America's Affordable Health Choices Act of 2009 - The USCHO debates

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Why would their pay be regulated? If anything, more people insured should equal more business (albeit at maybe less $$$ for Medicare/Medicaid patients per patient), shouldn't it?

You just said it. The whole plan is basically an expansion of Medicare which regulates reimbursment rates. Why would a doctor want to do more work for less pay?

If you are going to let the free market dictate price then you are going to have a massive price increase when you add 50M people to the system.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Rover - clearly, I'm all in favor of finding mechanisms to pay for any changes up front, and kudos to all those involved for doing so. All I'm saying is that I seem to be hearing more and more about funding and less and less about reform.

It seems like all we hear about are nebulous promises from "the industry" that they will identify a few billions in savings here and there. Somehow that seems a bit disingenuous to me - they're telling the government what it wants to hear in order to get this bill passed. What's a few billion in savings when the government is about to hand them a previously untapped, captive base of 45 million new customers? Without explicit cost controls, rationing, etc tied to mandatory coverage, I fear that "the industry" are about to make out like bandits at the expense of the quality of care for us, their customers.

In no way would I ever suggest that this plan is foolproof or will solve all problems. However I will say that there are some proposals which seem like they'll make it into the final draft that would help address your concerns. In particular the independent board who's actions can only be overriden by Congress (thus giving veto power to 41 Senators if needed) much like how base closings work. There's also some anti-fraud provisions, which if done right given the overall size of the program can also yield big savings.

Beyond that though, I also feel that if you make this effort once, it'll be easier to revise as time goes on, as opposed to if you don't make the effort, you're starting from square one all over again. Its easier to tweak an aspect of it than start from scratch again. You can address the singular issues of the industry making out like bandits and not living up to the publicly stated cost saving promises as they come up.

Fee for service is set by Medicare/Medicaid and is typically not enough to cover costs and a reasonable salary for the docs. More of those patients will not increase the doc's income as they already see too many patients in a day as it is.

Two things here. First doctors don't get their salaries exclusively from Medicare/Medicaid. Second, while I don't think they're going to get rich here, the point I was answering was the notion that they'll be less doctors because reform will squeeze their payments. It may, somewhat, but that should be offset to some degree by more people in the system. I know several doctors and none of them are poor. Furthermore, I haven't ever met anybody who was a practicing doctor but gave it up to work in fast food or retail so I think some of these concerns may be a bit exaggerated IMHO.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Why would a doctor want to do more work for less pay?

Why would anybody MinnFan? The answer - to keep your job. There are a lot of us in the working world right now working longer hours, and if you receive bonuses you're probably working for less pay because they haven't been as robust as in previous years. Is that a reason to stop working? No, it isn't, because that alternative is worse (no money at all) than working a little more for less. Americans have been doing that throughout this whole recession.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Why would anybody MinnFan? The answer - to keep your job. There are a lot of us in the working world right now working longer hours, and if you receive bonuses you're probably working for less pay because they haven't been as robust as in previous years. Is that a reason to stop working? No, it isn't, because that alternative is worse (no money at all) than working a little more for less. Americans have been doing that throughout this whole recession.

I realize that current doctors would have to suck it up. Some would leave, but most would stay. Anybody near retirement is gone. But how are you going to get more doctors coming out of med school in the future when there is less incentive to become one? Take a look at Canada and see what happened there.

 

[Red Cloud]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

He's just following his predecessors lead as all good Presidents do.

Then again, at least Bush was on record as saying he was glad he lived in a country where you could rally in the street against the President. Obama wants to hit dissenters back "twice as hard," and is recruiting informants on the White House website. There's your post-partisan President.

personally I think the president has opened the door to getting sued personally if somebody gets injured with his whole "hit back twice as hard" bit.

Yeah, about that.

http://www.youtube.com/watch?v=zTXBOgPCh9w

In case you're wondering, yes, that is two SEIU members, in full SEIU regalia, assaulting a conservative activist outside of a town hall in St. Louis.

They aren't brownshirts - they're clearly wearing blue. So that's good.

By the way, the audio is a little NSFW - a few four-letter words thrown around.

 

[ScoobyDoo]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

There's your post-partisan President.

I think you missed my point. There is no such thing. They all lie. Prostitutes lie less than they do.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I realize that current doctors would have to suck it up. Some would leave, but most would stay. Anybody near retirement is gone. But how are you going to get more doctors coming out of med school in the future when there is less incentive to become one? Take a look at Canada and see what happened there.

Because being a doctor is still a lucrative career. Again with the somewhat extreme example of how I've never encountered someone working in fast food or retail who gave up the medical profession to work there.

Its entirely possible a lot of professions won't be as lucrative as in the past. I've heard (but have no personal experience in) that code writers/programmers have had their wages decrease because of globalization. Doesn't mean its still not a job you'd do. Just it might make less money than people in the past made. You could also make the case that financial company CEO pay will not be as high as in the past, but I don't believe companies will have trouble finding CEO's as a result.

 

[MinnFan]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Because being a doctor is still a lucrative career. Again with the somewhat extreme example of how I've never encountered someone working in fast food or retail who gave up the medical profession to work there.

Its entirely possible a lot of professions won't be as lucrative as in the past. I've heard (but have no personal experience in) that code writers/programmers have had their wages decrease because of globalization. Doesn't mean its still not a job you'd do. Just it might make less money than people in the past made. You could also make the case that financial company CEO pay will not be as high as in the past, but I don't believe companies will have trouble finding CEO's as a result.

But will they be able to get the most talented CEO's?

When you consider the cost and effort associated with getting into the field any decrease is going to either get you less doctors, or less qualified doctors. Talent, like capital, is going to find its highest return. There are plenty of other options out there for talented people even if a few career fields start paying less. I have had plenty of doctors tell me that they wouldn't encourage anyone to go into the field if this bill passes.

And this is just talking about replacing the current crop. Now you have to find a way to add thousands more.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

But will they be able to get the most talented CEO's?

When you consider the cost and effort associated with getting into the field any decrease is going to either get you less doctors, or less qualified doctors. Talent, like capital, is going to find its highest return. There are plenty of other options out there for talented people even if a few career fields start paying less. I have had plenty of doctors tell me that they wouldn't encourage anyone to go into the field if this bill passes.

And this is just talking about replacing the current crop. Now you have to find a way to add thousands more.

That's a question you'll never know the answer to, so it shouldn't be used to hold up policy.

I'd also add that I'm not sure if you have the talent to be a doctor, you could just as easily be a lawyer or run a company. Sure the intelligence would be there, but the desire or interest to work in an alternative field may not. Again, these are highly hypothetical questions that can't be answered, and in fact you might have the same problems if you kept the current system the way it is.

 

[The Sicatoka]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Will socialized medicine be managed fiscally as well as Medicare/Medicaid?

Will socialized medicine be managed fiscally as well as "Cash-for-Clunkers"?

Will socialized medicine be managed as well as the Post Office (rate increases, fewer post offices, fewer delivery days)?

Will socialized medicine be run like "carbon credits" (where some pay and others are given free usage because they're a "FO--"*)?


* FO--: Friend of <name here>, common usages are FOBO (Friend of Barack Obama), FOOW (Friend of Oprah Winfrey), or FOACORN.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Will socialized medicine be managed fiscally as well as Medicare/Medicaid?

Will socialized medicine be managed fiscally as well as "Cash-for-Clunkers"?

Will socialized medicine be managed as well as the Post Office (rate increases, fewer post offices, fewer delivery days)?

Will socialized medicine be run like "carbon credits" (where some pay and others are given free usage because they're a "FO--"*)?


* FO--: Friend of <name here>, common usages are FOBO (Friend of Barack Obama), FOOW (Friend of Oprah Winfrey), or FOACORN.

I appreciate you taking some time out from playing in the sandbox to post such intellectually heavy stuff, but I think you're needed at one of those health care forums to chant at the top of your lungs in order to stop people from asking questions.

 

[ScottM]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

There's your post-partisan President.

I'd give that statement a bit more credence if the GOP actually offered more constructive ideas and input, instead of continually whining like a bunch of little biatches. And not just on healthcare.

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I realize that current doctors would have to suck it up. Some would leave, but most would stay. Anybody near retirement is gone. But how are you going to get more doctors coming out of med school in the future when there is less incentive to become one? Take a look at Canada and see what happened there.

Exactly.

If the health care bill is adopted in anywhere near its current form, you're going to see a lot of doctors retire, thus exacerbating the problem. And doctors aren't a commodity you can replace overnight.

 

[Jon]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

So in summation: Clearly there's a nice medium between crappy healthcare everyone can afford and great healthcare few can afford.
It would nice if we could find it.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

An on point (if a little melodramatic) editorial about one of the topics we've been discussing today...

http://www.nytimes.com/2009/08/07/opinion/07krugman.html?_r=1

 

[Bill]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

An on point (if a little melodramatic) editorial about one of the topics we've been discussing today...

http://www.nytimes.com/2009/08/07/opinion/07krugman.html?_r=1

Yah, he's not exactly neutral in his political views, and it shows.

 

[Rover]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

He's largely correct however. Politically speaking, this is backfiring. Its a stupid tactic. It would be far more effective to still pack the meetings but to ask respectful but pointed questions to congressmen. The same point would get across (we don't like this plan) but that would be the news instead of some fake outrage planted by well known conservative operatives. This will have two effects, both negative if you're on the right:

1) It puts the Republicans in the conversation as the opposition, whereas previously they've benefited as being the silent and invisible party while the Dems had fought with each other, which leads to...

2) Nothing with galvanize both Dem politicians and the 70% of the voting population that isn't hard core conservative like idiotic, juvenile tactics which were the hallmark of Bush/Rove politics (or Nixon politics from the article). Now Dems who may have considered opposing the legislation have a big reason to put aside their differences just to screw the activists causing these disruptions. Why would you do something to unite the other side who's in the overwhelming majority in Congress. Do they really think a majority of the public, even if they were on the fence, would enjoy attending a meeting where rude people have come to shout down everybody else in the room? That sort of thing doesn't tend to win you converts.

The rhetoric on the right is getting even more extreme. Death threats to a Congressman? Liking health care reform supporters to Nazi's? These are going to win people over???

 

[SPIN CONTROL]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

http://www.rasmussenreports.com/pub..._view_town_hall_protesters_favorably_35_don_t

Forty-one percent (41%) of U.S. voters have a favorable opinion of the people opposing health care reform at town hall meetings now being conducted by members of Congress, according to a new Rasmussen Reports national telephone survey.

But 35% view the protesters unfavorably. Twenty-three percent (23%) are not sure what they think of them.

Senior Democrats charge that many of the protests at the town hall meetings are orchestrated by special interests, but 49% of voters believe, generally speaking, that the protesting citizens are reflecting the concerns of their neighbors.

 

[ScottM]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

Yeah, they had some of these "attendees" raising hell when our local MOC came through town this week, and also protesting on the street. It was amazing how many were on Medicare/Medicaid, and failed to see the rich irony.

 

[The Sicatoka]

Re: America's Affordable Health Choices Act of 2009 - The USCHO debates

I appreciate you taking some time out from playing in the sandbox to post such intellectually heavy stuff, but I think you're needed at one of those health care forums to chant at the top of your lungs in order to stop people from asking questions.

Those are serious, legitimate questions that no one seems to want to answer.

They were asked calmly and rationally here. And they were ducked. So, Rover, go lay by your dish.

I believe this sums up the average person's feelings pretty well:

Pam Benson of Larch Mountain, 62, said she realizes (Congressman) Baird disagrees with her on health care reform.

But the lack of town hall meetings makes her feel angrier and more helpless, she said.

"He's supposed to be our representative," said Benson, a purchasing manager for Portland Cascade Architecture and Engineering in Portland. "He's supposed to listen to us, whether he's on our side or not."

Benson said she doesn't understand why health care reform is moving forward when everyone she talks to seems to oppose it.

"We are not nut cases that disagree with this issue," she said. "There are a lot of very well-informed people that are against this health care thing."

It's enough to make a Republican like her paranoid, she said.

"It makes me feel that there is a conspiracy here to screw up the whole entire United States," she said with a laugh. "It's just too much, too fast."