Obamacare: Romneycare: Time To Junk Them and Have Omnicare:

CharlatanTo get Obamacare the President Obama had to make deals – big deals. He had to sell out the American people to the pharmacies. Now he sees that was a bad idea.

He also had to make deals with other health entities. He guaranteed that the pharmacies they would not be undercut by sources outside the United States. You’ve seen how good that has worked out when you do away with competition and how some of the pharmacies have raised the cost of their medicines by over 700%.

What is there to stop them if they own a monopolyy. The pharmacies are like the railroads of the late 19th Century controlling the market and the price of their products.

Here is something to chew on. The cost of pharmaceuticals make up around 30% of the cost of Medicare. Medicare, which pays 110 billion dollars a year for drugs is prohibited from negotiating the prices by Congress. Who do these guys in Congress represent?  Most Americans want that changed.

The bottom line is that the American people are paying more for insurance and getting less. It is worse because the people who are totally unnecessary to the providing of health care, the insurance companies are suing the government for 2.8 billion which they allege are their losses for 2014. The Obama administration is looking to pay them that money so that they will keep quiet about the extent of damage the Obama plan has done to Americans.

The Obama administration is desperately trying to make people think its grand idea the 2700 page plan which now has over 20,000 pages of regulations actually works. It doesn’t. It is only going to get worse and worse and the costs to some American taxpayers is going to increase more and more. So will it be with the Massachusetts plan. But if President Obama can’t claim success for his health plan what can he claim as a success as president? Helping to reduce the number of Syrians in the world?

There is a way out though. Get rid of the insurance companies. Let the government be the provider of insurance for all the people as it is done in every other First World country. This will never be done because Congress does not represent the people but the lobbyists for the industry.

That Congress is a tool of the industry it is safe to say democracy has failed. It is a charade. Right now it is all pretend.

We already have a program where everyone is insured for their medical costs. It applies to people 65 years and over.  These are the most unhealthy in our society. Some are legitimately ill. Some have very serious illnesses. However many use the program as a means of giving some meaning to their lives by scheduling as many appointments as they can with doctors so that they can get out of the house and meet other people.

There are ways to control things like this but to do it would require courage which Congress lacks. No elected Washington official wants to have to run against an opponent who can say he voted against helping the elderly.

If Medicare were extended to all the people and if proper controls were put on it to prevent abuse we could have a system of medical care in the country better than any, and all would be covered as all should be. We could do it at less cost than we are now paying and the costs could be controlled better. Prices could be negotiated. Everyone could be a winner even those who worked for the insurance companies who would be absorbed into the government. The insurance companies would make a little less money but they too should be happy to get the monkey off their back that they are always complaining about.

I understand it will never be done. We have too many people who run frightened at the idea of the government paying all the costs – many have gold-plated plans they can easily afford and many just don’t like the idea of the government getting involved. Back at the turn of the 20th Century the industrialists would shout any time the workers went on strike that the reds (anarchists)  were behind their demands and the strikers would be hated by the public and suppressed by police forces. The same thing happens today where a plan to give every American health insurance causes the insurance companies to yell out that it is some sort of socialist plot.

I am reminded of all those people joining the Tea Party-type groups who were 65 or over who wanted the government out of their lives. Were any of them willing to give up their Social Security payments or Medicare? You bet they weren’t. How dumb can people be saying they don’t want the government to be handing out benefits while wanting the benefits for themselves.

Has it always been like this? Have we always been no more than a confederacy of dunces? Looking at our candidates for president I’d sy no. Things have become much worse. We should now be properly calle the Disunited Confederacy of Dunces.

No more “USA, USA!” It’ now has to be “DCD, DCD, we love thee, DCD.”

 

23 thoughts on “Obamacare: Romneycare: Time To Junk Them and Have Omnicare:

  1. Fine. Just get used to long waits in and out of hospitals. Six months for an adult neighbour to have an MRI this week.

    “Govt provider of insurance for all the people as it is done in every other First World country.”

    In Ireland – (Just children’s statistics; adults are worse):

    “THE NUMBER OF children waiting over 12 months for an inpatient appointment is now the highest on record, having passed the 1,000-mark for the first time.
    An analysis by TheJournal.ie of data prepared by the National Treatment Purchase Fund shows that the overall number of children on any hospital waiting list is also at a record high, and has been steadily rising.

    Overall, there are 11,519 children waiting over a year to be seen in hospital.

    There are 1,001 children currently waiting over a year for an inpatient appointment, compared to 545 in June 2015.

    There are now 69,878 children on the outpatient waiting list, the highest it has ever been – and over 10,000 higher than this time two years ago.

    There are 10,518 children on the outpatient waiting list for more than 12 months.

    The number of children waiting greater than 15 months for outpatient consultations is currently 2,388, meanwhile.

    http://www.thejournal.ie/children-waiting-lists-2885000-Jul2016/

    1. Henry:

      Good points as usual but does it have to be like that? Is it that all government services are slow and inefficient? Is the problem in Ireland the government or the lack of medical services? Isn’t it possible to structure our medical system that doctors, nurses, hospitals and other health care providers continue to do as well as they now are doing (at least some of them). Now we have the worst of all worlds where the premiums are going sky high but before that we had some who could not get insurance.

  2. It’s imperative that the next administration break the health insurance companies. No kid should go without medical care so fat guys in suits can drive luxury cars and live in gated communities. Straight to Hell with those bastards, and, their greedy stock holders. Nationalize the health care industry, now! Eat the rich!

  3. A number of years ago, I attended a week long training about fraud, waste and abuse in our medical system…the estimate THEN was 10% was the operative number! I was working midnights at Boston City Hospital the night the first Medicare patient arrived at the accident floor with TV strobe lights flashing to record that moment….it was some TEN YEARS afterward that the government considered there might be fraud involved in the program and began monitoring it….I have no love for insurance companies but to even consider, for a moment, the ability of the government to….eh gads!

    1. Bill:

      The insurance companies are middle men taking money for doing little. The government does have the ability to do things right. What we have done up to now has not worked when we left it in the hands of the insurance companies who are interested in a profit. Whatever their profit it is an additional cost to the person who is ill,

      1. Hey Matt….just a few thoughts as I have been watching this fairly closely. Government is neither flexible nor adept at most anything. The Affordable (sic )Care Act caused many doctors to leave medicine…one example is a former Dorchester man whose family practice in Worcester provided top notch care to his patients, who was instrumental in mentoring young doctors and whose expertise in hematology made him the “go to” “House-type man at UMass Medical….he closed shop when faced with the unavoidable move to computerize all medical records despite his own, effective and reliable and proven patient tracking system…bureaucratic thinking at its best caused the loss of a caring, talented MD who was an asset to the community, his patients and young doctors…the current system now moves doctors into typists ..the amount of coding and typing now in place is at the cost of patient care…and it won’t get better….finally, I recall a presenter/prosecutor on fraud reporting there are two major types of medical fraud; paying for services not needed and failing to provide necessary services..he was more concerned with the latter than the former as am I…that of course is meant to lead you to the rationing of health care that is a certainty under a governmental system…under an open market system, we still are…were… able to explore options and coverage that is best suited for our individual needs…I remember a joke about a man denied a transplant by a committee…his tombstone read..”Here lies Joe..Killed in Committee” Stay well.

      2. Worth reading…

        http://www.lifezette.com/polizette/risk-of-mass-exodus-of-doctors-from-medicare/

        Risk of ‘Mass Exodus’ of Doctors from Medicare
        New law’s success or failure will ‘profoundly influence the future of the U.S. health care system’

        by John S. O’Shea, M.D. | Updated 21 Oct 2016 at 9:22 AM

        In what may be the most significant modification to Medicare since the program began in 1966, on Oct. 15, the Centers for Medicare and Medicaid Services (CMS) released the final rule for implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). It dramatically changes how Medicare pays doctors for their services.

        Does it really matter how doctors get paid? Yes — the success or failure of the new payment system will profoundly influence the future of the U.S. health care system. And while the goals of MACRA are laudable, its implementation carries a number of unknowns and the potential for unintended consequences — for patients and doctors alike.

        One recent survey of physicians found nearly 40 percent expect a “mass exodus” from Medicare over MACRA.

        Before MACRA, Medicare used a fee-for-service payment system, reimbursing separately for each individual service provided, without regard to the quality of the care. The new system will reward doctors for providing high-quality, efficient care that leads to better patient outcomes, and penalize those who fail to do so. At least — that’s the idea.

        MACRA creates two pathways for physician payment. There’s the Merit-Based Incentive Payment System (MIPS), which will pay doctors based on how they score on a number of performance metrics relative to their peers. The second pathway will reward doctors who participate in Alternative Payment Models (APMs) meant to promote high-quality, cost-efficient care by incentivizing doctors to work together toward a common purpose: improving patient outcomes while eliminating unnecessary spending.

        This sounds good, but all the emphasis on better quality care comes with a trade-off. To assess the quality of care provided by doctors in the MIPS pathway, the physicians will have to report on a number of measures that many feel do nothing to help them improve the care they provide.

        Doctors already devote a considerable amount of time reporting on quality measures. A recent analysis found that a typical medical practice currently spends, on average, 785.2 hours a year per physician to track and report quality measures. That’s time away from patient care, and the costs — $40,069 per physician — present a particular hardship for small, independent practices operating on narrow margins. Moreover, three-quarters of the doctors surveyed felt that the measures did nothing to help them improve their care.

        How much MACRA will add to the already considerable administrative burden on physicians remains to be seen. To its credit, CMS has made some effort to minimize the reporting requirements and has allocated funding to help small practices prepare. Still, the impact will likely be substantial.

        The ultimate — and undeniably laudable — goal of the legislation is to base physician payments on the value of the care patients receive, rather than the volume of services provided. And the Obama administration has set a rather aggressive timeline of tying half of all Medicare payments to value through APMs by 2018.

        But a cloud lingers over that optimistic horizon: APMs have yet to fulfill their promise.

        Accountable Care Organizations (ACOs), the best known type of APM, accept responsibility for the total costs of care for their patients. If the providers in an ACO can reduce health care spending below an established benchmark, while maintaining quality of care, they can share in the savings. If spending is above the benchmark, they are on the hook for the excess. But after four years, ACOs still haven’t generated the savings that many had hoped for.

        This is cause for real concern. If faced with increased reporting and administrative burdens, declining reimbursements and new payment arrangements that put their income at risk, many doctors — especially independent practitioners — may feel that they simply can’t afford to participate in Medicare any more. One recent survey of physicians found nearly 40-percent expect a “mass exodus” from Medicare over MACRA. Given the predicted shortage of doctors over the next decade and an aging population, this would be disastrous.

        MACRA’s goal — to create a payment system that promotes better quality of care for patients and spends taxpayer money wisely — is sound. However, the necessary infrastructure to achieve that goal — meaningful quality measures and viable APMs — is not yet in place.

        If MACRA is implemented according to the arbitrary timeline set by the administration, it could force doctors to abandon private practice for salaried positions or leave practice altogether — neither of which would be good for patient care. So, yes, we all should care how doctors get paid.

        John S. O’Shea, M.D., is a practicing surgeon and a senior fellow in The Heritage Foundation’s Center for Health Policy Studies.

          1. Morning Matt….as my oldest has just finished the many years of Med School and Residency, and has been good enough to keep me informed about the issues he has seen with clarity through his fresh eyes, I really am not all that interested in his having to adjust to a new system that appears determined to dismantle quality of care for patients…he has yet to scream but it is possible that I might start to…and soon!

    2. A friend in Boston who was head of fraud investigation for New England said that 20% of Medicare payments were fraudulent, that they’d love to get it down to 10% — that was his goal.

      He told stories of fraud he’d uncovered that would astound.

      Gennaro A. should have given up loansharking and opened a ‘free clinic’ on Causeway street. …he’d have made much more money, legally.

  4. Right on Henry: Government generally delivers lower quality services and at a much higher cost. Care for the children? Don’t implement Nationalized Health a la Ireland.
    — From the subcontinent, an Indian Study: “(The authors) looked at a sample of qualified public doctors who were also in private practice. They found that the same doctors spent more time with patients, diagnosed them better, and were more likely to offer correct treatment in their private practice than in the public clinics. Noting that “free” public health care is not free to the taxpayer, they compared the per-patient cost in the two sectors and found it to be four times higher in the public sector.”
    2. Of course, T-Party people take their Medicare and Social Security benefits: the government extracted taxes from them their lifetime through promising such benefits.
    3. Minimize government’s role; free up the private sector; provide a safety net for the poor.
    4. Remember, it’s the taxes on “rich” folks that build hospitals that care for the poor children.

    1. Bill:

      1. We can do better than Ireland – you don’t see those lines under Medicare – compensate the doctors well and the service will be amazing (to steal a Trump word).

      2. Hardly did the amount put into Social Security and Medicare come close to paying for the services being handed out to pretend otherwise is to close one’s eyes to reality.

      3. We saw what the private sector did – it would not accept many with preexisting conditions – it left many more uninsured – it murdered the uninsured with enormous medical costs sending many into bankruptcy. The private sector wants to make a profit but doing so off the misfortune of people seems not right.

      4. It is not just the rich folk who get taxed. We all do. Keep in mind how Warren Buffet has said he pays at a lesser rate than his secretary. The rich take home more of their pay than the middle class who have not bought exemptions.

      1. Compensation isn’t a problem, really.

        “How much does a GP earn in Ireland?

        Recently, the HSE has moved to cut overtime payments and allowances for junior hospital doctors.

        The Competition Authority report also shows that GPs in Ireland earn an average of €220,000 a year from treating medical card patients.”

        That’s around $250,000 from the State and more from their private practice fees.

  5. Bill is right. The best plan would be to minimize the governments role. Government medicine is about as effective as Amtrac, the Post Office , the FBI and IRS. Health insurance policies should cover only hospital bills. All payments to doctors should be made directly by the patient. Cash only. Eliminate the middle man. Tort reform is needed. Premiums will decline. Competition for patients will increase. Prices will decline. The poor will always be with us so some assistance will be required. How has public housing worked in America? As Reagan said government is not the solution. Government is the problem. 2. Who voted for Obamacare? The Dems or the Repubs? Bill Clinton and other liberals are bemoaning it’s failings but they were it’s biggest proponents. Those who want to do away with the rich should move to Cuba, the workers paradise.

    1. NC:

      1. The Medicare seems to work all right despite the government’s role. There are ways to structure the affording of medical services so that they did not break the bank as you suggest make the recipients pay more up to a certain point where the government will step in where there are extraordinary expense. True we should eliminate the middle man as you suggest.

      2. No one wants to do away with the rich. If Buffet pays at a lesser rate than a middle class secretary; if Trump pays no federal income taxes; if Wall Street guys get low rates much below others, then the situation should be reformed. At one time in America the rich were taxed at 70% or above. Now they are in the teens. A guy bringing in a billion dollars a year should not be heard to complain if after taxes he only has five hundred million rather than seven hundred million.

  6. I don’t believe expanding Medicare to cover all Americans will solve the insurance problems. Obama was anxious to get insurance coverage for all and get it done quickly, as he didn’t know if he would have 4 or 8 years to do it. His administration made deals to keep the insurance and drug companies pacified and ready to do business with the government. People who enrolled in new programs and didn’t have coverage previously were sicker than the insurance companies had expected and it has cost them money. That situation should smooth out with time.
    One way to contain costs is for the states to monitor growth of new hospital buildings and unnecessary equipment. Gov. Dukakis did that in the 70’s and 80’s, before Obama
    Care and it worked.
    Also, when and if the IRS gets around to fining the uninsured , make certain that money is slotted to cover health care and doesn’t go into a general fund basket.
    Even with Medicare coverage, most people invest in supplemental insurance to cover expenses that medicare doesn’t.

    1. P.E.

      I assume by your comment you are a young person who is not on medicare.But if you were older you would appreciate how nice being on medicare is for the old folk. Some go to the doctors every day – some twice a day and have lunch at McDonalds – the other day a couple who had seen their hand doctor in the morning and were having lunch while waiting to see their back doctor in the afternoon were heard to complain that they had to pay at McDonald’s – they thought the government should have vouchers for people who have to go from one doctor to another so they could avoid having to pay for their lunch.

      Unfortunately P.E. the situation will not smooth out; it is only getting worse with the insurance premiums going up and insurance companies fleeing some states. By the way Obama didn’t make the deal because of his fear of losing he made it because without it he could not have got it passed so he sold out to the drug and insurance companies who are making a killing on it.

      There are lots of ways to restrain costs if it were done right; I see some hospital in Boston, don’t know if you are familiar with it, it is called Children’s Hospital is adding a humongous building to its present site. Hospitals like colleges believe they have to keep growing and both of them do it freely because the government provides the funds.

      I suppose the IRS will start doing its job after it finished the audit of Trump’s taxes which has been going on for years or figures out how to stop sending out bogus tax return money to crooks. Don’t hold your breath for them to act.

      Alexis deTocqueville in his Democracy in America noted two major things about the U.S. – it had outstanding women and the people were greedy and obsessed with money – is there a relationship between those observations?

  7. CRS identified 83 overlapping federal welfare programs that together represented the single largest budget item in 2011—more than the nation spends on Social Security, Medicare, or national defense. The total amount spent on these 80-plus federal welfare programs amounts to roughly $1.03 trillion.

    http://www.budget.senate.gov/newsroom/budget-background/crs-report-welfare-spending-the-largest-item-in-the-federal-budget

    Mandatory spending makes up nearly two-thirds of the total federal budget. Social Security alone comprises more than a third of mandatory spending and around 23 percent of the total federal budget. Medicare makes up an additional 23 percent of mandatory spending and 15 percent of the total federal budget.

    Medicare benefit payments totaled $632 billion in 2015; just under one-fourth was for hospital inpatient services (23%), 12% for the Part D drug benefit, and 11% for physician services. More than one-fourth of benefit spending (27%) was for Medicare Advantage private health plans covering all Part A and Part B benefits; in 2016, 31% of Medicare beneficiaries are enrolled in Medicare Advantage plans.

    1. Ed – and the Supremes give them all the aid and comfort they can, through all sorts of penumbras and other conceits, such as “it’s not a penalty, it’s a tax,” to expand the powers of the feds in an almost unlimited way

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