Not many times do we agree with Howard Dean, however, on the "death panel" provision we do agree. Yes, we know that is Sarah Palin's take on the rate setting mechanism, but it is clear that others are starting to agree with the former governor.
The Independent Payment Advisory Board is a artificial means of keeping down the premiums by limiting the availablity of certain procedures by keeping the cost to a point that no doctor will do them. Even the CBO, which has been terribly inaccurate in its "projections" of the cost of ObamaCrapCare, says this board will not make a difference for many years. We doubt that it ever will.
It will prevent your average 65 year old from getting a heart bypass or an alcoholic (of any age) from getting a liver transplant or giving an uncontrolled diabetic a prosthetic but it will not solve the costs of ObamaCrapCare which are built into the program. Those "guaranteed benefits" will end up drowning the system.
Isn't it time for the country to wake up and decide that ObamaCrapCare was, in theory, a good concept, however, its execution is a disaster. Even Democrats are starting to see the light.
Conservative Tom
Howard Dean: Obamacare's Rate-Setting Mechanism Won't Work
Sunday, 28 Jul 2013 07:41 PM
Dean generally likes the Patient Protection and Affordable Care Act, popularly known as Obamacare, but he as a few quibbles with it, he writes in a Sunday Wall Street Journal op-ed.
The Independent Payment Advisory Board is a "health-care rationing body," Dean explains, which has the power to set rates for certain procedures for Medicare and determine which procedures and drugs will be covered.
"The IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them," he said.
While Dean agrees that costs need to be contained, he says the mechanism that will run the IPAB -- known as rate-setting -- has a 40-year track record of failure.
"What ends up happening in these schemes … is that patients and physicians get aggravated because bureaucrats in either the private or public sector are making medical decisions without knowing the patients," he said.
The Congressional Budget Office has admitted that the IPAB won't save a penny before 2021, he said, but "(a)s everyone in Washington knows, but less frequently admits, CBO projections of any kind — past five years or so — are really just speculation."
Based on his own state of Vermont, and others, Dean said he believes the IPAB will never control costs.
So far, 22 Democrats have joined Republicans in Congress in an effort to kill the IPAB. Dean wants to see more join the effort, but fears current bickering is stifling the effort.
A group of Senate Republicans led by Sen Mike Lee, R-Utah, have threatened to block continuing to fund government operations past Sept. 30 if Obamacare funding is included.
"The IPAB will cause frustration to providers and patients alike, and it will fail to control costs," Dean said.
"Policymakers in other countries typically have shied away from setting an explicit cutoff price per QALY (or other measure of outcome) above which collective funds will not be used to purchase additional output from the health sector. Such a pronouncement would undoubtedly be politically controversial and divisive. Instead, countries typically have sought to set that upper limit implicitly, through a mixture of price controls and limits on capacity. If one had to make a rough guess on the implicit prices that health systems are willing to pay for QALYs, the relative overall positions of theUnited Kingdom, Canada, and theUnited States in Exhibit 3 seem plausible, although we make no pretense that the differentials suggested
ReplyDeletethere are accurate. It might be illuminating in future cross-national research to extract through opinion surveys from various stakeholders in health care more explicit notions on the maximum price that should be devoted to wrestling an additional QALY from nature through the health care system."
http://dzcowan.com/Tech%20Attachments/HS%206000/HealthCare%20Spending%20in%20International%20Context%20HS6000R3.pdf
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The other OECD countries have much lower per capita healthcare costs than the U.S., and this is partly due to government regulations and price controls over doctors, hospitals, and drug companies. The fact is, we have limited resources and it is best to distribute them in ways that maximize the health of the entire population, knowing that it will work adversely for some individuals. Kantian ethics: maximum good for the maximum number of citizens. The fact that other OECD countries with universal healthcare have better health statistics than the U.S. is partially because they are doing a better job of cost control and resource utilization.
--David
Did you know that the HR Ways and Means committee is holding hearings on implementation of ACA? I watched it on CSPAN yesterday. They had Werfel and Cohen (director in charge of implementation with private insurance companies) testifying.
ReplyDeleteThe most interesting thing I learned is that, contrary to what we have been assuming, no individual consumer is going to literally get "money in his pocket" from subsidies. The subsidy money goes directly to the insurance company.
The Republicans on the committee were all spoon-fed some "talking point" about a campaign promise Obama made back in 2007. Several Republicans claimed that Obama promised that the AVERAGE family would save $2,500 on health care if he is elected." I fact-checked it. Here is what he actually said…
"I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family's premium by up to $2,500 a year."
http://townhall.com/columnists/debrajsaunders/2013/06/11/obamacare-math-wont-add-up-n1617198/page/full
Three things to note:
1. We didn't get universal healthcare (Senate bill with public option was defeated in the House). So we don't know how much a family would save with public option. Obama simply said he would sign a bill giving universal coverage if it ever come to the president's desk.
2. He did not say "average". He said "up to."
3. Even with no public option (i.e., ACA) it will not be difficult to find examples of families that will save $2,500.
Dumbest comment of the day goes to Paul Ryan. He was trying to set up a "gotcha" hypothetical question where a 25-yr. old in Wisconsin goes on the individual exchange for insurance in Wisconsin in 2014 even though her parents have insurance in Texas. Yes, she would in 2016 have to pay back whatever subsidies were paid to her insurance company. But this will very rarely happen because a whole set of circumstances, including the idea that she and her parents are both ignorant that she is already covered on her parents' policy up to age 26, would all have to exist. That is one of the most publicized benefits of ACA.
An interesting statistic I learned is that 96% of employers with 50+ employees already provide healthcare, so postponing the employer mandate for one year for the other 4% is not such a big deal.
Also, our national healthcare costs under Obamacare are already lower than any year in the last 49 years, thanks partially to the 10% rule and the billion dollars in rebates the insurance companies like United Healthcare have to pay for going under 80-85% on their medical loss ratios. That is an outstanding result, considering that we haven't even started rolling out the exchanges yet.
You should start watching these hearings on CSPAN, Tom. You will learn how ACA is designed and already working. The Republicans are shooting themselves in the foot by having informed people come to Congress and explain the facts about ACA.
--David
We have read numerous reviews of the law, more than 95% of Americans.
ReplyDeleteI don't know where you find the cost of national health care are lower than any year in the last 49. You love the rebates by the insurance companies, this one little clause will cause many insurance companies to get out of the health insurance business.
Prices for personal consumption expenditures (PCE) on health care goods and services rose just 1.1 percent over the twelve months ending in May 2013, the slowest rate of increase in 49 years. Obamacare is having the opposite effect on health care costs than you predicted.
ReplyDeleteIf United Healthcare didn't want to pay their customers rebates, they could cut their administrative costs, such as exorbitant salaries for top management and the huge public relations television budget they are spending to try to counteract their horrible customer service ratings (well-deserved IMO).
--David