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<p>He specifically refers to a lot of things.</p>
<p>I think if you read up on IPAB, from a source that offers a balanced perspective (not just one side,) it will sound less fearsome. The law includes, “shall not include any recommendation to ration health care.” You can pick out a few concepts and get rattled, but it helps to look for the context and history, plus what they hope to accomplish.</p>
<p>Look at how we’re quickly accumulating comments on something one poster interpreted one way. Before you worry about how to repeal it, try to understand it, what it’s really about.</p>
<p>I dont get this issue …</p>
<p>Dont we want a board to study and see if there are ways to cut costs?</p>
<p>The board does not have the power to enact anything… Does it?</p>
<p>Unless I am misunderstanding, which is certainly possible and seems more than a little intentional, the board will decide whether a procedure makes sense for a particular patient given a cost-benefit analysis. It’s worrisome.</p>
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<p>Tort Reform- estimated (low) to save $50B
Create price sensitivity by encouraging HDHPs and catastrophic plans ($75B/yr)
Raise HSA contribution limits to encourage cash payment ($250B/yr savings $2.5T 10year)
Convert much of medicaid spending to HSA (included in savings above)
Fire all people associated with healthcare.gov ($627M)</p>
<p>You have expanded coverage, reduced costs, increase provider flexibility and improved market sensitivity to the consumer. Oh and HSA’s convert to savings funds.</p>
<p>Not for a particular patient!</p>
<p>You can sit there and project, OMG!, if I need an operation, they’re going to disallow it. And the next guy responds, OMG and we can’t repeal it! Or you can realize oversight in medical practice has existed for a long time and, (somewhat in parallel,) “medical ethics” has also examined what’s reasonable and in patients’ and families’ best interests. </p>
<p>Congress keeps veto power over proposed changes.</p>
<p>But note, that Medicare (Payment Advisory Commission) performs a similar function today, with direct ramifications for non-medicare beneficiaries. So, for example, if the MPPAC deems a procedure not cost-worthy or not benefit-worthy or “experimental”, it will recommend that Medicare stop paying for it. Since private insurers frequently use Medicare’s recommendations in their own schedule of benefits, something deemed ‘experimental’ by Medicare will rapidly become so by private insurers covering everyone else.</p>
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<p>To me, that is just semantics. </p>
<p>If an insurer says, as mine does, we only pay for xx procedure every other year (for ca follow-up), even though the doc recommends it every year…is that just good statistical medical practice, or rationing, or both?</p>
<p>Right. But Congress had to enact proposed changes and, “Since 1997, MedPAC had recommended cuts totaling “hundreds of billions of dollars” to Medicare that were ignored by Congress.”</p>
<p>My doc often explains why, despite what people think is the obvious way to go, the only treatment that makes sense, he recommends an alternative. “We don’t find that effective” or effective in the presence of x and y other factors or “at your age” or “considering these other risks,” etc. Or that it hasn’t been shown to improve quality of life. They don’t get these ideas out of thin air. It’s the result of someone doing the research and analysis and a doc’s responsibility to weigh.</p>
<p>Argbargy, your proposal is ridiculous…poor people and lower middle class people funding hsas?</p>
<p>Bluebayou, ipab does what? Ipab makes proposals if medicare spending increases at a certain rate? Correct? The proposals can be overruled…</p>
<p>I thought people wanted cost cutting.</p>
<p>Really, we’re back to the “death panel” canard? </p>
<p>People need to get a grip.</p>
<p>Okay, my mistake, for a patient over a certain age. This isn’t really new, though.</p>
<p>At age 45 a friend required a transplant and he was evaluated and got it because he was young and had 3 children. Had he been 80 I doubt it would have been approved.</p>
<p>You are already giving them subsidies- just direct them into the HSA.</p>
<p>Actingmt, yeah…</p>
<p>My 86 year old dad was already told some procedures are off limits.</p>
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<p>Not me. :D</p>
<p>:)…</p>
<p>Argbargy, really… Your plan…</p>
<p>It’s not a “plan.” It’s an idea. With big numbers attached, to make it get attention, seem valid.</p>
<p>:)…</p>
<p>At certain ages or in certain circumstances, some procedures should be moved to one side of the table. They are not going to do a certain operation on my mother because the recovery would take at least 6 months- and the recovery itself would likely kill her before that mark.</p>
<p>And despite the water cooler chat, fact is, that sort of tumor rarely proves troublesome. Stats, folks. Stats can be your friend, not just a perceived enemy.</p>
<p>^^no doubt, but one can also call that ‘rationing’ looking forward.</p>