Debates

[BamaFlum]

VP next debate.. What's the topic for the next MR and BO? Foreign policy?

 

[Bama Reb]

I think you're right. If I am to believe CNN, this election will basically come down to Ohio and Florida. Without Ohio, Romney has no chance to win and without Florida as well, it's going to be extremely tough.

I don't see either of those states going for Romney in this election. Stranger things have happened, though.

I do. Maybe not Florida, but Ohio for sure. Yes, Ohio is a big manufacturing state, and a big union state as well. But imo all that is swept aside by Obama's forcing coal plants to close, and many of those are in Ohio. That cost thousands of jobs and will be forcing their heating costs to skyrocket this winter.
And in another month, it's going be getting mighty cold in Ohio. :eek2:

 

[Tide1986]

And then fact check the fact checking fact checker

Before we glibly leave fact checking behind, let me point out an example:

ROMNEY: Obama's health care plan "puts in place an unelected board that's going to tell people ultimately what kind of treatments they can have. I don't like that idea."

THE FACTS: Romney is referring to the Independent Payment Advisory Board, a panel of experts that would have the power to force Medicare cuts if costs rise beyond certain levels and Congress fails to act. But Obama's health care law explicitly prohibits the board from rationing care, shifting costs to retirees, restricting benefits or raising the Medicare eligibility age. So the board doesn't have the power to dictate to doctors what treatments they can prescribe.

Does this board DIRECTLY specify which treatments a senior may or may not receive? No, it doesn't. But, does the board have the power to reduce Medicare reimbursements? Well, yes. And what is the impact of Medicare cuts? Reduced doctor choice and reduced treatment options for seniors? Well, yes...those would seem to be logical impacts of having less money to cover costs. So, does the board ultimately impact what kind of treatments seniors receive? Well, yes...it would appear so.

 

[Tider@GW_Law]

Does this board DIRECTLY specify which treatments a senior may or may not receive? No, it doesn't. But, does the board have the power to reduce Medicare reimbursements? Well, yes. And what is the impact of Medicare cuts? Reduced doctor choice and reduced treatment options for seniors? Well, yes...those would seem to be logical impacts of having less money to cover costs. So, does the board ultimately impact what kind of treatments seniors receive? Well, yes...it would appear so.

For better or worse, Medicare reimbursement rate reductions have little to no impact on physician choice or treatment options for Medicare enrollees. Physicians effectively have no choice whether or not to see Medicare patients, and, even if they did, Medicare rates have consistently remained at or above the average across the payor spectrum.

 

[Tider@GW_Law]

Were you actually in the spin room last night for the President, or do you just get the talking points?

I would guarantee that I speak for around 90% of the health policy community.

As far as actual repeal of the Affordable Care Act, you know and I know that it has never really been on the table.

 

[Tider@GW_Law]

At the very least the Medicare age needs to be tied to the full retirement age of SS.

A perfectly reasonable position.

 

[seebell]

 

[Tide1986]

For better or worse, Medicare reimbursement rate reductions have little to no impact on physician choice or treatment options for Medicare enrollees. Physicians effectively have no choice whether or not to see Medicare patients, and, even if they did, Medicare rates have consistently remained at or above the average across the payor spectrum.

Are you saying a physician must accept any and all Medicare patients who approach his practice for care and must accept Medicare reimbursements and no other forms of payment from Medicare patients?

 

[Tider@GW_Law]

You say that but Barack offers no more "specifics" to his plan other than the last one didn't work.

Barack's strategy was/is just to distract so that no one actually really looks at his inadequacies. He hasnt offered any
plan though.

Let me get this straight.

You complain both about how "Obamacare" (Obama's name being part of the term itself and the core of which will not be implemented until 2014) was a million pages and now you are saying that Obama has not offered any plan or provided any specifics?!?!

Which is it?

 

[Tider@GW_Law]

Are you saying a physician must accept any and all Medicare patients who approach his practice for care and must accept Medicare reimbursements and no other forms of payment from Medicare patients?

Any physician, whether a Medicare-participating physician or not, must file a claim with Medicare if the patient is a Medicare beneficiary. There is no "fourth option," so to speak.

 

[Tide1986]

Any physician, whether a Medicare-participating physician or not, must file a claim with Medicare if the patient is a Medicare beneficiary. There is no "fourth option," so to speak.

The first part of my question? Is a physician required by law to accept all patients into his practice? And oh by the way, may not assess a patient's financial worthiness?

 

[SavannahDare]

For better or worse, Medicare reimbursement rate reductions have little to no impact on physician choice or treatment options for Medicare enrollees. Physicians effectively have no choice whether or not to see Medicare patients, and, even if they did, Medicare rates have consistently remained at or above the average across the payor spectrum.

Oh, so when my Medicare patients can't get coverage/approval for the medications that actually work and have to settle for cheaper, oftentimes less-effective, generic options that are covered (because they can't afford to pay out of pocket), that's "having little to no impact on physician choice or treatment options?"

And, of course, physicians have the choice to opt out of seeing Medicare patients. It's just an all or nothing deal. The physician either is or is not a Medicare provider. As for the reimbursement rates, they are just "ok." The difference between Medicare (in the real world) and the privately insured patient is that the physician effectively has no hope of ever being able to recoup the balance from the Medicare patient between what is reimbursed and what the service provided actually costs.

Oh, and then there's that lovely little habit Medicare has of simply suspending payment when they run out of money. I went SIX WEEKS last December and this January without a single penny being reimbursed. Why? No money. Then it takes FOREVER for them to play catch-up. My medical billing people are only NOW receiving the final payments from that lovely little glitch ten months ago. In 2008 or 2009 (I forget which) I went for MONTHS without reimbursement for the same reason.

Government-run health care SUCKS for physicians. The ONLY reason I still accept it is out of loyalty to my older patients. That's it. I'm BLEEDING money because no one else will take care of them to the standard I can.

 

[SavannahDare]

The first part of my question? Is a physician required by law to accept all patients into his practice? And oh by the way, may not assess a patient's financial worthiness?

No.

And physicians find a way to straddle the fence in term of still accepting Medicare patients without being overrun by them.

 

[NationalTitles18]

For better or worse, Medicare reimbursement rate reductions have little to no impact on physician choice or treatment options for Medicare enrollees. Physicians effectively have no choice whether or not to see Medicare patients, and, even if they did, Medicare rates have consistently remained at or above the average across the payor spectrum.

Maybe you should stick to lawyering because you are completely wrong about this subject. On every single point you make.

 

[Tider@GW_Law]

Oh, so when my Medicare patients can't get coverage/approval for the medications that actually work and have to settle for cheaper, oftentimes less-effective, generic options that are covered (because they can't afford to pay out of pocket), that's "having little to no impact on physician choice or treatment options?"

And, of course, physicians have the choice to opt out of seeing Medicare patients. It's just an all or nothing deal. The physician either is or is not a Medicare provider. As for the reimbursement rates, they are just "ok." The difference between Medicare (in the real world) and the privately insured patient is that the physician effectively has no hope of ever being able to recoup the balance from the Medicare patient between what is reimbursed and what the service provided actually costs.

Oh, and then there's that lovely little habit Medicare has of simply suspending payment when they run out of money. I went SIX WEEKS last December and this January without a single penny being reimbursed. Why? No money. Then it takes FOREVER for them to play catch-up. My medical billing people are only NOW receiving the final payments from that lovely little glitch ten months ago. In 2008 or 2009 (I forget which) I went for MONTHS without reimbursement for the same reason.

Government-run health care SUCKS for physicians. The ONLY reason I still accept it is out of loyalty to my older patients. That's it. I'm BLEEDING money because no one else will take care of them to the standard I can.

Medicare is not a monolith in many of the respects to which you are referring.

As far as the treatment options point, it's unclear if you're talking about inpatient and physician-administered drugs (Parts A & B) or otherwise (Part D). Big difference here in terms of federal funding and its effect on the patient. Furthermore, generics must be bioequivalent (.8-1.25 at 90% CI) to the brand, so, yes, I would characterize that as "little" difference. I have seen an increasing number of commercial plan tiered formularies that are as bad or worse than just about anything you see in the Medicare program as far as patient cost-sharing goes.

Regarding the coinsurance, Medigap plans are a wise investment for any Medicare beneficiary and inexpensive relative to their value of coverage. I can't imagine the gnashing of teeth over the cost of Medicare if the coinsurance was even half what it is now.

Being "government-run" for instance, the payment issues to which you refer could very likely be the fault of your regional fiscal intermediary, which is a private entity providing processing and other administrative services for Medicare under a generally very strict contract. This is aside from the Medicare Advantage and Part D plans.

Despite one's feelings about Medicare, caring for seniors is a costly endeavor, and, if you look at the costs of Medicare Advantage plans versus traditional Medicare, it's not something the private sector insurance industry (with a few exceptions) has been able to show it can do more cost-effectively.

 

[Tider@GW_Law]

Maybe you should stick to lawyering because you are completely wrong about this subject. On every single point you make.

Care to actually support that claim with, I dunno, facts?

 

[Tider@GW_Law]

The first part of my question? Is a physician required by law to accept all patients into his practice? And oh by the way, may not assess a patient's financial worthiness?

EMTALA-obligated providers must see all patients. Otherwise, like SD said, no there is no such requirement but it is in effect a must regarding Medicare beneficiaries.

Beyond verifying coverage, assessing a patient's "financial worthiness" is dangerous territory for a physician - more or less dangerous depending on the state. It may be outright barred depending on the practice setting (e.g., FQHC).

 

[bamacon]

Despite one's feelings about Medicare, caring for seniors is a costly endeavor, and, if you look at the costs of Medicare Advantage plans versus traditional Medicare, it's not something the private sector insurance industry (with a few exceptions) has been able to show it can do more cost-effectively.

Rationing. Learn the word folks. Learn, like it, love it.

 

[rizolltizide]

Health "policy " community. Heh.

 

[BamaFlum]

Rationing. Learn the word folks. Learn, like it, love it.

Death panels?