The Canadians are Cutting Doctors’ Medicare Reimbursements due to the Costs of an Aging Population

Posted by PITHOCRATES - May 5th, 2013

Week in Review

The United Kingdom has national health care.  Which is struggling to meet the demands of an aging population.  And is currently working on cutting their health care spending by £20 billion ($31.8 billion) to help stretch their limited resources meet the demands of their aging population.

Canada has private health care providers but a single-payer system.  So it’s not quite national health care.  But it is somewhat universal.  And something the proponents of Obamacare would settle for if they can’t get national health care.  But like the UK the Canadians are struggling to meet the demands of an aging population (see ‘Future of health care’ hangs on medicare talks posted 5/3/2013 on CBC News).

More than 200 doctors have voted in favour of supporting a lawsuit against the provincial government over medicare cuts, says the head of the New Brunswick Medical Society.

The doctors, who gathered for an emergency meeting in Fredericton on Friday to discuss the matter, were unanimous, other than one abstention, said president Dr. Robert Desjardins…

Desjardins said doctors are still willing to help Health Minister Ted Flemming find ways to cut $20 million from the health budget, but first things first.

“First and foremost importance is respect of the actual signed agreement,” said Desjardins.

“There’s not much of an incentive to discus the future of medicare when there’s no plan on the table and the signed agreement isn’t respected. So from there, what are we talking about?”

In March, the government announced plans to cut funding for doctors who bill medicare for each service by $18.8 million to $425 million and to cap that amount for two years.

The medical society, which represents about 1,700 doctors, contends that violates a fee agreement that expires next March.

Cutting doctors’ Medicare reimbursements?  That’s how Obamacare plans on bringing down health care costs in the United States.  Guess cutting doctors’ Medicare reimbursements isn’t the panacea they thought it would be.  As Canadian doctors actually want pay commensurate with their education, skill and experience.  Imagine that.

Becoming a doctor isn’t easy.  That’s why few people in the population become doctors.  And why countries that don’t pay their doctors well have doctor shortages.  Like they often do in countries with national health care.  Or in countries with a single-payer system.  Who look to break contracts to pay their doctors less.  To help stretch their limited resources meet the demands of their aging population.

Just something to look forward to under Obamacare.  People will at first praise the government for punishing those who choose to make a profit off of other people’s suffering.  But when doctors start leaving the profession and these people have to wait months for an appointment because of the doctor shortage they will long for a return to the old days.  When we had the finest health care system in the world.  And doctors got rich for being the best in the world.  How it once was.  Before Obamacare.

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It Ain’t 1996 – Obama’s path to Reelection isn’t Quite the same Road Clinton Traveled

Posted by PITHOCRATES - January 24th, 2011

Obama Doesn’t have the Healthcare and Economic Edge Clinton Had

Clinton was lucky.  Hillarycare (Clinton’s attempt to ‘nationalize’ healthcare) was a disaster.  It crashed and burned.  So it was off the table come reelection time.  And he had a smoking hot economy.  He had both a real estate bubble and a dot-com bubble.  Now, strictly speaking, bubbles aren’t good things.  Because they burst.  And recessions follow the bursting.  But until they burst, you got a smoking hot economy with low unemployment numbers.  Just the kind of things that gets presidents reelected.  REDSTATE has a list of other things, but let’s focus on items 3 & 4 in their list (see Why 2012 Is Not 1996 by Dan McLaughlin posted 1/24/2011 on REDSTATE).

3: Obamacare passed; Hillarycare didn’t: As unpopular as the Clinton Administration’s health care plan was, it wasn’t a major issue in the 1996 campaign because it had failed and, with Republicans controlling both Houses of Congress, it wasn’t coming back…Not so Obamacare, which remains very much a live issue.

4: The Economy: The unemployment rate is the most obvious of numerous economic indicators showing the U.S. economy in bad shape in 2011: unemployment, as low as 4.3% when voters elected the Democrats to control Congress in November 2006, was 6.5% when Obama was elected and 8.5% when he was inaugurated, and he expended much political capital arguing that his “stimulus” package would fix this with federal spending on “shovel-ready” projects; instead it peaked at 10.6% in January 2010, and remains above 9% a year later. These are very high numbers historically; since 1960, the unemployment rate has been above 6% on election day five times, and the only time the party in power wasn’t booted was 1984, when the 7.2% rate was the lowest it had been since before President Reagan took office and had plunged more than three points in two years. By contrast, the unemployment rate in 1996 was 5.4%, down from 7.4% when Bill Clinton was elected. If Obama can’t make the argument that Presidents Reagan and Clinton made – that they were not only making major headway on unemployment but in better shape than they were when elected (in Reagan’s case, the slight drop in unemployment was accompanied by an enormous drop in interest rates and inflation and a stock market boom) – he’ll face an electorate that is much more suspicious of entrusting him with the economy for four more years.

Historically speaking, history will favor who is not Obama in 2012 on these two issues.  And they’re about the biggest issues you can have.  A recession that just keeps on keeping on.  And a massive explosion in new spending.  Which can’t possibly help anything economic.

Old People and Jobs:  One Unpleasant Tradeoff

And there you have the ultimate showdown.  Obamacare versus the economy.  More spending and even more taxes.  Or less spending, less taxes and more jobs.  On one side you have emotional tugs of the heartstring (we have to help those poor uninsured people).  The other you have reality (we can’t raise taxes or borrow anymore without ending up like Greece).   

Obama may go Clinton.  And Clinton scored some big points with Welfare reform.  Obama has a chance to reform Medicare.  It is, after all, a part of Obamacare.  Gutting Medicare.  But Medicare is not welfare.  Those old people are a powerful voting bloc.  Will anyone, especially a Democrat, throw himself onto that ‘third rail’ (see Health care and the contest of credibility by Michael Gerson posted 1/25/2011 on The Washington Post)?

With Jack Lew and Gene Sperling in charge of its economic policy, the administration’s Clintonian direction is clear. It will seek higher revenue, cuts in defense, spending caps and more aggressive health-care price controls. When measuring deficit reduction, the last is the most important. It is the combination of cost inflation, an aging population and expansive health entitlements that push America toward the fate of Greece. Unless this problem is addressed, no tax increase or cut in discretionary spending will cause federal outlays to flatten at a sustainable percentage of the economy.

Higher revenue means higher taxes.  This is why Obamacare ‘reduces’ the deficit.  It has more new taxes than new spending in it.  But it’s a poor way to reduce the deficit.  If you have a problem because you’ve spent too much on your credit cards, what’s the easiest way to fix that problem?  Increase your revenue (i.e., your salary)?  Or cut your spending?  Of the two, you have far more power over spending cuts than you do on increasing your revenue.  So the smart money always goes on spending cuts to cut any deficit.  If you’re spending too much you just stop spending so much.  Pretty simple and straight forward.

But the 800 pound gorilla in the room is spending on old people (Medicare and Social Security).  We’re spending a fortune on increasing the life of the old so they can keep on collecting social security.  You’d have to be an idiot to not see the problem with that in an ‘entitlement-based’ government.

“The fact is,” says Yuval Levin of the Ethics and Public Policy Center, “Medicare is going to crush the government, and if Republicans leave it unreformed then the debt picture is very, very ugly. They might never – literally never – show the budget reaching balance. Not in the 10-year window and not if they take their graphs out a hundred years. Obama could probably show balance just past the budget window in the middle of the next decade because of the massive Medicare cuts he proposes, even if in practice they will never actually happen.”

Incidentally, those “massive Medicare cuts” he proposed was how he got CBO to favorably score Obamacare.  Without those cuts Obamacare would never have gotten any traction because of the massive cost.  Even with the massive tax increases.

So you see the grim picture? 

The Democratic approach to Medicare cuts would give doctors and providers less and less money while expecting them to cover the same services. “In reality,” says Levin, “providers won’t just provide the same care for less money – some will stop taking Medicare patients, some will go out of business, and some will reduce the level of care or amenities. That’s what we see in every system that takes this approach to cost control: waiting lines, dirty, unsafe hospitals with horrible food and amenities.”

And this is nationalized healthcare.  Healthcare for everyone.  All at an equally horrible standard.  Unless you’re in the government, of course.  Or are affluent enough to fly somewhere where there still is quality healthcare.

Pity the Poor Democrat son of a bitch Running in 2016

Obamacare benefits don’t really kick in until after the 2012 elections.  So when rationing kicks in and the ‘death panels’ start thinning the herd, it will be after the 2012 elections.  This may help.  The quality of our healthcare (Medicare and Obamacare) won’t really really suck until later.  However, taxes, regulations and mandates (and waivers) are kicking in before the benefits.  So the economy will still be in the toilet.  There might still be some tricks in the election bag to pull off reelection.  Who knows?  But one thing for sure.  Pity the poor Democrat son of a bitch running in 2016.  Because he or she will have to answer for the unprecedented mess their predecessor gave us.  Perpetual recession.  And horrible healthcare.

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H.R. 2 “Repealing the Job-Killing Health Care Law Act”

Posted by PITHOCRATES - January 7th, 2011

Real Deficit Reduction Starts with the Repeal of Obamacare

The rallying cry last year was ‘repeal Obamacare’.  Those who promised to make that a priority are now sitting in Congress.  Some of those who voted for Obamacare are not.  The people have spoken.  The candidates have promised.  And now they are going to deliver.  At least they’re going to try.

The Republicans new and old are getting down to do the people’s business.  H.R. 2, aptly titled “Repealing the Job-Killing Health Care Law Act,” will try to do just that.  But the Left is digging in their heels.   First of all, they aren’t all that keen on the title of H.R. 2 (see Health repeal message-war ramps up by Brett Coughlin posted 1/7/2011 on the Politicol).

The White House released talking points and a “fact sheet” about the law, leading with how it creates jobs — a rebuttal to the title of the bill, “Repealing the Job-Killing Health Care Law Act.”

But they’re only getting started.  They then step it up.  And do what they do best.  Be disingenuous.

The White House stays on message about the law saving money, citing the Congressional Budget Office official estimate that the reform law reduces the federal deficit by $124 billion over 10 years. By contrast, the CBO said the House Republican package that repeals the law costs $230 billion.

So repealing a law that will extend benefits to every man, woman and child will add to the deficit?  Funny.  When I buy more stuff I pay more.  Because more stuff costs more money.  Doesn’t it?  If I buy an iPhone for my kid I pay for one iPhone.  If I buy an iPhone for everyone’s kids, I pay more.  So I’m pretty sure about this.  More stuff costs more.

So what kind of math is CBO using?

Robbing Medicare to Pay for Obamacare

Well, it ain’t calculus.  It’s just a variation on their old go-to formula.  Tax and spend.  With a twist.  They actually include spending cuts (see BREAKING: CBO Says Repealing ObamaCare Would Reduce Net Spending by $540 Billion by Philip Klein posted 1/7/2011 on The American Spectator).

The Congressional Budget Office, in an email to Capitol Hill staffers obtained by the Spectator, has said that repealing the national health care law would reduce net spending by $540 billion in the ten year period from 2012 through 2021. That number represents the cost of the new provisions, minus Medicare cuts. Repealing the bill would also eliminate $770 billion in taxes. It’s the tax hikes in the health care law (along with the Medicare cuts) which accounts for the $230 billion in deficit reduction.

So, yes, more stuff does cost more.  $770 billion in new taxes.  And $540 billion pulled out of Medicare.  (Which puts the cost of Obamacare at $1.31 trillion dollars).  Do the math ($770 – $540 = $230) and you get your $230 billion in deficit reduction.  A combination of one big-ass tax and a gutting of Medicare.  Now I understand their math.  They just told a bunch of lies.

AARP’s Backroom Deal to Endorse Obamacare

But didn’t the seniors oppose Obamacare?  I remember them fuming at the town hall meetings during the run up to Obamacare.  They were spitting mad, telling their representatives to keep their hands off of their Medicare.  To which their representatives replied not to worry.  Look, they said, AARP supports Obamacare.  And they only support things that are good for you old coots.  I’m paraphrasing, of course.

Well, AARP did endorse Obamacare.  And it does gut Medicare.  So why would they do this to the old coots?  Well, a good place to start would be to follow the money (see ObamaCare endorsements: What the bribe was by Dick Morris and Eileen McGann posted 11/6/2010 on The Hill).

The AARP got a financial windfall in return for its support of the healthcare bill. Over the past decade, the AARP has morphed from an advocacy group to an insurance company (through its subsidiary company). It is one of the main suppliers of Medi-gap insurance, a high-cost, privately purchased coverage that picks up where Medicare leaves off. But President Bush-43 passed the Medicare Advantage program, which offered a subsidized, lower-cost alternative to Medi-gap. Under Medicare Advantage, the elderly get all the extra coverage they need plus coordinated, well-managed care, usually by the same physician. So more than 10 million seniors went with Medicare Advantage, cutting into AARP Medi-gap revenues.

Presto! Obama solved their problem. He eliminates subsidies for Medicare Advantage. The elderly will have to pay more for coverage under Medigap, but the AARP — which supposedly represents them — will make more money. (If this galls you, join the American Seniors Association, the alternative group; contact sbarton@americanseniors.org.)

So that’s why.  They screwed their dues paying members so they can extort higher insurance premiums from them.  Boy, I’d hate to see what a group that isn’t paid to protect them would do to them.  Then again, I guess we’re going to see that real soon as Obamacare kicks in.  If it kicks in.

Obamacare Result in Higher Unemployment and a Longer Recession?

So they’ve been lying through their teeth and making backroom deals.  Tax and spend as usual.  Well, not quite as usual.  Because they have taken the spending thing a bit too far (see Deficit must fall to prevent economic crisis, Bernanke warns by Neil Irwin posted 1/7/2011 on The Washington Post).

If federal debt were to rise at the pace assumed in a plausible scenario analyzed by the Congressional Budget Office – such as extending most of the 2001 and 2003 tax cuts as spending rises at a steady rate – “diminishing confidence on the part of investors that deficits will be brought under control would likely lead to sharply rising interest rates on government debt and, potentially, to broader financial turmoil,” Bernanke said. He added that the high borrowing rate would limit private investment and push up the nation’s foreign debt, hurting U.S. incomes and standards of living.

There won’t be any income or standards of living if there are no jobs.  And just how is the jobs front after the stimulus they passed to keep unemployment under 8%?  It’s dropped unemployment all the way down to 9.4%.  But the drop probably has less to do with new jobs than it does with people just throwing in the towel in their job search.  So what’s the forecast?  According to Bernanke, bad.

“With output growth likely to be moderate in the next few quarters and employers reportedly reluctant to add to payrolls,” it will take five years before the unemployment rate has returned to a more normal level, he said.

Lovely.

Repeal Obamacare:  Real Deficit Reduction

It would appear that Obama, Pelosi and Reid are trying their all to destroy this country.  The economy is still in the toilet.  And, according to Bernanke, it’s going to stay in the toilet for another 5 years.  Or more.  And it will only be 5 years if we reduce our deficit.  If we don’t do that, all bets are off.  According to Bernanke.

Hmmm, deficit reduction.  If I’m not mistaken, there are two ways to cut a deficit.  I believe you can raise taxes.  Or cut spending.  One is good for the economy.  And one is bad for the economy.  So what to do?  Umm.  Of course, when you’re trying to revive an economy to pull it out of the worst recession since the Great Depression, you’re not going to do that by raising taxes.  No.  That doesn’t work.  Which leaves only one choice.  You have to cut spending.

Someone needs to knock the Left upside the head (figuratively, of course) and tell them to stop with the raising of the taxes already.  And the lying.  Yes, the deficit is too high.  But it didn’t get too high because of tax cuts.  It got too high because of spending.  I mean, if they didn’t spend so damn much all this talk about raising taxes would be a moot point.  Taxes are a function of spending.  Spend more; tax more.  Spend less; tax less.  More stuff costs more.  Less stuff costs less.  You know, that really is a difficult concept to grasp.  Unless you’re a Congress person, I guess.

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Government and Unions can Take a Bad Situation and Make it Worse

Posted by PITHOCRATES - November 27th, 2010

If you Think TSA is Dysfunctional and Unpopular Now, Wait Until it Unionizes

Question:  How do you make a bad situation worse?  Simple.  Add more government.  Or a union.  And if you really want to make things worse, add a government union.

The TSA is not very popular these days.  What with their nude imaging leering and their groping of our naughty bits.  They say it’s for our security.  But it feels more like we’re living in a police state.  But at least we can fire those who cross the line and enjoy these sexual assaults a little too much.  Well, for now, at least (see How to Make Air Travel More Infuriating by John Fund posted on 11/26/2010 on The Wall Street Journal).

But if you think TSA is dysfunctional and unpopular now, wait until it unionizes. This month, the Federal Labor Relations Authority ruled that 50,000 TSA personnel will be allowed to vote on whether or not to join a union with full collective bargaining rights…

Imagine if every change in procedures had to be cleared with union shop stewards. While it is not easy to fire TSA personnel now, just think how difficult it will be to remove bad employees if they are covered by union job protection agreements.

I think I see something questionable in your groin, ma’am.  By the power invested in me, I will need to take a closer look.  We have no female agents available, so I will have to insert my man-hands into your panties and feel around in the name of national security.  But you can trust me.  I work for the TSA.  And if you have a problem with this, tough.  I’m union protected.

If You’ve been Sexually Assaulted, it’s Best that You don’t Wear Pantyliners During TSA Security Screening

Sure, I’m being silly.  I mean, what could be suspicious in a woman’s panties (see Sanitary Towel Prompts TSA To Grope Sexual Assault Victim by Steve Watson posted on 11/25/2010 on Prisonplanet.com)?

I recently traveled via air, and was subjected to that new scanning device. “No problem,” I thought. I was wearing jeans and a linen tanktop, bra, panties, and one camouflage pantyliner.

No doubt common for women to wear bras and panties.  And pantyliners.  Should be no big deal.

These new scans are so horrible that if you are wearing something unusual (like a piece of cloth on your panties) then you will be subjected to a search where a woman repeatedly has to check your “groin” while another woman watches on….

Well, I guess in the name of security we must make some women uncomfortable.  What’s the worst that can happen?  A mild case of embarrassment?

But what ultimately happened is that I was subjected to search so invasive that I was left crying and dealing with memories that I thought had been dealt with years ago of prior sexual assaults.

Oh.  It can be that much worse.  We can traumatize a woman by invoking memories of a sexual assault.  Maybe we should revisit TSA screening procedures.  Come up with something that won’t traumatize people.  Maybe look for bombers instead of just bombs.  Use psychological behavior to narrow down the number of invasive bodily searches.  You know, as long as the collective bargaining agreement doesn’t object, of course.

Doctors to Save Medicare by being Screwed by Government

All right, we know what a train wreck the TSA is.  Surely there are things that government does well, aren’t there?  Well, let’s take a look at a big government program.  Medicare.  The government is cutting Medicare payments to doctors.  The program’s spending is so out of control that these cuts are pretty steep.  How steep?  Enough to make doctors drop Medicare patients (see Doctors say Medicare cuts force painful decision about elderly patients by N.C. Aizenman posted 11/26/2010 on The Washington Post).

Doctors across the country describe similar decisions, complaining that they’ve been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

Not only that, but the system is forcing doctors into specialties, depleting the ranks of the primary-care doctors.

On average, primary-care doctors make about $190,000 a year, kidney specialists $300,000, and radiologists close to $500,000, figures that reflect the income doctors receive from both Medicare and non-Medicare patients. The disparity has prompted concern that Medicare is contributing to a growing shortage of primary doctors.

But can you blame them for going into specialties?  Being a doctor is hard.  All that schooling.  Long hours during residency.  And they’re saving lives.  For which they get paid Bupkis.  Shouldn’t we pay them well after they go through all that hell?

“The argument that doctors literally can’t afford to feed their kids [if they take Medicare’s rates] is absurd,” said [Robert] Berenson [a Commissioner of the Medicare Payment Advisory Commission, an independent congressional agency]. “It’s just that doctors have gotten used to a certain income and lifestyle.”

Easy for a government bureaucrat to say.  But look at the life of a doctor.

But, “the whole system would need to change. … I graduated medical school $100,000 in debt. I worked 110 hours a week during my residency for $30,000 a year and sacrificed all through my 20s. And even now, you’re still seeing people all day, with meetings and paperwork at night, on top of the emotional side of worrying when the patients you care for aren’t doing well. This is life-and-death stuff. And I feel like that should be compensated.”

This doctor failed to mention the lawyers constantly nipping at the heels of doctors.  And malpractice insurance ain’t cheap.

Doctors are Paid too Much?!?  Have you seen what Members of Congress Pay Themselves?

All right, let’s take a closer look at some of these doctors’ critics.  Members of Congress pay themselves pretty damn well.  And they don’t save lives.  Or work hard.  They get a lot of time off.  Lots of travel.  Lots of perks.  We can describe doctors as angels of mercy.  We describe a lot of these politicians, though, as scum of the earth.   And look at their salaries (see Boehner under fire: First cut should be lawmakers’ salaries by Jordy Yager posted on 11/5/2010 on The Hill).

The base pay for House and Senate lawmakers is $174,000, while majority and minority leaders each make $193,400 per year.

A run of the mill member of Congress makes almost as much as a doctor.  Considering what little a member of Congress does for that paycheck, who out there can say this is fair?

Unions and Government

The problem with unions and government?  They make life for the average Joe that much harder.  They protect their own.  And force others to pay for their elevated lifestyles.  And they abuse their power.  Always have.  And always will.  At least nothing in history has suggested otherwise.   

It sure gives you a warm fuzzy when you think about Obamacare coming down the pike, doesn’t it?

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