Friday, October 19, 2012

Getting Specific

Critics of Romney complain about the lack of specifics in his plans, so I went looking for the specifics of what Obama means by saying that a $716 billion Medicare reduction in his "health care reform" bill will be “borne by providers and will not be reductions in services.”

The big one appears to be an “annual downward adjustments in payments based on the growth in economy-wide productivity.” Otherwise known as the more that the auto industry builds cars using robots, the lower payments will be to medical providers for services rendered to sick people. That may make sense to some people, but the logic of it rather escapes me.

Even if the cuts were based on “productivity” (which means fewer people doing more work) within the medical industry, how is having fewer people taking care of you when you’re sick not regarded as a reduction in services?

It will, in any case, almost certainly meet the same fate as the “doc fix” legislation of 1997, which mandated reductions in payments to doctors but which Congress routinely “postpones” every year with the result that payments to doctors have not changed since the legislation was passed.

Then there are “financial penalties for hospitals with high readmission rates,” designed to reduce costs by keeping people out of hospitals. That’s not a reduction of services though, because… “That does look bad, but let’s not readmit him until it gets worse.” Because readmitting him increases the readmission rate and incurs a penalty. The patient died, but that’s okay because there’s no penalty for patients dying, only for being readmitted.

Then there are “accountable-care organizations, which award hospitals and physician groups a share of any savings they can produce by streamlining care and reducing unnecessary or wasteful services.”

Seriously? “Streamlining care” and eliminating what the organization arbitrarily decides are “unnecessary or wasteful services” does not result in a reduction of services? And you're going to give doctors and hospitals a kickback for the services they decide not to provide?

Sometimes you are really better off not providing the specifics of your plans.

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