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Re: “Healthcare reform passes, political headaches begin

You wrote: "Such bottom-line concerns are utterly consistent with what Altmire has been saying since last summer. Say what you want, the guy didn't flip-flop. (Of course, that's partly because you can't flip-flop unless you first take a position one way or the other.)"

How is supporting the payment adjustments to Medicare Advantage plans last summer, thus saving the Medicare program $170 billion over the next decade -- talk about "bringing down the cost of health care" ! - and then NOT supporting the payment adjustments to Medicare Advantage, anything but flip-flopping?

Remember, one of the deciding factors on his NO vote was the "cuts" to Medicare beneficiaries in the district. He's talking about Medicare Advantage there, conveniently leaving out the donut hole relief they'll receive very soon.

Another way of saying Medicare Advantage cuts is "reductions in the over-payments to the likes of the Highmark and UPMC's Medicare Advantage insurance products," both of which will now have a business decision to make about how to adjust to getting only 100% of the average fee-for-service beneficiary, instead of 14% more. I don't know if you or anyone else reading this has access to the New Republic, but back when it was still a fairly important outlet in the mid-90s Matthew Miller wrote an interesting piece on the Medicare managed care model from a business perspective (what later became Medicare Advantage). Called the whole thing an arbitrage opportunity. Dig it up!

I could put all kinds of academic references in here, but it might get even more tedious (did I mention I wrote my dissertation on this stuff at USC in '98?). Here's a more recent (August '09) LA Times article on the topic that covers a lot: http://articles.latimes.com/2009/aug/19/nation/na-medicare19?pg=2

But the issue you're missing here is Altmire claiming to be a health policy expert while flip-flopping on the issue where there is almost uniform agreement regarding the necessary policy adjustment. It would be comical, if it wasn't so sad. He's making the baby health policy geeks weep.

So, you read "finesse" in that statement. Okay. But please report on how most of his grassroots has evaporated in the mean old PA-04.

I wouldn't buy the conventional wisdom that he got a pass from leadership on this one. You really think Obama the Organizer in Chief's three conversations with him ended with letting him off the hook? You think they believe it's a good idea to have their favorite in-house "expert" going off the reservation to some epistemological wilderness and scaring the old folks in the 'Burgh? No way Jose.

Posted by GeroAmericano on 03/22/2010 at 11:22 PM

Re: “Social media snowballing in winter weather

That "Howsmystreet" site really amplifies the digital divide, as though the streets across Penn Avenue were free and clear. I delivered Meals on Wheels in Lincoln-Larimer yesterday and it was tough sledding, even for a 4-wheel drive.

Posted by GeroAmericano on 02/12/2010 at 8:36 AM

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