Senator Ben Cardin: (Capitation)

[Thiebear]

I pulled out the part that seemed to jump out at me.

Capitation is the new word for whats going on.

Partial Quote

http://www.examiner.com/x-10183-DC-Health-Care-Examiner~y2009m7d23-Senator-Ben-Cardin-health-care-expert-and-leader-or-just-another-ideologue--time-will-tell

This was the party line, the demonizing of the uninsured as those who intentionally avoided paying emergency room charges. Yet, Cardin knew this was not completely true. The uninsured did not get free care when they sought medical attention. They paid; in fact, according to the Kaiser Family Foundation, 35% of the $100 billion worth of care that was rendered to the uninsured were paid out-of-pocket by the uninsured, themselves. Another 10% of their charges were paid by philanthropic contributions and 20% were paid through federal and state government sources. After doing the math, 35% of all charges still remained unpaid. These costs were not passed on but were absorbed by hospitals prompting Cardin to say that “those costs would cause many hospitals to chose to leave the community. I just think the overriding public interest is to require you and everyone in this country to have health insurance."

However, the 35% of all hospital charges for the uninsured that were absorbed as bad debts was approximately the same as the percentage of hospital charges for patients with insurance that were absorbed as adjustments after prospective payments were received from all third party payors. This cost, too, was not passed on. Therefore, if hospitals were teetering so close to the financial brink as to chose to leave a community, it was not just because of the uninsured. It was more because of the insured or, more precisely, all the third party payors that hospitals had contractual obligation with to accept prospective payment as payment in full. There were five times as many of these patients as there were the uninsured.

So, if Senator Cardin was so concerned about pushing hospitals to the financial brink, rather than publicly linking an overriding public interest for everyone in the United States to be required to have insurance with the economic survival of hospitals, it actually made more sense to link better reimbursements in the prospective payment system with their economic survivals. It certainly would be incongruous for him to support any health reform that would have as a fundamental principal of reform a worse system of reimbursement such as the bundling of payments to doctors and hospitals by capitation.

[Capitation was a pre-designated amount of money paid to a team of doctors and hospitals that covered an entire population of patients and all health risks therein, regardless of what it cost doctors and hospitals for the actual delivery of care. In such a system, hospitals and doctors were cost centers. They earned no money by providing care; rather they earned money by controlling the cost of care. Whatever was left over was their incomes. If anything handicapped the economic survival of health care organizations it would be capitation. Capitation also guaranteed rationing because the only way that capitation could be stretched out was for doctors and hospitals to decide who got what. When doctors and hospitals also relied on this same capitation as the sole source of their incomes, things really became interesting. Yet, by supporting HR 3200, this was precisely what Senator Cardin endorsed.

So just insuring somewhere between 17 and 50 million people is not the answer to the cost or the quality? Am I missing something here?

[Thiebear]

From the Bill:

Its total price tag remains unknown, but to comply with another presidential priority, it would rely on cuts in Medicare and Medicaid to begin slowing the rate of growth in health care spending overall.

***** NOTE They both went up this year 10% and 28% in the order above **** JUST till July.

Cuts mean - 22% increase as opposed to 28 or a real CUT

The measure is expected to impose a fee on large companies that fail to offer insurance; individuals who refuse to purchase affordable insurance will have to pay a penalty.

******So people will have to pay more that don't pay now. and the 8% per employee on larger companies is being fought by quite a few people, How many companies will fail due to an additional 8%+ loss to income that were on the edge due to the recession?

A new income tax on the wealthy, estimated to raise more than $500 billion over the next decade, would help pay for the bill.

***** Not sure how your going to get (guessing 250k+ =5,695,000 people) to pay (MOST optimistic number over 10. and that is NOT to cover everyone. 17 million are expected to still be outside. AND odds are you can quadruple that number based on not doing the numbers all the way out and not counting on the 23+ million that will lose private insurance and be put on the public option.

The AMA is going to pull it support if a key issue isnt kept in the bill that will RAISE the cost considerably.

[Thiebear]

2003 cbo report:

http://www.cbo.gov/doc.cfm?index=4916&type=0&sequence=4

Figure 3-1.

Total Federal Spending for Medicare and Medicaid Under Different Assumptions About Excess Cost Growth