Wonkette
Somebody take this Senator Jim DeMint and give him a lifetime appointment, because he is a national treasure. He is a Poet of Words. And for every sane thing he says — he does say some sane things, occasionally! — he says something sort of astonishing. Witness his latest interview with a South Carolina newspaper.
So, por exemplo:
What we’ve done is set up the whole system to reward employers for offering health insurance, but we don’t support people who don’t get their insurance at work, and that’s not fair.
Why yes indeed! Totally reasonable. And yet:
If nothing is done, we’re likely to end up with a single-payer system anyway in a few years. Every year we’re ratcheting down what we’re paying doctors and hospitals for Medicare and Medicaid, which means the cost shifting gets greater and fewer employers can offer health insurance. What we’re doing is driving the private market out of business anyway, and I think that’s why they don’t want anything to pass that would make it easier for people to have their own insurance. So if we don’t do anything, that’s bad too.
Wait, what? Can somebody explain this? Medicare and Medicaid pay less and less, so private premiums go up because healthcare providers have to make up the shortfall somewhere. Thus, fewer employers can offer healthcare to their employees, causing those employees to …. suddenly become destitute or elderly? Which causes private insurance companies to go out of business? CONFUSED.
DeMint offers his take on hot issues [The Post and Courier via First Read]
Sara, your confusion is caused by the fact that our president is a Muslin in sink with the santeria terrorists.
So, if the government Medicare and Medicaid programs pay less, private insurers of the non-Olds and non-Poors have to charge more?
They only give this guy half a vote, right?
Charleston SC is a beautiful place. That concludes the positive things that can be stated about South Carolina. Well, their goobernor is one entertainingly wacky dude, but he’s almost gone.
You have to look at the facts through the prism of communist voodoo cults, then it all makes sense.
Dave J.: Plucky Santeria terrorists.
It is DeMint’s sacred duty to stand astride history, yelling “Who hid my pants?”
Tsk tsk, Sara Sara Sara.
This is DeMint afterall. You might as well try to make sense out of Grassly or Trig’s Downish baby gurgles.
Looks like someone’s been getting into Chuck Grassley’s Night time Benadryl.
Only a mental midget whould talk out of their asshole like that. How do mental midgets get elected? Apparently, it takes an area chalk full of these bible thumping idiots to get there. Remember how bad Jesus treated the poors, pouring hot oil on them, cussing them out randomly, stealing prostitutes money so their kids got nothing to get, then he had the audacity to buy the prostitutes children as sex slaves.
Kill Medicare, Medicaid (and while you are at it, Social Security) = Jiffy Instant Death Panels for the Olds, immédiatement.
Let them depend upon the powers of Candomblé, just like our POTUS’s mom-in-law.
Is he a cocktail of Jim Beam mixed with Creme DeMint?
Dave J.: The president is in a boy band?
I’ll be honest, I don’t understand any of this stuff.
All I know is I go see a doctor, work pays for it, and as long as I’m not really sick, everything’s ok. Once I get pwnd by some disease or illness or injury they fire me for someone younger, and I work at Wal-Mart until I’m 80.
Bronkers says that DeMint’s not bonkers here. I’ve spoken to any number of physicians who say that they receive smaller and smaller reimbursements from Medicare (don’t know of any in my acquaintance that take Medicaid) and the private insurers, which makes the “business” of providing medical services increasingly untenable financially.
For example, an ophthalmologist friend of mine gets far less now from insurers/Medicare for performing a cataract operation on a patient in 2009 than he did in 1980. He still has major malpractice insurance premiums (they’ve sure not decreased in the past 30 years) he has to pay as a physician, as does the anaesthesiolgist, and so on. There’s a major shortfall throughout the healthcare provision system.
We need complete overhaul of this whacked-out system.
Sen. DeMented (Rep., S. Crackerheaven) spent too much time in South Carolina’s school system.
Don Juanquete: Crazy and refreshing!
So, if public insurance offering less competition is causing private insurance rates to go up, wouldn’t the solution be to offer more public insurance, say, in the form of a public option? Or is all of this just fucking retarded?
Sorry, fellow snarkers. Although he didn’t phrase it very foloowishly, he makes sense. Doctors who take Medicare and Medicaid patients don’t get reimbursed enough by the gubmint to keep up their liability insurance premiums and STILL buy tongue depressors ‘n’ such, so they pad the fees they charge patients who walk in with fancy-schmancy ACTUAL insurance — from companies who presumably don’t call them on it — to make up the shortfall. Insurance costs go up accordingly, employers rein in the extent of coverage they offer their employees to make up THEIR shortfall, some going so far as to increase employees’ co-pay percentage or even dropping coverage altogether. Companies forced to do this are probably living on the edge anyway — spending far too much on typewriter ribbons and Christmas candy for the janitorial staff — so probably they’re not far from going belly up, leaving all their former employees to limp along trying to scrounge up COBRA payments on temp jobs and bottle collecting, going on unemployment insurance if their states are still offering it, and when that runs out, becoming homeless millstones around the Great American Public’s collective neck equals SOCIALISM. It all makes perfectly good sense. What time is it? Is it too early to start drinking?
Makes complete sense to me. It’s crystal clear that DeMint is a fool.
Bronkers: Rats. You beat me to it with a more cogent explanation. I hate when people do that to me. I need to rip a live chicken apart now, just sayin’.
Bronkers: I understand healthcare providers feeling the squeeze. But how does that lead to everybody ending up on Medicare?
Sara: It’s lunch time. Can you bring your perky breasts over to the Naughty Circle?
Wonkette said: “he does say some sane things, occasionally.” I would very much like to see that.
you’re just confused because socialists are dumbs
When did DeMint raid Clinton’s tie drawer?
Forget the rest of it. DeMint only speaks in ‘Tard, and sadly I am not fluent.
I just argue that everyone should bring laser pointers and train them on any dumbfuck stupid enough to bring a gun to a political rally. Let them experience a bit a fear from perfectly legal expressions of our constitutional amendments for once.
Maybe our rates wouldn’t be so fucking high, if we just paid the goddamn hospitals, and set fire to the insurance companies.
But since that’s illegal, let’s work on legislation that exempts people from arson charges if they burn down insurance companies.
That read as : Errrrr, Errrrr, Errrrrr. Translation please.
I mean, honestly, everyone is saying the same thing. The gun-bearer is saying “I have a gun” and the laser pointers are saying “That is a man with a gun”. Can’t see a cogent argument against.
After reading that a few times, it actually makes a little sense. He’s saying that yes, we need some sensible reforms to help out the poor insurance industry we’re driving out of business, which is what I’m sure those lobbyists have been whispering in his ear while giving him his hourly reach-around. Then he can say the Republicans have some common sense ideas to tinker with the system without blowing it up the way but the liberal Dems wanted nothing to do with that, preferring instead to hasten along the inevitable government takeover. So despite his sympathy for uninsured Americans, he has to vote against the final reform bill because the changes it will bring about are too radical and sweeping.
I wanted to snark, but I couldn’t figure out how to do so without getting so pissed off I might put my head through my monitor.
Medicare and Medicaid are driving the private insurers out of business? Is that why Blue Cross Blue Shield was only able to eke out a $2.5 billion profit last year? Hell, you can barely keep clean on $2.5 billion.
What we should do is take everyone’s insurance premiums and invest them in the stock market. That way, when everyone loses their money they’ll have the satisfaction of knowing that their insurance company and AIG are splitting the profits. Not much consolation when you’re walking around on a bloody stump, but nobody said capitalism was perfect.
FINAL TRANSLATION: The system is broken, so why do anything to fix it, because it is breaking itself to the point that it will be fixed, and by fixed I mean socialist, which is evil but inevitable so pass me a DeMint JULEP!!!!!!!
It’s best not to try to make sense of what Jim “crème” de Mint says.
So is he voting with the dems? Sounds like he sees the public option as inevitable !
The snark is easy, yes its. But in the end what does it accomplish? While we’ve all been sitting on our asses stealing time from our employers while waiting for the chance to type something cute on da Wonkette real heroes like DeMint and Kristin Atkinson have bravely inserted themselves into the bizarro universe of the right wing as agents provacateur. What have you done today to push the right over the edge?
Sussemilch: Welcome to the Cycle of American Capitalism. I’m already excited about spending my golden years working the check out counter at Safeway.
Bronkers: I’ve heard the same thing, both from friends of mine who are doctors and my own doctors. It’s why primary care physicians have to try and sign up as many people as possible for their practice so they can make enough money to get by (which is, ironically, why you have to wait weeks before you can see them as they’re all booked up) and it’s why a lot of doctors are refusing to be primary care physicians and become specialists instead.
Having just spent an unfortunate several days in South Carolina, I can only say that Jim DeMint, Mark Sanford, Cubby Cubbyperson and anyone else with influence and power in South Carolina should take a long break from engaging in national (and, uh, international) politics, roll up their sleeves, take off their tango shoes, and get to work 24/7 on the state of that state. I mean, Jesus H. Christ - you people have a *LOT* of work to do before you can get your state up on the national stage.
And we all want the same kind of Health insurance these guys? Even when it obviously does nothing to treat dementia but force these patients out on the streets.
So DeMint is in favor of death panels for Medicare queens?
Ah, the good ol’ “If I just pull a bunch of utter, meaningless bullshit out of my ass, they’ll think the issue is too complicated to unnerstand” gambit, I see.
Paterlanger: I was going to be a positive force outside the Obama townhall meeting in DC- but for some reason, my boss thinks I have to stay at my desk. Maybe I can snark a LaRouchie when I go grocery shopping.
Paterlanger:
The only thing we can do at this point is hijack Palin’s facebook page and posing as her, subtly convince people that health reform is good. The media will jump on it right away (because “Sarah Palin” said it).
Might I be the first one to express awe that a republican is suggesting market forces are pushing towards a socialist solution?
I bet when Demint talks he sounds just like the adults in a Charlie Brown cartoon. You know, a trumpet played with a toilet plunger in the bell.
What’s that Demint? Wah wah wah. You say why bother doing anthing? Wah wah wah wah. You say the country is going down the socialist path to ruin? Wah wah.
And so on.
Market good, govt bad. Simple!
Sara K. Smith: If I was giving the impression in my remarks that everyone was ending up on Medicare or Medicaid, my apologies for lack of clarity. As JooJoo Beeand Hooray For Anything also mentioned, the reimbursement vs. costs gap is a Grand Canyonesque chasm, so providers are getting stiffed, or are not accepting assignment, or are getting out of the business altogether. Many of my physician pals are seriously contemplating leaving he profession entirely.
We have to get the costs under control across the board, so that appropriately priced services are available from providers and chosen by patients at the appropriate time to avoid untended-to conditions worsening and exacerbating costs. I’m for getting everyone under the doggone umbrella.
Somehow. (… except for Ms. Kristen, who’s beyond help, anyway.)
Paterlanger: What have you done today to push the right over the edge?
Ahem. Lemmings do NOT need to be pushed.
Sussemilch: “…and I work at Wal-Mart until I’m 80.”
Under the new ObamaCare we bear your medicare-sucking cost-center on a death panel to the rocks above the village and leave you for wolves, who now fly Piper Cubs to hunt for destitute, ailing olds.
Eco-friendly and reduces health care costs. Double win.
Sick Puppy: I thought carlos senteria was an old
Bronkers: Um. If it wasn’t profitable, they wouldn’t do it. Just saying.
Similarly, the internet is best thought of as a series of tubes.
Hey lighten up. He’s half right. Medicare Medicaid get volume discounts. But so do all the insurance companies. The result is that nobody actually know what anything costs so there is nothing resembling a market in health care. There are no prices only discounts from something called charges which are what providers of services would like to get paid as in “I would like to get paid a million dollars for my opinion”. You cannot construct a market on this basis which is why only the US and India are trying. The republican “plan” is really a pipe-dream that the US will adopt India’s cash and carry financing system. But neither providers (Please note: American doctors are not flocking to India to work for the high wages) nor the public (think about the PR implications of legless beggars dying in the streets) is gong to buy their Ayn Randiness in health care, ever.
widget09: Thank you for that. I am reminded of Al Franken’s Supply Side Jesus. The religion of the GOP.
Bronkers: George Bernard Shaw said: “That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity.” One of the things that needs to get reformed, due to the lack of an effective market in health care, will have to be a reduction in the number of people making their living cutting on other people and an increase in the number of people making a living by preventing the cutting on of people by other people.
JooJoo Bee:That’s a variation on the
” I don’t get paid enough so I steal” school of thought.
Doctors who find themselves in that position can always take a job at Walmart where they have security cameras to discourage that kind of activity.
Of course, they’ll have to send the Bentley back to the dealership and of course that trophy wife will have to go back to the trophy wife store (Hooters).
Doctors who steal from insurance companies are the victims of their own fraud? Puleese.
Listen, if the apple isn’t sweet enough I’m sure there are some perfectly nice Messikan doctors who’d work for those rates. Globalization, baby. It’s all fun and games till it’s your ass on the line.
Monsieur Grumpe: That’s not called his bell, and the plunger is wrong-way-round.
JooJooBee. DeMint’s argument is predicated on the fallacy that somehow the amount charge is for a service is related to the cost of production. Medicare and Medicaid can pay less and less every year because there is no mecahnism (e.g. a “free market) on the private side that might prevent the uncontrolled shifting of costs onto the privately insured. But the private insurers are also getting discounts. So who ultimately gets shifted onto? Individual (not through their employer) subscribers and the uninsured.
But forget that. There’s plenty of money sloshing around in the system. Enough to pay insurance company CEOS multi-hundred million salaries and enough so that a on average annual care for a Medicare patient in Florida costs twice as much as it would at Mayo clinic in Minnesota. Why is that???
What Senator Leghorn is saying (as best as I decipher) is that he would accept the portion of HR 3200 which provides individuals with income level-based, federal subsidies to purchse private health insurance. (This is essentially Part 1 of Grassley’s division of HR 3200 into 3 parts.)In re the other stuff in HR 3200 (public option, minimum benefits, no disrimination based on a pre-existing condition, etc.), you flush down the crapper.
Ducksworthy: you are so so correct. I was admitted to Yale-New Haven in Sept., stayed overnight, charges were about $10,000. United Healthcare got a “discount” of more than $3,000. So those least able to afford it pay the most.
Same with prescription drug costs. Aargh.
Gopherit: What becomes profitable, often, are the non-reimburseable services, for example, cosmetic procedures offered by dermatologists — cash on the barrelhead, no insurers involved, charged at “what-market-will-bear” prices. So the money’s in elective procedures, and no one save for the altruistic goes into general practice or internal medicine. And I do know a few of those selfless, noble souls, too.
Or, the provider over-tests and finagles the insurance form to maximize reimbursement and fudge on what procedures were formed. Yes, there are ways to make a profit, but they often aren’t ones that the doctor and his/her practice prefers to adopt.
dijetlo: I would suggest that they go into primary care, which might happen if there could be such as thing as a market in health care, which there can’t. But the result is as you suggest, they steal. Remember they guy who sent the the ‘Obama as a cannibal’ thing around? He is a neurosurgeon in Florida where they have 1.56 times as many back surgeons as they do in Minnesota (Dartmouth Atlas of Health Care’s favorite quality benchmark). This 156% concentration of supply would not occur in an efficient market. It can occur in Florida because Medicare will pay for back surgery whether you need it or not. So Florida olds get millions of dollars in extra back surgery compared to Minnesota olds (where they have to shovel snow for months on end). Hooray for capitalism.
“I think that’s why they don’t want anything to pass…” Who is this THEY he speaks of.
Bronkers: and Bronkers: Supporters of the proposed reform have discussed in detail that one of the reasons the President wants to decrease the amount funneled to hospitals and drug companies is so he can INcrease payments to doctors. Hopey has a lot of friends who are doctors and he won’t rest until they all have boats AND Bentleys.
Katydid: And for that “Service” the CEO of United was paid $112 million a year.
This was a brilliant yet sad segment on Olbermann; watch and laugh. (And sorry for the Quizno’s ad; think of it as our beloved Wonkette banner ads.)
http://www.msnbc.msn.com/id/3036677/vp/32484421#32484421
Bronkers: Actually because of the market failure of the present system, we have a shortage of primary care physicians. This happens because the present reimbursement system artificially values the delivery of procedures over “cognitive” skills like managing chronic diseases. Eye surgeons are have much bigger boats than pediatricians. Its been a while, but at one time the highest paying location and specialty ion the US (and thus the know and unknown universes) was to to be a proctocologist in Washington DC. Likely still is. Giving prostatic massage to Congress. No there’s a career.
Sara K. Smith: “Many of my physician pals are seriously contemplating leaving he profession entirely.”
Ha Ha. I’m showing my age but I heard guys (they were all guys then) saying that when Medicare passed.
dijetlo: & Ducksworthy: Don’t shoot the messenger. I merely sez what I sees.
Bronkers: We can both use our “I have a friend” anecdotes. Mine is a successful rehab doc. His practice is probably 60-70% medicare. When he joined his practice, they paid his $150K student loan debt, and he currently earns three times more money than I do. I don’t begrudge him this, but I really do have a hard time listening to docs gnash their teeth over how hard it is to get medicare/medicaid reimbursement, and how little it covers.
JooJoo Bee: My former employer “offered” me health insurance (that I wasn’t eligible for because of a pre-existing condition; generous, no?) and the application said that the insurer paid 80% of the cost of covered services, but that “many” health care providers would accept that as full payment. If that’s the case with private insurance, why is Medicare getting blamed for driving up costs?
As for malpractice insurance costs, and the calls for tort reform to limit awards, a Dartmouth study a few years ago said that “…malpractice insurance companies have raised doctors’ premiums to compensate for falling investment returns”.
JooJoo Bee: Sorry. I have been frustrated by the cost shifting argument for a long time. The fact is that there is no objective value to a service except what a market will assign to it. So Medicare’s price is as logical as United HealthCare’s. The market power lies with the payer in this case. The real problem is that the units of reimbursement are not things anybody wants. I’ve had enough colonoscopys and orthopedic surgery to last me a lifetime thank you.
We need to figure out how to pay for health not procedures. Richard Nixon, God bless his tortured soul, tried to do that by promoting HMO’s. But the HMO’s (some of which were the original health care coops Conrad dreams about) were forced by state by state insurance regulation (dominated by the insurance companies) to behave like insurance companies while the insurance companies launched their own “HMO’s” to compete with the real ones.
Hence the need for a public option. Or better yet, Medicare for all.
Sara K. Smith: I think the idea is not that more people are going to end up on Medicare, but rather that almost everyone will be uninsured, the only exceptions being those few who are on Medicare.
Sara K. Smith: If Medicare continues to be subsidized by private insurance at an increasing rate, then it’s reasonable to think that private insurance will eventually fail, and either (1) everyone will pay out of pocket, or (2) Medicare will take over.
But neither will really happen. What people forget is that insurance companies may well theoretically pay more than Medicare, the private insurers typically charge off 40% of billings. This is the single largest expense at the doctor’s office. So, I know docs who prefer Medicare because at least they get paid.
JooJoo Bee: I’m not irritated at you Joo-Joo. These arguments are just another example of the erosion of critical thinking skills nationwide. When a man stops his limousine and rolls down the window to complain bitterly about the horrible oppression he must labor under, I just see it as an opportunity to nick his hub caps, I don’t waste time drying his tears.
I think it’s clear these Republican people were all in the same place at the same time when something horrible struck the building turning part (all?) of their brains to mush. The symptoms (craziness of the mouth, etc.) are too similar to be happenstance.
NewAlgier:
” If Medicare continues to be subsidized by private insurance at an increasing rate”
What? I don’t understand what you are talking about. Private insurance subsidizes nothing.
BTW: To receive Medicare, you must be 65 or older. How is Medicare relevant to the availability of private insurance?
Try getting a private health insurance policy with coverage equal to Medicare when you are 65. Not happening.
‘ejemplo’. Sorry to be so late. Carry on.
Chickensmack: “Maybe our rates wouldn’t be so fucking high, if we just paid the goddamn hospitals, and set fire to the insurance companies.”
This.
One million times this.
unless you meant it in Portuguese, I mean.
I’m dizzy after reading that circle reasoning.
S.Luggo: “What? I don’t understand what you are talking about. Private insurance subsidizes nothing.”
Private insurance effectively subsidizes Medicare by having to pay more ever year as Medicare pays less. This being due to physicians having to charge the privately insured more in order to make up the losses incurred by the decreased Medicare payments.
El Pinche: No you have to go the opposite way. I’d have Sarah tweet that health care is for the godless and although she has good coverage she’s sure she doesn’t really need it ’cause God loves her.
This being due to physicians having to charge the privately insured more…
Groove, the insurance companies set the rates, not the Doctors. Seriously, think about it.
Everybody is trying to work the ref right now, don’t get taken in by the bullshit. These guys all make serious bank, you can go from one end of the foodstamp line to the other, you wont find a Doctor an insurance executive or a Hospital administrator. Everybody has an angle and they are working it for all their worth. None of them are hurting financially, everybody is running their poor mouth.
Seriously people, wise up.
Is he saying that we should oppose a single-payer system because we’re going to end up with a single-payer system no matter what we do?
That’s some kind of genius, there.
The rest of you: be prepared to be bored.
groove:
“Private Insurance subsidizes Part A (hospital) and Part B (health practioner) Medicare [because of Medicare's inadequate compensation rates]” is a GOP talking point/mantra being promoted to defeat the public option. The mantra continues: In order to make up for the Medicare shortfall, hospitals and docs, using their titanic market power, inflate their fee-for-service rates in order to soak the (pitifully powerless) private insurers, which must, must, absolutely must increase their premiums.
Unfortunately, the talking point is based on argument and supposition, rather than empirical evidence. In any case, the talking point does not take into account:
(a) The increasing number [and percentage) of uninsured patinets which hospitals provide uncompensated care to.
(b) The increasing number [and percentage) of underinsured (i.e. high deductable) patients which hospitals provide undercompensated care to.
(c) The differences between for-profit insurer premiums vs. not-for-profit and the difference between for-profit hospital rates vs. not-for-profit.
(d) The subsidies which private insurers receive under Medicare Part C (Medicare Advantage).
(e) That the Repugs themselves have been the driving force in cutting Medicare compensation. Thus, “Private Insurance subsidizes Medicare”, even if proven true, is a self-fulling prophesy.
Long/short: Bite me, neo-con boy.
Wow, I’m so proud of/shocked by the denizens of Wonkette having a substantive, thoughtful, and wonky (hey, I just got the name of the site!) discussion of the issue of Medicare reimbursement rates! Bored, too. If I want this shit, I go to Yglesias.
It’s late to post and I’m on my 3rd Bitburger tallboy, but I work in medical billing. There’s way too much smoke, mirrors and gamesmanship in the whole system. DeMint, unlike DeLay and DeFeat, isn’t wrong as far as he goes. 50 or 60 percent of the billing I handle is Medicare or Medicaid. Medicare billing is a headache (a 784.0 in ICD Code– not tonight dear, I have a 784.0)for the provider and almost always painless for the patient. It’s not that much of an exageration to say Medicare will pay for procedure A on odd-numbered Thursdays during months that end in “Y” but not on even-numbered Thursdays on months ending in “R”. It’s just that weird, that arbitrary and it changes every four months. Not for everything and every time but just enough to keep the system off-balance. Medicare sets the pace and the private insurers follow as far as payments go, beyond that Privates can not only toss you off for any reason they can deny payment at any time, but they can’t do that too often or no one would do business with them. More often is the casino deal, where the house always wins. It should be a simple contractual set-up, you and much more your employer pays big money, the insurer gambles on you and pays what they owe. Not so, imagine if you could tell your cable provider, a utility or your landlord/mortage company “Yeah, you know that bill you sent, for 400?, give ya 50, take it or leave it”. Same as any insurance in other field can deny a claim.
Malpractice claims that win account for about 1 percent of total Healthcare costs, malpractice insurance for doctors is a huge bite. Have the government underwrite it. Have the government subsidize the talented with scholarships so the student loans aren’t the huge load they are, in return for a few years as a general practitioner (old-style family physician) at what they make, plus maybe a year in a community clinic. The current system is how we’ve ended up with 8 dollar aspirins and 1400 a night hospital stays — do you have any idea what kind of a circus 1400 a night would buy in a top whorehouse? Ask Vitter or the NY former/governor blogger…
The ICD9 thing is kind of fun though in a wonky way. They’ve got something called E codes for accidents that apply to everything from “human fall in spacecraft” to (slight exageration) hot air balloon-horse-drawn buggy collision”
The 787 codes are rich. You have “Nausea with vomitting” (787.01) “Nausea without vomitting” (787.02) and the very saddest ICD9 code of all — 787.03 “Vomitting alone” [SOB] — not even a friend to hold your hair! The sadz!