bb

No hard numbers from the Canadian Conjecturist as of yet.

Thank you ever so much for the clever label.
But I did answer you. Here's what I said, after noting how Medicare and efence could be cut.

I don't know about the rest B, But I think its easiest to start with one number across the board and ask each department to implement the budget cuts as they see best. Its when politiicans start to micro mange that things get messy.

which was actually explained using bettterer language by Danivon...

Better to set a target of a set level, invite each deparment to explain how it can meet or exceed it (and what the impacts would be), and what level of savings they can make without making a material difference to front line services. And then use such a review to take a more intelligence-led approach to reducing spending

.

Wow! Republicans are willing to trade 300 billion cuts in deductions so that they can not only get the Bush tax cuts permanently but also reduce the tax rate for the rich a further 7% to 28%. And I thought Republicans were unreasonable..And this came from the Sentate Republicans, the moderates in the party as compared to the House.

freeman2 wrote:Wow! Republicans are willing to trade 300 billion cuts in deductions so that they can not only get the Bush tax cuts permanently but also reduce the tax rate for the rich a further 7% to 28%. And I thought Republicans were unreasonable..And this came from the Sentate Republicans, the moderates in the party as compared to the House.

Combine that with cuts and you can get somewhere. This also included tax code simplification, which most believe will spark the economy.

Again, that was an offer by the GOP. Democrats may not like it, but in politics an offer ought to lead to a counter and negotiations. It's called "compromise."

So, what was the Democratic counteroffer? Where is the post-partisan President's plan?

rickyp wrote:As for Medicare, if i were all three levels of government I would simply mandate that they begin negotiating with supplied services to ensure that they are receiving the best possible prices...
Right now, its usually the opposite.

Sorry but this is not the case. In all cases besides Part D, i.e. Parts A, B & C, the Federal Gov't tells the providers how much they will pay. The provider can take it or leave it. If they leave it, then the provider is not allowed to accept Medicare patients.

As a matter of fact, this is the entire point of the Medicare "Doc fix". A law passed years ago said the Medicare reimbursement rate to doctors had to be cut by X% (I believe 20%) by year 19XX (I believe 1997). However, every time the rate is supposed to be lowered, Congress votes to not lower it because they know most Doctors will just stop accepting Medicaid patients.

Obama counted the doc fix to pay for his health legislation. That's why Reps say it cost $1 trillion and Dems say it pays for itself. However, they have to doc fix every year or docs will stop offering medicare.

Steve,

My counter-offer would be this:

(1) reduce defense spending 10% a year for five years
(2) reduce all other discretionary spending 5% a year for five years
(3) immediately end the Bush tax cuts for the top 2% (adding successive tax brackets until after five years you have completely ended the Bush Tax cuts.)

After five years, you will have reduced defense spending 350 bilion dollars a year, other discretionary spending something like 150 billion dollars a year. Then tack on 370 billion dollars a year in getting rid of the Bush Tax cuts. I would raise capital gains to 28%, that should bring in some more revenue. I think you are getting pretty close to dealing with the budget deficit at that time within a reasonable amount of time. At the end of the day, the budget deficit is mainly the Bush Tax Cuts plus increases in military spending.(similar to what happened under Reagan--massive military build-up plus tax cuts equals huge deficits--and you wonder why we don't really take Teaparty Republicans seriously when presidents they supported are the ones that got us into the budget mess in the first place).

archduke
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However, every time the rate is supposed to be lowered, Congress votes to not lower it because they know most Doctors will just stop accepting Medicaid patients.

And they know this because the medical lobby pushes hard to explain this to them.
Given the choice of not having a significant clientele or acepting lower fees .... most doctors would accept the lower fees.
Doctors in Canada have the option of opting out of medicare and billing their own schedule of fees directly. Few do. And one reason is that collecting the bills is a lot tougher, whereas medicare pays immediatly and always . The other is that the luxury of immediate service at a much higher price isn't attractive to too many clients.

Federal Gov't tells the providers how much they will pay

Yes, but those fees aren't aggressively negotiated. They are exceedingly generous, and often have the hand of legislators involved...Just as the Doc fix is lobbied hard against,, Pharma lobbies to ensure that drug prices, for instance, remain extraordinarily generous.
A visitor to the US can often get a service for fees below the regular fee schedule, when there is unused demand.

rickyp wrote:archduke
.

However, every time the rate is supposed to be lowered, Congress votes to not lower it because they know most Doctors will just stop accepting Medicaid patients.

And they know this because the medical lobby pushes hard to explain this to them.
Given the choice of not having a significant clientele or acepting lower fees .... most doctors would accept the lower fees.
Doctors in Canada have the option of opting out of medicare and billing their own schedule of fees directly. Few do. And one reason is that collecting the bills is a lot tougher, whereas medicare pays immediatly and always . The other is that the luxury of immediate service at a much higher price isn't attractive to too many clients.

It depends on the specialty ... for some critical specialties such as primary care, the medicare / medicaid rates are very low which is a critical problem.

Ray you and I have discussed whether or not there is elasticity in the medical servcies market in the US. I always said no, or nothing substative. You disagreed.

This fall I was made aware that there is flexibility. For Canadians visiting border specialists for certain procedures, apparently prices had been slashed considerably and uniquely. (CBC Radio : White Coat Black Arts) Now, if true that seems to indicate that when faced with surplus operating room time, there is a willingness to try and drum up activity with lower prices. My guess is that they dropped prices for Canadians rather than to American insurance companies because the latter would set a precedent and establish a new price point for all those procedures from the insurer or all insurers....
What I read from this is that the insurance/doctor relationship eliminates the possibility of market forces working they would in a true demand market.
The difference in a single payer system, is that the price negotiated has to be sufficient to reward doctors enough to keep them providing the procedures. But as low as possible to keep costs down. And the taxes that support those prices.
Private insurers should be able to do this as well, except that they can't all act in concert in order to provide maximum pressure on pricing (legality) and they also have a release mechanism . That is, they can always pass along medical inflation to the cost of premiums.
Its probably harder to raise taxes to pay for a single payer system, then it is for private insurers to just keep raising premiums. (There is a politcal price to pay for governments raising taxes. even in France)
The evidence fo this, is that medical inflation runs ahead in the US versus other countries.

Yes, the Volt did miss its sales target by 23%--so says a GM spokesman:

Speaking at the Automotive News World Congress event on Tuesday evening at the 2012 Detroit Auto Show, Girsky was keen to point out that while the Chevrolet Volt missed its 10,000 car sales target for 2011 by 2,329 vehicles, it didn’t mean the Volt was a flop.

“I think it’ll be May or June before we know whether this thing really has legs,” he said. “We are prepared for if it does.”

Despite the Chevrolet Volt fire news stories which broke in November, Girsky said GM is still filling orders from dealers across the U.S.

But while some dealers are still requesting healthy numbers of cars, some dealers aren’t performing as well.

“I don’t think the dealers are really pushing this car yet, as most of them only have one or two,” he explained.

As more cars become available and news of the battery-pack safety upgrade spreads, expressed his hope that will change.

Although sales figures are lower than GM first predicted, many of its first-time Chevrolet customers are making the switch from other luxury brands just because of the plug-in hybrid.

According to Girsky, the median income of the average Volt buyer is around $175,000. Given the high ticket price of the 2012 Chevrolet Volt, that’s hardly surprising.

“[The Chevy Volt] is bringing more BMW customers to GM than Cadillac is,” he joked.

I'll call it now: "flop."

rickyp wrote:

Federal Gov't tells the providers how much they will pay

Yes, but those fees aren't aggressively negotiated. They are exceedingly generous,

I am sorry but this is just false. I can give a number of examples that I learned from my time in the state senators office like the cost of an average ambulance run in the Phila suburbs is about $1,000 but Medicare only pays $350. Medicare's doctor reimbursement for cancer treatment is only about 55% of the actual cost. If the Doc fix went in as required for 2010 that would have been dropped down to 45%.

One of our major local hospitals that has a patient base of largely Medicare and Medicaid patients is always either on the brink of or filing for bankruptcy because the reimbursments are not sufficient enough to cover actual costs. Here is an article from 2006 about a hospital in Florida that faced a similar situtation.

Also, I can't tell you the number of actual doctors I talked to (not lobbying groups but actual practicing doctors) that said they could not maintain their practice solely on medicare reimbursements. Here is an article that discussiong Doctor's no longer accepting Medicare patients because the reimbursements are not enough to cover the costs. From the article.

Dr. Edward Kornel, a neurosurgeon based in White Plains, N.Y., stopped seeing Medicare patients two years ago. Two colleagues in his group practice have joined him in dropping Medicare patients over the past six months.

Kornel, who's been in practice for 27 years, said he had always accepted Medicare patients in the past.

"But when I looked at my income from reimbursements, I was losing money every time I took care of a Medicare patient," said Kornel. "It wasn't covering my costs."

I get it Arch. The theory that you can switch from your current system to a collaborative industry/govenrment negotiation might well be very difficult, with the resulting dislocation from an attempt to be crippling...\
. I think part of this is that doctors in other systems are compensated differently for more than just reasons of cost. Many aren't service for fee for instance...
But, its also important to note that doctors in the US are better compensated, even accounting for cost of living differences than anywhere.
.
From an OECD study:

According to this model, the 2007 report says, “The U.S. position above the trendline indicates that specialists are paid approximately $50,000 more than would be predicted by the high U.S. GDP. General practitioners are paid roughly $30,000 more than the U.S. GDP would predict, and nurses are paid $8,000 more.”

But it’s important to keep in mind, the report notes, that health care professionals in other O.E.C.D. countries pay much less (if anything) for their medical educations than do their American counterparts. In other words, doctors and nurses in the rest of the industrialized world start their medical careers with much less student loan debt compared to medical graduates in the United States.
http://economix.blogs.nytimes.com/2009/ ... ries-make/

rickyp wrote:But it’s important to keep in mind, the report notes, that health care professionals in other O.E.C.D. countries pay much less (if anything) for their medical educations than do their American counterparts. In other words, doctors and nurses in the rest of the industrialized world start their medical careers with much less student loan debt compared to medical graduates in the United States.
http://economix.blogs.nytimes.com/2009/ ... ries-make/

It's also important to note that someone is paying for that education. Who is that?

Yes, the government! So, in order to "save" money on salary, we should expend money on education? Is that your thesis?

Interesting post ricky but it doesn't contradict your early incorrect point. Medicare reimbursement is not generous and does not cover the cost of the actual medical services they provide.

arch

Medicare reimbursement is not generous and does not cover the cost of the actual medical services they provide.

In the instances you've noted... Do you have a general study?
The second point I'll make is that Medicare payments to pharma are ceertainly in excess of what an individual could get by shopping online for the same drugs imported from Winnipeg.... If an ordinary shpper can do better, why can't a government agency negotiate better terms?

And third; Who defines "The cost of the actual medical services they provide"?
For instance, if the actual cost of a service like an operation includes a $15,000 payment to a surgeon, a $10,0000 fee to an anetheologist and $9,000 for three surgival nureses, $4500 for equipment and supplies, a $6000 fee for the operating room (and I'm making up these numbers ) & etc. ...
Who says these are the appropriate costs?
The current American system is more beaucratic than the french. And in beauacracies there is little flexibility or adaptability. Thats the opposite of how a free market works efficiently. In a free market, when a supplier wants to provide a service, and finds its major customer balking at the price they go down the line and start reeling in the costs of their suppliers with negotiations.
That doesn't seem to happen in the American system. There is an established, cost of providing the service, and it isn't attacked. Either by market forces, or by regulation or by monopoly collaborative bargaining. (With the exception of medicare where some doctors say they are taking a hit by accepting medicare patients...)
I understand clearly that there is a great deal of complexity in the system that a simple minded fix, like bringing in socialized medicine over night could not possibly deal with efficiently immediatley. Your illustrations on medicare reimbursement demonstrate that.
But that complexity has been used by the suppliers to ensure a steady upward movement in prices in the US that always runs past what socialized countries have been able to deliver.... And in examining the macro end result, incomplete delivery of health care and the most expensive system in the world (even accounting for purchasing power comparisons) - a neutral observor can only surmise that without significant change the sector WILL cripple the economy.
Incremental movement towards systems that have proven more effiicent still is the only realistic way to bring the cost of health delivery down. To my mind, the best approach is to empower Medicare administrators to drive suppliers to find efficiencies.... And to expand medicare provision to more and more citizens...
(This is Not dissimilar to cutting budgetary spending with a set goal and letting the administrators find the best ways of getting to the goal....). Conservatives on this board seem to accept that concept.