Ryan booed for slamming Obamacare

[_Brackite]

AMAC is now the leading Conservative alternative to the Liberal AARP.

http://amac.us/

[_EAllusion]

I have to sign up a bunch of clients for med part D at the end of every year. AARP and Community Care Rx (CCRx) consistently offer the best plans around for my clients. I say that just as a matter of fact.

[_mledbetter]

Let's just stick with 1 and 2 for now. Do you think 1 and 2 are both valid criticisms of the ACA? Do you think the American Medical Association (AMA) endorsed the ACA? Why would they do that?

1. I think one would have to be naïve to think that a $60 billion tax raise on the medical industry isn't going to affect the consumer's wallet.

The AMA represents about 20% to 30% of doctors nationwide and their numbers have recently been in decline, many doctors angry with their support the Affordable Care Act. So, why did they support the Affordable Care Act? Apparently a lot of doctors are asking the same questions. I guess you would have to follow the money. From what I understand, more and more doctors who join the AMA tend to be salaried, and salaried doctors tend to be more progressive. I'm thinking that maybe more and more of AMA money is coming from corporations and the doctors they employ.

I'm also guessing that there is a big difference between the way salaried doctors view government regulation of medicine (including medicare payout cuts) and the way private practice doctors view it.

My counter question to your second question.
Do you think that each time there are more complex regulations in the medical industry and medicare payment cuts to doctors are passed at the federal level that this in turn pushes out more doctors from private practices and encourages newer doctors to be salaried in order to avoid the headaches and costs of running their own businesses so they can focus more on being just doctors to their patients?

If so, do you think that it is good that the medical industry could then become more centralized into fewer more wealthy and powerful corporations?

Aren't progressives against this?

[_mledbetter]

Being boo'd by the AARP is good news telling us that Ryan is on the right track as that organization represents not the elderly, but the interests of a few left-wing insurance companies seeking to make money by preying on the elderly.

The AARP likes the Affordable Care Act, probably because it gives them a $1 billion windfall in profits on their insurance business. It would lose that money if the act was repealed.
http://www.demint.senate.gov/public/ind ... 7ffa15b9d5

*AARP’s $458 million in health insurance revenue in 2011 would rank it as the nation’s sixth-most profitable health insurer.
*The health care law, which AARP lobbied heavily for, could lead to over $1 billion in new AARP health insurance profits over the next decade by forcing seniors off Medicare Advantage plans into Medigap supplemental coverage.
*AARP earns more profit the higher premiums rise on seniors in Medigap plans, charging a “royalty fee” of 4.95% of every premium dollar paid by seniors on these plans.
*In 2011, AARP failed to disclose to its senior membership that it lobbied Congress to oppose Medigap reform, legislation that could lower senior premiums by as much as 60%, and save seniors $415 per year on average.
*AARP could lose as much as $1.8 billion in revenue over ten years if Medigap reforms pass and successfully lower senior premiums.

[_Analytics]

Let's just stick with 1 and 2 for now. Do you think 1 and 2 are both valid criticisms of the ACA? Do you think the American Medical Association (AMA) endorsed the ACA? Why would they do that?

1. I think one would have to be naïve to think that a $60 billion tax raise on the medical industry isn't going to affect the consumer's wallet.

Did you mean to say the medical insurance industry?

Anyway, just to be sure I understood your answer, by "1" you meant that the cost of the ACA is a valid criticism, but the criticism that it radically cuts the amount of money doctors will make is not a valid criticism. You seem to be conceding that overall, the medical industry in the U.S. is positioned to profit handsomely because the ACA will result in tens of millions of people acquiring health insurance. You seem to be conceding that the vast majority of the costs associated with the ACA will in fact make it into the wallets of healthcare providers.

The AMA represents about 20% to 30% of doctors nationwide and their numbers have recently been in decline, many doctors angry with their support the Affordable Care Act. So, why did they support the Affordable Care Act? Apparently a lot of doctors are asking the same questions. I guess you would have to follow the money. From what I understand, more and more doctors who join the AMA tend to be salaried, and salaried doctors tend to be more progressive. I'm thinking that maybe more and more of AMA money is coming from corporations and the doctors they employ.

I'm also guessing that there is a big difference between the way salaried doctors view government regulation of medicine (including medicare payout cuts) and the way private practice doctors view it.

My counter question to your second question.
Do you think that each time there are more complex regulations in the medical industry and medicare payment cuts to doctors are passed at the federal level that this in turn pushes out more doctors from private practices and encourages newer doctors to be salaried in order to avoid the headaches and costs of running their own businesses so they can focus more on being just doctors to their patients?

If so, do you think that it is good that the medical industry could then become more centralized into fewer more wealthy and powerful corporations?

Aren't progressives against this?

You are suggesting that progressive doctors are salaried, and yet progressives are against the companies progressive doctors prefer to work for?

Anyway, those are interesting questions. It's hard to talk about the effect that "complex regulations" in abstract have upon the medical industry. I'd rather belong to a system where doctors focus on being doctors to their patients, rather than a system where doctors are businessmen in the business of maximizing their profits. The incentives in the fee-for-service delivery model are quite skewed—what is in the best financial interest of doctors who are paid on a fee-for-service basis is to provide the most expensive care possible that keeps the patients sick and dependent upon ongoing expensive care.

[_MeDotOrg]

An interesting article about what can happen when 'for profit' healthcare gets going:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

[_mledbetter]

Did you mean to say the medical insurance industry?

Anyway, just to be sure I understood your answer, by "1" you meant that the cost of the ACA is a valid criticism, but the criticism that it radically cuts the amount of money doctors will make is not a valid criticism. You seem to be conceding that overall, the medical industry in the U.S. is positioned to profit handsomely because the ACA will result in tens of millions of people acquiring health insurance. You seem to be conceding that the vast majority of the costs associated with the ACA will in fact make it into the wallets of healthcare providers.
====
You are suggesting that progressive doctors are salaried, and yet progressives are against the companies progressive doctors prefer to work for?

Anyway, those are interesting questions. It's hard to talk about the effect that "complex regulations" in abstract have upon the medical industry. I'd rather belong to a system where doctors focus on being doctors to their patients, rather than a system where doctors are businessmen in the business of maximizing their profits. The incentives in the fee-for-service delivery model are quite skewed—what is in the best financial interest of doctors who are paid on a fee-for-service basis is to provide the most expensive care possible that keeps the patients sick and dependent upon ongoing expensive care.

1. Yes, I meant insurance industry. I don't think that the insurance industry is terribly worried when a) they can just pass their tax increases onto us and b) they are in position to gain quite a few more customers with this new law.

2. My questions are more sincere then you may think.
I am honestly wondering if this is a good thing or not. I was under the impression that progressives were for the little guy. Well, all things being relative, in the health care industry the private practice is the 'little guy'. These guys are getting tired of putting up with the increasing headaches of running their own businesses. It's too costly for them to fight with insurance companies all the time for payouts, and new regulations, and lower medicare payouts. New doctors coming into the field tend to be more progressive and tend to want to focus on being just doctors, so they go work for a hospital or large corporate medical provider. They have no idea what it takes to run their own practice. I can see the good and bad in this.
Also, I'm not sure that I agree with you that private practice doctors are more concerned with profits than with practicing medicine, or that they are more focused on maximizing their profits. That's a huge assumption. I'm sure that many are, but that many just want to be doctors, but not have to work for some large corporation or hospital.

[_Analytics]

1. Yes, I meant insurance industry. I don't think that the insurance industry is terribly worried when a) they can just pass their tax increases onto us and b) they are in position to gain quite a few more customers with this new law.

2. My questions are more sincere then you may think.
I am honestly wondering if this is a good thing or not. I was under the impression that progressives were for the little guy. Well, all things being relative, in the health care industry the private practice is the 'little guy'. These guys are getting tired of putting up with the increasing headaches of running their own businesses. It's too costly for them to fight with insurance companies all the time for payouts, and new regulations, and lower medicare payouts. New doctors coming into the field tend to be more progressive and tend to want to focus on being just doctors, so they go work for a hospital or large corporate medical provider. They have no idea what it takes to run their own practice. I can see the good and bad in this.
Also, I'm not sure that I agree with you that private practice doctors are more concerned with profits than with practicing medicine, or that they are more focused on maximizing their profits. That's a huge assumption. I'm sure that many are, but that many just want to be doctors, but not have to work for some large corporation or hospital.

Just to clarify something I said, I didn’t mean to imply that doctors in private practice are more concerned with their own profits than they are with the best outcomes for their patients. What I said is that the fee-for-service system gives doctors individually and collectively a certain set of financial incentives. The extent to which those incentives affect their standards and choices is an open question.

I would think that hard-core progressives would want to go to a single-payer non-profit system such as Canada’s. In such a system, there are neither large profit-motivated corporations, nor small profit-motivated private practices. Rather, doctors are simply doctors rather than the owners of small businesses.

For my part, I’m more interested in keeping the discussion honest. For example, one of the most significant elements of the law is in section 2701(a) which says that health insurance companies can’t vary rates by age by more than a 3-1 ratio. The result is a huge premium subsidy that goes from young people to old people. The only reason this subsidy is in the law is because the AARP demanded that it be included in order to win their endorsement. This is a huge lobbying victory by the AARP that benefits all old people and has nothing to do with money the AARP earns by marketing Med-Supp insurance. So of course, DeMint’s hit-piece on the AARP doesn’t mention this.

[_krose]

If so, do you think that it is good that the medical industry could then become more centralized into fewer more wealthy and powerful corporations?

Aren't progressives against this?

I am. I would much rather we had a single-payer type of system. But this is the one we could get passed, and it's better than the mess we have had. I hope it's a step toward something better.

But I don't believe I have seen you advance a solution to the problem. Surely you agree that people dying prematurely -- or going bankrupt -- because they can't afford medical care is a problem that must be addressed.

What's the better solution?

And thinking practically, if Romney wins and Republicans take back the majority in the Senate and kill the ACA, can the mysterious, unnamed "replacement" pass and become law?

[_Analytics]

An interesting article about what can happen when 'for profit' healthcare gets going:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

Excellent article. It explains quite clearly why I'd much rather my family gets its healthcare from salaried doctors than from ones in private practice. A meme that is floating around is that nothing should be allowed to interfere with the doctor-patient relationship when making medical decisions. Shouldn’t financial conflicts be prohibited from interfering in that relationship as well?