In violation of House rules, members were given less than 24 hours to read the page document, and the final vote was called about 3 a.
IPAB's charter also requires its mandated spending reductions to be "scoreable" by CBO within a single implementation year. And that trend is expected to continue: There have been a number of crucial points in the past years of American history where proponents of reform initiatives to expand healthcare coverage were sanguine about their chances of success only to be defeated by a highly orchestrated and well-funded counter attack by special interest groups.
Yet the study might also be understating the savings that could have been achieved through premium support. This approach, known as "bundled payment," involves making one payment for an "episode of care" — including, say, the hospital charges, surgeon's fees, and follow-up visits for a hip replacement — rather Medicare effects on special interest groups a separate payment for each individual service.
But in its current form, the program is simply incapable of rising to this challenge. It would commit the program to a structure more resistant to lobbying by interest groups and meddling by Congress. For instance, if hospitals lobbied for higher premium-support payments, how would they know that the extra funding would flow to them rather than to ambulatory surgical centers, doctors, or medical-device manufacturers?
Yet reclassifications are a big business: Today's Medicare program exercises nationwide, take-it-or-leave-it buying power, which gives it negotiating leverage over even these regional health-care powerhouses.
Kessler Fall Induring the fight over President Bill Clinton's health-care reform proposal, Senator John Breaux told a story meant to illustrate how confused Americans were about health-care policy. A study by Zirui Song, David Cutler, and Michael Chernew in the Journal of the American Medical Association examined the bids plans made, rather than just the payments they received, to consider how the premium-support plan proposed by Wyden and Ryan would have worked had it been in effect in A study by Zirui Song, David Cutler, and Michael Chernew in the Journal of the American Medical Association examined the bids plans made, rather than just the payments they received, to consider how the premium-support plan proposed by Wyden and Ryan would have worked had it been in effect in But the common criticisms of such a market-based approach are not persuasive.
Insurers would be forced to offer good value relative to their competitors; if they failed to do so, they would lose customers' business. Medicare currently uses a top-down approach: Under traditional Medicare, providers who oppose competitive pricing have no natural counterparty pushing against them; under premium support, however, both insurers who would claim some of the residual profits of successfully competing for customers and beneficiaries who would share in efficiency gains through lower premiums would play this role.
One need not be a political-science professor to see that this offers Congress plentiful opportunities to dole out benefits to well-organized constituencies. But they are not equally well suited to the task.
In administrative pricing, information flows in the other direction: But it remains an open question whether retaining Medicare's administrative-pricing structure is the appropriate policy response.
It's easy to see why this practice has continued as long as it has: It is also worth examining which reform approach does the most to address the problems those influences have caused — and thereby does the most to improve Medicare.
The current debate over Medicare reform is often framed as a choice between centralized administration and market mechanisms, but there is a more clarifying way to evaluate the various reform proposals: There are statutory limits to its authority.Special interest groups slow health care reform Bill King says a future shift to a single-payer system may be in the offing if incessant infighting among various stakeholders continues.
By Bill King. John McManus, for instance, is described on his firm’s Web site as the “chief staff architect” of Part D, who “led the policy development, drafting and negotiations with interest groups. Power and Influence of Interest Groups Last Updated on Sun, 22 Jul | Health Policy Some interest groups, including several in the health domain, have been extraordinarily powerful and influential participants in the political marketplace.
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Implementation of any complex health-related law readily provides examples of what Thompson () calls the "strategic interaction" that occurs during rulemaking between implementing organizations and affected interest groups.
Yet he's spent months assembling a formidable lineup of special interests of his own. ‘Special interests’ on both sides in health fight and they're interest groups when they're against.Download