Like everybody else, Howard Dean needs to get paid:
Dean argues that IPAB can’t work and thus that “getting rid of the IPAB is something Democrats and Republicans ought to agree on.” He’s Howard Dean, and he represents the Democratic wing of the Democratic Party! He also represents McKenna Long & Aldridge LLP, a Washington lobbying firm.
Dean’s op-ed notes his affiliation in the tagline, but it doesn’t say what his clients think about IPAB. For that matter, Dean has refused to disclose which firms he’s representing on behalf of McKenna Long & Aldridge. It seems to be regular practice at the Journal editorial page to let retired Democrats lobbying for the health-care industry write op-eds calling for a repeal of parts of the law that reduce the industry’s profit margin.
He’s not so different from Evan Bayn or Chris Dodd, I’m sad to say.
raven
Nobody is that different from anybody else. Take it to the bank.
Just Some Fuckhead
I knew he’d turn out to be impure. Fucking nutroots.
Shakezula
I wouldn’t be surprised if the AMA is on the client list. There is a thought that the IPAB would make the AMA’s RUC obsolete.
Zifnab
This is the first Op-Ed I’ve seen out of Howard Dean in, what? A good two or three years at least? The man was a tiny god in 2004, when challenged John Kerry from the left. He popped up as an advocate for a more-liberal health care bill in 2009. Since then, he seems to have just disappeared from the political radar.
The DNC had an asset in Dean, if only they’d bothered to use him. Now they’re losing him. :-p If I’d been kicked to the curb by my political party, I’d probably just say “Fuck it” and start selling out, too.
beltane
Very disappointing. And, no, he really doesn’t need the money that badly. I’m sure he could have had a comfortable semi-retirement as some kind of UVM poo-bah. Once a politician sets foot in Washington in any capacity, the big money boys must slip them date-rape drugs or something.
Jeremy
I like Howard Dean but he is wrong on this issue. IPAB is one of the best provisions in the health care law because it will extend the life of medicare and make it more efficient. The 700 billion that was cut from medicare was a reduction in provider payments and subsidies to insurance companies in Medicare Part D. Those are the types of reforms we need to strengthen Medicare.
schrodinger's cat
But mostly its the devil, isn’t it?
beltane
@Zifnab: It’s one thing to sell out a political party, quite another thing to sell out the actual human being who benefit from that political party’s policies.
Chickamin Slam
Everyone’s got their price. The magic number where they’d sell their soul, their grandmother, etc …
Go on take the money and run! … Woo hoo hoo!
http://www.youtube.com/watch?v=YiUEjG3ddPA
Senyordave
Dean has also been shilling for the MEK, everyone’s favorite terrorist group (they have a very interesting collection of paid shills, inclusing Guiliani, Bill Richardson, Dean, John Bolton). Dean’s become a whore, plain and simple. And being kicked to the curb by the DNC doesn’t make it any more acceptable.
lojasmo
From the responses here, I’m guessing nobody clicked through the chait bullshit to see what the governor actually had to say.
http://online.wsj.com/article/SB10001424127887324110404578628542498014414.html
Zifnab
@beltane: Corporate lobbyists don’t pay you top dollar to go out and lobby for the betterment of humanity. Selling out necessarily means you’re trading on the good will of your constituents for fat stacks to be delivered to yourself and your new employer.
Jeremy
@Zifnab: So it’s the Democrats fault that he “Sold out” ?
The guy was the chairman of the DNC, but you don’t need a political position in Washington in order to create change.
Davis X. Machina
The DNC had an asset in Dean, if only they’d bothered to use him.
Besides mollifying the internet left, what is his unique selling proposition? What does he get you that you can’t get elsewhere? His e-mail list?
geg6
I know a lot of doctors who feel the same way. Probably because their own profit margin will take a hit. So why would Dr. Howard Dean be any different? Not to mention that he thought he should be in Kathleen Sebelius’ job right now.
beltane
@Zifnab: Thus DougJ.s point that Howard Dean is ultimately no different than Evan Bayh. I guess the Vermont progressives who used to always refer to Gov. Dean as a “good little Republican” will be experiencing some schadenfreude over this.
Zifnab
@Davis X. Machina:
He was pioneering the 50-state strategy before it was cool. Put the man to work organizing Democrats in the Gulf Coast and the Southwest. It’s a job that no one else seems to want to do, but that Dean was quite zealous about.
Belafon
My thirteen year old son does not have a girlfriend. I think he knows what kind of girl he wants: Smarter than him, into anime, and adventurous. So he has four girlfriends, and a number of other girl friends (at his bday party, there were 6 girls and no boys from his school).
I bring this up because there is not perfect person. Dean is wrong about this, and his fifty state strategy needed some work, but he’s really the best spokesman for how Democrats need to campaign throughout the country.
(OK, I also brought it up because it makes me laugh when I think about it. I’ve told him he won’t know what hell is until he chooses one of them.)
Violet
Can someone remind me if Dean was part of the “Kill the bill” folks when the healthcare bill was up for a vote?
@lojasmo: That’s part of the set up. He says a few things are good about the law:
That sentence is right before what you quoted.
Then he goes on to complain about the parts he doesn’t like. The part that will affect his or his clients’ income, no doubt.
Zifnab
@geg6:
So did Tom Daschele. I’ll take Howard Dean over Tom Daschele in any position imaginable.
smintheus
Speaking of Medicare, there’s this incredibly tendentious article in WSJ today: More doctors steer clear of Medicare
Worst kind of scaremongering. Buried deep in a graph, but never acknowledged explicitly by the reporter, is the fact that the number of US doctors opting out of Medicare has only risen from 2.8% to 2.9% since 2010. On that tiny factoid is the ‘trend’ founded.
Ted & Hellen
Beyond hilarious: Supporters of Barack Obama mocking any other Democrat as a sell out.
lol
Smoky room Dems, from whose loins sprung our current president, threw Howard under the bus for daring to talk and act like a Democrat.
Thus: Fuck them.
beltane
@Violet:
Yes he was, though I think he may have subsequently toned down his venom somewaht.
Ted & Hellen
@Belafon:
(OK, I also brought it up because it makes me laugh when I think about it. I’ve told him he won’t know what hell is until he chooses one of them.)
Ummm…or he’s gay. In which case he won’t have to choose. Which would be nice.
Straight girls love gay boys. Ask my beautiful, intelligent, and wisely ex-wife. :D
smintheus
@Senyordave: Yeah, there is no way to put a positive spin on lobbying for the MEK.
jeffreyw
His better angel is hanging with bad company.
Davis X. Machina
@Violet
On the 12/17/09 WaPo editorial page, yes….
Violet
@beltane: I thought he was. Didn’t he write some diary at GOS about it? I remember GOS being full of Kill the Bill kind of stuff at that time.
I guess that’s why I don’t take what Dean says very seriously about Obamacare. He didn’t want it, he’s now working as a lobbyist, and he’s working to protect the interests of his clients. He’s in no way working for the interests of the American people. Why should we listen to him?
Let him take another job–organizing the South for Democrats, as someone upthread said, or running for another office, or a cabinet position–and then he might have something interesting to contribute on the subject. But now? No.
Lev
This is worse than Bayh, who never made any pretense of being anything other than a Centrist-Beltway Establishment creature. Dean spent years out-progressiving everyone else, and now he’s taking the payday? Disgusting.
In general, of course, the out-progressiving should have been a clue. Someone who’s really progressive should not need to constantly talk about how much more progressive they are than everyone else. It gets to be like a Jennifer Lopez song, if you’re so much more real and normal than everyone else, why do you need to constantly tell everyone about it?
catclub
@Zifnab: ” I’ll take Howard Dean over Tom Daschele in any position imaginable.”
That sounds nastier than you may have intended.
Jeremy
@Ted & Hellen: Do you ever talk about anyone besides Obama ? People like you with ODS are boring as hell. Obama this, Obama that, Obama, Obama, Obama, Obama…
We get it. You hate the President and blame him for all the problems in this country and the world. Get some new talking points.
srv
Death panels are for the individual lame. IPAB is the real monster, more like a genocide panel.
Belafon
@Ted & Hellen: No, in his case, it’s pretty obvious he’s straight. He’s just got a schedule: He’s not going to get a gf until high school. I think part of the reason the girls like him is that he hasn’t chosen: None of them are really wanting to commit to anything either.
raven
@jeffreyw: Is that from Animal House
beltane
@Violet: I remember him ranting against the bill on NPR several times (I stayed away from DKos during that time).
PeakVT
IPAB for the acronym-challenged (like me).
Violet
@beltane: Yeah, I don’t see why someone who was vehemently opposed to the healthcare bill should now be held up as some kind of progressive expert on the former bill, now law. It’s telling that he had his editorial published in the WSJ. It’s not like he published it in Mother Jones. He is protecting the interests of his clients. He is not someone that should be listened to on this healthcare law.
raven
@JeremyIt’ll talk about ANYTHING to get you to talk to it. Wise up, it’s called a pie filter.
Gin & Tonic
@Ted & Hellen: Why does “have to choose” have anything to do with sexual orientation?
Another Halocene Human
@Ted & Hellen: Not so wise when she married Mister “I Can’t Stop Talking About Child Rape”, though, now was she?
Hopefully the statute of limitations has passed, &so on, &so forth. Hope she wasn’t in a job that made her a mandatory reporter.
I had a coworker who constantly talked about “theoretically, hee hee” taking lost&found items. Then she went to jail… for taking lost&found items.
Another Halocene Human
@Jeremy: Obama, Obama, Obama
beltane
@Violet: Absolutely. It’s also important to remember that Howard Dean as governor was a centrist from the pro-business wing of the Vermont Democratic party. It was his early, and sincere, opposition to the Iraq invasion that caused him to be considered a progressive. Perhaps the fact that Dean was ever considered a progressive firebrand in the first place is more a testimony to the darkness of those years after 9/11 than it is to Dean’s actual ideology.
Shakezula
@smintheus: DOCTOR’S LEAVING MEDICARE IN DROVES is a RW classic.
To give you an idea of the mendacity involved in these articles, consider that opting out doesn’t mean the doctor will no longer treat Medicare patients.
burnspbesq
@lojasmo:
Chait cherry-picked quotes from the Dean op-ed that support his view of the world.
So did you.
smintheus
@beltane: I lived in VT under Dean, and thought and still think his treatment of preservation/state business regulations was outlandish. Seemed silly that out of staters wanted to see him as a progressive because he was anti-war.
Redshirt
@raven: Are you referring to good friend of blog owner John Cole?
Remember – he’s just “tweaking”.
burnspbesq
@Ted & Hellen:
Since Cole let the cat out of the bag and exposed you as a pure troll with no actual beliefs, I no longer give a shit what you write here, on any subject. Feel free to either ramble on incoherently or stuff it.
lojasmo
This is AWESOME!
smintheus
@Shakezula: Exactly. There is a slight uptick in doctors becoming “non-participating”, but that just means they’ll still take medicare money but fill out different paperwork for it. The ‘trend’ amounts to a big nothing.
jeffreyw
@raven: fuckers carded me!
lojasmo
@burnspbesq:
Zifnab
@smintheus:
Should be noted that 2-3% is the amount of money you’ll start losing this year if you haven’t tried to meet the new EMR requirements phasing in for 2014 and 2015. That can’t possibly be a coincidence.
Davis X. Machina
@beltane:
This, exactly.
Look, I love the guy. Northern New England is small. I know people who knew him quite well back then. I gave to his campaign in June of ’03. I caucused for him. I was a Dean delegate to the ’04 state Democratic convention. But this hits the nail on the head. If there were no Iraq war, and a lot of waffling going on among Democratic bigfeet over it, in the spring of ’03, the governor’s not even a footnote.
It’s instructive to look at Dean’s 2004 health plan — coverage up to age 25 by expansion of Medicaid and SCHIP; SCHIP expansion up to 185% of FPL; support for small businesses to purchase insurance for employees; a federal plan to sweep up basically what doesn’t get addressed by the other three points.
Roger Moore
@beltane:
FTFY. Progressives haven’t had anything much to cheer about for a very long time, so it shouldn’t be a huge surprise that they’ve gotten in the habit of building up and tearing down heroes over every little thing. Although a lot of these people are more of leftist utopians who want the perfect world and are dissatisfied with anyone who fails to deliver it whole than progressives, who ought to get at least some joy as long as we’re moving in the right direction.
lojasmo
Edit hell. Chait only quoted one sentence from Dean’s op ed.
raven
@jeffreyw: D-Day!
Belafon
@srv:
@lojasmo:
So I went and read about IPAB and Accountable Care Organizations (ACOs). While the ACOs sound more like what I like about capitalism (no central organization needing to make decisions), I get the feeling they would be subject to the same abuses you get in capitalism. In one sense, we already have ACOs. We call them HMOs.
beltane
@lojasmo: That blockquote is a masterpiece of corporate jargon and capitalist weasel-speak.
James E. Powell
There are Democrats and Democratic-leaning writers who feel the need to denigrate Howard Dean. It’s a smaller and more up to date form of hippy punching.
It’s a little strange because everyone who knew about Dean had to know he was a conventional DLC Democratic governor in a state that was, for the most part, more liberal than he was. Two things – his opposition to the Iraq invasion and his failure to hate gays/lesbians – were enough for the corporate press/media and the Democratic Party establishment to brand Dean as something close to crazy. And that was before the scream speech.
At the same time, a certain portion of the Democratic activist imagined Dean to be our own Olof Palme..
For the latter group, Dean must be denigrated because he failed to be the liberal hero of their dreams. They experience this as a betrayal.
For the former group, the big time bosses of the Democratic Party and those who write on their behalf, Dean’s existence is an embarrassment to them. He was right on Iraq, they were wrong. Kerry’s gutless support for the invasion was not enough to get him the White House. He could never out war-monger the actual war-mongers. And support for the war is the most often cited reason for Clinton’s loss to Obama.
jayjaybear
The problem with purity is that nobody is.
Omnes Omnibus
@beltane: This. Dean never sold himself as a Progressive hero of the Left. He was a pro-business, pro-gun moderate Dem as a governor. He is being damned a bit unfairly here. Wrong on the merits, sure. Progressive sellout? No so much.
Jeremy
Like I said Dean is a good guy overall but I disagree with him on this issue. I think people on both sides need to get over this purity crap because no politician no matter how liberal he or she is will ever be 100 % pure in a democratic system.
srv
@James E. Powell: Hippies have it hard. Punching bags when they’re right, punching bags when they aren’t pure enough.
Ted & Hellen
@Jeremy:
Ah…if only it were this simple.
Which is why you reduce it to this; as a means of matching the world to your simple mind.
flukebucket
@raven:
Amen brother. Why is it that people have to be 60 years old or over before they finally figure that shit out?
Ted & Hellen
@Belafon:
Sounds like a remarkably centered young man.
Bravo!
Ted & Hellen
@Jeremy:
Also too: You sound remarkably, no, EXACTLY like those on the right who accused sane people of having BUSH DERANGEMENT SYNDROME back in the day.
Because there can never be valid reasons for criticism of one’s hero-leader-love object.
Joey Maloney
@Zifnab: Including “prone”.
taylormattd
@burnspbesq: wait, do you have a link for that?
raven
@flukebucket: equanimity
raven
@taylormattd: Links, we don need no stinkin links. . .
Ted & Hellen
@Gin & Tonic:
Is there a reason why he would “have to choose” unless he was going to select one of them as a steady girlfriend? Which, if he were gay, he would quite obviously not have to do.
I stand ready to bask in your enlightenment.
Jeremy
@Ted & Hellen: Dude, the trolling is annoying. But most people that like the president do not worship him. People can disagree on one issue or two and still like the person.
Also there are people who really do have ODS like yourself. You have an irrational hatred for the man and his family.
taylormattd
@Ted & Hellen: you are the one who brought up this topic for literally no reason, you dumb fuck.
Chyron HR
@Ted & Hellen:
Oh, is that why you’re defending the sainted Dr. Dean?
Shakezula
@smintheus: Non-par is even less of a big deal than opting out.
But you can’t scare people with DOCTORS CHANGE THE WAY THEY HANDLE MEDICARE CLAIMS!
As an aside I must note that Medicare is almost 50 years old and dipshits are still trying to kill it.
Ted & Hellen
@Another Halocene Human:
Moron.
You talk about child rape 20 times more than I do. As you just did in this comment, when you brought it up out of nowhere. Again.
My ex wife is a wonderful person. She has been happily remarried 14 years. We are on excellent/affectionate terms with each other. We have three gloriously wonderful young adult children in common, whom we enjoy immensely and talk about often.
My story/our story is a common one.
That the above ruins your fantasies about me and my life is icing on the cake.
Now…run along and plan your next comment in which you use me as an excuse to fantasize and titillate yourself about child rape.
Comrade Mary
OT: John Scalzi has a post on his blog about a sweet, GORGEOUS black cat who needs a new home. (Not one of his pack, but his mother-in-law’s cat).
Queenie needs a new home. Helps if you’re in driving distance of his town in Ohio.
Ted & Hellen
@Redshirt:
Cole’s words, not mine.
Fascinating that Bots and haters react to my comments not by responding to the subject matter, but with personal insults about ME and general attacks on ME, then whine about how I make a thread all about ME.
Freaks.
Zifnab
@Ted & Hellen: What is your opinion on pie? Do you have any favorite flavors?
Shakezula
I was just thinking of Scalzi. And kittens.
Ted & Hellen
@burnspbesq:
Cole’s words, not mine. He was trying to be honest about our relationship while still kissing ass to his reliable BJ Bot base of dipshits.
Fuck yourself.
Ted & Hellen
@jayjaybear:
The only people talking about purity are Obots who want to delegitimize pressue on Obama from actual liberal/progressives.
beltane
@Jeremy: I think T & H suffers from generalized DS more than just ODS, but that’s only my non-professional opinion.
scav
T&H wouldn’t have to troll so hard on all subjects if he had a personality to work with. The brief feint at liking animals was even more manifestly bogus and internally inconsistent then his self-congratulation on purity in all things liberal. There is no there there, beyond PR and positioning.
I met a man who wasn’t there
He wasn’t there again today
I wish, I wish he’d go away…
Ted & Hellen
@Jeremy:
I don’t hate any of these people, especially not his family. But like the right wingers who claimed everyone who criticized and loathed GWB’s reign of error HATED him and his family, you’re seeking to trivialize any attacks on Obama by portraying them as irrational and emotionally based.
I despise a lot of what Obama DOES and DOES NOT DO. A few of the things his wife does. And none of the things his daughters do.
So, you know….fuck off.
The prophet Nostradumbass
@scav: everything he posts serves one aim: steering the subject of a comment thread to himself.
Roger Moore
@Shakezula:
Yeah, and Social Security is 80 years old and the Federal Reserve is 100, and that doesn’t keep the Republicans from wanting to kill them. Hell, the Civil War ended almost 150 years ago, and some people still want to refight it.
scav
@The prophet Nostradumbass: Exactly, P&R.
raven
@The prophet Nostradumbass: ding. hence, pie
Ted & Hellen
@taylormattd:
Specify what “topic,” ass breath.
ODS? No, I very much did NOT bring that up.
Obama? Why yes I did. When supporters of our sell out president cry out that another politician has sold out, why yes, I do like to spotlight that contradiction. Does that hurt your fee fees?
rikyrah
http://www.nj.com/politics/index.ssf/2013/07/lautenbergs_and_booker_had_a_tortured_history.html
……………………………………..
one of the things that bothers me most when people criticize POTUS is when they call him lazy.
it doesn’t just burn me up because it’s racial
it pisses me off because it’s not true.
I don’t know of any politician that started from the bottom – EVERY FUCKING TIME THEY RAN
and built the apparatus with which to win.
when he ran for State Senate…
when he ran for Senate—who the hell knows a Chicago-based State Senator in downstate Illinois?
NOBODY.
Barack Obama got in the van and visited all those small-town hellholes all around Illinois when he was running for Senator. Built it, small gathering by small gathering.
And, do we even have to recount what he began with when running for President?
Yet, every step of the way, he DID THE WORK.
DID THE SMALL STUFF.
DID THE GRUNT STUFF that you have to do in order to build a campaign FROM SCRATCH.
Booker is an entitled mofo who thought it should be handed to him.
DAMN, I wish the situation was reversed between Booker and Kendrick Meeks – who ALSO did all the work for his Senate Campaign, but even as a Congressman, he got the leg up because of his mother. MEEKS did the work like Barack Obama…Booker wants to coast.
Cannot stand Booker.
kindness
“It may be the devil or it may be the Lord” but you have to serve somebody.
And I’m off to lunch to serve me. Hope Dylan approves.
Ted & Hellen
@scav:
If I”m not there, and yet you feel the need to comment on a person who is not there, how there can you really be?
My beloved dogs Ted and Hellen say for you to eat cat shit and die.
I’m merely passing that along.
Belafon
So, I made this comment. @Belafon: Does anyone know why ACOs would really be preferred over IPABs?
Ted & Hellen
@Chyron HR:
Who sainted him, mum nuts?
How often do you read me commenting about him? Oh, today! In a thread about him! How outrageous Deaniac of me!
Jeremy
@Ted & Hellen: No one has an issue with criticism but when it’s not rooted in facts and reality people with common sense will dismiss it. No Democratic politician is good enough for you and since we are talking about Howard Dean why don’t write about him instead of whining about Obama like you always do.
Ted & Hellen
@The prophet Nostradumbass:
Why you would be incorrect. The morons who respond with attacks on ME do that, then attack me for doing what they just did.
Moronozoids.
Jeremy
@beltane: Probably right.
Ted & Hellen
@Jeremy:
Elizabeth Warren is good enough for me. Dean is up there. Alan Grayson is pretty awesome.
Now…please list all of the Republican politicians of whom I have sung the praises of here, contra your implication.
Have you considered that Obama is president of the united states and head of the Republican Wing of the Democratic Party, and thus his name will tend to come up frequently during his terms?
Shakezula
@Belafon: Those are two entirely different things. In the most simplistic terms imaginable, ACOs require a number of health care providers to act in concert to deliver care to patients. The IPAB is a panel of providers who decide how much services costs.
Kay
It’s interesting that Dean opposes Vermont’s cost control mechanism, because there wasn’t going to be single payer in Vermont without it:
States or the federal government are simply never going to put in universal single payer without some method of controlling the rate of increase in per capita expenditures, which is what the IPAB (and Vermont) does. They don’t intervene on overall spending; they intervene when per capita spending exceeds projections. That’s why Dean’s comment on the IPAB “not reducing spending by a dime until 2021” is dishonest. The Board won’t reduce spending by a dime until 2021 because per capita spending on Medicare is projected to have a slower rate of increase. That’s a good thing. It’s not a reason to get rid of the IPAB. They want Medicare solvent and sustainable, just like Vermont wants their single payer system solvent and sustainable. If Vermont had screwed it up like Dean wanted, and NOT controlled costs, single payer would fail and be discredited.
They can’t do it. If they’re paying, they need some control on what they’re paying for.
Belafon
@Shakezula: Thanks. Then why did it sound like Dean was arguing for ACOs to replace IPABs? I guess he’s making two different arguments. But, in that case, does he have a good argument for stopping IPAB, or is it, as Doug is implying, that he’s getting paid by the people who don’t want them?
Jeremy
@Ted & Hellen: There is no republican wing of the democratic party. The party has been moving more leftward especially after many Blue Dogs got eliminated in the 2010 election. The fact that you say Dean is good enough for you when he governed Vermont as a moderate- centrist Democrat shows that you are not serious. Elizabeth Warren ? She and the president have similar positions on a whole bunch of issues and she was appointed as an adviser by the president to create the Consumer Financial Protection Agency created by Dodd-Frank. Warren is not a purist and if you believe that then I have ocean front property to sell you in Arizona.
Also, you never sing the praises of republicans but all you do is bash Democrats which shows that you are a phony.
schrodinger's cat
@rikyrah: Did you read Bill Keller’s piece on Obama, I think he describes the critics both on the right and left very well. I usually am not a Keller fan, but this one was good.
raven
Sara Smile – Daryl Hall & Rumer –
Won’t ya smile a while. . .
NobodySpecial
I’m a bit puzzled at whomever thinks Dean was a leftie on anything other than the war. Of course, the big hate hate hate from the establishment came when he got pushed into the DNC head job and implemented the 50 State thing. Rahm later took credit for it, but that was yet another thing that Dean was hated on for being premature in his support for it.
Of course, all the Reagan Democrats around here love them some Third Way DLC, so Dean is cast as a wild eyed leftie.
gelfling545
@raven: I think I now finally understand the British phrase about a person being “no better than he should be”.
Kay
@Shakezula:
No, it isn’t. The IPAB makes (binding) recommendations to control the rate of increase in per capita Medicare spending to the projected rate. Not total spending, which always goes up, not even per capita spending, which alway goes up. It’s a mechanism to slow the rate of increase. They do that by looking at whether cost is justified by outcomes. If Congress doesn’t like what the IPAB recommends, they can act to get the per capita rate of increase within projections some other way.
The general consensus was that the IPAB would increase payments to “front line” providers, who are tasked with “coordinating care” (better!) under the ACA, and decrease expenditures to the whole host of provider services that are not “front line” care, but that’s not “deciding” what services cost. It’s deciding what services get the most bang for the buck.
Gin & Tonic
@Ted & Hellen: Because if he were gay, and had four boy friends who could become boyfriends, he would also “have to choose.” Most gay people I know have pair-bonded just like the heteros. You presented the notional gayness as an alternative to having-to-choose-ness.
Jeremy
@NobodySpecial: Do Reagan Democrats even exist anymore ? Many of them have died or will be dead soon. DLC ? They had to close their doors due to lack of support.
Most of the people on this blog are liberals and pragmatist who don’t hate Howard Dean. We just disagree with his position on IPAB.
Omnes Omnibus
@NobodySpecial: You started off well but quickly went off the rails.
Shakezula
@Kay: Sorry, it is my understanding that it will replace the RUC, hence the AMA not being happy with it.
Jeremy
@Kay: Thank you Kay for thoroughly explaining what the IPAB does.
Botsplainer
@Ted & Hellen:
Bad troll – you went for the money shot on that one with zero foreplay, and thus lost all trollpoint credibility.
Kay
@Shakezula:
It’s just gotten so dumb. Rural areas bill for fewer specialists, because specialist (perhaps understandably!) don’t want to live in the middle of nowhere. So primary care doctors take that role. But rural state and district Senators and House members come back and say “that’s not fair! It doesn’t matter if we actually use specialists, we want compensation for NOT using them!” I mean, there’s a logical argument in there, if generalists are doing the work of specialists, perhaps they should be paid for that, but shouldn’t it have some rational connection to what’s actually being delivered, and by whom?
Ted & Hellen
@Gin & Tonic:
wtf? The young man, gay or straight, is dealing with a bevy of young women, not boys.
The boys you’re talking about exist in your mind.
Zifnab
Ted & Hellen, I’m really interested in your opinions on pie.
Ted & Hellen
@Jeremy:
ROTFLMFAO
Ted & Hellen
@Botsplainer:
Troll!
Omnes Omnibus
@Botsplainer: FWIW I like Hrayson. Politicians like him are useful. He was quick witted and made points with humor.
Ted & Hellen
@Zifnab:
Good. Why don’t you eat your pie and quit responding to people you claimed to have pied so that you con’t have to respond to them?
Oh…is this to let everyone know that you are so cool and have other commenters pied because you can’t handle reading typed words you disagree with?
Oh…OK then.
Omnes Omnibus
@Omnes Omnibus: Grayson, that is. Fucking little buttons.
Ted & Hellen
@Botsplainer:
So what’ syour problem with Grayson, assuming I’m reading your comment correctly…troll?
Kay
@Shakezula:
It’s a pdf:
They’re trying to make Congress own increases, instead of just patching with increases, which is what they’ve been doing since they “balanced the budget” in the 1990’s. It’s not “balanced” if they never follow through on the constraints. IN THEORY, I guess, it’s “balanced” :)
“Best case! If we don’t over-ride our own legislation! Which we will! Every year!”
Gin & Tonic
@Ted & Hellen: Belafon’s original comment read to me as the son having to choose one exclusive romantic companion from a set of four (or was it six) possible companions, not as having to choose one female companion from a set of four (or six.)
Heh. Whose reading was the more “liberal” one? Pretty funny.
Gin & Tonic
@Omnes Omnibus: Useful or entertaining? Did he get much legislation passed?
Dave Anderson
@Belafon:
A bit of a different twist on other examples provided. ACOs are primarily about driving value of care so that those who get paid to provide care also absorb a good deal of population health management risk. The idea is that coordinated care should save significant sums of money, while also providing for better quality of care. The ACOs split the cost savings with the Feds (different splits for different models.)
The IPAB is an expert commission (confirmed by the Senate) that can make provider payment changes if the trend cost path of Medicare goes above a certain limit. Congress can change IPAB’s recommendations at any time, provided the Congressional changes are equal to or greater than the cost savings IPAB recommends.
Why should we prefer ACOs over IPAB — we shouldn’t really. ACOs give health care providers strong incentives to restrain costs and promote better health, and if they work really well, IPAB does not have to do anything. IPAB is the distant heavy if ACOs and other cost containment strategies fail.
Joel
@burnspbesq: when did that happen?
Jeremy
@Ted & Hellen: All I can do is laugh at you and the ridiculous things you say.
Shakezula
@Kay: And then there are senators who demand a higher pricing index for their locality on Medicare’s fee schedule.
But primary care docs (and nurse practitioners) have traditionally gotten the shitty end of the stick while a host of entities (including specialty orgs) have had to power to say “Gee, we really think our work (which usually involves opening the patient up) is worth X dollars. But to maintain that level we’ll need to make cuts from somewhere else. But where … ? [Looks at primaries].” And so the cost of that knee surgery goes up while the cost of that office visit for the persistent cough stays flat.
The IPAB will (in theory) be one of the ways in which the scales are re-balanced in favor of the primaries. But then a lot of what will make the ACA work is a large pool of primary care providers and that will mean providers deciding to be PCPs instead of surgeon/specialists.
Botsplainer
@Ted & Hellen:
Noisy, bombastic, thoughtless, reckless.
Omnes Omnibus
@Gin & Tonic: Not all legislators are brilliant at initiating legislation. I think John Kerry was a good senator although his legislative record was rather thin. He used the committees he was on to conduct investigations; those investigations led to legislation. Did Kerry write it? No. Was he a but for cause? Yes.
Grayson was willing to be a strong public left wing voice. This was a good thing. Do I want a Congress full of people just like him? Probably not. Was Barney Frank better at it than Grayson? Yep. But still….
Zifnab
@Ted & Hellen:
Hey, that’s not very nice. I was just asking a friendly question. There’s no reason to get so upset.
Roger Moore
@Belafon:
He’s making an argument about effectiveness. He believes that the IPAB won’t be effective in controlling costs because it’s a top-down decision making body that will be seen as interfering in the doctor-patient relationship, while ACOs will be a market mechanism. It’s a plausible sounding argument, but I suspect that it’s wrong overall. It’s basically restating the idea that government trying to control costs equals death panels, but insurance companies trying to control costs are hunky dory.
Shakezula
@Kay: Yes, I get to watch the Conversion Factor Roller Coaster every year (sometimes several times a year).
There seems to be more talk about a permanent fix this year and for once Medicare didn’t issue a CF in its proposed rule. This could be because the agency has gotten sick of enduring several months of the AMA and other medical orgs screaming “We’re gonna leave Medicare if you don’t give us what we want!”
This would be an ideal time for a political party that talks about fiscal responsibility and tough choices to come up with a permanent fix, no matter how painful.
So that won’t happen.
EDIT: ” …while ACOs will be a market mechanism.”
Snort.
Jeremy
Alan Grayson is a good guy who is right on a lot of issues but the man is more like Dennis Kucinich than a Nancy Pelosi or Al Franken who can actually get things done. Al Franken who created the 80/ 20 rule in health care reform has worked hard since being elected and the reason why his popularity has risen in Minnesota is because the guy delivers for his constituents.
Ted & Hellen
@Botsplainer:
Not sufficiently deferential to the establishment Dem traditions of go along to get along with Republican pigs don’t make waves within the hallowed halls of selfless statesmanship within the Beltway for you?
I’m guess you also believe that Howard Dean “screamed” maniacally and inappropriately and in an unhinged manner and thus was disappeared with good reason?
Ted & Hellen
@Zifnab:
Hmmm….I think your alleged pie filter is broken.
beltane
@Kay: However, rural residents still see specialists, probably at a similar rate to non-rural residents. They just have to drive further to see specialists. I live in a rural area and can assure you that primary care physicians do not fill the role of specialists-they simply refer patients to specialists who practice in more urban areas. The whole argument is disingenuous.
Kay
@Shakezula:
I agree. That’s why I sort of go along with paying them more if they’re doing the actual work of specialists. That part makes sense. What doesn’t make sense is my House member saying he wants some X amount “equal” to what Cleveland gets, because… wah wah wah rural discrimination! SOME connection to reality, please, Congress.
Eric U.
I miss the pie filter at work. Would feel guilty installing it here
Kay
@Shakezula:
It bothers me, because Vermont actually had the political courage to address cost. Dean is waving that away, “don’t worry, ACO’s will be FINE!” and I think really honestly looking at what it costs and what we’re paying for is a predicate to national single payer.
The resistance to this discussion is huge. I think it will actually happen, but only after the payment mechanism is in.
I look at it like this: Vermont addressed cost first, then put in a payment mechanism. Massachusetts (and the US) addressed the payment mechanism first, and put off cost.
I would have gone Vermont’s way, but obviously we weren’t emotionally ready for it, or something, judging by how people went freaking insane even discussing insurance.
Dean shouldn’t be helping people avoid it by bringing death panels back in.
max
He’s not so different from Evan Bayn or Chris Dodd, I’m sad to say.
Since I wasn’t a Deaniac back in the day, and I’m not a Deaniac now, I don’t care very much about that. I care if he says dumb & wrong shit for money.
max
[‘So that is really not cool.’]
catclub
@Jeremy: I think you may be behind the times. I recently read an article about ‘Grayson has gotten more bits inserted into legislation than any other democrat’
Now it may be just a PR job, but it may also be that Grayson has learned and changed.
Robert Caro has a section in “Master of the Senate” about learning the levers of power.
Jeremy
@catclub: Good for him. It’s great that he is being more proactive on the legislative front and it seems like he learned some lessons from his first stint in congress.
Kay
@beltane:
Right. I agree with that, too. I’ve only gone twice, once for my sister and once for my son, I’ve been lucky enough to personally avoid that the vast majority of the time. But I didn’t mind at all going to Ann Arbor and Cleveland (respectively) because it makes sense to me that they’d be located there. We don’t need a giant fancy facility every 20 miles.
I do think it’s probably accurate that rural generalists might not refer so often, because it’s both inconvenient for patients and patients don’t expect “a specialist”.
I actually just went to a nurse practitioner for a minor condition that was turning into this big dramatic comic-tragedy because I wait too long for health issues to “go away” of their own accord, and she was great. I’m a terrible patient. I hate to go to the doctor. I’m completely open to a “front line” care approach.
Botsplainer
@Ted & Hellen:
No. He seems to be the sort of mostly nerdy jackass that was not cool enough to sit in the back of the class, but would sit in the middle and giggle at the sound and smell of his own farts.
Never had a problem with the scream. I thought it was just some exuberance – the guy clearly felt it and believed in what he was doing.
Shakezula
@Kay: Yep, because the expense of running a practice in Chilicothe is identical to the expense of running one in Cleveland.
Tossers.
As for ACOs being the savior of everything, I have to say that “the industry” is gradually emerging from the Fucking ACOs, who do they work? phase of things so I’m not sure how he can say this. Granted, the idea on paper is neat, but I could see it becoming another type of HMO if someone doesn’t stand over the various entities with a cattle prod.
jayjaybear
@Ted & Hellen: That would be a relevant response if I had posted that about Obama, specifically. I was commenting on Dean, specifically, and purity princesses, generally. I don’t think we’re disagreeing (which alarms me slightly, but what can you do?).
Just Some Fuckhead
FYI, I was never a Dean supporter so I won’t be smeared for his firebaggery or DLCism or Thirdwayism or whatever the hell is wrong with him now.
I was a Wes Clark guy in 2004. Wes Clark is The One True Liberal. After Obama, of course, Who always does the most left thing unless it isn’t possible or because of more important calculations that small-minded stupid people can’t understand or won’t understand because they want the President to fail because He’s black.
Omnes Omnibus
@Just Some Fuckhead: That was very helpful. You cleared up a shitload of confusion and we, if I may be permitted to speak for everyone, we are truly grateful for this contribution. Thank you. Sincerely, thank you.
Just Some Fuckhead
@Omnes Omnibus: I was an Obama guy as soon as it became clear Clark wasn’t running in 2008. Mrs. Fuckhead and I took the field of candidates one by one and charted their positions, strengths and weaknesses. We saw Obama’s speech at the Jefferson Jackson dinner on Youtube and we were completely blown away.
Ted & Hellen
@Eric U.:
Would feel guilty installing it here
Why?
Cassidy
Wow. Looks like I missed a day of Sandusky & Ramirez stating his epic like for pie.
Omnes Omnibus
@Just Some Fuckhead: Sadly, I started out an Edwards guy and switched to Obama when it became obvious that Edwards was going nowhere.
Zifnab
@Ted & Hellen: Why can’t you just have a friendly conversation T&H? Why the hostility?
Steeplejack (tablet)
@Joel:
In the “It’s Steve” thread:
Just Some Fuckhead
@Omnes Omnibus: And you call yourself an Obot? You should be ashamed you weren’t more loyal when it really mattered.
taylormattd
@Just Some Fuckhead: I crack up every time you write “Mrs. Fuckhead”.
Redshirt
@Steeplejack (tablet): When Internet Historians look back at Balloon Juice, they will note that it was the “It’s Steve” thread which led, ultimately, to the destruction of the blog.
Joey Giraud
I rather enjoy Ted and Hellen doing his Mohammed Ali dance of rhetorical skill around the clay-footed chorus, who are clearly outclassed in the wit department.
But nothing like a classic troll, IMHO. There are real points to be had, for those not consumed with antagonistic rage.
And pies are for pussies.
mclaren
Howard Dean needed to get paid, Bill Clinton needed to get laid. To-may-to, to-mah-to.
In either case better than [fill in the name of generic Republican politician] who needed to get gayed. In a sleazy hotel room while smoking some crystal meth. And sponsoring a new law against gay marriage.