http://www.cnn.com/2009/POLITICS/07/08/biden.health.care/index.html

Quote :

" Biden cheers deal with hospitals on health care reform (CNN) -- Vice President Joe Biden announced Wednesday that a deal has been reached with hospitals to help fund health care reform. "We're here today to make our health care system healthy again," Biden said in announcing the agreement. Biden said the hospital industry has pledged to contribute $155 billion in Medicare and Medicaid savings in the next decade. "Hospitals have acknowledged that significant health care savings can be achieved by improving efficiencies, realigning incentives to emphasize quality care instead of quantity of procedures," Biden said. "In the last several weeks, they've been working with [Senate Finance Committee] Chairman [Max] Baucus and are coming forward with a proposal that produces real savings in federal health care spending. Savings that will be applied toward the president's firm goal ... of enacting health care reform that is deficit neutral." As the health care system becomes more efficient through technology and innovation, Biden said, increases in Medicare and Medicaid payments to hospital will slow and, as more people are insured, hospitals will bear less of the financial burden in caring for those without adequate coverage. "Today's announcement, I believe, represents the essential role hospitals play in making reform a reality. And the reality will be we must enact this reform this year," Biden said. "We must, and we will, enact reform by the end of August, and we can't wait." Biden was joined by Health and Human Services Secretary Kathleen Sebelius and representatives of the hospital industry. The hospital deal follows Obama's announcement last month of an agreement reached with the nation's pharmaceutical industry to cut drug costs for elderly Americans, calling it an example of the kind of compromise required for successful national health care reform. That agreement discounts medications for Medicare beneficiaries facing high out-of-pocket expenses when their benefits reach a gap in coverage. Following Biden's announcement, House Minority Leader John Boehner accused the administration and Democrats of "bullying health care groups into cutting backroom deals to fund a government takeover of health care." "Democrats, Republicans, and health care stakeholders must work together on real reform to give Americans better access to affordable health care, but that's not happening in Washington," Boehner, R-Ohio, said in a statement. "It's time for Washington Democrats to abandon their 'go it alone' approach and work with Republicans on true reform that expands Americans' access to affordable health care," he said. "

Apparently Biden doesn't understand economics. If the hospitals are going to "ask for less money" from the federal government for the services they will provide, then they will simply recoup the money by charging every one else more. Duuurrrrr. Either that, or they expect to get more out of this deal than they are giving up, thus making the touted "savings" bullshit to begin with. And, if it's neither of those two, then it must be the case that the hospitals are gouging consumers.

Put simply, hospitals aren't going to simply take a pay cut. They will simply do what economics says they will do: shift the cost elsewhere. How's that for the government "competing with the private market?" It amazes me that people who are so fucking ignorant of the basics of economics can rise to be a senator or even the fucking Vice President.

7/8/2009 6:42:18 PM

i'm sure you could school him, brian.

7/8/2009 6:45:04 PM

I probably could.

7/8/2009 6:59:21 PM

I don't get why so much emphasis on healthcare reform is the heartfilled helping "struggling poor families" and health care available to everyone. Why not just first start with making healthcare better, more efficient, and cost-benefit worthy to help EVERYONE. Instead it seems we are trying to pass the buck once again to Johnny upper middle class lawyer and Billy the plumber so that Juanita the illegal immigrant can visit the doctor anytime one of her 10 kids has a cold.

7/8/2009 7:09:41 PM

Welcome to Husseins America

7/8/2009 10:38:49 PM

HUSSEIN

7/8/2009 10:44:19 PM

why can we refer to dubya by his middle name but not hussein

7/8/2009 11:00:10 PM

who's saying you can't?

7/8/2009 11:14:50 PM

^ "they"

7/8/2009 11:16:39 PM

Because we have to distinguish this president from Barack HW Obama

7/9/2009 12:45:15 AM

I was not aware that W's middle name was, well, W

7/9/2009 12:49:04 AM

When Obama's campaign starts printing "H '12" bumper stickers, the two situations will be analogous.

7/9/2009 1:11:26 AM

Quote :

"heartfilled"

Did you mean: heartfelt

7/9/2009 7:07:31 AM

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"As the health care system becomes more efficient through technology and innovation"

These two things aren't making health care more efficient. If anything, the increasing technology available, combined with guaranteed payments by the government or HMOs, and our litigious society, causes doctors to order tests that may or may not be necessary. Someone has to pay for all that new equipment and that only happens when it gets used. Since the person about to get a CAT scan isn't going to be the one paying out of pocket, they don't object.

The fundamentals of good health are being buried by the increasing reliance on technology whose real benefit is at the margins, after the basics have been taken care of.

7/9/2009 9:14:40 AM

^Thats completely wrong, sorry to say. Paper-based medical records are the biggest source of medical spending waste. Moving to an electronic, web-integrated records system is hospitals' biggest priority right now.

7/9/2009 9:37:56 AM

Why weren't electronic records implemented 10 years ago? And why is it requiring gov't persuasion to finally get on board?

School systems have had electronic records for years. Heck-- all student records and grades in NC are in one, giant database. If NC DPI can do it, anyone can.

7/9/2009 9:51:07 AM

^ Among a host of other reasons, most physicians work in small practices, where it is often not worth investing and implementing the infrastructure necessary. Most larger providers (hospitals) do have some form of electronic record-keeping, though.

Unfortunately, IT and preventative care are not the cost savers many think them to be...

Quote :

"Other approaches—such as the wider adoption of health information technology or greater use of preventive medical care—could improve people’s health but would probably generate either modest reductions in the overall costs of health care or increases in such spending within a 10-year budgetary time frame."

http://www.cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf

7/9/2009 12:33:38 PM

Quote :

"Why weren't electronic records implemented 10 years ago? And why is it requiring gov't persuasion to finally get on board? School systems have had electronic records for years. Heck-- all student records and grades in NC are in one, giant database. If NC DPI can do it, anyone can."

As noted, there are the significant costs involved with the hardware, support and infrastructure, needs for a standard electronic format (after all, all of the electronic records in the world do you no good if you have to print them out and re-enter them by hand when you want to switch providers or systems), and then there are the mass of privacy rules that apply to medical records that don't apply to school records. The fact that in many small practices, unless you require the purchase of specialized dedicated equipment the software will be running on the same systems that the secretary installs bonzai buddy, gator, weatherbug toolbar and not_a_virus_I_swear_really_naked_paris_hilton.exe onto. Also, most folks have an aversion to their medical records being stored in some giant database somewhere and as the VA showed us a few years ago, and the credit card companies have shown us time and again, all it takes is someone leaving a laptop somewhere and all of a sudden thousands of people's medical history becomes public.

If your kid's grades get made public because some teacher left her laptop outside one day, he gets teased for that time he failed 1st grade and life moves on. However, if the fact that your kid is HIV+ winds up public because the doctor left windows file sharing turned on while he was browsing the net at starbucks, your kid could suddenly find his life a whole lot lonelier.

There are a host of problems with electronic medical records, unfortunately they won't be solved until the tech becomes more wide spread, but I'd rather see the bugs worked out at larger institutions like hospitals and such before we start forcing it on every doctor everywhere.

[Edited on July 9, 2009 at 12:53 PM. Reason : asdf]

7/9/2009 12:53:17 PM

Quote :

"Apparently Biden doesn't understand economics. If the hospitals are going to "ask for less money" from the federal government for the services they will provide, then they will simply recoup the money by charging every one else more. Duuurrrrr. Either that, or they expect to get more out of this deal than they are giving up, thus making the touted "savings" bullshit to begin with. And, if it's neither of those two, then it must be the case that the hospitals are gouging consumers"

They're going to ask for less money because they'll be doing fewer services pro-bono, since everyone will have insurance. Hospitals charge everyone a premium because they have to recoup the loss they take from treatments that end up not being paid for. Take away these losses and costs should go down.

Thats the general idea anyways. I'm pretty skeptical.

7/9/2009 3:48:36 PM

Quote :

"Thats completely wrong, sorry to say. Paper-based medical records are the biggest source of medical spending waste. Moving to an electronic, web-integrated records system is hospitals' biggest priority right now."

You are correct. However, since the cost of paper based systems has been steady, and since integrated systems have not been implemented widely yet, one of the larger drivers of cost in the late increase has been the cost of new medical equipment.


It'd probably be fair to say that new digital integration holds promise, but it alone will not save the system.

7/9/2009 4:54:48 PM

Quote :

" Take away these losses and costs should go down. "

wrong. costs will be shifted from individual hospitals (and their patrons) to the tax payer. This is good for hospitals because it guarantees they'll get paid on time.

7/9/2009 4:58:02 PM

I'm not talking about tax payers saving money. I'm talking about hospitals.

7/10/2009 10:25:27 AM

if by save them money you mean save their investors money then yes it probably will.

7/10/2009 10:35:21 AM

I heard one of the news outlets recently saying there is a new proposal floating around to set up tax breaks, grants etc.. to create not for profit medical insurance companies as an alternative to having outright government run insurance policies....Anyone heard anything more about this?

The whole universal heath care thing has the potential to be ugly, but I do like the not for profit idea.

7/10/2009 12:13:44 PM

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"not for profit medical insurance companies"

I thought BCBSNC is a NPO and made $186M in profits last year, but I can't find anything to back it up right now.

[Edited on July 10, 2009 at 1:57 PM. Reason : .]

7/10/2009 1:51:16 PM

I think BCBS operates in a few states under not for profit status (I think it was not for profit in NC in the past), but most of them have gone for profit. I think they all still pay federal taxes tho.

Also, I think BSBC is operated almost like a franchise with individual state entities under the same name as the central parent organization, but separate.

But given the options out there, I think creating big operating advantages for non-profit health insurance entities is a decent option to explore. The vast majorty of providers are out to make a profit, which is fine, but naturally some people are more "profitable" than others....and if the gov wants everyone to be covered, there has to be some incentive or realistic way to cover those "expensive" people while not bogging down the whole system for others...Which is what would happen if the gov tried to manage it.

maybe even take the non-profit idea to the next level, with a separate network of resources primarily for those covered under that plan...similar to hmo's but all one entity.

imo, anything would likely be better the the gov being directly involved.

[Edited on July 10, 2009 at 2:58 PM. Reason : .]

7/10/2009 2:57:46 PM

The existence of profits is not in and of itself a bad thing. Else, one could make the argument for government's involvement in any sector of the economy. (e.g. think of all the money that could be used to feed the poor if profits in the food industry did not exist)

Economist, Alex Tabarrok, paints the idea well:

Quote :

"Picking out one measure of health care "costs" to compare systems is sadly reminiscent of the arguments for socialism. Do you remember those arguments? Under socialism: * "Think of how much money we will save on advertising!" * "Socialism will lower costs by maximizing economies of scale!" * "Money will be used for production not profits!" Exactly these arguments are regularly trotted out in the debate over administrative costs in health care so color me unimpressed. To be clear, the point is not that these statements are false - the point is that these premises to the argument are all in some sense true it's just the conclusion, socialism is more efficient than capitalism, which turned out to be false. We tried that and it didn't work. In other words, you have to compare systems not arbitrarily pick out for comparison one type of costs."

7/10/2009 3:01:00 PM

Quote :

"The existence of profits is not in and of itself a bad thing. Else, one could make the argument for government's involvement in any sector of the economy."

Agree 100%....however, the crux of the health care issue is getting coverage for those people who in all likelyhood will be unprofitable at a cost they can reasonably afford to pay. Also, I'm not at all in favor of any direct gov administration.

the for profit companies are free to operate and make money, while not for profit cooperatives fill a niche for those who may only want or can only afford a lesser level of care, or options.

Its incredibly complicated no matter how you look at it.

[Edited on July 10, 2009 at 3:11 PM. Reason : .]

7/10/2009 3:10:51 PM

I agree. I have no prob if the government wants to pave the way to make it easier to set up cooperatives. although, I strongly disagree with funding them. Doing so will create an implicit cost-of-capital advantage, as the GSEs shared - allowing an unfair advantage that could possibly crowd out private providers.

[Edited on July 10, 2009 at 4:00 PM. Reason : .]

7/10/2009 3:59:51 PM

when you help the middle class and poor sections of the American public you've pretty much covered everyone except for a few percenatages who then bitch about it.

[Edited on July 10, 2009 at 11:31 PM. Reason : pere]

7/10/2009 11:30:45 PM

and why should we help those sectors to the detriment of the other?

7/11/2009 6:14:14 PM