“At issue is a new payment scheme that pays renal doctors a lump sum, or ‘bundled payment,’ for taking care of dialysis patients. Under the program, the doctors mostly get one fixed payment regardless of how much time they spend with patients, or how many drugs and procedures they use in caring for these folks. These ‘bundled payments’ are a key feature of the Obama health plan. That legislation uses various forms of capitation to shift financial risk onto providers in a bid to cut down on the use of costly, and some argue wasteful, medical services.”

“The rebates that will go to four-star and higher plans are to be used to provide additional benefits, such as lowering beneficiary premiums or reducing co-pays for doctor visits. Lower-income seniors are, arguably, more in need of those benefits. But not all plans are available in all counties. The report notes that four-star plans are offered in less than 14% of the counties where at least 25% of residents are below the federal poverty level. Thus, poorer Medicare beneficiaries are less likely to have access to the plans that receive the rebates and have better benefits.”

“No doubt Obamacare’s apologists will try to seize on the Fidelity finding from last year and claim the law is actually good for seniors. It won’t work. America’s seniors already understand that cutting Medicare’s reimbursement rates by $450 billion over a decade isn’t going to be good for their health care. No amount of spin is going to change their minds on that.”

“One of the enduring mysteries of President Obama’s health law is how its spending constraints and payroll tax hikes on high earners can be used to shore up Medicare finances and at the same time pay for a massive new entitlement program. Isn’t this double counting? The short answer is: Yes, it is. You can’t spend the same money twice. And so, thanks to the new health law, federal deficits and debt will be hundreds of billions of dollars higher in the next decade alone.”

“If you like your doctor, you can keep her — unless you’re poor or disabled.
The latest installment of ObamaCare is a scheme that’s uprooting the elderly poor and disabled who get care under Medicare and herding many into state-run Medicaid plans.”

“This year, the actuaries incorporated a more realistic ‘alternative scenario’ for future Medicare spending directly into the trustees’ report. The alternative scenario drops the unrealistic cuts from Obamacare and assumes a permanent ‘doc fix’ to prevent deep cuts in physician reimbursement rates. With these more realistic assumptions, Medicare spending is still headed through the roof. Indeed, in 2085, under the alternative scenario, Medicare spending would reach 10.5 percent of GDP, up from 3.7 percent today.”

“So how is Medicare, the nation’s biggest health care entitlement, doing now? Not so well. Two years after the passage of the Patient Protection Protection and Affordable Care Act, the program’s Trustees are reporting that the seniors’ health program is on a glide path to insolvency—perhaps by as soon as 2016. The technocratic reforms that were supposed to remake the program aren’t working nearly as well as hoped.”

“The nonpartisan Government Accountability Office said it’s not clear that the $8.3 billion Medicare Advantage bonus program will improve quality because most of the money is going to plans just rated average. The auditors did find, however, that the bonuses would temporarily ease the pain of unpopular cuts to insurance plans under President Barack Obama’s health care overhaul law.”

“Last week the Mercatus Center published my study showing that the health care law of 2010 (the ACA) will add at least $340 billion to federal deficits over the next ten years, and more than $1.15 trillion to net federal spending. The study has received a great deal of attention, which has highlighted the need for wider public understanding of federal budget procedures. In this article I will explain some of those budget rules while further substantiating that my basic conclusion is correct.”

“The IPAB was created by an act of the last Congress and is supposed to meet an arbitrary spending target that is not feasible without structural changes in Medicare and the health care delivery system. The IPAB has one tool—price controls—to hit the same kind of fiscal target that the SGR has. If the board requires politically unacceptable payment cuts, a future Congress will neutralize IPAB just as it has neutralized the SGR.”