http://www.forbes.com/sites/aroy/2012/08/20/how-obamacares-716-billion-in-cuts-will-drive-doctors-out-of-medicare/

As for Mitch Daniels, he didn’t run for President but you might want to check out his education and Medicaid reforms in Indiana to get a sense of what kind of policies he might have in mind.

“Paul Krugman recently remarked that he could put forward an even better plan than Romney’s five point “recovery plan”: Every American will have a good job with a good salary, a blissful marriage, and a pony.”

The problem is that you’re not going far enough down the rabbit hole. You should consider the possibility that, on Keynesian grounds, Krugman would prefer a pony for every American not only to Romney’s proposed program, but also to Obama’s stimulus. Maybe he hasn’t thought through the environmental implications.

I don’t see what is especially wrong with a program that includes greater energy utilization and lower, flatter tax rates (though there are competing political and policy considerations.) Both those polices would tend to increase trend economic growth. And Krugman probably knows this but feels the need to stay in the partisan lunatic/middle school child persona he sometimes takes on in his polemical work. Don’t get me wrong, the effects wouldn’t be huge, but then again Romney’s 12 million jobs target is impressive-sounding, but actually pretty realistic.

http://www.nationalreview.com/agenda/331484/zachary-goldfarb-interpretation-economic-statistics-reihan-salam

But there are economic limits here as well. And the very fact that allowable Medicare expenses will be under constant downward pressure for a very long time is still very much a future economic headache for providers.

Even the option of not accepting Medicare has its limits. I see a cardiac specialist, a pulmonologist, and an arthritis specialist. For all of these doctors, their patients are largely above the age of 50. If they don’t accept Medicare patients, pretty soon they won’t have a practice.

If what you are talking about is something else, you’ll have to be more explicit.

As to Mr. Daniel’s remarks, all I can say is, nice work if you can get it. If members of the Republican Party have put forth a real plan with substance to reverse this inglorious decline, I have yet to hear it.

Paul Krugman recently remarked that he could put forward an even better plan than Romney’s five point “recovery plan”: Every American will have a good job with a good salary, a blissful marriage, and a pony.

If Mr. Daniels has something up his sleeve more practical than this, I’m all ears.

It does if you don’t assume that that the key players will always be thinking cynically rather that in a public spirited way. That’s not the way I’m betting mind you…

Micha, you don’t have to lionize anybody to note that Daniels got the tone right when he said:

“The president’s grand experiment in trickle-down government [romney used that] has held back rather than sped economic recovery. He seems to sincerely believe we can build a middle class out of government jobs paid for with borrowed dollars. In fact, it works the other way: A government as big and bossy as this one is maintained on the backs of the middle class and those who hope to join it.

Those punished most by the wrong turns of the last three years are those unemployed or underemployed tonight and those so discouraged they’ve abandoned the search for work altogether. And no one’s been more tragically harmed than the young people of this country, the first generation in memory to face a future less promising than their parents did.

As Republicans, our first concern is for those waiting tonight to begin or resume the climb up life’s ladder. We do not accept that ours will ever be a nation of haves and have-nots. We must always be a nation of haves and soon-to-haves.”

I salute your efficiency.

The Feds have only one serious option: lowering the allowable expenses. The rest of it is mandated by law, including the fact the the provider is prohibited by law from charging more than the federal allowable.

How do I know this? I’ve been on Medicare since 2007. I also worked as a medical claims adjuster for 4 years.

How could you know this? By putting your “economic knowledge” in the Pending box and doing some reading about how these things actually work. If you do, you are likely to find that Medicare has been far more successful at holding down per patient costs. Why? Because the Feds don’t have to sell insurance policies to anybody, so they cannot price themselves out of the market by too vigorous cost cutting.

From the provider’s viewpoint, Medicare patients have to be treated in high volumes in order to break even or make a very slight profit. Any losses on Medicare treatments either have to be written off or shifted onto what they charge non-Medicare patients.

The other option, which many medical specialists choose, is to simply not accept Medicare at all and either bill the patient directly or, more usually, demand payment up front at the time of service. They simply cannot do a large enough volume of Medicare business to stand the losses.

Further, there are some specialties, such as independent psychiatric services, where providers I know of accept no insurance at all because the cash flow from any carrier, private or public, is too slow for them to stay in business, and the extra staff they need for billing is too costly for them. You pay cash and carry with these providers as well.

How do I know all this? Because I see around six doctors on a regular basis and my life largely confines me to my home. So I make friends with my doctors or other providers that I see from time to time: nurses, home health aides, pharmacists, counselers, physical therapy specialists, and so on. I also ask lots of questions and listen carefully.

In fact, that’s how I know most of what I know. I have read omnivorously since about 1956 and trained myself to observe and listen with my full attention no matter where I am or what I’m doing.

Read or heard anything good lately?

I…Um…Well…I…

Seriously, I’m speechless. What can possibly be said in the face of economic ignorance on this scale?

[Yes, I know that our supergenius president says this sort of thing all the time, but by his own account he can't do math. Why would our resident statistical guru feel the need to parrot such laughable innumeracy? He's not running for office too, is he?]

“Cuts in Medicare payments to providers and insurance plans (those cuts are limited to 2 percent of such payments in any year, or about $10.8 billion in 2013).
o About $5.2 billion in cuts in the other mandatory programs that are subject to sequestration, the biggest of which is farm price supports. A number of key mandatory programs are exempt from sequestration, including Social Security, Medicaid, CHIP, SNAP (formerly known as the Food Stamp Program), child nutrition, Supplemental Security Income (SSI), refundable tax credits such as the Earned Income Tax Credit, veterans’ benefits, and federal retirement.”

Now from direct experience I can tell you that the programs on this exempt list include all of the most important things that support seniors and the disabled in this country: Social Security, Medicaid (the secondary insurance coverage for any senior below the poverty line), SSI, SNAP, veteran’s benefits, and federal retirement.

Further, there is no change whatever in the Medicare benefits received. They will still be 80% of the allowable expenses with a 20% deductible that the patient must pay on their own. For the seniors in poverty, that 20% is usually covered in full by Medicaid, as I pointed out above.

By law, the service provider CANNOT bill the patient above the allowable expenses. What will be cut are the allowable amounts the provider may charge. Thus all the burden of these cuts will be borne by the hospitals, the doctors, and the labs. And the generous prescription drug coverage now available will keep the large pharmaceutical companies well insulated.

Moreover, Medicaid, SNAP, child nutrition, and refundable tax credits are the primary forms of aid given to the working poor. And they are exempt as well. These cuts will have no special impact on seniors and the poor beyond that of the other groups that do not qualify for this aid.

What I’m quite certain will happen if the cuts are made is that there will be a large Reduction In Force of federal employees, ballooning the unemployment statistics; a similar release of state and local government workers who administer federally funded programs such as highway funds; and a sharp curtailment of big ticket weapons procurement resulting in massive layoffs in the over specialized defense industry.

Beyond the cuts in farm subsidies, I suspect there will be similar cuts in the Bureau of Land Management, the Forest Service, and the National Park Service–maybe even the funding of forest and wildfire fighting–as well as the considerable perks farmers, ranchers, and loggers receive from these agencies.

As an aside, I have to chuckle at the negotiating skills of Harry Reid and Nancy Pelosi. A massive part of the burden of these cuts is going to fall on the states of the Deep South, Great Plains, and Rocky Mountain West, as well as the rural areas of most other states. In other words all the major areas of Bush–McCain–Romney country.

But there is no indication that the Republican leadership in the Senate and House are that long on brains. Besides, they’ve had a far more important job to do: defeating Barack Obama at whatever cost their legislative inattentiveness has to the country as a whole.

Then there are NOAA and the NWS who have been doing such a bang-up job of tracking hurricanes and forestalling loss of life by doing so. Probably cuts in FEMA as well, so there will be no reason to bother “cutting through red tape” to distribute federal disaster aid for events like Hurricane Sandy.

These, of course, are just the first few of the falling dominoes. Everything else will crash shortly after.

Now I am no more indifferent to the massive amounts of human suffering, particularly among middle-class taxpayers driven onto services like Medicaid, SNAP, and child nutrition, that these cuts will create. And I wouldn’t advocate it under any other circumstances

But there is something more important at stake. For thirty years the kind of outright foolishness that has brought us to this pass has been driven largely by the Republican Party and its supporters, armed with mere slogans and unconquerable ignorance of cause, effect, and relevant factual information in the real world which we all share.

It is high time that the people of America and, particularly, the Republicans of America, learn a little bit about what the federal government is doing for them as well doing to them.

It boils down to three principles:

Sooner or later Services=Taxes. Sauce for the goose is sauce for the gander. Don’t spit in the soup, we’ve all got to eat.

If it takes going over the “fiscal cliff” to finally learn such lessons, then I say let’s do it.

Japan has proved that there is no such thing as a fiscal cliff and that true wealth comes from patent and efficient engineering. (disaster comes from regulatory shortcuts, and not applying yourself to the science of ending or redirecting the energy of earthquakes) So long as the people are relatively virtuous and proffesional, the amount of debt generated by Washington doesn’t really matter. Instead the only thing that matters is that we find better ways of doing things.

The ageing demographic is not going to improvrish us even if we spend 40% of our GDP on it. What this would actually do is enrich us in the means to fight illness. Technically we would also be enriching the whole world, especially given that one reason for our high cost medicine is the tremendous amounts we spend on R+D and patent. It will certainly bend the nature of progress…but there is a demographic rational basis for it.

@Brian: Debt+demographic time bomb! One man’s time bomb is another man’s opportunity to advance the constitutional progressive mandate of advancing the cause of science and the usefull arts. It is all about article I section 8, clause 8. But I tend to think you guys are all copyright heavy here!

For what it is worth copyright is the most iffy usefull art. Trademark or authenticity over time is more important. While I probably agree with Cindy…it should go without saying that Authentic political leadership is needed. In fact a good chunk of the “tea party” and a lot of other folks are confused about how bad government is vis a vis the free market, in part because there is no real debate that Coke shouldn’t have piss in it. It should be authentic… The market in other words certainly provides us with authentic goods. The market in politics seems to do okay with the copyright, coining terms like fiscal cliff/debt bomb and other modicums of creativity fixed in a tangible medium of expression. But it is fairly bad on the authenticity front. A key reason for this is market structure. Politicians are subject to a different market structure than say Lawyers…but they run like unethical Lawyers taking on clients without regard to conflicts of interest. It is this authenticity problem that gives rise to gaffe’s by say Romney(who is trying to reasure a bunch of rich folks that his true duties of loyalty lie with them).

On one level the debate over a constitutional republic and a democracy is just a question of the authenticity structure of the representation. Obama’s Audacity of Hope was copyright on this front. The equivalent of Patent on this front would be regime change. No one is proposing this, except in copyright, which is the domain of the Utopia.

On the other hand I am most definately saying that there was a Patent level change in 1972, that took the issue of the national debt and decoupled it from a Natural materialistic barrier (the price of Gold). in a very loose sense “Natural Law”.

Europe has a synthetic natural barrier in the form of bureaucrats, and competing nationalistic interests and treaties. All sorts of “positive law”.

The US is completly wide open, except for the congressional debt ceilling. The U.S. then is no longer subject to “Natural Law” vis a vis the debt ceilling… it is a pure policy choice.

The “fiscal cliff” and the “debt bomb” are simply aspects of copyright deployed for the sake of persuasion.

“If I were thinking cynically, I don’t know why I would go along with a program of unpopular spending cuts proposed by the other party in exchange for tax increases that would hit a vocal element of the public.”

Really…does “If I were thinking cynically” add anything to this sentence?

I think it makes a lot more sense as “I don’t know why I would go along with a program of unpopular spending cuts proposed by the other party in exchange for tax increases that would hit a vocal element of the public.”

I don’t know, you haven’t persuaded me. But I am a much bigger believer in global warming, than I am in the “fiscal cliff”. I certainly believe in Hurricanes! I also believe in the demographic bomb, but really such is my fate, to live in times when the macroeconomy will be tilted towards serving the interests of the old. But I am also a Capitalist and a Progressive rightly understood. A “Lockeian” I suspect, but also a Puritan. I tend to believe that we will be better off developing innovative solutions, regardless of accountant cost.

So I believe politics should focus upon negotiating legal barriers to the deployment of patent in large and small scale projects, and funding these in the classical progressive sense of the Tennesee Valley Authority.

A healthy economy is about how we use the wealth that is out there to drive innovative solutions.

The first thing a progressive president would do, would be to end Hurricanes. (by creating a TVA clone for the purpose of deploying Salter’s Sink’s).