Is ObamaCare even sustainable?

May 27, 2014 20:15:45 GMT pjohns1873 said:

Your assertion that nothing but "unproven pseudo-science medications and procedures" would be barred by IPAB is not in keeping with what I have heard.

You may not care for FNC (where I first heard this); but it was stated forthrightly, as a matter of fact--not a mere opinion.

If you wish to claim that FNC simply distorted the truth--in short, that it lied--then please feel free to do so.  But please do not hide behind the claim that it was merely stating an "opinion" with which you disagree.  It has never presented this as a mere "opinion." 

Benjamin Franklin once said. "Believe none of what you hear and half of what you see" but I'm not quite that skeptical (studies have shown you can believe about 60% of what you see in retrospect). What I seriously doubt is that the IPAB could reject payment for clinically proven effective medical treatments and/or medications. The IPAB denying clinically proven treatments and/or medications would result in a scandal equal to Watergate with both Democrats and Republicans in Congress calling for heads to roll. I can't even imagine anyone being appointed to the IPAB that would entertain such a proposition with one possible exception. If the entire IPAB was filled with Tea Party Republicans then I'd be worried as they've already demonstrated that they'd throw the American people under the bus to save a buck.

Any future predictions are always a matter of opinion and when the projections are juxtaposed to the law they're a highly dubious opinion at best.

May 29, 2014 2:44:25 GMT pjohns1873 said:

What was stated on FNC (to which I referred) is not that denials by IPAB are a mere "prediction," or a "projection," or an "opinion"; but that anything disallowed by the IPAB may not be paid for by other insurance or out-of-pocket, under the ACA.

To reiterate:  You may wish to claim that this is untrue.  But you should not characterize it as a mere "opinion," as it was never presented as such. 

That statement by the FNC is only accurate related to procedures that would be paid for under Medicare Part B and Part D. The IPAB has no authority related to the private sector's providing of medical insurance or benefits or what a person can pay cash for.

For example Medicare Part B and Part D don't authorize payments today for cosmetic breast enhancements but a person can pay out of pocket for it and that will never change. I don't believe any insurance policy covers cosmetic breast enhancements  but we do know that they're a clinically approved medical procedure that isn't going to stop occurring just because of any IPAB decision.

The IPAB cannot prevent any medical facility from performing a clinically approved medical procedure or of the person paying for it either with
"cash out of pocket" or through insurance and anyone that claims IPAB can deny the procedures or the payment for them is a damn liar. 

May 30, 2014 0:39:34 GMT pjohns1873 said:

Well, at least your final statement--i.e. that any assertion that the IPAB may deny medical procedures that would be covered by private insurance or by out-of-pocket cash must be made by "a damn liar"--is unequivocal enough.

Since I really do not view FNC as a mere coterie of "damned liar," you will probably understand why I have come to a different conclusion than you have. 

Here is the point. Today we have "elective" medical procedures that aren't covered by "general" insurance benefits and some can be covered by specific insurance and all can be paid for "out-of-pocket" if a person wants those medical procedures. Any belief that this will change in the future is absurd. We're not going to see "breast enhancements" surgery being stopped by any decisions by the IPAB for example.

While some elective procedures could be denied payment by the IPAB they're not going to deny clinically proven treatments that address illness. As note this would create a scandal to rival Watergate when news of it reached the public and the politicans. As noted I can't even imagine a member of the IPAB proposing that Medicare shouldn't fund proven medical procedures.  Their head would roll if they were found to be doing that.

There are and always will be "elective" medical procedures that are unfunded by insurance and people will always be able to obtain these by paying cash out of pocket. Anyone that claims otherwise is a liar and we know they're a liar regardless of who they might be.

May 30, 2014 17:21:30 GMT pjohns1873 said:

Let us be clear: I was never speaking of "elective" medical procedures, such as "breast enhancements."

The following is my understanding of the matter:

If two treatments for a disease are available--one of these being pricier, but more effective--the IPAB could (quite conceivably) approve the less-expensive treatment, and require that the more expensive treatment not be performed or prescribed--even if the patient should prefer this, and be willing to pay for it out-of-pocket.

Do you disagree with this?

I would not agree with the wording you provided. Here is what I'd agree to.

The IPAB can selected one treatment and decline another treatment that might be more effective but also more costly under Medicaid. The IPAB cannot prevent that more effective and more costly procedure from being prescribed and performed and paid for by a private insurance policy and/or paid for with cash by a person. 

The IPAB has no authority to tell medical providers or insurance companies what they can and can't do related to anything that isn't associated with Medicare. 

Of course if that "more effective" treatment actually is more effective then I can also see the lawsuits flying against Medicare and members of Congress becoming really irate that the IPAB is denying the procedure and, in spite of claims the the contrary Congress can force Medicare to pay for the procedure if they want to. Hell, Congress can abolish the IPAB if it gets out of line.

If we agree that Congress can abolish the IPAB whenever it wants, and we both know that is true, then all of this discussion by the right-wing is really nothing but unnecessary fearmongering. They're like a child crying before getting a shot just because the child thinks it might hurt.  

May 31, 2014 16:54:02 GMT pjohns1873 said:

How might Congress "abolish" the IPAB when Harry Reid is in control of its upper chamber?  (Granted, it is possible that this could change within a few months.)  Or, even if the GOP were to take control of the Senate in November--well, actually, in January, when the new members are sworn in--President Obama could easily issue a veto that could not conceivably be overridden by a two-thirds supermajority of both chambers of Congress. 

And your understanding of what the IPAB can and cannot do--specifically, your belief that it may control nothing but Medicare spending--is certainly not in keeping with what I have learned from news reports on the subject.   

If the IPAB engages in questionable conduct then, as little faith as I have in Congress, I believe there would be bi-partisan support to deal with it. Would it result in abolishment? Only if the abuse of power of the IPAB was excessive and warranted it.

When it comes to what I believe about the IPAB it is cased upon the statutory authority granted to it by the law and under the law it only has authority to address Medicare. My opinion is not based upon hypothetical violations of the authority granted to the IPAB which is what "Republicans" seem to assume will happen. To "assume" that the IPAB will exceed it's statutory authority is an invalid opinion. It is, of course, possible but it is doubtful it will actually happen. Such an assumption is really a "conspiracy theory" that the IPAB will violate the law.

Jun 2, 2014 17:04:19 GMT pjohns1873 said:

Again, you misstate my potion.

My position is not--is not--that the IPAB might "violate the law" with regard to healthcare decisions.

Rather, my position is that the IPAB has the lawful authority to declare what procedures may or may not be done, and what medications may or may not be prescribed; and that this is not confined to those who have Medicare, but also to those with private insurance, or who would prefer to pay out-of-pocket.

This is not some "conspiracy theory," but a description of how the law currently reads, according to what I have heard on the news.

Would you disagree? 

The IPAB only has authority to authorize or decline coverage under Medicare. It cannot dictate which medical procedures can be done in our health care system.  

Jun 4, 2014 0:47:14 GMT pjohns1873 said:

Well, we appear to be at an impasse here, as you clearly have heard one thing, whereas I have heard another. I am not certain, therefore, that there would be any significant utility in our simply reiterating our respective understandings of the law.

As regarding Medicare patients alone, however--and most seniors have Medicare; and the largest portion of medical spending is the result of the illnesses attendant to aging--the IPAB's (virtually certain) cuts in Medicare reimbursements, coupled with its (probable) tendency to ration healthcare according to green-eyeshade-style cost-benefit analyses, will surely result in less beneficial outcomes for seniors. Would you disagree?

I don't like Medicare, period, which is one reason for my privatization proposal for Social Security because it eliminates Medicare completely.

It should be noted that all insurance plans have limitations in benefits and reimbursements though. Will the IPAB's actions be draconian? I don't think any of us can make that determination at this point in time and assuming they will be is tends to be wild partisan speculation bordering on a conspiracy theory.