Health Care reform has passed and the threats to it now, mounted by Republicans, don;t seem credible. As I said, this plan is a start and nothing more, and it is not even as good as it was because it does not cover as many of the uninsured as originally intended. Nevertheless, the best part of this plan is that it will expand coverage and bring more people into medical care as paying consumers. The bad part is is does nothing to reform the system, the only cost cutting is through price-controls and limits. There are other ways to do it, free market ways, and we have looked at a few here such as the Community health Plan and changes to physician tiers and reimbursement that I have also discussed here. The really good thing is while expanding coverage, this new system does nothing to stop us from utilizing all the reforms I talk about, or that others may devise. It is only a beginning, and only an acceptable one, but at least it begins. If the Republicans had their way it would not. They should rue this decision. Their gambit seems to be to delay health care reform and convince the public it is dangerous in the meantime. This time, unlike in the past, the gambit will not work, and the public may make the Republicans pay for getting in the way. We shall see.... Nevertheless, reform begins now....
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The process was rather ugly, filled with backroom deals. And Obama showed that he has little to no interest in a bipartisan embrace...otherwise there would be serious tort reform in there.
The bill is injurous to the Hospice industry...one close to my heart. And there is no effort at promoting primary care initiatives.
We are in agreement that there is not a lot of good ehre. But then, this was not really about reform---it is about expanding coverage without breaking the bank. They won;t be covering everyone, but get about 35 million of the uninsured 45 million, so on thata ccount maybe they get a B or B-. I would like to know more about how it negatively impacts the hospice industry as that is very important, and I understand you are very concerned. As for primary care--not surprising ebcause again, this is not really reform. It does create a framework where I think reform, sucha s what we discuss here at this blog, can and will happen. As for bipartisanship---the Republicans sank that ship and it is they that won;t let it resurface. They showed no willingness unless everything was their way. The Democrats left out a public option, left out the most comprehensive and expensive plan that originally covered all 45 million uninsured, and tightened up the abortion guidelines. Nothing but complete capitulation would seem to work for the Republicans. They did not want bipartisanship. They wanted this to fail to pass, or if not, to fail eventually, so they could say they unanimously voted against it---either for the good of America, or because they knew it would fail. If it succeeds, which I think over time and with many modifications it will, they may come to rue their unanimous vote this year.
As best I understand it, there are built in payment reductions over several years for both Home Care and Hospice.
I believe there are other Medicare cuts as well.
Yes, I have tried to make it clear that I do not find cuts to providers as any kind of reform. Especially if no other reforms are enacted that lower costs or improve productivity. This new legislation is going to bring millions of uninsured into the system. If we think volume will make up for reasonable payments, we will get an overcrowded system with a negative impact on outcomes. We have talked about many reforms here, from incentives to get students and med schools to create more General practitioners, to Community Health Plans that will allow providers to offer plans and benefit when they find their own cost controls, to tiered systems that make consumers pay more for the providers that tend to cost the system more without showing any benefit. These are ways to save money without merely cutting payments.
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