

FRANCE:
France is often seen by liberals as the ideal system. It has universal health care, with few waiting lists. France has the highest level of satisfaction with their health care among all European countries. How can this be? What is their secret?

France provides a basic, universal health insurances through large occupation-based funds. The General National Health Inusrance Scheme covers 83% of French workers, while other occupational specific (e.g.: for agricultural workers, for the self employed, for miners, etc.) cover the remainder. About 99% of individuals are covered by this universal health insurance system.

However, France utilizes more market-based ideas than most people realized. Copayment rates for most services are 10%-40%. About 92% of French residents have complementary private health insurance.

http://healthcare-economist.com/2008/04/14/health-care-around-the-world-france/

GERMANY:
Copayment/Deductibles. Until recently, there have been almost no copays or deductibles. Recently, Germans have begun paying €10 copays for prescription drugs, doctors visits, and hospital stays.

http://healthcare-economist.com/2008/04/24/health-care-around-the-world-germany/

SWITZERLAND:
opayment/Deductibles. Premiums are community rated and only adjusted for sex and age. Employers do not pay for workers insurance and thus many Swiss have opted for less expensive plans with higher deductibles. This has lead to the Swiss paying for 31.5% through out of pocket expenses.

http://healthcare-economist.com/2008/04/23/health-care-around-the-world-switzerland/

[emulatorloo]

14. Facts do not matter to Republicans and some DU'ers. Thanks for posting.

[Recursion]

24. Wait.. the CPI is about how Social Security calculates inflation... nothing to do with Medicare

I'm not sure why they're being brought up in the same context.

[boppers]

31. Does CPI include costs of medial are?

I'm guessing not, because inflation has been flat, as has the COLA, while medical are costs keep growing....

[Recursion]

33. CPI prices specific physical commodities

Medical costs have been increasing at three times the rate of nominal inflation, and attempts to slow that increase have been demagogued on this very board as killing Grandma.

[Bluenorthwest]

27. CPI has nothing to do with Medicare.

Not sure about the title going with the text, because they don't. But you know that. Sad.

[DU GrovelBot]

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