Wall Street Journal - The Liberal Reckoning of 2010

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    Jan 01, 2011 6:00 PM GMT
    Wall Street Journal, Opinion Section, December 31, 2010
    The Liberal Reckoning of 2010 - The year voters saw the left's unvarnished agenda and said no.

    http://online.wsj.com/article/SB10001424052748703909904576051803529108190.html?mod=WSJ_Opinion_LEADTop

    Senate Majority Leader Harry Reid sent out a press release last week headlined "111th Congress Accomplishments." It quoted a couple of Democratic Party cheerleaders calling this the greatest Congress since 1965-66 (Norm Ornstein) or even the New Deal (David Leonhardt), and listed in capital letters no fewer than 30 legislative triumphs: Health Care Reform, the American Recovery and Reinvestment Act, a Jobs Package (HIRE Act), the Lilly Ledbetter Fair Pay Act, Food Safety, the Travel Promotion Act, Student Loan Reform, Hate Crimes Prevention, and so much more.

    What the release did not mention is the loss of 63 House and six Senate seats, and a mid-December Gallup poll approval rating of 13%. Never has a Congress done so much and been so despised for it.

    While this may appear to be a contradiction, it is no accident or even much of a surprise. The liberal wing of the Democratic Party had been waiting since the 1960s for its next great political opening, as we warned in an October 17, 2008 editorial, "A Liberal Supermajority." Critics and some of our readers scored us at the time for exaggerating, but in retrospect we understated the willful nature of that majority.

    Democrats achieved 60 Senate votes by an historical accident of prosecutorial abuse (Ted Stevens), a stolen election (Al Franken) and a betrayal (Arlen Specter). They then attempted to do nearly everything we expected, regardless of public opinion, and they only stopped because the clock ran out.

    The real story of 2010 is that the voters were finally able to see and judge this liberal agenda in its unvarnished form. For once, there was no Republican President to muddle the message or divide the accountability. The public was able to compare the promise of 8% unemployment if the government spent $812 billion on "stimulus" with the 9.8% jobless result. They stood athwart liberal history in the making and said, "Stop."

    Note well, however, that the Democrats still standing on Capitol Hill remain unchastened. In her exit interviews, Speaker Nancy Pelosi has said she would do it all the same way again, and her colleagues have seconded her lack of remorse by keeping her as their leader despite their November thumping. Her consolation to defeated Democrats was not to invite them to the House caucus meeting when she denounced President Obama's tax deal with Republicans.

    Note, too, that the organized left and its media allies are also beginning to rewrite the story of the 111th Congress as an historical triumph. The same people who claimed that ObamaCare was a defeat because it lacked a public option are suddenly noting it will put 32 million more Americans on the government health-care dole. It won't be long before liberals and the press are defending the 111th Congress's every achievement as historic.

    There is a lesson here both about modern liberalism and for Republicans who will soon have more power in Congress. For today's left, the main goal of politics is not to respond to public opinion. The goal is to impose the dream of an egalitarian entitlement state whether the public likes it or not. Sooner or later, they figure, the anger will subside and Americans will come to like the cozy confines of the cradle-to-grave welfare state.

    This is the great Democratic bet with ObamaCare. The assumption is that once the benefits start to flow in 2013 the constituency for "free" health care will grow. As spending and deficits climb, the pressure for higher taxes will become inexorable and the GOP will splinter into its balanced budget and antitax wings. A value-added tax or some other money-machine will pass and guarantee that the government will control 40% to 50% of all economic resources.

    If the price of this bet was losing control of the House for a moment in time in 2010, Mrs. Pelosi's view is so be it. You have to break a few Blue Dog careers to build a European welfare state. Liberals figure that as long as President Obama can be re-elected in 2012, their gamble will pay off and the legacy of the 111th Congress will be secure. The cheerleaders will write books about it.

    The lesson for Republicans is to understand the nature of their political opponents and this long-term bet. The GOP can achieve all kinds of victories in the next two years, and some of them will be important for economic growth. But the main chance is ObamaCare, which will fundamentally change the balance of power between government and individuals if it is not repealed or replaced.

    While repeal will no doubt founder in the Senate in the next two years, Republicans can still use their House platform to frame the debate for 2012. They can hold hearings to educate the public about rising insurance costs and other nasty ObamaCare consequences. And they can use the power of the purse to undermine its implementation.

    ***

    The difference between the work of the 111th Congress and that of either the Great Society or New Deal is that the latter were bipartisan and in the main popular. This Congress's handiwork is profoundly unpopular and should become more so as its effects become manifest. In 2010, Americans saw liberalism in the raw and rejected it. The challenge for Republicans is to repair the damage before it becomes permanent.
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    Jan 01, 2011 6:10 PM GMT
    The "damage" was inflicted by the GOP...and we ARE repairing it.

    Thanks!
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    Jan 01, 2011 6:11 PM GMT
    OtterJoq saidThe "damage" was inflicted by the GOP...and we ARE repairing it.

    Thanks!

    Delusion at its most typical form. You and your very small radical brethren have been uncovered by the public. Get used to it. All your rewriting of history won't matter because you are the only ones who believe it.
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    Jan 01, 2011 6:46 PM GMT
    Demographics and near-term economics have and will dictate voting patterns. For example, younger voters did not turn out like they did in 2008, which is one major reason the Democrats did so poorly. In fact, this demographic imbalance is going to be exacerbated in the coming years:

    20110101_usc835.gif


    http://www.economist.com/node/17800237
    In recent years the elderly have become a more distinctive voting block. People over 65 increasingly identify themselves as conservative and vote Republican, while young voters do the opposite, according to Andrew Kohut of the Pew Research Centre. The pattern was particularly striking in the last mid-term elections (see chart 2), when Republicans’ share of the over-65 vote exceeded the Democrats’ by a whopping 21 percentage points. For those under 25 the shares were reversed.

    This may reflect a “cohort effect”, the notion that a person’s lifelong voting habits are established early on. Charlie Cook, a political analyst, says today’s retired were shaped by the perceived failure of Jimmy Carter in the late 1970s and the success of Ronald Reagan in the 1980s. In 2008 some may also have identified more with the 72-year-old John McCain than the 47-year-old Mr Obama.

    But it was the result of the 2010 mid-term elections that most clearly revealed entitlements as a driving political force. Andrea Campbell of the Massachusetts Institute of Technology believes it was the creation of Social Security in the 1930s and Medicare in the 1960s that transformed the elderly into the most politically engaged age group in America. Ever more comfortable in retirement, they had the time and the means to follow politics and an issue to motivate them. But threats to the programmes seldom seemed significant or imminent. That may have changed in 2010 with Mr Obama’s health-care reform.

    The president sought to insulate the elderly from any bad effects. While workers with employer-provided insurance will have their tax benefits curtailed and the affluent will pay Medicare tax on their investment income, the elderly got an immediate expansion of their Medicare drug coverage. In spite of that they remained, as they had begun, staunchly opposed to Mr Obama’s reform. “They already have national health care,” Ms Campbell explains, “and can’t imagine extending coverage to 16% of the population without a hit to their benefits.”

    Republicans made hay with this. In August 2009 Sarah Palin falsely claimed that government “death panels” would decide who received health care. Republican senators targeted the Independent Payment Advisory Board, an expert panel created under the new law to recommend changes to Medicare coverage. Last July they accused it of threatening “access to quality care for seniors”—while at the same time, perversely, they attacked the health bill’s failure to rein in “skyrocketing costs”.


    Some of the more popular parts of the ACA have just started this year (free 2x/year physicals for Medicare patients, decreasing of the donut hole).

    Best thing the president and the Democrats can do is to allow the House Republicans to try to cut Medicare and SS benefits.
  • rnch

    Posts: 11524

    Jan 01, 2011 6:54 PM GMT
    socalfitness said
    OtterJoq saidThe "damage" was inflicted by the GOP...and we ARE repairing it.

    Thanks!

    Delusion at its most typical form. You and your very small radical brethren have been uncovered by the public. Get used to it. All your rewriting of history won't matter because you are the only ones who believe it.


    Laud, Laud! talk about "delusion" at the deepest possible roots! icon_sad.gif



    "there are none so blind as those who refuse to see....."--Ray Stevens, "Everything is Beautifull", 1971.
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    Jan 01, 2011 7:11 PM GMT
    socalfitness said
    OtterJoq saidThe "damage" was inflicted by the GOP...and we ARE repairing it.

    Thanks!

    Delusion at its most typical form. You and your very small radical brethren have been uncovered by the public. Get used to it. All your rewriting of history won't matter because you are the only ones who believe it.


    "very small radical brethren?" Oooh! Like a roving band of progressive Keebler elves? SCARY.

    We don't need to rewrite history. Facts are facts. Like this one: We have Obama. You have GWB. Hurts, don't it? icon_wink.gif
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    Jan 01, 2011 7:14 PM GMT
    OtterJoq saidWe don't need to rewrite history. Facts are facts. Like this one: We have Obama. You have GWB. Hurts, don't it? icon_wink.gif
    I would take GWB over Obama any day. Class, character, and integrity for starters.

    31 Aug 10 - Ohio voters prefer Bush over Obama 50-41 pct. But the argument going forward is not about Bush, even though the libs would like to frame the debate that way.
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    Jan 01, 2011 7:23 PM GMT
    southbeach1500 said
    socalfitness said You and your very small radical brethren have been uncovered by the public.


    You mean "very small numbers of radical brethren" yes?

    In the overall population, yes, that is correct.

    Here on RJ, though, nothing could be farther from the truth. Radical liberalism is alive and well (and embraced by the majority) here on RJ.

    But so be it.... by the time the massive income taxes kick in on everyone by mid-decade, I hope to be retired and no longer having to fork over the fruits of my labor. It's the radical RJ liberals and the younger RJ members (the true victims) that will be slaves to the Federal government because of what this Congress has done over the past two years.

    Agree, but even on RJ there is more evidence that younger guys are seeing the light. There are increasing numbers who do not post in these political threads, but have identified themselves as supporting fiscal conservative positions. They are beginning to realize how much the libs want them to fork over for others' health care costs, among other stagnating effects of socialist policies.
  • rnch

    Posts: 11524

    Jan 01, 2011 7:24 PM GMT
    socalfitness said
    OtterJoq saidWe don't need to rewrite history. Facts are facts. Like this one: We have Obama. You have GWB. Hurts, don't it? icon_wink.gif
    I would take GWB over Obama any day. Class, character, and integrity for starters....


    i refer you (and all RJ brothers) to my above thread reply.


    sf, with this reply, you lost and/all credibility you had with me.
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    Jan 01, 2011 7:44 PM GMT
    Typical WSJ automasturbatory bloviation.
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    Jan 01, 2011 8:05 PM GMT
    socalfitness said
    OtterJoq saidWe don't need to rewrite history. Facts are facts. Like this one: We have Obama. You have GWB. Hurts, don't it? icon_wink.gif
    I would take GWB over Obama any day. Class, character, and integrity for starters.

    31 Aug 10 - Ohio voters prefer Bush over Obama 50-41 pct. But the argument going forward is not about Bush, even though the libs would like to frame the debate that way.

    Funniest post ever! Thanks for starting my year with a laugh. An AWOL dry-drunk election thief has integrity?
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    Jan 01, 2011 8:42 PM GMT
    socalfitness said
    OtterJoq saidThe "damage" was inflicted by the GOP...and we ARE repairing it.

    Thanks!

    Delusion at its most typical form. You and your very small radical brethren have been uncovered by the public. Get used to it. All your rewriting of history won't matter because you are the only ones who believe it.



    Excuse me but your the best example of the very black Pot, doing its best to claim the Kettle is Blacker. You repubs over the last decade went to previously unheard of levels to rewrite history, this time the rewrite was over Bush's lies to get us into war and his lies about how he conducted it with what was historically termed torture, and now even he takes credit for it.

    There recently was a list of about 8 major issues your repub. False News watchers who were around 70% more likely to believe untruths and False News as you know, has the same owner as the WSJ. Add to these media the false news spread by Limbaugh, Palin, Bachman, Ingraham, and multiple other radio personalities who further spread the False News of the republicans to influence the masses to vote against their own interests. So is it any wonder the truth about the accomplishments has been hard to find, and why so many voted against the Dems ?

    You truely are blinded by these influences like the Sheeple who follow Beck and his ilk, I'll bet your one of the ones who also believe that the recent FCC Net Neutrality ruling was bad for the publics free use of the internet, because Beck and Limbaugh told you so. My how Laughable it is to read your statements above, that come from your parroting these False News sources, while they laugh all the way to the banks with their profits. Like grandma used to say, "would you jump off the bridge just because they told you to ??
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    Jan 01, 2011 9:44 PM GMT
    jprichva saidThe Wall Street Journal?
    Seriously?
    You mean "Fox News" in newsprint form?
    And anyone should care what they say or think?

    HAHAHHAHAHAHAHAHAHAHA


    Only anyone who cares about credible news...

    Seriously -- it's one of only a few newspapers that's implemented a sucessful online subscription model.

    The New York Times has tried, but has been unsucessful in impementing a profitable online subscription business.

    WSJ's readership tends to be upscale and highly educated. Although owned by NewsCorp, it's much above other outles such as Fox news or the New York Post.
  • Webster666

    Posts: 9217

    Jan 01, 2011 11:05 PM GMT
    The OP radical right wing Republican opinion piece is very amusing, because it's so full of shit.

    The ONE big mistake that Obama and the Democratic Congress made was not providing temporary Federal jobs to as many unemployed people as possible. That would have instantly put the country's economy on the road to a fast recovery.

    Instead, Obama farted around with trying to appease the Republicans and their Fascist agenda: a continuation of the exact same policies that got us into the George W. Bush Great Depression.
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    Jan 01, 2011 11:49 PM GMT
    Webster666 saidThe OP radical right wing Republican opinion piece is very amusing, because it's so full of shit.

    The ONE big mistake that Obama and the Democratic Congress made was not providing temporary Federal jobs to as many unemployed people as possible. That would have instantly put the country's economy on the road to a fast recovery.

    Instead, Obama farted around with trying to appease the Republicans and their Fascist agenda: a continuation of the exact same policies that got us into the George W. Bush Great Depression.

    Only full of shit if you're a radical left-winger socialist. And a big factor to the recession was the Democrats - Fannie, Freddie, Franklin Raines, Dodd, Obama, Frank, ACORN. And you might be interested in this reference that actually identifies fascism as a left-wing phenomenon.

    Liberal Fascism: The Secret History of the American Left, From Mussolini to the Politics of Meaning [Hardcover]
    Jonah Goldberg
    http://www.amazon.com/Liberal-Fascism-American-Mussolini-Politics/dp/0385511841/ref=sr_1_3?ie=UTF8&s=books&qid=1284589600&sr=8-3

    From Publishers Weekly
    In this provocative and well-researched book, Goldberg probes modern liberalism's spooky origins in early 20th-century fascist politics. With chapter titles such as Adolf Hitler: Man of the Left and Brave New Village: Hillary Clinton and the Meaning of Liberal Fascism—Goldberg argues that fascism has always been a phenomenon of the left. ...
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    Jan 02, 2011 12:33 AM GMT
    socalfitness said
    Webster666 saidThe OP radical right wing Republican opinion piece is very amusing, because it's so full of shit.

    The ONE big mistake that Obama and the Democratic Congress made was not providing temporary Federal jobs to as many unemployed people as possible. That would have instantly put the country's economy on the road to a fast recovery.

    Instead, Obama farted around with trying to appease the Republicans and their Fascist agenda: a continuation of the exact same policies that got us into the George W. Bush Great Depression.

    Only full of shit if you're a radical left-winger socialist. And a big factor to the recession was the Democrats - Fannie, Freddie, Franklin Raines, Dodd, Obama, Frank, ACORN. And you might be interested in this reference that actually identifies fascism as a left-wing phenomenon.

    Liberal Fascism: The Secret History of the American Left, From Mussolini to the Politics of Meaning [Hardcover]
    Jonah Goldberg
    http://www.amazon.com/Liberal-Fascism-American-Mussolini-Politics/dp/0385511841/ref=sr_1_3?ie=UTF8&s=books&qid=1284589600&sr=8-3

    From Publishers Weekly
    In this provocative and well-researched book, Goldberg probes modern liberalism's spooky origins in early 20th-century fascist politics. With chapter titles such as Adolf Hitler: Man of the Left and Brave New Village: Hillary Clinton and the Meaning of Liberal Fascism—Goldberg argues that fascism has always been a phenomenon of the left. ...


    OH MY GOD !!! You and Glen Beck been spiking that tea pretty heavy eh !!!! Do you seriously connect Hitler and fascist politics as does Beck with the progressive ideas and goals of Healthcare/education for all Americans ? If so your so far right your off the Beck Blackboard.
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    Jan 02, 2011 12:40 AM GMT
    http://www.ellensplace.net/fascism.html14 points of fascism:
    Any of this sound familiar?
    1. Powerful and continuing expressions of nationalism (Tea Party)
    2. Disdain for the importance of human rights (Guantanamo)
    3. Identification of enemies/scapegoats as a unifying cause (Islam, gays, evolution, abortion)
    4. The supremacy of the military/avid militarism ("cut anything but the military")
    5. Rampant sexism (including discrimination against gays)
    6. A controlled mass media (Fox anyone?)
    7. Obsession with national security (see 4. above)
    8. Religion and ruling elite tied together (C street)
    9. Power of corporations protected (Citizens United, tax loopholes)
    10. Power of labor suppressed or eliminated
    11. Disdain and suppression of intellectuals and the arts (National Endowment of the Arts among others)
    12. Obsession with crime and punishment (we have more people in prison than entire countries)
    13. Rampant cronyism and corruption (speaks for itself, the revolving door of lobbyists)
    14. Fraudulent elections (Bush vs. Gore)
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    Jan 02, 2011 12:44 AM GMT
    realifedad said
    socalfitness said
    Webster666 saidThe OP radical right wing Republican opinion piece is very amusing, because it's so full of shit.

    The ONE big mistake that Obama and the Democratic Congress made was not providing temporary Federal jobs to as many unemployed people as possible. That would have instantly put the country's economy on the road to a fast recovery.

    Instead, Obama farted around with trying to appease the Republicans and their Fascist agenda: a continuation of the exact same policies that got us into the George W. Bush Great Depression.

    Only full of shit if you're a radical left-winger socialist. And a big factor to the recession was the Democrats - Fannie, Freddie, Franklin Raines, Dodd, Obama, Frank, ACORN. And you might be interested in this reference that actually identifies fascism as a left-wing phenomenon.

    Liberal Fascism: The Secret History of the American Left, From Mussolini to the Politics of Meaning [Hardcover]
    Jonah Goldberg
    http://www.amazon.com/Liberal-Fascism-American-Mussolini-Politics/dp/0385511841/ref=sr_1_3?ie=UTF8&s=books&qid=1284589600&sr=8-3

    From Publishers Weekly
    In this provocative and well-researched book, Goldberg probes modern liberalism's spooky origins in early 20th-century fascist politics. With chapter titles such as Adolf Hitler: Man of the Left and Brave New Village: Hillary Clinton and the Meaning of Liberal Fascism—Goldberg argues that fascism has always been a phenomenon of the left. ...


    OH MY GOD !!! You and Glen Beck been spiking that tea pretty heavy eh !!!! Do you seriously connect Hitler and fascist politics as does Beck with the progressive ideas and goals of Healthcare/education for all Americans ? If so your so far right your off the Beck Blackboard.

    I haven't seen Beck discuss the subject, but I do get some of my information from books. From past discussions, I recall you aren't willing to do any similar research, and your attempt at debating reflects that.
  • musclmed

    Posts: 3274

    Jan 02, 2011 1:00 AM GMT
    q1w2e3 saidDemographics and near-term economics have and will dictate voting patterns. For example, younger voters did not turn out like they did in 2008, which is one major reason the Democrats did so poorly. In fact, this demographic imbalance is going to be exacerbated in the coming years:



    http://www.economist.com/node/17800237
    In recent years the elderly have become a more distinctive voting block. People over 65 increasingly identify themselves as conservative and vote Republican, while young voters do the opposite, according to Andrew Kohut of the Pew Research Centre. The pattern was particularly striking in the last mid-term elections (see chart 2), when Republicans’ share of the over-65 vote exceeded the Democrats’ by a whopping 21 percentage points. For those under 25 the shares were reversed.


    The president sought to insulate the elderly from any bad effects. While workers with employer-provided insurance will have their tax benefits curtailed and the affluent will pay Medicare tax on their investment income, the elderly got an immediate expansion of their Medicare drug coverage. In spite of that they remained, as they had begun, staunchly opposed to Mr Obama’s reform. “They already have national health care,” Ms Campbell explains, “and can’t imagine extending coverage to 16% of the population without a hit to their benefits.”

    Republicans made hay with this. In August 2009 Sarah Palin falsely claimed that government “death panels” would decide who received health care. Republican senators targeted the Independent Payment Advisory Board, an expert panel created under the new law to recommend changes to Medicare coverage. Last July they accused it of threatening “access to quality care for seniors”—while at the same time, perversely, they attacked the health bill’s failure to rein in “skyrocketing costs”.


    Some of the more popular parts of the ACA have just started this year (free 2x/year physicals for Medicare patients, decreasing of the donut hole).

    Best thing the president and the Democrats can do is to allow the House Republicans to try to cut Medicare and SS benefits.


    Yes. totally I agree the reason for the 2010 election was that young people just didnt get the email right?? Yep....
    It wasnt a repudiation of the policies and a rejection of the so called " open congress" of the 111th congress. ( very few bills run out of committee)

    BTW Seniors also just dont know how good it will be right? They are BRAINWASHED.

    Right now, Medicare needs a almost yearly "DOC FIX" because it is rigged to look solvent, it says that medical costs and pay to doctors should be LESS in the future. Makes sense right? Its the reason doctors who take medicare are decreasing, not increasing.

    one the physical is 1x a year. ( not 2x a year)

    2) On paper is nice, but very few of my colleagues use the Welcome to medicare code. Why? It pays LESS than a problem focused visit.

    They tell the Senior, you get a freebie, look how good Obamas healthcare is, its worthless, because WELLNESS means preventive physical. Not a followup or new problem. Medicare will deny this code if it is used that way. So its a sham.
    Very few Seniors are problem free. Its own guidelines say with an arcane algorithm that if a certain level of medical decision making is met it goes to a problem focused exam and the SENIOR then pays 20% * usual medicare amount if they dont have Secondary Insurance.

    So less doctors taking medicare, very few if any will use that code because it pays LESS / encounter. And the tendency will be for patients to load up and try to come with 10 problems 1x a year ( they dont have to pay the 20% for this visit. BUT MEDICARES OWN GUIDELINES CONVERTS IT TO A PAYING VISIT ONCE CERTAIN PROBLEMS AS A NEW PROBLEM EXIST.
    Simply there is no alchemy here. Unless you can turn lead to gold anyone who knows medical billing knows this is garbage. Because maybe few to any seniors who would need to get a visit once a year for wellness lack medical problems.
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    Jan 02, 2011 1:07 AM GMT
    Sorry, 1x physical per year. But free colonoscopies and mammograms and bone density tests and nutritional counseling! 50% cut in donut hole for nongenerics!
    And most of all, now 80-85% of non-Medicare insurance premiums are used for "medical" care!
    http://www.washingtonpost.com/wp-dyn/content/article/2010/12/31/AR2010123103189.html

    Well, if you're the GP with the free physical, you're always welcome to schedule the patient back for another problem oriented follow up visit. icon_razz.gif
  • musclmed

    Posts: 3274

    Jan 02, 2011 1:51 AM GMT
    q1w2e3 saidSorry, 1x physical per year. But free colonoscopies and mammograms and bone density tests and nutritional counseling! 50% cut in donut hole for nongenerics!
    And most of all, now 80-85% of non-Medicare insurance premiums are used for "medical" care!
    http://www.washingtonpost.com/wp-dyn/content/article/2010/12/31/AR2010123103189.html

    Well, if you're the GP with the free physical, you're always welcome to schedule the patient back for another problem oriented follow up visit. icon_razz.gif


    Uh because the washington post didnt actually read the guidelines as written.

    you can schedule whatever you want. It gets billed based on medical decision making.

    Since as it sounds you dont practice medicine, you can just say come back and we can address your new hypertension.

    Of course we can always schedule followups. Simply the "health care act" is telling seniors they are getting something more. But in fact its window dressing.
    Less Docs take medicare, no one will use the code as patients would like. A free doctor visit.

    Colonoscopies well, provided you can do it out of the hospital. And of course if the gastroenterologist takes Medicare. Depending on the area of the country there is no glut of Gastreoentrologist. So again you end up paying as non medicare provider, and as far as I know the coverage is ONLY FOR MEDICARE PROVIDERS. So you cant even pay out of network and get reimbursed as other insurance companies. This is foolishly designed to keep doctors within medicare, but is having the opposite effect.
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    Jan 02, 2011 2:00 AM GMT
    I'm sorry for your billing burdens. In my part of the country the GPs usually use 1 of the Welcome to Medicare exams (at least the ones I know of) and ask the patient to come back for a separate followup exam if a problem is detected. It's not called Welcome to Medicare for nothing (it's supposed to be the first visit when you enroll in Medicare, even though some people don't take advantage of that).

    Anyway, you know more than I do about billing. That's why I chose to go into a specialty where things are a little simpler. And yes, I depend primarily on Medicare (you should be able to guess what specialty I'm in).

    And may I remind you that Medicare has just increased the payments for internal medicine and family practice, at the expense of specialties like radiology and invasive cardiology?
  • musclmed

    Posts: 3274

    Jan 02, 2011 2:13 AM GMT
    q1w2e3 saidI'm sorry for your billing burdens. In my part of the country the GPs usually use 1 of the Welcome to Medicare exams (at least the ones I know of) and ask the patient to come back for a separate followup exam if a problem is detected. It's not called Welcome to Medicare for nothing (it's supposed to be the first visit when you enroll in Medicare, even though some people don't take advantage of that).

    Anyway, you know more than I do about billing. That's why I chose to go into a specialty where things are a little simpler. And yes, I depend primarily on Medicare (you should be able to guess what specialty I'm in).

    And may I remind you that Medicare has just increased the payments for internal medicine and family practice, at the expense of specialties like radiology and invasive cardiology?


    well medicare billing isnt simple at all so im stumped on your question.
    If its Geriatrics. Ill pray for you.

    And i practice in a area where the majority of the chronic patients are covered by medicare after 2 years and are indigent for the most part. See if you can guess that one.

    And my thoughts on the topic are not self serving. No one is making money on Medicare ( docs anyway)
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    Jan 02, 2011 2:18 AM GMT
    And I think your statement regarding that problem focused visit pays more than the IPPE is wrong:

    http://www.acponline.org/running_practice/practice_management/payment_coding/medicare/changes2010/feeschedule.htmCMS increased the work RVU assigned to the code that describes the Initial Preventive Physician Exam, also known as the "Welcome to Medicare" exam since it must be furnished with a year of when a beneficiary enrolls in Part B to be covered. CMS increased the work RVU from 1.34 to 2.30. This will increase the Medicare payment for the Welcome to Medicare exam significantly beginning in 2010. The CMS-assigned 2.30 work RVU is equal to the work RVU assigned to CPT 99204, Evaluation and management new patient, office or other outpatient visit. CMS determined that the intensity and effort associated with the Welcome to Medicare exam is equal to this moderate-to-high-level new patient office visit service.


    For comparison, RVUs for 99213 is 1.82 and 99212 is 1.08 (you did say "problem-focused," right? So you're not billing for a 99214, which is 2.73)

    If it's a new patient, 99202 is 1.87, 99203 (expanded problem-focused) is 2.71.
    [url]http://www.codapedia.com/templates/Codapedia/resources/455/EM%20RVU%202010.pdf[/url]

    I.e. IPPE>99213>99212
    99203>IPPE>99202

    Maybe you should think about using the IPPE code next time instead of the problem-focused code. icon_razz.gif

    I feel for GP's, really I do. For the amount of work they do, they really have to master Medicare billing to survive. Whereas, my specialty colleagues always bill a level 4 or 5 followup even though it's not that involved in my field, whereas I always bill to a level 3 or 4 at the most, unless I spend the requisite time. Now that might change with our new auto-billing EMR...when I'll be forced to bill more. icon_cry.gif
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    Jan 02, 2011 2:22 AM GMT
    musclmed said ...And my thoughts on the topic are not self serving. No one is making money on Medicare ( docs anyway)

    Thanks for providing an intelligent and practical discussion of the topic. Based on discussions with medical friends in different parts of the country, your assessment of fewer doctors taking medicare patients is right on. But isn't that really part of the plan to restrict medical services for seniors and redirect the services to more reliable voters for the Democrats?