Thanks to President Barack Hussein Obama... this woman and many others with the same job in the health care insurance business, WILL NOW BE OUT OF A JOB. Her job? To decide who lives and who dies... or Death Panels, as Conservatives like to call them.
Thanks to ObamaCare, this job has been eliminated in the Insurance Industry.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Box, are you really naive enough to think this is going to go away, or do you just have your DNC pom poms on? The same thing will happen, but instead of outright denial of care, it will be denial by delay. If the affordable health care act does what the Dems want it to do, it will put MILLIONS of NEW people into the health care system, a system that is losing doctors via retirement and other means at an alarming pace. It's losing Hospitals as well... just look at our area... remember the hospitals that have closed in the last 10 years. You may be able to open facilities, but where are the Doctors to fill them? Even if we started now and sent people to school to be a doctor for free, it would take 8 years to even make a dent.
I predict what we will get are a ton of PA's (physicians assistants) into the workplace. PA's are not Doctors, in fact, my mother-in-law died due the incompetence of a PA...all after BEATING pancreatic cancer and living another 10 years... she died way before her time.
"Arguing with liberals is like playing chess with a pigeon; no matter how good I am at chess, the pigeon is just going to knock out the pieces, crap on the board, and strut around like it is victorious." - Author Unknown
Box, are you really naive enough to think this is going to go away, or do you just have your DNC pom poms on? The same thing will happen, but instead of outright denial of care, it will be denial by delay. If the affordable health care act does what the Dems want it to do, it will put MILLIONS of NEW people into the health care system, a system that is losing doctors via retirement and other means at an alarming pace. It's losing Hospitals as well... just look at our area... remember the hospitals that have closed in the last 10 years. You may be able open facilities, but where are the Doctors to fill them? even if we started now and sent people to school to be a doctor for free, it would take 8 years to even make a dent.
I predict what we will get are a ton of PA's (physicians assistants) into the workplace. PA's are not Doctors, in fact, my mother-in-law died due the incompetence of a PA...all after BEATING pancreatic cancer and living another 10 years... she died way before her time.
Hospitals are closing??? I wonder if Hospitals would have closed if those 50 million uninsured Americans who, if they needed emergency medical care, were treated in US Hospital Emergency Rooms and never received a dime for their services? Under the present system... a system that Conservatives are fighting to continue, hospitals are closing... and yet they still want to continue that failed system. Time for a change and the change to fix the problem is called ObamaCare.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Hospitals are closing??? I wonder if Hospitals would have closed if those 50 million uninsured Americans who, if they needed emergency medical care, were treated in US Hospital Emergency Rooms and never received a dime for their services? Under the present system... a system that Conservatives are fighting to continue, hospitals are closing... and yet they still want to continue that failed system. Time for a change and the change to fix the problem is called ObamaCare.
Once again Box, you redirect when I harpoon a thread YOU started. YOU implied the days of denial of care are over... I say, Bullshit...it will still happen, but for a different reason. This is not Health care Nirvana, far from it. If the Dems came out and said, "hey, healthcare should be a right, BUT it will cost ALL of us more money to attain it" at least I could respect the effort and transparency. But they don't... they claim it will save us money...it won't..in fact, I can't think many gov't mandated programs that have. They are already 250 billion in the hole for what the Supreme court struck down relating to Medicare expansion....unless they abandon the people who can least afford to pay for insurance and now have to face a penalty tax for not having it
"Arguing with liberals is like playing chess with a pigeon; no matter how good I am at chess, the pigeon is just going to knock out the pieces, crap on the board, and strut around like it is victorious." - Author Unknown
A common theme in the health care reform debate in recent years has been the need for a board of impartial experts to oversee the health care system. Market forces alone, it is argued, cannot control health care costs, and Congress is too driven by special-interest politics and too limited in expertise and vision to control costs.
Provisions of the Patient Protection and Affordable Care Act (now being referred to as the Affordable Care Act, or ACA) create an Independent Payment Advisory Board (IPAB) to meet the need to oversee health care system costs.1 The legislation establishes specific target growth rates for Medicare and charges the IPAB with ensuring that Medicare expenditures stay within these limits. The IPAB must also make recommendations to Congress as to how to control health care costs more generally.
The IPAB will have 15 members appointed by the President for 6-year terms, supplemented by 3 officials representing the Department of Health and Human Services (DHHS). IPAB members are supposed to be nationally recognized experts in health finance, payment, economics, actuarial science, or health facility and health plan management and to represent providers, consumers, and payers. Service on the IPAB is a full-time job. Members will be compensated at a rate equal to the annual rate prescribed for level III of the executive schedule (for highly ranked appointed positions in the government's executive branch), which is currently $165,300.2
The board is charged with developing specific detailed proposals to reduce per capita Medicare spending in years when spending is expected to exceed target levels, beginning with 2015. The DHHS must implement these proposals unless Congress adopts equally effective alternatives. The board is also charged with submitting to Congress annual detailed reports on health care costs, access, quality, and utilization. Finally, the IPAB must submit to Congress recommendations regarding ways of slowing the growth in private national health care expenditures.
Each year, beginning April 30, 2013, the chief actuary of the Centers for Medicare and Medicaid Services (CMS) will make a determination as to whether the projected average Medicare growth rate for the 5-year period ending 2 years later will exceed the target growth rate for the year ending that period. For years before 2018, the target growth rate is the projected 5-year average of the mean of the Consumer Price Index (CPI) and the medical care CPI; for 2018 and later years, the target is the nominal per capita growth rate of the gross domestic product plus 1 percentage point. If the CMS actuary determines for any given year that the projected Medicare growth rate will exceed the target rate, the board must make proposals that would reduce Medicare spending overall by either a percentage set in the statute (1.5% after 2017) or the projected excess, whichever is less.
The effects of the IPAB's proposals, however, may not be to “ration health care,” raise costs to beneficiaries, restrict benefits, or modify eligibility criteria. Proposals may not, before 2020, target the rates of particular providers — primarily hospitals and hospices — that are already singled out by the ACA for extraordinary cuts. The board is not prohibited from cutting payments for physicians, but its powers may be limited if a permanent fix for the sustainable growth rate — the formula that determines increases or decreases in Medicare's physician payments — is passed.
Each September 1, the IPAB must submit a draft proposal to the secretary of health and human services. On January 15 of the following year (beginning with 2014), the board must submit a proposal to Congress. If the board fails to submit a proposal on deadline, the DHHS must itself submit a proposal. Congress must consider the proposal under an expedited procedure. Congress cannot consider any amendment to the proposal that does not meet the same cost-reduction goals, unless both houses of Congress (and three fifths of the Senate) vote to waive this requirement. If Congress fails to adopt a substitute provision complying with the statute by August 15, the DHHS must implement the board's proposal.
The ACA appropriates $15 million for the IPAB for 2012 and increases its funding at the rate of inflation for subsequent years. This standing appropriation may relieve some of the political pressure on the IPAB, but it may well prove too little to fund the complex research and data analysis that the board must conduct to design implementation-ready proposals.
The Congressional Budget Office concluded in its analysis of the ACA that the IPAB would reduce Medicare spending by $28 billion over the period from 2010 to 2019, with significant savings continuing beyond 2019.3 In his report, however, the CMS actuary questioned whether this goal was achievable, noting that IPAB target growth rates would have been met in only 4 of the past 25 years and would have approximated the sustainable growth rate, the formula for updating Medicare's physician fees, which Congress has routinely overridden.4 The chief actuary expressed concern that health care providers would have difficulty remaining profitable and might leave the Medicare program when faced with these constraints.
Many questions remain about how, and indeed whether, the IPAB will work. Staffing the board with 15 leading experts who are willing to give up research, practice, and teaching for 6 years for a relatively modest salary will be a challenge. The relationships between the IPAB and other boards and commissions, such as the Medicare Payment Advisory Commission and the Center for Medicare and Medicaid Innovation created by the ACA, will need to be negotiated. Although multiple entities pursuing the same tasks could stumble over each other, there are also real opportunities for synergy. In particular, shared staffing between the IPAB and the innovation center could strengthen both.
The legislative requirement that the IPAB submit annual proposals will encourage recommendations for short-term payment fixes rather than long-term changes that might in fact bend the cost curve. If the IPAB is to be truly effective, it must consider not just cuts in provider payments but also changes in how providers are paid, or perhaps even in consumer incentives. Although the statute prohibits reduction in “payment rates” for hospitals before 2020, it does not prohibit the IPAB from recommending changes in payment methods, which might have longer-term effects on cost. But the necessity of making year-to-year cuts will probably focus the IPAB's attention on short-term cuts in Medicare Advantage plans, which are already slated for deep cuts under the ACA, or on prescription drug prices.
The IPAB's success will also depend on Congress's reactions to its recommendations. A three-fifths Senate vote will be needed to override payment cuts, but Congress could increase Medicare funding through independent legislation. The fact that legislators regularly evade the sustainable growth rate has been cited as proof that Congress cannot cut Medicare costs. On the other hand, Congress left in place the vast majority of the Medicare-savings provisions in the 1990, 1993, 1997, and 2005 budget reconciliation acts.5 And our current fiscal crisis may sharpen lawmakers' resolve to cut spending.
Another major question is whether it is possible to cut Medicare's provider payments as long as private payers' rates remain unconstrained. If the gap between private and Medicare rates continues to grow, health care providers may well abandon Medicare. And the IPAB can make only nonbinding recommendations to Congress regarding private payments. In the long run, Congress may not be able to cap Medicare expenditures without addressing private as well. If the IPAB opens the door to rate setting for all payers, it may well be the most revolutionary innovation of the ACA. http://www.nejm.org/doi/full/10.1056/NEJMp1005402es
A common theme in the health care reform debate in recent years has been the need for a board of impartial experts to oversee the health care system. Market forces alone, it is argued, cannot control health care costs, and Congress is too driven by special-interest politics and too limited in expertise and vision to control costs.
Provisions of the Patient Protection and Affordable Care Act (now being referred to as the Affordable Care Act, or ACA) create an Independent Payment Advisory Board (IPAB) to meet the need to oversee health care system costs.1 The legislation establishes specific target growth rates for Medicare and charges the IPAB with ensuring that Medicare expenditures stay within these limits. The IPAB must also make recommendations to Congress as to how to control health care costs more generally.
The IPAB will have 15 members appointed by the President for 6-year terms, supplemented by 3 officials representing the Department of Health and Human Services (DHHS). IPAB members are supposed to be nationally recognized experts in health finance, payment, economics, actuarial science, or health facility and health plan management and to represent providers, consumers, and payers. Service on the IPAB is a full-time job. Members will be compensated at a rate equal to the annual rate prescribed for level III of the executive schedule (for highly ranked appointed positions in the government's executive branch), which is currently $165,300.2
The board is charged with developing specific detailed proposals to reduce per capita Medicare spending in years when spending is expected to exceed target levels, beginning with 2015. The DHHS must implement these proposals unless Congress adopts equally effective alternatives. The board is also charged with submitting to Congress annual detailed reports on health care costs, access, quality, and utilization. Finally, the IPAB must submit to Congress recommendations regarding ways of slowing the growth in private national health care expenditures.
Each year, beginning April 30, 2013, the chief actuary of the Centers for Medicare and Medicaid Services (CMS) will make a determination as to whether the projected average Medicare growth rate for the 5-year period ending 2 years later will exceed the target growth rate for the year ending that period. For years before 2018, the target growth rate is the projected 5-year average of the mean of the Consumer Price Index (CPI) and the medical care CPI; for 2018 and later years, the target is the nominal per capita growth rate of the gross domestic product plus 1 percentage point. If the CMS actuary determines for any given year that the projected Medicare growth rate will exceed the target rate, the board must make proposals that would reduce Medicare spending overall by either a percentage set in the statute (1.5% after 2017) or the projected excess, whichever is less.
The effects of the IPAB's proposals, however, may not be to “ration health care,” raise costs to beneficiaries, restrict benefits, or modify eligibility criteria. Proposals may not, before 2020, target the rates of particular providers — primarily hospitals and hospices — that are already singled out by the ACA for extraordinary cuts. The board is not prohibited from cutting payments for physicians, but its powers may be limited if a permanent fix for the sustainable growth rate — the formula that determines increases or decreases in Medicare's physician payments — is passed.
Each September 1, the IPAB must submit a draft proposal to the secretary of health and human services. On January 15 of the following year (beginning with 2014), the board must submit a proposal to Congress. If the board fails to submit a proposal on deadline, the DHHS must itself submit a proposal. Congress must consider the proposal under an expedited procedure. Congress cannot consider any amendment to the proposal that does not meet the same cost-reduction goals, unless both houses of Congress (and three fifths of the Senate) vote to waive this requirement. If Congress fails to adopt a substitute provision complying with the statute by August 15, the DHHS must implement the board's proposal.
The ACA appropriates $15 million for the IPAB for 2012 and increases its funding at the rate of inflation for subsequent years. This standing appropriation may relieve some of the political pressure on the IPAB, but it may well prove too little to fund the complex research and data analysis that the board must conduct to design implementation-ready proposals.
The Congressional Budget Office concluded in its analysis of the ACA that the IPAB would reduce Medicare spending by $28 billion over the period from 2010 to 2019, with significant savings continuing beyond 2019.3 In his report, however, the CMS actuary questioned whether this goal was achievable, noting that IPAB target growth rates would have been met in only 4 of the past 25 years and would have approximated the sustainable growth rate, the formula for updating Medicare's physician fees, which Congress has routinely overridden.4 The chief actuary expressed concern that health care providers would have difficulty remaining profitable and might leave the Medicare program when faced with these constraints.
Many questions remain about how, and indeed whether, the IPAB will work. Staffing the board with 15 leading experts who are willing to give up research, practice, and teaching for 6 years for a relatively modest salary will be a challenge. The relationships between the IPAB and other boards and commissions, such as the Medicare Payment Advisory Commission and the Center for Medicare and Medicaid Innovation created by the ACA, will need to be negotiated. Although multiple entities pursuing the same tasks could stumble over each other, there are also real opportunities for synergy. In particular, shared staffing between the IPAB and the innovation center could strengthen both.
The legislative requirement that the IPAB submit annual proposals will encourage recommendations for short-term payment fixes rather than long-term changes that might in fact bend the cost curve. If the IPAB is to be truly effective, it must consider not just cuts in provider payments but also changes in how providers are paid, or perhaps even in consumer incentives. Although the statute prohibits reduction in “payment rates” for hospitals before 2020, it does not prohibit the IPAB from recommending changes in payment methods, which might have longer-term effects on cost. But the necessity of making year-to-year cuts will probably focus the IPAB's attention on short-term cuts in Medicare Advantage plans, which are already slated for deep cuts under the ACA, or on prescription drug prices.
The IPAB's success will also depend on Congress's reactions to its recommendations. A three-fifths Senate vote will be needed to override payment cuts, but Congress could increase Medicare funding through independent legislation. The fact that legislators regularly evade the sustainable growth rate has been cited as proof that Congress cannot cut Medicare costs. On the other hand, Congress left in place the vast majority of the Medicare-savings provisions in the 1990, 1993, 1997, and 2005 budget reconciliation acts.5 And our current fiscal crisis may sharpen lawmakers' resolve to cut spending.
Another major question is whether it is possible to cut Medicare's provider payments as long as private payers' rates remain unconstrained. If the gap between private and Medicare rates continues to grow, health care providers may well abandon Medicare. And the IPAB can make only nonbinding recommendations to Congress regarding private payments. In the long run, Congress may not be able to cap Medicare expenditures without addressing private as well. If the IPAB opens the door to rate setting for all payers, it may well be the most revolutionary innovation of the ACA. http://www.nejm.org/doi/full/10.1056/NEJMp1005402es
And??? Where does Shadow get his information on this issue???? From the New England Journal of Medicine... The closest thing to a Doctors Union there is.
I wonder if when the subject is "Teachers Pay" if Shadow will get all his information from The Teachers Union??? Yea Right.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Once again Box, you redirect when I harpoon a thread YOU started. YOU implied the days of denial of care are over... I say, Bullshit...it will still happen, but for a different reason. This is not Health care Nirvana, far from it. If the Dems came out and said, "hey, healthcare should be a right, BUT it will cost ALL of us more money to attain it" at least I could respect the effort and transparency. But they don't... they claim it will save us money...it won't..in fact, I can't think many gov't mandated programs that have. They are already 250 billion in the hole for what the Supreme court struck down relating to Medicare expansion....unless they abandon the people who can least afford to pay for insurance and now have to face a penalty tax for not having it
Health care costs were, and are continuing to rise at an alarming rate. I doubt that HCR will STOP those increases but they will slow them down... but a more important point... The costs will continue to rise at a slower rate, BUT MILLIONS MORE AMERICANS WILL HAVE HEALTH CARE that were denied under the Republican party of NO!
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Box, are you really naive enough to think this is going to go away, or do you just have your DNC pom poms on? The same thing will happen, but instead of outright denial of care, it will be denial by delay. If the affordable health care act does what the Dems want it to do, it will put MILLIONS of NEW people into the health care system, a system that is losing doctors via retirement and other means at an alarming pace. It's losing Hospitals as well... just look at our area... remember the hospitals that have closed in the last 10 years. You may be able to open facilities, but where are the Doctors to fill them? Even if we started now and sent people to school to be a doctor for free, it would take 8 years to even make a dent.
I predict what we will get are a ton of PA's (physicians assistants) into the workplace. PA's are not Doctors, in fact, my mother-in-law died due the incompetence of a PA...all after BEATING pancreatic cancer and living another 10 years... she died way before her time.
I haven't seen a doctor in 8 years. I see the PA.
I pay $1300/month for Blue Shield 2 person plan.
Sometimes the PA has someone with him, as he is training the next PA.
Physician's Assistants, Nurse Practitioners and urgent care facilities are the new methods being used.
In Scotia, on rt 50 there is a walk in office next to Stewart's at Swaggertown Rd. The nurse practitioner will see anyone for minor issues. The cost is $40.
Anyone who doesn't want everyone to have health care, are part of the "me first, who cares about them" selfish, "all about me," party of exclusion by exclusivity.
From the New England Journal of Medicine... The closest thing to a Doctors Union there is, per Box. Who will be more controlled, receive less money, and know more about how this will affect doctor patient relations than the doctors. I will certainly not believe Obama and his ilk because they have a proven track record of being liars.
Health care costs were, and are continuing to rise at an alarming rate. I doubt that HCR will STOP those increases but they will slow them down... but a more important point... The costs will continue to rise at a slower rate, BUT MILLIONS MORE AMERICANS WILL HAVE HEALTH CARE that were denied under the Republican party of NO!
The Dems assume that everyone that doesn't have health insurance will end up getting it. The HUGE gamble is will young Americans, who are healthy and don't feel they need insurance, actually pay for it, OR will they pay the penalty instead? We know the premise of health care bill is to spread the cost of care amongst everyone that has insurance, it makes up for people that don't have it at their employer or can't afford it themselves.
If the young Americans above decide they are going to pay the Penalty instead, you can throw all the CBO estimates on cost out the window.
"Arguing with liberals is like playing chess with a pigeon; no matter how good I am at chess, the pigeon is just going to knock out the pieces, crap on the board, and strut around like it is victorious." - Author Unknown
I haven't seen a doctor in 8 years. I see the PA. I pay $1300/month for Blue Shield 2 person plan. Sometimes the PA has someone with him, as he is training the next PA. Physician's Assistants, Nurse Practitioners and urgent care facilities are the new methods being used. In Scotia, on rt 50 there is a walk in office next to Stewart's at Swaggertown Rd. The nurse practitioner will see anyone for minor issues. The cost is $40.
When I go to my Doctor for a yearly check up, I see my DOCTOR, not a PA. If I call his office for a more pressing issue, and there is no appointments open, I can still go to the Doctors office and will see as PA, who determines if my situation is serious enough to need a DOCTOR'S attention. Sounds like good use of medical services to me.
Amsterdam Memorial Hospital was taken over by St Marys Hospital in Amsterdam. The old Amsterdam Memorial now runs an Urgent Care Center in the old ER. The Urgent Care Center has a doctor in attendance, and treats patients with injuries and illnesses that require immediate medical attention but are not life threatening. And they do it at half the cost to the patient. Again... Sounds like good use of medical services to me.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
When I go to my Doctor for a yearly check up, I see my DOCTOR, not a PA. If I call his office for a more pressing issue, and there is no appointments open, I can still go to the Doctors office and will see as PA, who determines if my situation is serious enough to need a DOCTOR'S attention. Sounds like good use of medical services to me.
Amsterdam Memorial Hospital was taken over by St Marys Hospital in Amsterdam. The old Amsterdam Memorial now runs an Urgent Care Center in the old ER. The Urgent Care Center has a doctor in attendance, and treats patients with injuries and illnesses that require immediate medical attention but are not life threatening. And they do it at half the cost to the patient. Again... Sounds like good use of medical services to me.
Good for you, Box... but let me tell you, that is the exception rather than norm. This is particularly true for specialists. I have been going to same gastro place for three years, and the ONLY time I see my doctor is when I needed a procedure that by law, a physician is required to perform. Expect that to grow exponentially with millions of people entering the system. Yes, many more will be covered, but the quality of care is bound to go down. Only the rich will be able to afford premium health care... and of course the congressmen who voted for the law and the president who signed it. And as far as the urgent care center, you get who is on call. Don't expect to go in there and find the doctor who cared for you the last time...kiss the doctor/patient relationship goodbye
Bottom line is many more people will be covered, but with an already strained system, anyone that believes the quality will be the same ( it won't be the same for a LONG time), is either a partisan hack, or a fool.
"Arguing with liberals is like playing chess with a pigeon; no matter how good I am at chess, the pigeon is just going to knock out the pieces, crap on the board, and strut around like it is victorious." - Author Unknown
Good for you, Box... but let me tell you, that is the exception rather than norm. This is particularly true for specialists. I have been going to same gastro place for three years, and the ONLY time I see my doctor is when I needed a procedure that by law, a physician is required to perform. Expect that to grow exponentially with millions of people entering the system. Yes, many more will be covered, but the quality of care is bound to go down. Only the rich will be able to afford premium health care... and of course the congressmen who voted for the law and the president who signed it. And as far as the urgent care center, you get who is on call. Don't expect to go in there and find the doctor who cared for you the last time...kiss the doctor/patient relationship goodbye
Bottom line is many more people will be covered, but with an already strained system, anyone that believes the quality will be the same ( it won't be the same for a LONG time), is either a partisan hack, or a fool.
Tbird, You have sucky health insurance coverage. I have over the last several years needed to see a few specialists. I made an appointment, was treated and the bill was paid. The CoPay was slightly increased for specialists. As far as the rich affording premium care... I'm certainly NOT rich and have basic health care insurance. I received all the care that I needed.
The modern conservative is engaged in one of man's oldest exercises in moral philosophy; that is, the search for a superior moral justification for selfishness. John Kenneth Galbraith
Tbird, You have sucky health insurance coverage. I have over the last several years needed to see a few specialists. I made an appointment, was treated and the bill was paid. The CoPay was slightly increased for specialists. As far as the rich affording premium care... I'm certainly NOT rich and have basic health care insurance. I received all the care that I needed.
No.. I have the best rated managed care insurance in the area... In my case, to get the best specialized doctor, I had to put up with the PA's...again supply and demand. Tell me how your care is when all 49 million without health insurance are in the system. Its just like increasing the capacity of a stadium and not adding any more restrooms and concession stands.. You'll be able to get a beer or take a piss, but you're going to wait longer to do it. But unlike being thirsty or having a full bladder, your health may not have time to wait. BTW, if this health care plan is going to be so great, why did Congress opt out of it?
"Arguing with liberals is like playing chess with a pigeon; no matter how good I am at chess, the pigeon is just going to knock out the pieces, crap on the board, and strut around like it is victorious." - Author Unknown
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