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Statistical Fascism: Obamacare Already Cutting Medicare Spending, Using ’Evidence-based’ Criteria
1 March 2013
(LPAC)—Data released this week show that Obamacare is already taking its toll, with dramatic cuts in Medicare spending. While the forefront, the high-profile fight has been over the Independent Payments Advisory Board (IPAB), the Obama Administration — cheered on by both Democrats and Republicans — is chopping away in the background at Medicare, and using Nazi statistical methods to penalize doctors and hospitals and otherwise reduce payments to health-care providers. Earlier this week, the New York Times reported that the Congressional Budget Office is projecting a $400 billion decline in its projections for Medicare spending over the 2012-2020 period — exceeding the $303 billion in "savings" over that period recommended in 2010 by the Simpson-Bowles "Catfood" Commission. At least some of those "savings" are due to fewer people getting medical care, due to the economic collapse. At a hearing today of the Senate Finance Committee, a "progress report" was presented by Jonathan Blum, a top official of the Center for Medicare and Medicaid Services (CMS). The hearing was opened by committee chairman Max Baucus (D-Mont.) declaring that the objective is to change the way we pay for healthcare, and the top priority is eliminating the fee-for-service system, which results in too many medical tests. Sen. Orrin Hatch (R-Utah) complained that Obamacare isn’t doing enough to reduce the high costs of healthcare, and demanded that we have to hold providers accountable for the quality of care. Sen. Charles Grassley (R-IA) applauded the move away from fee-for-service to (capped) coordinated care. CMS’s Blum told the committee that, for the first time, CMS is paying for "value," and not just the amount of treatment. ("Value" in the CMS/Obamacare lexicon, means statistical outcomes.) The Medicare cost curve is being bent downward, Blum boasted. He was particularly proud that rate of hospital re-admissions is "trending downward," because of penalties imposed on hospitals who re-admit too many Medicare patients within 30 days of discharge — thus providing a financial incentive for hospitals to bar the door to patients once they’ve been sent home. Bloomberg News reports that average fines for a hospital for excess re-admissions are about $125,000. In backup material provided for the hearing, Blum quantified the decrease in the rate of patients returning to the hospital after being discharged. "After fluctuating between 18.5 percent and 19.5 percent for the past five years, the 30-day all-cause re-admission rate dropped to 17.8 percent in the final quarter of 2012," CMS reported. Blum also bragged that the rate of growth in per-capita Medicare spending has been at historic lows for the past three years, which he called "very exciting." His written statement reported that "beginning in October 2012, Medicare began adjusting payments to acute care hospitals according to how well they meet Medicare’s quality standards," adding that, "These standards are consistent with evidence-based clinical practice for the provision of high quality care." (Emphasis added.) In a presentation at the Brookings Institution on Feb. 26, health care economist Michael Chernew, who proposes capping care for all ill patients, claimed that the per capita spending on Medicare had actually gone from increasing at a rate 2% higher than GDP, to a rate .7% below. Perhaps with unintended irony, Sen. Richard Burr (R-NC) asked Blum: with all these cost-cutting efforts already underway, why is IPAB necessary? Blum responded that it is still tremendously important to have outside pressure to force more cost-cutting, and that’s what IPAB brings to the situation. [EWS] |