Squeezing Hospitals Vs Squeezing Doctors III
ACA misinformation. Just for schadenfreude read Ezra Klein on Peggy Noonan on the ACA. Ouch that has to leave a mark. If Noonan were capable of shame, she should would just shut up forever and a pony.
Wonkblog is affordable care act (aka ACA aka Obamacare) anti-missinformation central. Unfortunately, right there at wonkblog, Dylan Matthews links to this fun survey of leading economists (with a feature which says which leading economist the respondent is most like). I was having fun till I got to question 28 which enraged one of the bees in my bonnet (see part II of this series)
The premise of question 28 is highly misleading. The question presents changes in Medicare compensation of hospitals and doctors symmetrically. The premise is not flat out totally false (at say the Peggy Noonan level) because the ACA will affect compensation of doctors (especially hospital house staff). However, the law treats hospitals nursing homes and home health care agencies (Medicare Plan A) and office practices (Medicare plan B) completely differently. This is fundamentally important, because physicians with office practices can and do refuse Medicare patients. In contrast all hospitals obey CMS dictates. One or two might opt out (I am thinking of the Mayo clinic and adding “or two” from an abundance of caution). Deleting the distinction between payments for physicianss services”and other Medicare payments is part of a long standing right wing hack strategy to mislead people about the ACA.
The Booth School (and Chris Said and, sadly, Dylan Matthews) have fallen for a right wing myth.
Importantly, the conflation of the extreme severe squeezing of hospitals nursing homes and home health care agencies (which can and will be squeezed but which will do fine because of the huge increase in insured patients) and a totally mythical nonexistent effort to squeeze doctors with office practices is a major factor in creating confusion and nonsense about Obamacare.
Liking to the survey, you should have noted that the premise to question 28 is highly misleading. Objecting to Peggy Noonan incorrectly describing home health care in Oregon and letting question 28 pass without flagging the highly misleading premise is swallowing an elephant and choking on a gnat.
I have another problem with question 28 (and others). Note the word “may”. “might” makes right and “may” means an extremely unlikely claim is okay. The ACA may lead to an alien invasion. This is not very likely, but the probability isn’t exactly precisely zero.
Given the first amendment questionaire writers may use “may” but they may burn in hell as a result of the asault against truth (I note that I consider it a billion times more likely that they go to limbo and a trillion times more likely that they end up stung by insects chasing the banderuolo in the vestibolo degli ignavi and also a quadrillion times because I am irrational and my subjective probability that any of those places exist is 0)
the supply of doctors who decline to offer services at Medicare rates may not decline when those doctors decide they would rather have the money after all. it’s called the free market, oddly enough.
Most government programs overspend and under-perform, but then the left was never about economic efficiency…
Sorry Robert, but many ACA activities, particularly bundling, will impact both hospitals and private practice physicians.
Yes, Part A and Part B are separate and distinct, but ACA is moving the two closer together indirectly (ACOs) and directly (bundling).
As to Klein versus Noonan, neither known enough to be exactly accurate about these issues. I’ll give the win to Klein though, as speechwriters are not good with technical discussions.
And question #28 is really clumsy, bad question.