Why Medicare cuts are the right thing to do.

[Hamlette]

Howard Dean was on either some MSNBC show or Olbermann to talk about the WP story that the WH is going to cut SS and Medicare.

Dean said it was absolutely the right thing to do. The host (can't remember who) was too stunned to engage in a discussion and had been expecting, I suppose, Dean would trash the WH.

What Dean said is was right and should be what we are talking about.

You can cut Medicare spending without cutting Medicare benefits and make us all healthier in the process. You pay medical providers for results, not for procedures. (If I remember correctly this is the "capitation" discussion we had during Clinton's push to reform health care.) He said that if you cut spending procedure by procedure doctors will just find a way around the billing process by ordering different procedures to make up the difference in payment. If you give a provider X amount of money and say "care for this person by providing a minimum of this level of care" health care costs will go down without sacrificing the quality of care.

So it surprises me to see all these threads about how the Democrats are done and you are all done with Obama if the WP article is true and Obama has put Medicare on the table. It should be on the table, not the way Ryan does it, which does not control costs, but the way Dean proposed (and we all supported a few years ago).

Is Dean wrong or are we just playing push back because we think Obama's staff reads these web sites and we want to make it clear we are unhappy?

[Sarah Ibarruri]

1. I can think of thousands of things to cut! WHY MEDICARE?

Are these people doing drugs?

[madfloridian]

2. Howard Dean is wrong. He has no idea how little Medicare pays.

He is trumpeting everything the WH says now. .

[dbonds]

3. Defense spending cuts are the right thing to do ...

Leave Medicare and SS alone except to ensure they will stay as they are.

[Raven]

4. ".... care for this person by providing a minimum level of this care" ???

Does that mean "take an aspirin and call me in the morning"?

[davsand]

15. "Self control over spending" is how I understand it.

It means Medicare would not be paying for a cat scan if a sonogram will provide equally reliable information. The docs make decisions about what tests to order, and if they can order a cheaper, equally safe, equally accurate alternative it makes sense they would do it. Many, however, do not.

A similar argument has been made about the use of Generic drugs -v- the name brands. Sometimes there simply is NO generic, sometimes there is...


:shrug:



Laura

[Rex]

5. We waste trillions on pointless wars, just gave the MIC 600 billion

to keep the killing ongoing, but yeah...no way we can bring troops home in an attempt to save trillions...lets fuck over grandma and grandpa. Much better idea.

[sarcasmo]

28. +1

[polichick]

6. Problem is, as Dean pointed out, he doesn't know what the prez has in mind.

[pscot]

25. And the devil lurks

in the fine print.

[Enrique]

7. if he's assuring us that benefit cuts are off the table

then i don't believe him. Obama has been talking about "painful" cuts.

[newfie11]

8. my concern is who controls what appropriate treatment

Isn't this the problem with many insurances? What is cut to save money.

[Warren Stupidity]

9. Dean is also accepting the framing that deep cuts must be made.

So he is a useless enabler of Disaster Capitalism too.

[Big Blue Marble]

14. I saw him the other night making these arguments.

Have they chipped him or do they have his kid locked in the basement?
His body language looked like he had just eaten a sh*t sandwich.

[kenny blankenship]

19. He is hostage, along with the rest of the Party, to Obama's Presidency

If the deal fails because the Democrats won't go along with the President's sellout to Republicans, Obama's Presidency goes down in flames. Congressional Dems are also at high risk in a finger-pointing war over the default, and the Senate already looked bad for Democrats in 2012 before all this started.

Understand: the Republicans may have taken the Treasury hostage with the debt ceiling gimmick, but Obama is taking the Democratic Party hostage in turn, forcing them to begin negotiating on (negotiating away in what will a long excruciating series of "crises") their most important historical achievements as a party. Bush could NEVER do this. McCain would have failed just as laughably. Because we're supposed to oppose Republican assaults on our core values and programs. But with Obama it's Yes We Can. To oppose him is to be pilloried as Those Disunited Dems! Those Crazy Liberal Flower Children Who Just Won't Grow Up And Throw Grandma Into the Sausage Grinder! Through this leverage Barack Obama will complete the Reaganification of the Democratic Party.

And Howard Dean is not immune to the pressure to "Save the Party!" at the expense of the lives of its constituents. He thinks we'll survive to fight another day or some similar self-deluding bullshit. Anyone who wants a role in the Party or who has had a role in the Party is eventually faced with decision: is my main loyalty to the Democratic Party, or to its constituents? If Howard Dean wants to continue to be asked on TV to give an opinion for the Democratic Party, if he wants to be "relevant", he may at times feel obliged to take the side of the Party and its immediate prospects over the interest of some of its constituents. This is one of those times. Such is the fate of all partisan animals.

[Hamlette]

22. Obama gives us all too much credit

he probably thought we could think for ourselves. Using reason and logic.

We cannot afford the current health care delivery system in this country regardless of who pays for it.

[Hamlette]

20. it is the same thing he's been saying for years, in the same way

I didn't think he looked like he'd eaten a shit sandwich. He looked like Dean to me. And he was saying the same thing as when he ran for president. Exactly the same thing, which is what attracted me to support him in the first place.


and its the same thing most of us supported under Clinton. Sort of a hybrid between the German, Canadian, and French systems.

One of the reasons health care costs have risen so much is they can. There is no one to tell a provider he/she can't buy some new expensive piece of equipment or do unnecessary tests. If Medicare which is already highly efficient, can now control the costs of health care without cutting benefits, why the hell not?

The best system, IMHO, is like Oregon did for Medicaid. List services that will be covered and cut off services that have not demonstrated they do much good. That is how I see universal coverage could work here. Use France as the model. If you want a procedure that hasn't demonstrated it is successful or will do much good, buy a policy to cover that. As a tax payer, I don't want to pay for Rupert Murdoch to have a penis implant, his secondary insurance should care for that.

[WingDinger]

10. Then we damn well better not have tort reform.

[Big Blue Marble]

11. They are planning to cut benefits.

They are asking the recipients to pay more of their medical expenses out of their own pocket.
The pocket that has been drained of pension benefits and now is being drained of Social Security
benefits. Exactly how are these elderly people suppose to pay more for medical when they are
now struggling to eat and pay for their meds while keeping the heat on?

First cut the subsidies to the corporations; cut the war budget; and raise taxes on the wealthy,
then come and tell me we can no long afford to take care of weak and elderly. Tell me then
you are willing to break the promises that their lives depend on.

[cbayer]

12. Don Berwick, who Obama named as head of CMMS is the guru of improving patient

safety and increasing efficiency. The inefficiencies, waste and poor practices throughout the system absolutely need to be on the table. The end result will be more funds available for appropriate care to more patients.

To say we shouldn't touch it is short sighted. If our goal is a single payer system modeled on Medicare, then the first thing we need to do is revamp Medicare to make it a system that actually serves those it was intended to serve.

I trust Dr. Donald Berwick to do this. IMHO, Obama could not have made a better choice for this post.

[Hamlette]

17. exactly

the costs of medical care are out of control in this country especially when compared to other countries.

The government only has control of health care costs in programs it controls like Medicare and Medicaid. If the government can control those costs, like say Germany does, it will improve care while showing how the government can be effective in delivering health care.

If we want single payer (which I do) then we make Medicare even better by a system of capitation.

[ProfessionalLeftist]

13. Cutting waste and fraud is fine with me. Cutting benefits is NOT

That said, cutting benefits and calling it "cutting waste and fraud" is equally unacceptable.

And what did Dean say obout SS?

[woo me with science]

16. And the familiar dance repeats itself...the inevitable shift in the forum arguments......

from denying that the policy will happen to defending it.

[Hamlette]

18. of, stopping to think about what is happening instead of say "worst President ever" whenever the WP

writes something that might be bullshit.

If and when the WH or the dems say they are going to cut benefits, I'm with you. Until then, I'm with Dean.

[woo me with science]

21. Cutting payments to providers hurts seniors,

because said providers stop accepting Medicare out of sheer self-preservation. Talk to the doctors who have posted here at DU. If you support this, you are essentially supporting the growth of a two-tiered medical system.

If you confine yourself to cutting waste and fraud, I have no problem with that. But that will in no way yield even close to the numbers the White House is looking for...which tells us that cutting waste and fraud is NOT what this is all about.

[Hamlette]

23. how is capitation hurting seniors?

How would Dean's plan hurt seniors?

[woo me with science]

26. It hurts seniors when payment to providers sinks below what they can afford

and still sustain their practices.

Please do not engage in disingenuous attempts to broaden the argument here. CUTS are what we are talking about here. Not the concept of capitation, but the CUTS to both providers *and* benefits that all this theatrical panic about the deficit is suddenly making possible. In case you hadn't noticed, Dean appears to support both.

[Hamlette]

29. that's not what Dean supports

he supports capitation. Which cuts the cost without cutting the quality of care.

And, calling me a liar doesn't help your argument. I understand Dean's proposal and I've not heard the WH say it will cut benefits or payments to providers for services. I'm not changing the subject, and I don't see how what Dean says is different from what he "appears to support."

What is wrong with capitation. That is what Dean is talking about.

If you allow providers to charge what they want and/or do what they want it will bankrupt us all. That is Dean's argument.

[woo me with science]

31. Okay, point taken.

I apologize for saying you were being disingenuous. My rhetoric can get heated when I am upset, and I am extremely upset about the sudden, convenient false urgency to cut Medicare, Medicaid, and Social Security, when we are extending multiple wars and tax cuts to billionaires, and when the debt ceiling was raised eight times during the Bush administration.

I see Dean calling not only for structural changes in Medicare, but also direct cuts to benefits, so I do not trust him to begin with. The endorsement of capitation in this context is, IMO, not just an endorsement of the concept itself, but of the more urgent fundamental goal here - a goal he has publicly backed for Medicare for at least 5 to 10 years - which is to slow the growth of the cost of the program. Under capitation, this goal will occur through reduced payments to providers.

If you slow the growth of payment to providers without addressing the underlying problem of escalating costs of treatment, the net effect is that provision of care will have to be affected. I understand the arguments that, under capitation, a physician will have less incentive to pad the bill with services and more incentive to offer cost-saving, effective treatments. Those savings, however, will not even begin to compensate for the combined effects of slowing growth of payments to providers and skyrocketing medical costs over time.

Medical costs are still spiraling at far above the level of inflation, and physicians will OF COURSE be put in a position of limiting care as payments are slowed and costs continue to escalate. Top-down payment caps are a false fix that put physicians in an untenable position, and for anyone to pretend that this will solve our problems is beyond irresponsible, IMO. I see nobody putting forth serious measures to control the spiraling of costs in this sick corporate system we have now, except by limiting care. Throw into the mix administrative costs of making these structural changes, and I don't think it's even clear yet that expanding capitation is a good idea. Maybe it is worth further discussion, but it is certainly not going to be the solution to our problems.

DC is in a cutting and slashing frenzy right now, and everyone is ready to make huge structural changes to bedrock programs within a few weeks' time, because someone is blowing the urgency horn. IMO, Dean is leaping in with quick, false solutions that will harm seniors or continue to harm them, without first questioning the frenzy itself.

[obxhead]

24. Eliminate the need for Medicare.

Enact Single Payer. Cut out the parasite insurance industry completely.

[sarcasmo]

27. Stop the Trillion dollar wars, budget problem solved.

[Rex]

30. It is so obvious that at this point it should be criminal

to keep the troops gone a day longer and a dollar shorter. I think Washington DC is scared to bring the troops home.