Pelosi agrees to key aspect of health care deal (reached with blue dog Democrats)

[steven johnson]

Source: CNN

House Speaker Nancy Pelosi signed off Thursday on a key component of a health care deal reached with conservative Democrats this week, potentially paving the way for a new consensus among the fractured House majority.

The deal between four fiscally conservative congressmen -- part of the so-called Blue Dog Coalition -- and the chamber's Democratic leadership allowed debate to resume in the critical House Energy and Commerce Committee.

Pelosi told Capitol Hill reporters that she is OK with language instructing the health and human services secretary to negotiate reimbursement rates for doctors and hospitals under a government-run health care option.

The idea is a key concession to conservatives worried that a public plan would have an unfair advantage over private insurers if it is allowed to tie its hospital and doctor payments to lower Medicare rates.

Read more: http://m.cnn.com/cnn/ne/politics/detail/340746/full

---

Welcome to the sausage making aspect of crafting legislation.

[Warpy]

1. I have to agree with this one

because we're starting to see doctors and some for profit hospitals refusing Medicare patients.

A public plan won't do much good if the reimbursement rates are so low no provider will accept it.

[FreakinDJ]

3. Let them refuse - because they will be an insignificant minority

The Health care for Profit Industry has already turned doctor's offices into a "Cattle-Call/Production Line" to increase their gluttonous profits. Also all the additional staff to process the claims forms is ridiculous.

So if a doctor receives patients at a lessor rate of guaranteed payment his margin is the same

[pinb1212]

4. That has been one of the problems with medicare

The government simply sets the reimbursement rates. Insurance companies have to negotiate.Doctors and hospitals have been cost shifting to private insurance patients to cover their losses on medicare patients.

[defendandprotect]

18. What we obviously need is negotiation by Medicare ... not only on drugs . . .

which need to be brought down, but on doctor's salaries --

Too many doctors have gone into medicine for $$$$$$$$$$$$$$$$$$$$$$$$ --

That philosophy needs to be changed.

And, we need to move Medicare to a PREVENTION system --

[InkAddict]

19. What level of salary cap would you place on

cosmetic "only" plastic surgeons who practice only out of a facility in which he/she is an "owner/investor." Those docs have a "if you are sick or have unhealthy lifestyle," go away, IF they are ethical/moral. Their referrals are to "diet consultants, trainers, or real doctors who care for the unwell, and they don't do "insurance."

For fairness, should these doctors be "encouraged" to at least provide reconstructive care to, let's say, trauma victims and/or persons with acquired deformities?

[defendandprotect]

20. We're covering plastic surgery now ... for non-medical reasons ???

And, do you think there is a "salary cap" on doctors in European countries and

other nations which have universal health care?

What we need is economic democracy -- you can't have democracy without it -- so

there are certain features of capitalism which shouldn't continue.

First, we need to re-regulate capitalism -- and deal with some of the conflicts

that have arisen in health care. One of the most treacherous is doctors being

"paid" . . . ??? to prescribe more expensive medications and particular drugs!!

There should always be plastic surgeons on call for real emergencies -- and for

people who have problems with prevent them living normally.

Again -- we're not reinventing the wheel. Other nations have already deal with most

of these issues -- and we can pick it up from there.

[InkAddict]

22. Still the case?

http://articles.latimes.com/2003/feb/24/health/he-cosmetic24

The South Carolina insurer believes the discount program helps discourage some members from switching to rival plans, said Rick Gallion, director of complementary health care. "When they compare us and the price is almost the same, they say they might as well get the the discounts."

Blue Cross and Blue Shield of South Carolina, for example, is offering 20% discounts for tummy tucks, liposuction, nose reshaping, breast enhancements and lifts, and other cosmetic procedures. The caveat: The procedures must be performed at two plastic surgery centers that the insurer contracts with.

[MarjorieG]

2. Problem is leaving it to the whim of whatever current admin. Like GW?!

[annabanana]

5. Isn't this one of the provisions that the Progressive Caucus said was

"not ok"?

edit: link
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=102x3993682

[Laelth]

6. Why would she do that?

The Progressive Caucus has made it clear they will not vote for the bill unless the private option pays providers at the Medicare rate + 5%.

As per their letter to the speaker today:

July 31, 2009

The Honorable Nancy Pelosi The Honorable Henry Waxman
Speaker Chairman
U.S. House of Representatives House Committee on
Energy and Commerce
H-232, The Capitol 2125
Rayburn House Office Building
Washington, DC 20515 Washington, DC 20515


The Honorable Charles Rangel The Honorable George Miller
Chair Chair
House Committee on Ways and Means House Committee on
Education and Labor
1102 Longworth House Office Building 2181 Rayburn House Office Building
Washington, DC 20515 Washington, DC
20515


Dear Madame Speaker, Chairman Waxman, Chairman Rangel, and Chairman Miller:


We write to voice our opposition to the negotiated health care reform agreement under consideration in the Energy and Commerce Committee.

We regard the agreement reached by Chairman Waxman and several Blue Dog members of the Committee as fundamentally unacceptable. This agreement is not a step forward toward a good health care bill, but a large step backwards. Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates - not negotiated rates - is unacceptable. It would ensure higher costs for the public plan, and would do nothing to achieve the goal of "keeping insurance companies honest," and their rates down.

To offset the increased costs incurred by adopting the provisions advocated by the Blue Dog members of the Committee, the agreement would reduce subsidies to low- and middle-income families, requiring them to pay a larger portion of their income for insurance premiums, and would impose an unfunded mandate on the states to pay for what were to have been Federal costs.

In short, this agreement will result in the public, both as insurance purchasers and as taxpayers, paying ever higher rates to insurance companies.

We simply cannot vote for such a proposal.


Sincerely,

What is the Speaker thinking?

:shrug:

:dem:

-Laelth

[nightrain]

8. perhaps a sop to practitioners? (I'm one)

[Laelth]

9. But most practitioners from whom I have heard ...

... would prefer to be paid at Medicaid +5%. That's much better than having to deal with the insurance companies, isn't it? With the insurance, they'll approve high fees as long as patient hasn't reached their deductible yet. Then, practitioner is often in collections against a patient who can't afford the fee.

I refer to what I learned from Faryn Balyncd in this thread: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x6181703

Besides which, the bill can't pass without the votes of the Progressive Caucus. Pelosi knows that.

:dem:

-Laelth

[Lasher]

12. Faryn Balyncd's post was excellent.

Got that sucker bookmarked.

[nightrain]

13. Hi. Do you mean "Medicare", rather than "Medicaid +5%" there? nt

[Laelth]

15. Indeed. It's Medicare rates + 5% that the Progressive Caucus is insisting upon.

Thanks for the correction.

:dem:

-Laelth

[nightrain]

7. one of the criticisms of this is that it might mean that hundreds/?thousands

of contracts will have to be drawn up with ?individual practitioners, or perhaps practitions type groups, rather than go with the established Medicare rates, even though they are ~20% lower than commercial rates. There would be more of a cost savings if the Medicare rates were used. Personally, I'd go with the Medicare rates--for ease--as a practitioner.

Congress is making this sooo difficult and convoluted. It's going to be another messy layer to have to deal with as a practitioner. Hellish and a waste of my time.

[defendandprotect]

21. Other nations have pretty much deal with all these issues . . .

We have an imbalance going on historically re "values" which we've inherited

from the Reagan years -- corrupt and greedy.

Our values need to change -- and we need to get Americans on a healthier road.

That involves a lot of things, like cleaning up our water supplies.

Looking at chemical medications vs natural plants -- alternative health care.

23 million Americans have gone for treatment in other countries -- and either

Medicare or insurance companies have paid those bills!

[nightrain]

27. I'm not strongly supporting using Medicare rates, but it does seem simpler

and more cost-effective, even if less reimb than commercial rates. (Mostly speaking from the progressive practitioner side).

Yes, I'm aware of the hybrid financing mechanisms, partic in Europe... And their population is significantly less. We have hundreds and thousands? of health insurance companies, their policies,benefit and exclusion programs to deal with. The Congressional proposals only worsen that.


Taiwan has successfully moved into a single payer system after having a for-profit system. I think it would be less disruptive than some fear.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

[defendandprotect]

28. The point of "reform" is to get rid of insurance companies and "for profit" health care industry . .

Again, all we have to do is to remove the age limitations from Medicare and

we're set to go -----------------------

Meanwhile, Europe does have smaller populations, but at least in UK they have greater

representation than we do -- I think it's something like 75,000 per elected rep whereas

in America we're grossly underrepresented -- Forget the figure, but it's very high here.

Therefore, with single payer, we should also be cautious that there is sufficient

representation -- we're paying for it now. Only difference is we're not getting the health

care we're paying for.

[nightrain]

30. yes, it could be very simple... removing the age limitations on Medicare...

but also increasing the type of practitioners that can bill Medicare. I support permitting any licensed professional practitioner to bill Medicare. As it is now, many types of practitioners are excluded.

I also believe we need to close that 20% gap in Medicare, to something more reasonable, like 5% or some small copay if absolutely necessary. And, I think that the private insurance corporations should get out of the Medicare billing business entirely.

And we need to fix Medicare Part D, close the doughnut hole. I imagine that there are other Medicare limitations that would need to be looked at if the Medicare population were to be broadened.

Much simpler than all this convoluted bs and protection of the insurance extortion corporations. Congress is just dancing around the major issues.

Interesting idea about the population/representative... I hadn't thought about that before... I wonder what impact an increase of, say 10-15% would have on the make-up and ?functioning of Congress?...

[defendandprotect]

31. Medicare Part D is a dog . . . because of insurance companies/pharms . . .

but I wouldn't support "co-pays" . . .

Well, think about gender balance laws and what effect that would have on the Supreme Court --
Especially if we increased the number of justices.

[nightrain]

32. good point on the justices! About Medicare co-pays, it's been

my experience as a practitioner that when a person pays a small amount that they tend to value the service more and it leads to fewer no-shows or cancellations of appointments. I mean small, like $5 or something. And I realize that might be too much for some people... Or perhaps there would need to be a code for some reimbursement to practitioners for the no-shows. It's a tricky issue. I certainly haven't really worked it out well..

[defendandprotect]

33. My experience with fees ....

like "co-pays" is that it is too easy to increase them.

People do appreciate good care -- and when we're all in it together, it is

more easily recognized that our costs go up when people behave irresponsibly --

that's why we need to change to a system based on preventive medicine vs cures . . .

Look at the impact cigarette smoking is still having on our health care costs!

Meanwhile, those who rip off Medicare/Medicaid are CORPORATIONS.

Pharmaceutical corporations and "for profit" health care corporations.

Every one of the pharmaceutical companies have been involved in some kind of FRAUD

of Medicare/Medicaid -- there was a video on that recently with Sen. Bernie Sanders

pointing that out. Large numbers of the "for profit" health care involved, as well.

THAT's where we have to look when we think of applying penalties -- You can't bar

all of the pharmaceutical companies from all involvement with Medicare/Medicaid,

but we can assess penalties on them according to how much fraud they've been involved with.

Also, close scrutiny and penalties whenever their company/products are involved.

[DeltaLitProf]

10. Perhaps one of the good points is . . .

. . . this would make it more likely doctors will come to or stay in rural areas, where so many transactions would be through medicare, medicaid and the government option.

[OHdem10]

11. Smart Move: The CEO, Cleveland Clinic (Doctor) says this is

important because when left to Congress, they can lowball the
Docs. This hurts Medicare and causes some to refuse to take
Medicare Patients.

[depakid]

14. Every one of the blue dogs needs to have the health insurance racket tied around their necks

Like an albatross.

[primavera]

23. And here I was thinking they needed to go to the vet's to get tutored

Forgive me Gary Larson! :-)

[defendandprotect]

29. They need to have their government paid for health care recinded . .. .

[Hugin]

16. So much for collective bargaining...

Which would be the real working part of any so-called "public option".

[defendandprotect]

17. I'm sure Emmanuel is being very helpful in this cause . .. !!!

[mmonk]

24. Bad idea. It will politicize it.

[No Elephants]

25. And the problem with gubbamintt having an advantage over the gougers is?

[Winterblues]

26. Nothing wrong with being able to negotiate...

Republicans would not allow such negotiations with their Health Reform Bill under Bush*. In fact negotiations were forbidden..