Thursday, January 27, 2011

Brad's blog is still eating my comments

update: This comment appeared on Brad's blog. My mistake.

He attempts to discuss the ACA and Medicare actuary Richard Foster but he's confused. He wrote


"To say that the Affordable Care Act will in the end not reduce costs because doctors will successfully lobby Congress to repeal some of its provisions ... "

Wrong Brad wrong in an important way. The provisions in question apply to Medicare plan A (hospitals, nursing homes and home health care agencies) not to Doctors as such including Doctors with office practices (Medicare plan B). Given the ability of Doctors to get doc fixes once a year, there would be reason to worry if the ACA included attempts to squeeze doctors with office practices.

Such doctors can't be squeezed as many already refuse to deal with the CMS. However, hospitals don't refuse (I googled for half an hour for hospital refuses medicare in all permutations I could think of without finding an example in the past 10 years). The ACA squeezes those that can be squeezed not those who can't be.

There are doctors with over busy office practices which have to turn patients away. There aren't such hospitals (in any case there aren't two of them). This makes a huge difference.

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