dayman

Now Republicans block a bill to give tax breaks to those bringing jobs back, and none to those shipping them over seas. "Turrible" - Charles Barkley

And here's a video that talks about the challenges of moving away from fee for service and why it takes a while: http://www.youtube.com/watch?v=d_FcdP6JfTY

Here's an article that talks about the long term pay shift I'm talking about: http://news.harvard.edu/gazette/story/2012/07/moving-beyond-health-cares-fee-for-service/ The AQC predates, but is similar to, the Pioneer Accountable Care Organization contracts that Medicare began this year through the Affordable Care Act, an initiative in which Medicare will reward groups of providers based on improved outcomes and lower health care spending. The researchers looked at the first two years of data from the AQC and found that the program has, in fact, succeeded in lowering total medical spending while simultaneously improving quality of care. On average, groups in the AQC spent 3.3 percent less than fee-for-service groups in the second year, the study showed. Provider groups that entered AQC from a traditional fee-for-service contract model achieved even greater spending reductions of 9.9 percent in year two, up from 6.3 percent in the first year. Compared with those groups, groups that entered from contracts that were already similar to the AQC achieved fewer savings in both years. The researchers also found that the improvements in quality of chronic care management, adult preventive care, and pediatric care associated with the AQC grew in the second year. “Moving away from fee-for-service models is high on the agenda of those looking to establish a fiscally sustainable, efficient health care system,” said Michael Chernew, professor of health care policy at Harvard Medical School (HMS) and senior author on the study. “It is likely that this type of new payment model will grow rapidly in coming years in the nation as a whole, and particularly in Massachusetts. By analyzing this program, we’re studying the future before it gets here.”

Look just be to clear here, the shift in payment procedures is still experimental and what I'm saying is the ACA includes Medicare in the game to a substantial degree. The gov't (being such a large spender in the messy public-private hybrid we've had and will continue to have) is one of the primary parties people blame for the explosion of costs. What Medicare does, how Medicare pays, the providers structure around the private payers eventually follow. So in that manner, provisions in the ACA for new Medicare payment schemes look to lead the way (on the large scale necessary) to spur along the change. The change itself is organic. The ACA did not invent this, nor would this have not occurred without it. The ACA responded to the need for it and got on board with the push towards it. 10 years..IDK..that's a number I've heard kicked around. The point is to move substantially away from the fee-for-service oriented healthcare system (read: high costs) we have now is not overnight. It will take time. It will take time to bring down costs. And there are things the ACA brings along that will aid that effort. So when I say 10 years I'm not saying 10 years for the ACA to work. I'm saying 10 years for our system to really be departed from the current pay structures that contribute substantially the explosion of costs.

I did a google search on her district and one lady (who apparently has an MBA)running against had this to say: She told the St. Cloud Times: "I feel this is a real opportunity for a candidate to raise the economic issues that the Occupy movement is talking about." So maybe it's just Minnesota. If you don't have a trendy "movement" to link with you can't speak to them? For the record I didn't click on them all but it looked like other people running too like some Hotel Developer. Na she's special. She's not just an R. I don't just think all people with an R by their name are retarded contrary to popular belief.

LOL my God you are a terrible poster. I certainly don't care if you think I'm an Obamabot or if you don't understand/agree on the timing of shifting the pay-structure as a means to reduce costs w/ Medicare leading the way...but to still not understand what was said in the other topic regarding campaign messaging puts you in total retard territory. You are basically a big ball of emotional idiocy. I still love you though so don't worry.

Would you say her cowtowing and usage of the far right xenophobic conspiracy-loving blogoshpere for popularity/power has backfired and will end with her getting the boot?

Did you tell that to your right wing brethren when they were chanting about death panels to oppose reform during the ACA's creation? And in any event the fight to bring down costs is a system-wide shift that will take about 10 years and the ACA addresses medicare/caid's role in that shift there isn't much more it can do.

As Bird said they are basically the same in a system where insurance is the means by which everybody has access to care, and where most people cannot afford care without it. And in any event, the claim that the ACA doesn't attempt to address healthcare costs shows that you don't really have a strong understanding of the ACA, or the historical impact Medicare had on costs.

I think the thought of 3rd passing it brings a smile to all of our faces.

Try giving them the hard facts on American healthcare as is compared to other nations (who do a bunch of different things...different from us...different from each other) and poll them on if we should do something. That'll be unanimous. Then we can sit here and debate and ACA structure, a medicare for all structure, or just total social medicine. If you really care about small business and state budgets so much I take it you want to socialize the entire thing? At least a public payer? Of course that would take even more taxes...tsk tsk...so now we're back to ACA? But then again the ACA is still ultmately more expensive than single payer...so we should shift back over there at least...and now wait a minute single payer could lower the cost of care more if we go to socialized medicine! But wait socialized medicine doesn't sound good...let's just stick w/ single payer....bleh the taxes! Back to ACA. You know the ACA has a huge lobby against it and seem complicated...let's just do nothing? At some point we have to pick one. We picked the conservative approach. This is Romney's own damned approach. As a nation (and by nation I mean the GOP), we should all stop forcing him to run against it and repeal it and just move forward on implementing it well and revising where necessary.

Shhh...everyone just got free care anyway for the last 50 years there wasn't any problem (and btw it was truly free!)..shhhh...don't spoil the talking points that blast the ACA as the devil...sshhh

Well first off you have to realize the first paragraph there is me saying "don't demonize the private insurance companies" but I admit there is basically no reason that they provide any benefit it was purely political reality that the right wing (and some of the left) wouldn't' get rid of them. The second part is me talking not about the ACA...but about a public provider system. AKA...Great Britan. Which I came to the conclusion that in the end that would still probably be the better option for the most people...despite both private and public provider systems having their strengths. So when you ask about your dad's shoulder and picking your doctor realize I was talking about public payer and later on public provider...neither of which we have now under the ACA or had before (although we have public payer for basically everyone that is old or poor).

I don't disagree that we could probably save about 12% administrative costs going to public payer. My point is, in terms of the system we have...the insurance companies NEED about 20% of that dollar. It's not pure waste in the environment we have so they shouldn't be demonized over it. The fact of the matter the common wisdom that the private sector is more efficient that the public sector just doesn't match up when it comes to healthcare...I don't deny that...but it's not b/c they're evil or making a killing off us...it's just the facts of life. To say "why have private insurers who get 20% when Britan and Canada have admin costs closer to 6-8%?" is fair...to say "our private insurers don't need 20% they're dirty cheats who steal" is not fair. As for gov't run healthcare system I don't doubt they could it more it more cheaply. It's a fact. But it's questionable if the service would be the same per dollar...for many non-emergency procedures the wait time could be months and even then they would cover everyone...but not everything...and yet taxes would still be high to pay for it. So what's the difference between the taxes you pay there and the premium you pay here as compared to a procedure not covered there but covered on your plan here? The answer to that question will vary depending on your income and the procedures you end up needing. But the idea is the same...both systems have their pros and cons...which is better for any given individual depends on that individual and their circumstances. I would agree though that ultimately I think the total socialization of that market is probably better for more more people than less. But that's neither here nor there b/c we will NEVER have that in America. As I said earlier I would say the best system for the US would ultimately be public payer, private provider...or "medicare for all" as you call it. But for now, given the circumstances...the ACA will have to do.

Plus it's not that absurd to begin with guys. They DO do a lot. You can't sit there and acknowledge how complicated the medical services sector is and then roll over and say the insurance companies do nothing. There are large administrative costs. And you can't sit there and say "yes, we need to work on transitioning pay structures and experiment with different ideas to control costs" and then say "the insurance companies do nothing." Not to mention it stayed private...so there are marketing costs as they compete with each other. And then yes, God forbid they take a profit which for most insurance companies is about 2%...putting it at the low end of all business. Don't demonize the insurance companies. They're the most picked on group in this whole mess and the damned truth is it's more the government and the medical providers that have ****ed up everything in the past. There is a lot of stuff here that will nudge (probably not enough) the doctors/hospitals and some serious stuff that will attempt to remedy the mistakes in the way medicare has paid stuff out as quickly as possible...so they're working on it as are the insurance companies...but you shouldn't demonize the insurance companies for making 2% profit and b/c you don't understand where the 20% on that dollar goes. How much off a $15K 12 hour hospital stay where the patient gets fluids and a Xanex do you think went to "patient care?" 20%?

Scalia will be on Piers Morgan Tongith at 9 I think for an hour long interview

Allow me to clarify he "gaffe" that I'm talking about is the: "If you've got a business you didn't build that, somebody else made that happen" as opposed to "you didn't build it alone" b/c of all the other things he was saying. That's the gaffe/sound byte. Not the entire speech. Romney isn't going to go around using his entire speech against him....that's his damn pitch you are right it may well turn some people off but they're both talking at different crowds. It's that line they want circulating. "If you've got a business you didn't build that, somebody else made that happen." = the sound byte. The entire speech =/= sound byte. Attacking the entire speech = campaign messages clashing = going to last. I'm sorry if you didn't read all the previous posts or didn't understand what you were reading etc. It's not that confusing. Obama saying you we're all in it together and you didn't do anything on an island is on message. Saying you didn't build your business someone else did is a gaffe. Any Republican saying the government should be small and people should pull themselves up etc is on message. Saying black people want free stuff or something along those lines is a gaffe that those candidates walk the line with sometimes (I think Santorum might have literally said this at one point but I could be wrong...in any event Romney has come close but avoided literally saying that). Do you understand basic media now?

World you don't understand the conversation I'm trying to have. It has nothing to do with how you feel or what the candidates are in your mind or even in reality. Basic messaging, and attack tactics...of both campaigns. It's politics talk in here. So you can leave your emotion at the door.

All in all you can reason from basic ideology but we live in a messy public private model as is. To me the above is a step in the right direction...I honestly do believe that a public payer private provider done right is the most efficient way but if we aren't going to do that then this is the first step in doing the only other thing possible to do what every other rich nation does...try to provide basic healthcare to all citizens.

Through the entire scheme. It's all estimates but they (CBO) estimate over 30M more insured raising our overall insured to roughly 94% of legal non-elderly population The basic scheme as I generally understand it is as follows (includes my opinion): Guarantee issue and community rating (read: no preexisting discrimination ... generally if you are older and sicker you pay less if you are younger and healthier you pay more per community rating...controversial) Mandate to make that work (obvious controversy) Failure of political nerve to include "death panels" which we desperately need (there is a board that performs VERY limited functions that determine payment amounts not procedures and even then only when cost goals for medicare/medicaid goals fall short...this is our biggest shortfall w/ the bill IMO you NEED a board ) 80-20 rule (most like) 26 stay on insurance (most like) no life time limits on essential benefits (most like) preventative care w/ no cost sharing (ideally keep you healthy lowering your overall costs, critics say it prevents free market from working to lower costs IMO that's wrong the costs crisis is in the more serious care that represents 50% of the overall costs that 5% of us use) No dropping you when you are sick except for fraud (most like) mandatory appeals (no objections here) Medicaid expansion for basic minimum coverage for less then 133% of poverty line (for states taht take the money, it's free until 2020 then fed draws back and covers 90%....this is where a huge amount of uninsured come in) exchanges w/ credits and subsidies for those getting insurance on their own (This has problems imo most obviously there's a 2% tax on these plans but we are subsidizing/crediting the plans...classic government) Aggressive cost control experimentation in medicare/medicaid payment structures to slow rate of cost increases promotion of PCP/Health centers by giving them more money! (PCPs can make more from medicare/medicaid...encourage preventative/regular care and entry into this field...hospitals and specialists get less it hurts them) increased tools for fraud identification in medicare/medicaid CBO budget estimates are what they are nobody trusts them but they aren't bad

Stop attempting to give an actual response indicating how you feel to a flawed question by writing a poli-sci thesis . In any event, I agree with most (but not all) of what you have said in this post

There's actually a fantastic documentary on HBO on demand about Bush Sr. and he's real frank and open but when asked if he'll talk about Perot he just says: "No...I don't like him and I think he cost me the election and that's all I'll say about that." lol

Obama 83% Romney 21% Paul 11% Somehow with nobody on economics and Romney on domestic policy lol. Also strong showing for !@#$ing Jill Stein whoever the hell that is but I think that's b/c of by my science emphasis? Funny survey.

At it's core it's going to be "Blue Collar Obama" v. "White Collar Romney" and Obama is going to be able to explain/appeal to people pretty well in that way. And Romney will be able to sell his pitch well as well. All I was saying with regards to the Obama blurb is that even though a botch, it's somewhat on message with his blue collar pitch and it will be naturally clarified and damage minimized as a matter of course. Where as Romney's tax issues and any suspicion over that they keep drummed up while the campaign goes on hurt his pitch and won't be explained by it. Hence...one will last longer. They will hammer Romney on taxes until the end or until they're released.

That'll be the way you and many choose to take his pitch as, and thus you won't identify with it, but that isn't what his pitch will be. It's simple he'll say the middle class makes it all possible and the other side will say the upper class pulls everyone up. It's all nonsense b/c they're both true. But this is what they'll run on and see what resonates more and who can pitch their nonsense better. The reason I say the attack on his quote there is less substantial is simply b/c it was not well said and a blurb they will attack, but it is something he'll be able to clarify given the long term pitch of his campaign. Where as Romney's tax attack isn't something his pitch over time does anything to clarify or marginalize. The tax attacks will probably continue to November unless he releases some more...just my opinion it won't just go away. The attacks on one quote when Obama will continue to give his pitch...that will fade that much if obvious. Hence, the tax issue will stick around longer than the current Obama blurb. EDIT: LOL look this topic is about the politics. His campaign narrative isn't' that he's a Marxist and government is responsible for all. That is obvious. Calm down, understand we're talking messages here...and that no way in hell would anyone in their right mind run on that message.