07-17-2012, 04:26 PM
michaelb wrote:
This thread makes no sense to me, what issue are we discussing?
The ACA has quality incentive payments built into to Medicare reimbursement? How is that a bad idea generally?
The ACA will dramatically reduce the number of uninsured going to hospitals for acute care. This is a major problem for hospitals everywhere. Having coverage for most everyone wil outweigh reimbursement rate issues (which actually aren't going down) by 10 to 1. The States that opt out of the Medicaid expansion are of course going to have major problems that they will be completely responsible for bringing on themselves. Their money will flow for once to the states that do expand so that will be a nice change of pace. The overwhelming pressure and obvious need will flip those states, it is just a matter of time (but yes, some of their hospitals may collapse due to the uninsured).
Malpractice lawsuits are not a major factor in overall health care spending. But States are free to adopt all the changes and restrictions they want. Malpractice is not a federal issue, that is left to the states. The States that have adopted malpractice reform haven't seen any meaningful cost reductions. But reasonable reform makes sense to me too.
I can't spend the time to fight point to point (I have data and evidence for each of them). Suffice to say that the 'quality' metrics have been reviewed by the doctors and overall we think that they wont help at all (search medscape 2012 survey).
States that opt out wont face the financial burdens under ACA. The Federal government would (i.e. taxpayers). This is the major concern--how in the world is ACA going to control costs when it has eluded generations of administrators and politicians? The simple answer is that costs will balloon and the individual taxpayer will get saddled with the bill.
As for malpractice--how can it be a state's issue? If insurers are multi-state (and many if not all attorney groups are inter-state), then it is definitely interstate commerce. In addition, since ACA has setup national benchmarks of quality and safety metrics for hospitals and doctors, thereby establishing a national standard of care, then all hospital based lawsuits should be Federal. I suspect some hospital/group/organization will try that argument very shortly.