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The Language and the Look of Obamacare


Any new situation requires learning and understanding and the Patient Protection and Affordable Care Act (PPACA) calls for a class in terminology and structure.

The new vocabulary includes, but is not limited to:

ACO’s: Accountable Care Organizations will be the government’s preferred and encouraged provider of Senior healthcare. Picture a combination of an HMO and Department of Motor Vehicles…take a number, take a seat, and hope to be called before they close for lunch and all federal and state holidays.

CER: Comparative Effectiveness Research, funded by 1.1 billion inserted in the first stimulus bill, will determine which treatments and medications are the most effective. Everyone agrees that knowing which treatments have good results is a good thing. What to do with that information is the issue.

Health and Human Services (HHS) Secretary, Kathleen Sebelius and Dr. Donald Berwick, administrator of the Center for Medicare and Medicaid Services (CMS) will have primary responsibility for implementing Medicare changes. The law says changes are not to be based on cost alone, but the law also does not prevent the use of the information to determine care and reimbursement. Say what?

Confusion abounds and interpretation will be dictated by the bureaucrats, not by the needs of a unique patient with unique needs conferring with the doctor who knows their case well.

IPAB: Independent Payment Advisory Board of 15 members appointed by the President. They are not elected and their decisions cannot be appealed. The board will be in charge of keeping Medicare costs within preset bounds. The board is not allowed to ration care, increase premiums or reduce coverage. So in order to cut Medicare costs they will reduce payments to providers.

By the end of the decade a doctor will be paid less to see a Medicare patient than to see one on Medicaid. Doctors, hospitals, clinics, etc. are already stretched to treat Medicare patients and the CBO has predicted that 20% of current providers will refuse Medicare patients and 17% of current hospitals will go out of business.

Where will Americans turn for their healthcare?

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