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“The Rising”: Return Of The Big GOP Medicare Lie

The participant’s in last night’s GOP presidential debate once again took the opportunity to pretend that the Affordable Care Act (“Obamacare”) put a massive dent in Medicare by cutting $500 billion from the program.

Michele Bachmann told us that “We know that President Obama stole over $500 billion out of Medicare to switch it over to Obamacare.” Mitt Romney intoned “He cut Medicare by $500 billion. This is a Democratic president the liberal, so to speak, cut Medicare.”

Yeah…except that nobody stole anything and Medicare was not cut by $500 billion.

Here are the facts:

For starters, nobody cut anything from the Medicare budget in the health care reform bill. The actions taken in the legislation are designed to slow the growth of Medicare spending without cutting benefits. Further, not one cent that would have gone to Medicare is somehow being shifted over to a program created by Obamacare (for first time readers, I readily use the term Obamacare because I believe that this name will ultimately stand as an honor to the President who made it happen.)

With respect to the infamous $500 billion, the non-partisan Congressional Budget Office has made it clear that the bulk of the projected savings will come from two primary sources—ending the subsidies to health insurance companies who offer Medicare Advantage programs and reining in the growth of payments to physicians. The remainder will, hopefully, come from cutting back on the waste and fraud that have long been rampant in the Medicare system.

Let’s begin with the Medicare Advantage program. Established via the Medicare Modernization  Act of 2003. the program—a Bush/GOP creation—was ostensibly invented to encourage Medicare beneficiaries to gravitate towards privately operated insurance programs pursuant to the theory that the private sector could do a better job of  delivering care to our seniors than the government.

I say ‘ostensibly’ because the true purpose was to create a windfall for the private insurance companies who have done so much for so long for so many Republican elected officials.

The way the script played out, the private  insurance companies said that they would only be able to paricipate in the program if, and only if, the government gave them a head start by agreeing to subsidize their “start up costs” until the year 2010.

As  a result of the deal, Medicare found itself paying, on average, an 11%  surcharge on medical services and procedures provided by Medicare Advantage plans. This was enough to guarantee the insurance providers  a tidy profit fully comprised of the government subsidies, creating one of the greatest examples of corporate welfare in the history of the nation.

Not surprisingly, the health insurers took advantage of the windfall to attract customers by offering very low premium charges, not  to mention free gym memberships, one pair of eyeglasses per year, spa treatments, zero co-pays and  assorted other benefits not available to those who opted to take their Medicare  directly from the government. And why not? The insurers don’t need to make a penny from those who were insured as each customer guarantees them an 11 percent return on any medical benefit receieved courtesy of the Medicare program. Thus, they are more than happy to offer a free toaster to anyone who agrees to sign up.

What Obamacare did was put an end to the subsidies, thereby reducing future costs to the program by billions while continuing to provide Medicare beneficiaries with the benefits promised.

By any standards, this was a no-brainer in terms of reigning in the growing costs of Medicare and creating a system that is fair to all beneficiaries.

Now, the doctors.

This gets a bit tricky and, to be honest, I don’t really believe that these savings will ever materialize.

At the heart of the discussion is a formula that was designed during the Clinton Administration called the Medicare Sustainable Growth Rate, or SGR. The approach was created in an attempt to control Medicare spending for physician services with the idea being that the yearly increase in the expense per Medicare beneficiary should be tied to the growth in GDP. Thus, when actual Medicare spending exceeds the annual target in a given year, the SGR requires that physicians, and other system providers, must take a cut in order to bring the spending back in line with the annual spending targets.

The docs, understandably, do not like the idea of taking less in their Medicare payments. As a result, Congress has been delaying the cuts for years, constantly rolling them over into the next year at which time they roll them over again and again. Were Congress to ever stop delaying the SGR cuts, the physicians would find themselves feeling the cumulative pain of the delays with a one time Medicare rate reduction in excess of 20 percent.

These cuts are factored into the Medicare savings projections, along with hoped for savings to come by encouraging physicians to try some different approaches to practicing medicine.

Will this ever happen? Probably not.

So, while a skeptic can argue that these projected savings may never materialize, one cannot argue that this is, somehow, a cut to the Medicare program.

The bottom line is that there is nothing in the ACA that takes anything away from Medicare beneficiaries, now or in the future. Yet, the GOP continues to do its best to scare the hell out of seniors, the most reliable voter block in the nation.

We need to take this very seriously.

If the 2010 elections taught us anything, it is that a frightened voter  population will do some crazy things. So, it’s on us to make sure that our grandparents and parents understand that Repubican fear peddlers are selling nothing but lies and that falling for the lies could result in the end of Medicare as we know it if the Republicans are permitted to gain full control of the government.

If you would like more information on this to share with family and friends, just let me know. The effort to mislead our senior citizens worked well in 2010. We simply cannot permit it to work again in 2012.

 

By: Rick Ungar, Mother Jones, September 13, 2011

September 13, 2011 Posted by | Affordable Care Act, Class Warfare, Congress, Conservatives, Consumers, Democrats, Elections, GOP, Health Care Costs, Health Reform, Ideologues, Ideology, Medicare, Middle Class, Politics, Public, Republicans, Right Wing, Tea Party, Uninsured, Voters | , , , , , , , , | Leave a comment

Texas-Style Tort Reform: Rick Perry’s Texas Health Care Hoax

In his quest to win the Republican presidential nomination, Texas Gov. Rick Perry is perpetuating a convincing hoax: that implementing Texas-style tort reformwould go a long way toward curing what ails the U.S. health care system.

Like his fellow GOP contenders, Perry consistently denounces “Obamacare” as “a budget-busting, government takeover of healthcare” and “the greatest intrusion on individual freedom in a generation.” He promises to repeal the law if elected.

Unlike those in the “repeal-and-replace” wing of the Republican Party, however, Perry has emerged as leader of the “repeal-and-let-the-states-figure-it-out” wing that believes the federal government has no legitimate role in fixing America’s health care system.

“To hear federal officials tell it, they’ve got all the answers on health care and it’s up to the rest of us to sit, wait and embrace whatever solution — if any — they may eventually provide,” Perry wrote in a newspaper commentary in 2009. “I find this troubling, since states have shown they know a thing or two about solving problems that affect their citizens.”

Even as he points with pride to the alleged benefits of malpractice and other tort reforms that have been enacted during his tenure as governor of Texas, Perry says he is opposed to tort reform at the federal level. He cites the 10th Amendment to the Constitution, which states-rights advocates say limits the role of the federal government.

But if Perry had his way, all the states would do as Texas did in 2003 when lawmakers enacted legislation, which he championed, limiting the amount of money juries can award patients who win malpractice lawsuits against doctors and hospitals. The legislation capped non-economic (pain and suffering) damages at $250,000 in lawsuits against doctors and $750,000 against hospitals. A few months after he signed the bill into law, the state’s voters narrowly passed a constitutional amendment, also endorsed by Perry, which had the same effect. Proponents of the amendment wanted to be sure the new law would be constitutional.

Texas, he wrote in that 2009 commentary “stands as a good example of how smart, responsible policy can help us take major steps toward fixing a damaged medical system, starting with legal reforms.”

As a result of the 2003 tort reform law, malpractice liability insurers reduced their rates in Texas and, according to Perry, the number of doctors applying to practice medicine in the state “skyrocketed.”

He says that in the first five years after tort reform was enacted, 14,498 doctors either returned to practice in Texas or began practicing there for the first time.

Tort Reform Backfires in Texas

That certainly sounds impressive — so long as you look at that number in isolation. But when you look at how Texas stacks up with the rest of the country in terms of physician growth in direct patient care, tort reform appears to have given Texas no leg up in competition with others states for doctors. In fact, according to statistics compiled by the American Medical Association and other physician organizations, Texas has actually lost ground when it comes to the number of doctors practicing in the state since tort reform was enacted. Big time.

In 2008, the number of physicians in patient care per 10,000 civilian population in the United States was 25.7. At just 20.2 doctors per 10,000 people, Texas ranked near the bottom of the 50 states. In fact, only nine states fared worse. In 2000, three years before tort reform, Texas was still bringing up the rear, but not as badly. Back then, 11 states fared worse than the Lone Star state.

Even more revealing, the number of doctors in patient care increased 13.2 percent nationwide from 2000 to 2008. It increased only 12.8 percent in Texas. The rate of growth was actually greater in 41 other states and in Washington, D.C. than it was in the Lone Star state.

It is true that malpractice insurance rates dropped in Texas after tort reform was enacted, but Texans would be hard pressed to claim any direct benefit from that drop — except, that is, Texans who are doctors.

The Dallas Morning News published a chart earlier this year showing that the average malpractice rate charged ob/gyns in Texas by the state’s largest domestic insurer of physicians fell from $53,752 in 2003 to $33,881 in 2011. The paper reported drops of similar percentages for doctors in family practice and general surgery.

Advocates of tort reform have long claimed that one of the reasons for escalating health care costs is the “defensive medicine” doctors practice, such as over-treating and prescribing more medications and diagnostic tests than necessary, out of fear of being sued. Well, if Texans believed their own health insurance rates would go down once tort reform made defensive medicine less prevalent, they have by now been disabused of that notion. The chances of a Texas family saving a few bucks on premiums would actually be greater if they moved to another state.

In 2010, the average premium for family coverage in Texas was $14,526. That’s $655 higher than the U.S. average. Those numbers seem to indicate that doctors have not passed on their own insurance savings to their patients and that they are not practicing medicine any less defensively than before tort reform was enacted.

Not only are Texans paying more for their own insurance while doctors are paying less for theirs, their chances of getting employer-subsidized coverage is less than it would be if they lived in another state. The Dallas Morning News, citing statistics from the Agency for Healthcare Research and Quality and other sources, reported that a smaller percentage of employers in Texas offered coverage to their workers last year than in the U.S. as a whole (51 percent and 53.8 percent, respectively). And the Texans who do have coverage through the workplace are contributing far more out of their own pockets for that coverage than people who live in most other states. In Texas last year, the average employee contribution toward company-sponsored coverage was $4,500. The U.S. average was much lower: $3,721.

Another statistic Perry is not likely to mention when he talks about the benefits of tort reform is the number of Texans who are uninsured. The U.S. Census Bureau reports that Texas continues to be the state with the highest percentage of its residents without coverage, a whopping 25 percent last year, compared to about 16 percent nationwide. It was dead last in 2003 and it is dead last now.

All this should leave us wondering what “thing or two” states have come up with to solve the problems that affect their citizens. Considering the dismal state of health care in Texas, perhaps Perry had Massachusetts in mind.

 

By: Wendell Potter, Center for Media and Democracy, September 1, 2011

September 1, 2011 Posted by | Conservatives, Consumers, Elections, Freedom, GOP, Government, Governors, Health Care, Health Care Costs, Ideologues, Ideology, Lawmakers, Middle Class, Politics, Public, Public Health, Republicans, Right Wing, State Legislatures, States, Teaparty, Uninsured, Voters | , , , , , , , , , , , , , , , , , | 1 Comment

How The Budget Deal Affects The Affordable Care Act

So how does this mammoth budget-cutting deal, with its congressional “supercommittee” affect health reform?

Good question, because lots of people in Washington are asking it too.

More specific answers will become clearer in the next few weeks, but here’s a first version of the road map to both the policy and the politics.

First, understand there are two different processes – and each, separately, aims at cutting more than $1 trillion over the next decade.

The one that you’ve probably heard most about is the “supercommittee” of 12 members of Congress. They are supposed to identify savings by Thanksgiving. Entitlements – Medicare, Medicaid, Social Security and aspects of the Affordable Care Act – are part of their turf. So are taxes and revenue – at least in theory. It’s not so clear that the Republicans see it that way given the public statements of Congressional leaders.

If they agree on some kind of grand deal by Thanksgiving, Congress has to take it or leave it by the end of December, eliminating the usual congressional dilly-dallying. (It looks like dilly-dallying to the casual observer or much of the public, but remember that all that arcane, tedious process IS policy in Congress. If you slow something down, make it go through hoops, amend it, hold it up, etc., it doesn’t become law. That may be good or, depending on your point of view, bad politics.)

If Congress takes any recommendations that the supercommittee agrees on, that’s the law. If the committee fails, or Congress rejects it, then the “trigger” gets pulled. The official name is “sequestration.” That’s a fancy name for automatic cuts – 2 percent across-the-board cuts in Medicare, for instance, affecting all health care providers, doctors, hospitals, etc. It won’t affect beneficiaries – at least not directly.

Medicaid is not subject to the trigger. Neither, according to the preliminary interpretations I’ve received from analysts and congressional staff, are the big, key subsidies in the health care reform law – the Medicaid expansion and the subsidies that will help low-income and middle-income people afford health care in the new state exchanges.

Other parts of the health reform law are, however, subject to automatic cuts. Among them: Cost-sharing subsidies for low-income people. This isn’t the help paying the premium; this is the help with the co-pays when people do get care. But the payments are made to health plans, not directly to beneficiaries so it won’t have the direct impact of discouraging care. It may affect how health plans make decisions about what markets to participate in. Gary Claxton and Larry Levitt at Kaiser Family Foundation explain here.

Also, the supercommittee could have a partial deal – meaning there’s still a trigger, but a smaller one. Maybe they won’t reach agreement on $1.2 trillion to $1.5 trillion in savings, which would avoid the trigger. But maybe they could agree on, say, $500 billion. That means a trigger wouldn’t have to go as deep because some of the savings would already be identified.

To recap – before we go on to the second stage of this process: The “super-committee” can do whatever it wants to health care, Medicare, Medicaid, Social Security, etc. – if it can agree, if it can get the rest of Congress to agree and if the president doesn’t veto it.

Will the Democratic Senate and the Obama White House agree to cuts that eviscerate health reform? Not likely. In fact, the Democrats “won” on very few aspects of the budget/debt deal. Walling off Medicaid and key parts of the health coverage expansion were two of the “wins.” That’s a bright line worth paying attention to as this moves forward.

Does that mean other health-reform related spending will be untouched? Given how many moving parts there are to any spending deal, and the fact that defense and tax policy are also part of the mix, chances are it will be affected. But expect to see that bright line remain visible – maybe not quite as bright, but visible. (The CLASS Act, the voluntary long-term care program created under health reform, is a different story; it’s quite vulnerable.)

The second part is the annual appropriations process. The budget deal provides for cuts – real cuts in spending, not just slowing the rate of growth. Health programs (aspects of the health reform legislation touching on exchange creation, prevention, community clinics, etc., and just about everything else at the Department of Health and Human Services – the FDA, NIH, CDC, etc. – will be subject to these cuts. But this isn’t an across the board process, it’s a line-by-line, or at least category/agency-by-category/agency, process. And there is some horse trading.

It’s safe to say that the Republicans will try to cut discretionary portions of the new health law. That’s not a new political dynamic, it doesn’t arise out of the debt ceiling or the Wall Street woes. It’s what we’ve seen since last fall’s elections and the repeal/defund fights of the past few months. And House Budget Chairman Paul Ryan has publicly tried to insert health care into any potential deal. So expect to see more Republican push to cut, and continued Democratic push back. Will health spending emerge unscathed? It’s too soon to know but, given the amount of savings Congress needs to find –both in this budget deal and in the perennial quest to fund the “doc fix” payments – some cuts are clearly possible. Some of it may affect aspects of exchange establishment, regulation, prevention, public health, etc. But it’s hard to see the Democrats allowing cuts so deep that they basically constitute a side door to repeal.

One further twist – some Republicans are calling for a delay in health reform implementation to save money.”Delay” may sound better to an ambivalent public worried about spending than “repeal.” What’s delayed (if anything), how it’s delayed, how long it’s delayed, and what stopgaps are created in the meantime could have an impact on how many people get covered in 2014.

Assorted committees and government agencies are still examining the new budget law and how it will affect … everything. So the perspective I’ve outlined here – and I’m writing amid all the market turbulence – may change as the economic and political climates change. But the lines in the sand around the trigger – health reform, Medicaid and Social Security – tell us something about where the White House will come down.

By: Joanne Kenen, Association of Health Care Journalists, August 10, 2011

August 11, 2011 Posted by | Affordable Care Act, Budget, Congress, Conservatives, Debt Ceiling, Debt Crisis, Deficits, Democrats, Economy, GOP, Government, Health Care, Health Reform, Ideologues, Ideology, Individual Mandate, Insurance Companies, Journalists, Lawmakers, Medicaid, Medicare, Politics, Public Health, Republicans, Right Wing, Social Security, Tax Increases, Tax Loopholes, Taxes, Teaparty | , , , , , , , , , , , , , , , , , , | 1 Comment

Drug Marketing and Free Speech: U. S. Supreme Court Says Data Mining Trumps Your Medical Privacy

Pharmaceutical companies, which spend billions of dollars a year promoting their products to doctors, have found that it is very useful to know what drugs a doctor has prescribed in the past. Many use data collected from prescriptionsprocessed by pharmacies — a doctor’s name, the drugs and the dosage — to refine their marketing practices and increase sales.

The Supreme Court on Thursday made it harder for states to protect medical privacy with laws that regulate such practices. In 2007, Vermont passed a law that forbade the sale of such records by pharmacies and their use for marketing purposes. The ruling upheld a lower court decision that struck down the law as unconstitutional.

Justice Anthony Kennedy, writing for the 6-to-3 majority, said the law violates First Amendment rights by imposing a “burden on protected expression” on specific speakers (drug marketers) and specific speech (information about the doctors and what they prescribed). It is unconstitutional because it restricts the transfer of that information and what the marketers have to say.

In dissent, Justice Stephen Breyer explains that the law’s only restriction is on access to data “that could help pharmaceutical companies create better sales messages.” He notes that any speech-related effects are “indirect, incidental, and entirely commercial.” By applying strict First Amendment scrutiny to this ordinary economic regulation, he warns, the court threatens to substitute “judicial for democratic decision-making.”

The law would have been upheld, Justice Breyer says, if the court had treated it as a restriction on commercial speech, which is less robustly protected than political speech. The court’s majority unwisely narrows the gap between commercial and political speech, and makes it harder to protect consumers.

By:  Editorial, The New York Times, June 23, 2011

June 24, 2011 Posted by | Big Pharma, Constitution, Consumers, Corporations, Democracy, Freedom, Pharmaceutical Companies, Politics, Regulations, Supreme Court | , , , , , , , , , , , , , , , | Leave a comment

The Continuing Fight Against Women: House Passes Amendment To Defund Medical Schools That Teach Abortion

Not content to defund health care for women, the Republicans in Congress, who just can’t stop obsessing about abortion, have now passed yet another bill, brought to us by the lovely Rep. Virginia Foxxxxxxxxx, to prohibit government funding of abortion. Only this one also bans medical programs that receive government dollars from even teaching students how to perform abortions. Because taxpayers shouldn’t have their hard-earned dollars spent on training doctors to provide health care to women.

And, in case we didn’t get the message the first gazillion times Republicans mentioned it, the amendment re-reiterates that taxpayer dollars should not be used to fund abortions. Which they aren’t.

But despite the endless parade of bills to make it really, really, really clear that taxpayers should not pay for abortions, Rep. Foxxxxxxxxxx still wanted to make it “crystal clear.” In case the bill they passed three weeks ago didn’t quite get the message across.

The measure is an amendment to H.R. 1216, the Republicans’ latest never-gonna-happen attempt to repeal the Affordable Care Act. Because nothing creates jobs like passing ideologically-driven symbolic measures to appease teabaggers and woman-haters everywhere.

Next up: a bill to ensure that taxpayer dollars are not used to repair roads that lead to medical schools that teach doctors how to perform abortions, and to re-re-reiterate that taxpayer dollars should not be spent on abortions. And then I’m sure they’ll get around to that jobs, jobs, jobs thing.

By: Kaili Joy Gray, Daily Kos, May 25, 2011

May 25, 2011 Posted by | Abortion, Affordable Care Act, Class Warfare, Congress, Conservatives, Equal Rights, GOP, Government, Health Care, Health Reform, Human Rights, Ideologues, Ideology, Lawmakers, Planned Parenthood, Politics, Pro-Choice, Public Health, Republicans, Right Wing, Tea Party, Women, Women's Health, Womens Rights | , , , , , , | Leave a comment

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