Howard Dean Attacks Important Piece Of Obamacare (updated 3x)

[ProSense]

Last edited Mon Jul 29, 2013, 07:18 PM - Edit history (2)

Howard Dean Attacks Important Piece Of Obamacare

In a Wall Street Journal op-ed Monday, Howard Dean calls for the repeal of an important piece of Obamacare -- the board set up by the law to contain Medicare costs at a certain level.

The Independent Payment Advisory Board, set to take effect in 2015, is tasked with cutting reimbursements to health providers if Medicare costs per patient in a given year exceed per-capita GDP plus one percent. Although it's a key cost-control mechanism, IPAB is not essential to the functioning of Obamacare.

"The IPAB is essentially a health-care rationing body," Dean writes. "There does have to be control of costs in our health-care system. However, rate setting—the essential mechanism of the IPAB—has a 40-year track record of failure."

A former governor, Democratic National Committee chair and 2004 presidential candidate, Dean is now a senior strategic adviser and consultant on health care and energy issues for the lobbying firm McKenna Long & Aldridge LLP, which has some health provider clients.

- more -

http://livewire.talkingpointsmemo.com/entry/howard-dean-attacks-important-piece-of-obamacare

Oh my, Dean attacks "death panels." Any thoughts on the issue?

Why Sarah Palin Is Still Wrong About ‘Death Panels’
http://thinkprogress.org/health/2010/12/10/171830/death-panel-palin/

Rep. Renee Elmers Revives ‘Death Panel’ Lie: IPAB Will Make Coverage Decisions On Case By Case Basis
http://thinkprogress.org/health/2011/07/06/262114/rep-renee-elmers-revives-death-panel-lie-ipab-will-make-coverage-decisions-on-case-by-case-basis/

Health Care Cost Reform Rediscovers an Old Progressive Idea
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x8037705

Republican Leaders Refuse To Make Appointments To Key Obamacare Panel
http://tpmdc.talkingpointsmemo.com/2013/05/boehner-mcconnell-letter-obama-ipab-obamacare.php


Updated to add this from Dean's op-ed:

<...>

To date, 22 Democrats have joined Republicans in the House and Senate in support of legislation to do away with the IPAB. Yet because of the extraordinary partisanship on Capitol Hill and Republican threats to defund the law through the appropriations process, it is unlikely that any change in the Affordable Care Act will take place soon.

The IPAB will cause frustration to providers and patients alike, and it will fail to control costs. When, and if, the atmosphere on Capitol Hill improves and leadership becomes interested again in addressing real problems instead of posturing, getting rid of the IPAB is something Democrats and Republicans ought to agree on.

http://online.wsj.com/article/SB10001424127887324110404578628542498014414.html

Here are the bills and co-sponsors.

H.R.351 - Protecting Seniors' Access to Medicare Act of 2013
http://beta.congress.gov/bill/113th-congress/house-bill/351/cosponsors?pageSort=firstToLast&Political_Party=Democratic

House - 169 Republican and 21 Democratic co-sponsors. Democrats:

Rep. Schwartz, Allyson Y. [D-PA-13]*
Rep. Bishop, Timothy H. [D-NY-1]*
Rep. Christensen, Donna M. [D-VI-At Large]*
Rep. Courtney, Joe [D-CT-2]*
Rep. Sanchez, Linda T. [D-CA-38]*
Rep. Matheson, Jim [D-UT-4]*
Rep. Capuano, Michael E. [D-MA-7]
Rep. Pascrell, Bill, Jr. [D-NJ-9]
Rep. McIntyre, Mike [D-NC-7]
Rep. McCarthy, Carolyn [D-NY-4]
Rep. Ruiz, Raul [D-CA-36]
Rep. Maloney, Sean Patrick [D-NY-18]
Rep. Barrow, John [D-GA-12]
Rep. Negrete McLeod, Gloria [D-CA-35]
Rep. Maffei, Daniel B. [D-NY-24]
Rep. Scott, David [D-GA-13]
Rep. Sanchez, Loretta [D-CA-46]
Rep. Barber, Ron [D-AZ-2]
Rep. Lynch, Stephen F. [D-MA-8]
Rep. Sinema, Kyrsten [D-AZ-9]
Rep. Kirkpatrick, Ann [D-AZ-1]

S.351 - Protecting Seniors' Access to Medicare Act of 2013
http://beta.congress.gov/bill/113th-congress/senate-bill/351/cosponsors

Senate - 34 Republican and one Democratic co-sponsors.

Democrat: Sen. Pryor, Mark L.

All Dems Opposing Medicare Panel Have Major Industry Ties
http://www.motherjones.com/mojo/2011/04/all-dems-opposing-medicare-panel-have-major-industry-ties

Update 2:

Howard Dean's misplaced IPAB fight
http://maddowblog.msnbc.com/_news/2013/07/29/19758220-howard-deans-misplaced-ipab-fight

Update 3:

Howard Dean serves up IPABlum on Obamacare
http://www.dailykos.com/story/2013/07/29/1227496/-Howard-Dean-serves-up-IPABlum-on-Obamacare

[cali]

1. What the heck? You felt compelled to post this thing again?

Yikes.

[ProSense]

2. Because it's news, and a word in the other OP was detracting focus from the issue.

Why do you think it shouldn't be posted?

[PoliticAverse]

8. In other words your 'Dean screams "death panels"' comment backfired. n/t

[ProSense]

10. Evidently, now what are your thought on the issue? n/t

[Puzzledtraveller]

13. Makes you wonder doesn't it?

Professional posters, maybe they get paid by an outside consulting firm that employees people to post in message boards to persuade opinion or to keep a constant effort in place to legitimize and when necessary de legitimize opposition. Yes I know it's "tinfoil" of me but I do wonder.

[mattclearing]

14. That's not tinfoil. Astroturfing is an established messaging tactic. n/t

[mattclearing]

21. Also:

http://www.democraticunderground.com/10023358242

[Puzzledtraveller]

32. Very interesting

I had not seen this, thanks.

[ProSense]

27. "Professional posters, maybe they get paid by an outside consulting firm"

So you're saying that posting Howard Dean's op-ed means I'm a "paid" shill?

Why did Dean write it if it can't be posted anywhere without "tinfoil" popping up?

[zipplewrath]

45. Backwards

They probably already thought you were a paid shill. I just so happens that today was the day for posting about Dean's comments.

[ProSense]

47. "They probably already thought you were a paid shill."

"I just so happens that today was the day for posting about Dean's comments."

Yeah, but what are your thoughts on Dean's call to repeal the panel.

I mean, I really don't care if you or anyone else thinks calling me or anyone else a "paid shill" is cool or bolsters your progressive credentials. You can go on thinking that, announce it in every thread if it makes you feel better, but at least comment on the topic...or not.

I look forward to the next thread and the "paid shill" accusations.

[zipplewrath]

48. Hey, you asked the question

I just explained that you had the logic backwards.

[ProSense]

54. There is no "logic" to calling people "paid shills"

It's a cheap deflection tactic.

My comment was snarky and I didn't need your explanation. You likely knew that, but decided to offer it any way.

[zipplewrath]

57. Your logic

I was commenting on your logic, that tried to place the conclusion that you were a paid shill as a function of the OP.

By the way your comment was also a deflection tactic, trying to avoid the subject of whether you are a paid shill or not.

Oh, and I'm also glad to see you admit that you were snarky. Now, back to whether you are a paid shill.

[ProSense]

61. It was snark,

By the way your comment was also a deflection tactic, trying to avoid the subject of whether you are a paid shill or not.

Oh, and I'm also glad to see you admit that you were snarky. Now, back to whether you are a paid shill.

...and you're really not that clever. Again, I look forward to more of this from you in upcoming threads. Enjoy.

[kelliekat44]

133. Dean is only lobbying for whom he now works.

That Dean's employer has health care clients that stand to lose money from IPAB is a relevant detail that the Wall Street Journal's editorial board did not include for readers to consider. (In 2011, Salon asked the lobbying firm and Dean's office for a list of his clients. They both declined.)

[quinnox]

3. I would trust what Dean says on this

I'm not familiar with all the complexities of this area, but I think Dean knows what he is talking about when it comes to health care and the medical field, since he is a physician.

[Bunnahabhain]

7. What you say does not follow

Just because Dean is a physician does not mean he understands healthcare economics. However, he's right in this case. Tying together two such disparate things is stupid. What the metric of per capita GDP should have to do with Medicare payments is beyond me.

[cali]

11. Well, that combined with being Governor and that his main area of expertise

is health policy would indicate that he does indeed understand the economics of the field.

[Bunnahabhain]

15. Please read the statement I was responding to.

The sole criteria given was because Dean's a physician, now wasn't it? I find many people seem to think being a healthcare practitioner means they understand healthcare economics and nothing could be more remote from the truth 99.9% of the time. You will also note that I stated he was correct in this case.

[cali]

17. Don't you think most people here know that Dean was also Governor and

don't you think they know about his expertise? I believe they do and I think people tend to say he's Dr. as a shortcut.

[Bunnahabhain]

19. The poster said...

"...since he's a physician."

Have a nice day.

[cali]

24. lol. you too bunna.

ta ta

[Hoyt]

35. The biggest problem for me is that Dean (whom I like a bunch) is working for a lobbying/legal firm

McKenna Long, that represents a lot of hospitals, physicians, etc. Consequently, I now have to take his opinions about like I would the Hospital Association, sometimes right, but always biased.

[ProSense]

16. That is a mischaracterization of the panel. n/t

[Bunnahabhain]

18. Huh?

It says pretty clearly that payments shall be cut based on per capita GDP. How am I misrepresenting anything?

[ProSense]

22. That's

"It says pretty clearly that payments shall be cut based on per capita GDP. How am I misrepresenting anything?"

...not the point. It's to reduce inefficiencies, control costs and improve the quality of care. The notion that this is simply about cutting payments is where the "death panels."

This could help to significantly reduce drug prices, etc.

[Bunnahabhain]

26. You've confused me.

I agreed with Dean and said I think tying per capita GDP with rate cuts makes no sense. From there you infer I am misrepresenting the panel into some sort of Palin-esque bullshit? Umm, okay.

[ProSense]

29. I disagree with Dean's characterization. n/t

[Bunnahabhain]

31. Fair enough but my question is...

If part of the charge of the panel, as you said, is to improve quality of care and find efficiencies, will these recommendations be listened to? I tend to doubt this and would use as an example what happened when an expert panel made recommendations concerning breast cancer screening. Obama and Sebelius completely threw that panel of experts under the bus and ignored their advice. I was completely floored and thought it was a very Republican move to ignore science like that.

[ProSense]

37. Well

"If part of the charge of the panel, as you said, is to improve quality of care and find efficiencies, will these recommendations be listened to? I tend to doubt this and would use as an example what happened when an expert panel made recommendations concerning breast cancer screening. Obama and Sebelius completely threw that panel of experts under the bus and ignored their advice. I was completely floored and thought it was a very Republican move to ignore science like that."

...if no one is going listen to the recommendations, then what's the concern?

[Bunnahabhain]

42. Really?

The concern would be twofold. First wasting the time and money to have said panels make said recommendations and the second would be ignoring sound advice that would lead to both improved quality of care and saving scarce medical resources.

[ProSense]

44. Wait,

"The concern would be twofold. First wasting the time and money to have said panels make said recommendations and the second would be ignoring sound advice that would lead to both improved quality of care and saving scarce medical resources."

... how is offering "sound advice" wasting "time and money"?

I mean, concern that the "sound advice" would be ignored is not justification for repealing the panel.

[Bunnahabhain]

46. If it's offered but ignored

then it's a waste of money. The impact is zero yet the costs of acquisition of said advice were incurred, this the system is at a net negative. This is not apparent to you?

It also has other various collateral effects such as creating an anti-science attitude. It's bad enough the Republicans want to ignore science we really do not need the Dems to get that way too.

[ProSense]

49. You don't know if it will be ignored.

That's not a good reason to repeal the law. Good recommendations, "sound advice" needs to be presented. People can work on pushing elected officials to enact them. Happens all the time.

[Bunnahabhain]

50. I have relevant data points

that indicate politics will get in the way of big decisions. Yes, I cannot predict the future with 100% accuracy but I feel very safe in predicting that politicians, of all stripes, will want to get re-elected or be well thought of by their base for legacy if not up for re-election. I feel very confident this will tend to make decisions driven by politics and not science.

Btw, by "repeal the law" are you talking about the entire ACA or merely tweaking parts of it? I mean, it's not a binary situation here.

[Scuba]

4. Dean is right. Again. Improving the ACA is important work to be supported

[ProSense]

40. I don't think this is going to improve the bill.

In fact, this is a call for repealing an important provision that will strengthen Medicare.

[mattclearing]

5. Better.

I still think it's questionable to throw Dean in with Sarah Palin, and it's not clear to me that his complaint is in the same ballpark as "death panels," but at least this isn't a jab in the eye of Dean supporters masquerading as a policy dispute.

[think]

6. Universal healthcare would solve this problem...

[Mr. David]

9. And do you have a problem with Dr. Dean?

Who happens to be a doctor and knows EXACTLY what he is talking about?

Dr. Dean's right.

If he knows what's wrong with the rate setting, and has first-hand experience about it, then he doe have the right to attack the IPAB. He clearly says "IPAB is not essential to functioning of Obamacare" - and I happen to agree, and will back Dean 100% on this.

I certainly hope Dr. Dean decides to announce his candidacy in 2016. I know he is a centrist, but he is a true centrist that won't back down from stupid Republicans. I am ready to help him fill in the bat once again.

[tridim]

12. "Rate setting" now has a law behind it. The ACA.

Because of this the price of HEALTHCARE is going to fall very quickly after 2014.. The free ride is over for doctors, hospitals and insurers. No more collusion.

Competition is key, something we have never had in this country.

[Bunnahabhain]

23. The problem is

they are using a silly metric for said rate setting. Dean is completely correct here.

[Mr. David]

20. It's also clear to me that you are attempting to attack Howard Dean before he announces

and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.

No, it's still not going to happen. Dean is thinking about throwing his hat in 2016, and if he does announce, I will be happy to fill his bat once again.

He got screwed in 2004, and he won't be screwed again.

Had he not gotten screwed back then, Dean would have been ready to retire last year, paving the way to maybe a older and wiser Obama.

But now he's gotta move the Party back to the progressive side, and to do that, he has to pull the Party out of the right end of the spectrum first.

And that OP of yours is an failing attempt to destroy Dean. And you are comparing apples and oranges with Sarah Palin.

[ProSense]

25. WTF are you talking about?

I disagree with Dean's call for repealing part of the law.

Your CT is beyond bizarre.

[Mr. David]

92. I think Dean intends to repeal that part of the law to IMPROVE on Obamacare...

Not trash it.

There are more ways to improve Obamacare - and this happen to be one of them, and thanks for the CT designator. It just means you're a bully.

[ProSense]

96. The repeal

"I think Dean intends to repeal that part of the law to IMPROVE on Obamacare..."

...is being led by Republicans. Only one Senate Democrat, Mark Pryor, supports it.


"There are more ways to improve Obamacare - and this happen to be one of them, and thanks for the CT designator. It just means you're a bully."

That hilarious. You're calling me a "bully" for saying that this comment:

It's also clear to me that you are attempting to attack Howard Dean before he announces and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.

http://www.democraticunderground.com/10023364911#post20

...is a CT.

[Mr. David]

99. So far you're just bullying everyone who disagrees with you..

Downthread...

And being selective about it too. And just proving my "conspiracy theory" each time. Repeatedly.

[ProSense]

113. No, I'm responding to anyone discussing the OP topic, and find it bizarre

So far you're just bullying everyone who disagrees with you..

Downthread...

And being selective about it too. And just proving my "conspiracy theory" each time. Repeatedly.

...that you're name calling and pushing a CT throughout the thread, and then claiming that I am a "bully."

[Just Saying]

28. Maybe there's a better way to try to control costs?

I understand what the law is attempting to do but apparently Dr. Dean believes it's patients who will lose out and I'm sure that wasn't the intention.

I hate the term "death panels" as this was just a GOP talking point used against government involvement in healthcare when any rational person knows they already exist-in the insurance industry.

[leftstreet]

30. Is it primary season already?

Comparing Dean to Palin...so he's running then?

[PowerToThePeople]

33. I support Dean.

http://online.wsj.com/article/SB10001424127887324110404578628542498014414.html

The Op Ed that your livewire blurb quotes is much better. He is trying to do the right thing for the public. That is why I wanted him instead of Kerry. I still despise that the Dean scream smear campaign was successful.

[ProSense]

34. Fine, but I think he's wrong. n/t

[Bunnahabhain]

36. Part of the problem is counting on ACOs

to deliver. Your link, which is a good one, says:

Accountable Care Organizations could eliminate duplicative services and prevent medical errors while seeking to reduce costs for individuals, particularly if their creation ultimately leads to the end of fee-for-service medicine, as I believe it will.

The problem is the ACO concept, as currently designed, is failing. Of the 32 original pioneering ACOs, nine have already given up and I read something last week that another 14 are going to dissolve. The one I am involved in went from 0 to 100 mph and then 100 mph to 5 mph. Basically the initial enthusiasm is all gone and people are realizing what is at stake and the complexity of this system. IMO, the only good thing is an ACO is provider driven vs. being driven by insurance but even that is not completely true. The carrot and stick is still being held out by CMS, so at its root, the ACO mechanism is to punish organizations that do not adequately meet the metrics determined by CMS. I think involving providers in determining the metrics would be a more intelligent move as decision makers at CMS are often pretty removed from real life health care delivery.

Just IMO.

[ProSense]

38. You're against "Accountable Care Organizations"?

Those are among the best things in the health care law.

"The problem is the ACO concept, as currently designed, is failing. Of the 32 original pioneering ACOs, nine have already given up and I read something last week that another 14 are going to dissolve. The one I am involved in went from 0 to 100 mph and then 100 mph to 5 mph. Basically the initial enthusiasm is all gone and people are realizing what is at stake and the complexity of this system. IMO, the only good thing is an ACO is provider driven vs. being driven by insurance but even that is not completely true. The carrot and stick is still being held out by CMS, so at its root, the ACO mechanism is to punish organizations that do not adequately meet the metrics determined by CMS. I think involving providers in determining the metrics would be a more intelligent move as decision makers at CMS are often pretty removed from real life health care delivery. "

That is not accurate.

More Doctors, Hospitals Partner to Coordinate Care for People with Medicare

Providers Form 106 New Accountable Care Organizations

Doctors and health care providers have formed 106 new Accountable Care Organizations (ACOs) in Medicare, ensuring as many as 4 million Medicare beneficiaries now have access to high-quality, coordinated care across the United States, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.

Doctors and health care providers can establish Accountable Care Organizations in order to work together to provide higher-quality care to their patients. Since passage of the Affordable Care Act, more than 250 Accountable Care Organizations have been established. Beneficiaries using ACOs always have the freedom to choose doctors inside or outside of the ACO. Accountable Care Organizations share with Medicare any savings generated from lowering the growth in health care costs, while meeting standards for quality of care.

“Accountable Care Organizations save money for Medicare and deliver higher-quality care to people with Medicare,” said Secretary Sebelius. “Thanks to the Affordable Care Act, more doctors and hospitals are working together to give people with Medicare the high-quality care they expect and deserve.”

ACOs must meet quality standards to ensure that savings are achieved through improving care coordination and providing care that is appropriate, safe, and timely. The Centers for Medicare & Medicaid Services (CMS) has established 33 quality measures on care coordination and patient safety, appropriate use of preventive health services, improved care for at-risk populations, and patient and caregiver experience of care. Federal savings from this initiative could be up to $940 million over four years.

The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20 percent of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities.

The group announced today also includes 15 Advance Payment Model ACOs, physician-based or rural providers who would benefit from greater access to capital to invest in staff, electronic health record systems, or other infrastructure required to improve care coordination. Medicare will recoup advance payments over time through future shared savings. In addition to these ACOs, last year CMS launched the Pioneer ACO program for large provider groups able to take greater financial responsibility for the costs and care of their patients over time. In total, Medicare’s ACO partners will serve more than 4 million beneficiaries nationwide.

Also today HHS issued a new report showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth.

For more information on the HHS issue brief, “Growth in Medicare Spending per Beneficiary Continues to Hit Historic Lows,” visit: http://aspe.hhs.gov/health/reports/2013/medicarespendinggrowth/ib.cfm

Additional information about the Advance Payment Model is available at http://www.innovations.cms.gov/initiatives/ACO/Advance-Payment/index.html.

The next application period for organizations that wish to participate in the Shared Savings Program beginning in January 2014 is summer 2013. More information about the Shared Savings Program is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/index.html?redirect=/sharedsavingsprogram/

For a list of the 106 new ACOs announced today, visit: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/News.html

http://www.hhs.gov/news/press/2013pres/01/20130110a.html

[Bunnahabhain]

39. I can only report the facts.

and my personal experience. Nine of the original 32 ACOs are gone, I've read more are on the way. I can tell you my personal work experience. What I have said is accurate. Your choice whether to believe it or not.

As I said, they need tweaking. I am far from the only person that actually does this for a living saying that. You find it surprising that CMS want you to believe CMS got it right on the first try? Given the level of complexity does that even give you any pause? It's okay to say something is not working quite as intended and needs tweaking.

Feel free to share your personal experience too.

[ProSense]

41. Do you

"Nine of the original 32 ACOs are gone, I've read more are on the way. "

...have a link to this information?

[Bunnahabhain]

43. Of course.

http://www.healthcareitnews.com/news/pioneer-acos-endurance-game-many-fail

That's just one quick link. This info is all over the place in trade publications.

"Pioneer model’s benchmarks can move throughout the plan year," he wrote in an emailed statement. And that's like trying to get a bull's eye on a moving target. Because of how the benchmarks were set, Plus ACO is at risk of paying $6 million to $9 million in annual penalties.

The other eight saying sayonara to the Pioneer program include: Prime Care Medical Network; University of Michigan; Physician Health Partners; Healthcare Partners Nevada ACO; Healthcare Partners; California ACO; JSA Care Partners; and Presbyterian Healthcare Services.

For Denver-based Physician Health Partners – one of the nine groups dropping out of the Pioneer model but vowing to continue with a shared savings plan – the benchmark setting process within the Pioneer needed some serious re-working.

Considering there’s still significant tweaking going on with benchmarks, "We can’t take that much risk when the game keeps changing a little bit," Kenneth Nielsen, president and CEO of Physician Health Partners, told Healthcare IT News, especially when these adjustments aren’t geographically based. "The Denver market, where our benchmark was $8,000 per beneficiary, per year is a lot different than an East Coast market where their benchmark was twice that."

Notice the criticism was with the metrics, just as I said above.

[ProSense]

52. This is an

...article about financially-strapped organizations. That aspect has nothing to do with the effectiveness of the ACOs. In fact, the article mentions a number of ways in which they were effective in meeting the objectives.

For PHP, it wasn’t all bad news, however. They were able to decrease their readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasn’t viable. They reported shared losses for fiscal year one, which was anticipated, Nielsen says, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just weren’t able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "We’re between bleeding edge and cutting edge."

<...>

The good news, he points out, is that all of the ACOs did well from a reporting standpoint in terms of quality. Ten of the 32 also produced collective shared savings of $87.6 million last year.

Here's a similar article:

Blame ObamaCare
http://www.democraticunderground.com/10022780631

[Bunnahabhain]

59. If it's not financially viable for the participants

Do you expect them to continue participating?

[ProSense]

71. One of the articles you posted

"If it's not financially viable for the participants

Do you expect them to continue participating? "

...mentioned a letter to CMS explaining what can be done. The article goes on to say that the organization was determined to make the program work.

Not all programs are running into difficulty. See the HHS piece in my previous comment.

Will ACOs Pave the Path to Reform?

by David GornFriday, July 26, 2013

Accountable care organizations could be the linchpin of successful health care reform, according to experts at a forum last week in San Francisco.

"ACOs only take up seven pages in the uncountable number of pages in the Affordable Care Act but they are at the moment one of the fastest growing and most important elements of reform," said Wendy Everett, president of NEHI, previously known as the New England Health Institute, which sponsored the July 17 event in San Francisco.

"They're changing how health care is delivered and paid for in this country," Everett said, "and they're a vital and important part of what we're doing."

Everett said there are currently about 250 ACOs in the country, "with another 500 new groups that have submitted to be an ACO so far this year," she said.

- more -

http://www.californiahealthline.org/capitol-desk/2013/7/will-acos-pave-the-path-to-reform

[Bunnahabhain]

74. Straw man

I did not say "all programs are running into problems." Time to pull out the logical fallacies now, eh?

And you never answered my direct question: if an organization finds the ACO not to be financially viable for them do you expect them to continue participating?

I am completely unsure why you are so against modification of ACOs so they are a huge success. The two links I gave you clearly echoed the criticism from my real life experience namely that of metrics. Do you want the ACA to fail? I mean, what's your agenda here for fighting the concept that the first iteration of ACOs is not going to work and intelligent changes need to be made?

[ProSense]

77. LOL!

"I did not say 'all programs are running into problems.' Time to pull out the logical fallacies now, eh?"

I didn't say you did. In fact, no where in my comment does it say "all programs are running into problems."

I said in reference to the articles I posted that "not all programs are running into difficulty."

[Bunnahabhain]

79. I see you

Have a great day.

[Mojorabbit]

132. My husband is in one. Jury still out on how it will end up. nt

[Bunnahabhain]

51. Here is another link

that specifically deals with what I have said repeatedly; metrics.

http://aishealth.com/sites/all/files/marketplace_pdf_samples/abn0413.pdf

It also brings up the interesting issue of possible anti-trust situations. ACOs basically want to align into vertical market sharing groups and this could be an issue.

[ProSense]

53. Again, the article is about

asking for time to ramp up and financial support in the interim.

[Bunnahabhain]

56. You can lead a horse to water

but you can't make him think.

There is always room for improvement in my world. If we are not going to get single payer I want ACOs to be the best they can be...and they currently have problems as I have clearly demonstrated. Your choice to ignore the data I have so kindly shared (which is exactly what I'm have already predicted will happen, no? You're just proving that point for me.)

[ProSense]

58. Nothing

"There is always room for improvement in my world. If we are not going to get single payer I want ACOs to be the best they can be...and they currently have problems as I have clearly demonstrated. Your choice to ignore the data I have so kindly shared (which is exactly what I'm have already predicted will happen, no? You're just proving that point for me.)"

...I stated has anything to do with a "choice to ignore the data." In fact, I read the articles carefully, and they are about improving the ACOs, which was not the point of your first comment. These are new organizations implementing a new program. There will be adjustments and growing pains.

[Bunnahabhain]

62. And have I not repeatedly talked about improving ACOs?

I mean, you missed where I said that in almost every post I have made to you?

ACOs are not currently viable. They need improving.

Please feel free to share your relevant real life experience as I have. Otherwise, have a great day.

[ProSense]

67. "The problem is the ACO concept, as currently designed, is failing."

Your words, and you provided a couple of articles that have nothing to do with the "concept" or that it's "failing."

The articles you posted were about the struggles of financially-strapped organizations. Both articles show that the objectives were being met, but more time and funding are needed.

Given the short period of time these organizations have been in existence, I'd say that it's remarkable that they can show positive results.

[Bunnahabhain]

69. I have made progress

because you started off asking for proof nine of the original 32 ACOs are gone. Now I just have you rationalizing why they left so that is improvement.

And after repeated requests you have yet to share your relevant real life insight. Arm chair quarterbacks never want to believe what people actually in the trenches have to say. More proof for my prediction above.

[ProSense]

73. Well, you went from saying they're a "failing" concept to supporting them.

That's "progress" too.

[Bunnahabhain]

76. Nice misquote of what I said.

But hey, if that's what you need to do to continue supporting whatever it is you're supporting...more power to you.

[ProSense]

78. "The problem is the ACO concept, as currently designed, is failing."

You didn't say that?

[Bunnahabhain]

80. Of course I said that and but that is not what you claimed I said above

There is a huge difference between your initial misquote and what I actually said. Why are you playing such stupid games? I mean, do you think I have demonstrated such a low level of intelligence, reading comprehension, critical thought and actual real life experience that your silly games would confuse me?

Give it a rest. We all see what you're about.

[ProSense]

81. So you weren't saying the "ACO concept" is "failing"?

There is a huge difference between your initial misquote and what I actually said. Why are you playing such stupid games? I mean, do you think I have demonstrated such a low level of intelligence, reading comprehension, critical thought and actual real life experience that your silly games would confuse me?

Give it a rest. We all see what you're about.

Please tell me what this:

"The problem is the ACO concept, as currently designed, is failing."

...meant if not that the "ACO concept" is "failing."

I really want to know.

[Bunnahabhain]

82. Is selective editing a hobby?

Leaving out that very important clause, "as currently designed," is selective editing. Selective editing is a cheap trick and blocks any actual dialogue. If you have to dice and splice my words to support some position you feel I hold I obviously do not hold it and one must wonder your intent in so doing. So I really want to know...what is your intent in what must be intentional misportrayl of what I'm saying? I have taken the time to engage you, offer relevant facts and insights, given my honest input on a course correct, and your response is to use stupid high school rhetoric tricks vs. maybe learning something?

[ProSense]

84. But

"Leaving out that very important clause, 'as currently designed,' is selective editing."

...they aren't "failing" "as currently designed."

I repeat, the articles you posted were about the struggles of financially-strapped organizations. Both articles show that the objectives were being met, but more time and funding are needed.

Given the short period of time these organizations have been in existence, I'd say that it's remarkable that they can show positive results.

[Bunnahabhain]

85. Ignoring your selective editing

you have now taken to selective data picking.

I repeat: if the program is not financially viable it's a failed program! When participants are dropping out for a reasonable and identified dissatisfier it only makes sense to fix it. Payment methodologies are not simple; it's not like we have a FFS in the age of DRGs, co-morbidity modifiers/add ons, PPS, etc. along with claw backs, penalties, and potential at risk payments. In particular participants have also identified the metrics used for program success criteria to need work.

You can keep repeating your bullshit or you could make everyone here think you are intelligent and simply acknowledge ACOs, if they do not change, will probably fail. Things have to be a win for the providers or it is completely unreasonable to expect their participation let alone their willing participation.

Also, surprise, surprise, you're misrepresenting the article. In my first link only one organization, the first one, speaks of being "financially strapped." Why are you continuing to be so deceitful? What is your agenda?

[ProSense]

86. Nonsense

"Ignoring your selective editing you have now taken to selective data picking."

You keep repeating that, but your original statement is clear, including the comment about "failing."

The problem is the ACO concept, as currently designed, is failing. Of the 32 original pioneering ACOs, nine have already given up and I read something last week that another 14 are going to dissolve. The one I am involved in went from 0 to 100 mph and then 100 mph to 5 mph. Basically the initial enthusiasm is all gone and people are realizing what is at stake and the complexity of this system. IMO, the only good thing is an ACO is provider driven vs. being driven by insurance but even that is not completely true. The carrot and stick is still being held out by CMS, so at its root, the ACO mechanism is to punish organizations that do not adequately meet the metrics determined by CMS. I think involving providers in determining the metrics would be a more intelligent move as decision makers at CMS are often pretty removed from real life health care delivery.

You now say:

I repeat: if the program is not financially viable it's a failed program! When participants are dropping out for a reasonable and identified dissatisfier it only makes sense to fix it. Payment methodologies are not simple; it's not like we have a FFS in the age of DRGs, co-morbidity modifiers/add ons, PPS, etc. along with claw backs, penalties, and potential at risk payments. In particular participants have also identified the metrics used for program success criteria to need work.

That's like claiming that Solyndra is an indication of a "failing" program.

The organizations are struggling financially, that doesn't mean the ACO concept is a failure, and especially because there are others that aren't financially strapped, and all indicate the concept is effective.

[Bunnahabhain]

87. *yawn*

You've grown boring. From the article:

For PHP, it wasn’t all bad news, however. They were able to decrease their readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasn’t viable. They reported shared losses for fiscal year one, which was anticipated, Nielsen says, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just weren’t able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "We’re between bleeding edge and cutting edge."

MedeAnalytics’ Perez says this is all too common. Stepping down to a shared-savings ACO, he opines, is better than ditching the models altogether, but don’t expect the big paybacks years down the road. "It’s kind of like saying, 'We were in the English Premier League in soccer, and we didn’t do very well, so now we’re going to play in the United States, or play basketball in Australia versus the NBA,'" said Perez. "So you’re still in the game, except Kobe Bryant’s not going to shoot over you."

This will be my last post to you on this topic so please feel free to post another non-responsive or intellectually false reply and deem yourself the victor of this conversation. Anyone reading this can see exactly what I've said, how I've supported it, and my obvious actual knowledge on the topic. They can also see you for what you are.

[ProSense]

89. "But, financially, it wasn’t viable."

You've grown boring. From the article:

For PHP, it wasn’t all bad news, however. They were able to decrease their readmissions and hospitalizations rates and met all the quality metrics. But, financially, it wasn’t viable. They reported shared losses for fiscal year one, which was anticipated, Nielsen says, but another two years before reaping the supposed financial benefits? It proved just too risky. "We just weren’t able to take enough time to take the risk over three years at this point," Nielsen added. Right now, he said, "We’re between bleeding edge and cutting edge."

MedeAnalytics’ Perez says this is all too common. Stepping down to a shared-savings ACO, he opines, is better than ditching the models altogether, but don’t expect the big paybacks years down the road. "It’s kind of like saying, 'We were in the English Premier League in soccer, and we didn’t do very well, so now we’re going to play in the United States, or play basketball in Australia versus the NBA,'" said Perez. "So you’re still in the game, except Kobe Bryant’s not going to shoot over you."

This will be my last post to you on this topic so please feel free to post another non-responsive or intellectually false reply and deem yourself the victor of this conversation. Anyone reading this can see exactly what I've said, how I've supported it, and my obvious actual knowledge on the topic. They can also see you for what you are.

What does that have to do with the ACO concept? You're posting analysis of a few financially strapped organizations.

As I pointed otu earlier, the article mentions a number of ways in which they were effective in meeting the objectives. The next paragraphs:

The good news, he points out, is that all of the ACOs did well from a reporting standpoint in terms of quality. Ten of the 32 also produced collective shared savings of $87.6 million last year.

One problem, however, is that a handful of the 33 quality measures pertain to preventive screenings.

"The problem with it, of course, is that preventative care screenings don’t give you a short term financial benefit," Perez explained. "They’re good solid pillars of population health management, but they show the benefits three, four, five years down the road."

Thus, at the end of the day for the Pioneer model, patience does indeed prove itself a virtue, but also a luxury that many cannot afford, as many providers simply don't have the financial or psychological stamina to stick with it and reap the long-term rewards.

The article addresses a case study of a specific group of ACOs related to their financial viability. More time and funding is not about the ACO concept. It's about financial stability of a startup organization.

[Mr. David]

97. Nonsense! Yes, that's YOU!

(snipped Prosense's selective word choices)

You're just losing the battle with BB, so you just don't know when you can quit, can you?

[ProSense]

98. Dealing with some issues? n/t

[Mr. David]

95. Ignore Nonsense.

She called me a Conspiracy Theorist when she is being attacked.

It's a sign of a bully running away from the subject when called upon it.

Nonsense wanted a smear article to get rid of potential candidates to her beloved Hillary Clinton.

She has earned the nickname "Nonsense" and wants to push shill articles favoring the Third Wayers and not progressives.

That's the best you can do.

[ProSense]

100. Apparently

She called me a Conspiracy Theorist when she is being attacked.

It's a sign of a bully running away from the subject when called upon it.

Nonsense wanted a smear article to get rid of potential candidates to her beloved Hillary Clinton.

She has earned the nickname "Nonsense" and wants to push shill articles favoring the Third Wayers and not progressives.

That's the best you can do.

...you are dealing with some issues.

It's also clear to me that you are attempting to attack Howard Dean before he announces and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.

http://www.democraticunderground.com/10023364911#post20

Yikes!

[Mr. David]

102. Attacking me with my own words?

Just proving yourself a bully. And ignoring what everyone else has told you - REPEATEDLY to shove your agenda.

Not working here, and it's failing. Your ways are gone, forever.

[ProSense]

108. Should I criticize you for other people's "words"

They're your words. Why do you equate quoting you with "attacking you"?

"Just proving yourself a bully. And ignoring what everyone else has told you - REPEATEDLY to shove your agenda.

Not working here, and it's failing. Your ways are gone, forever. "

You're upset that I have my own opinions and defend them?

This:

It's also clear to me that you are attempting to attack Howard Dean before he announces

and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.

http://www.democraticunderground.com/10023364911#post20

...is quoting you. The fact that it makes no sense is on you. I characterized it as a CT, IMO.

[Mr. David]

109. Continuing to attack me is just a good way to solidify your creds as a shill and a bully

And I bet you want to have the last word on this. So goodbye and I won't be responding to any more of your silly bullshit.

[ProSense]

112. Bizarre.

[Bunnahabhain]

111. +1

[zipplewrath]

60. Not what they are paid for

I strongly suspect this horse isn't paid to think. They are paid to promote.

[Bunnahabhain]

63. You would seem correct.

[ProSense]

65. LOL!

Welcome to DU!

Where was my manners?

[ProSense]

64. Are you "paid" by the circus? n/t

[zipplewrath]

68. More deflection n/t

[ProSense]

72. Can't answer, can you?n/t

[Mr. David]

101. That nag?

Yeah, the nag is a fully paid Democratic strategist for the Third Way politics.

In other words, a shill.

So I'm not buying one single iota of NonSense's bullshit. And you shouldn't too.

[ProSense]

103. Wow!

[Mr. David]

104. Yeah, yeah, laugh it up.

Soon you'll be crying.

[ProSense]

107. I disagree with Dean, and the panel isn't going to be repealed.

It's also clear to me that you are attempting to attack Howard Dean before he announces

and trying to save your future nominee, Hillary Clinton, a Third Wayer/DLC from any real challenges before her bethrothal to 2016 Presidental nominee.

http://www.democraticunderground.com/10023364911#post20

[PowerToThePeople]

110. Guess what? I still support Dean.

n/t

[wtmusic]

55. I suppose early Dean hits should be considered a good sign. nt

[Pretzel_Warrior]

66. No one would be saying anything about him if

He hadn't just written a NYT op-Ed attacking part of Obamacare.

I think he wants the controversy. So ProSense is actually helping further publicize Howard Dean.

[ProSense]

83. Take the OP for whatever. I simpy disagree with Dean on this. n/t

[freshwest]

70. Tying medical care to the GDP in any form sounds bad on the face of it and will be demonized.

Last edited Mon Jul 29, 2013, 08:20 PM - Edit history (1)

Single Payer health care financed by general revenue is where such a mechanism makes sense as it maintains basic care for all of its citizens regardless of income.

IMO, the ACA was designed to convince Americans to accept Single Payer in time. But there is a form of 'rationing' in Single Payer countries Americans don't want to accept as a reality. But it is not for profit and is not unjust.

Many Americans see themselves as more entitled than others by the lives they have lived. We have a mixed system since a majority don't really support Single Payer for that reason. The issue isn't in Washington. It's more personal than some are willing to admit.

For example, should a person who is mobility impaired be guaranteed a regular wheelchair or a top of the line, all bells and whistles, high powered scooter?

The answer to that question in a Single Payer system is a snapshot of the prosperity of a nation and its tax funded health care system. It is proof of unspoken beliefs about equality. I was brought up with this meme:

'Budgets are moral documents.'

Because they show what a nation values. Some Americans don't care about equality in that arena, despite their lip service to it.

They have worked hard and their SOL has been good enough to afford what they feel they deserve and pressure the current system to give them the best, even if that mixed system means others get little or nothing.

Freedom isn't free and neither is Equality. People need to consdier the costs before they blithely say it's easy. This is where Single Payer gets down to the Nitty Gritty.

Visualize our population of raging Tea Partiers running around on taxpayer funded electric scooters, cursing socialized medicine.

Or just look at the Tea Party to see arrogance in action to others in need in help. A trip down memory lane during the ACA debate, even before the Republicans called for the death of the uninsured for 'freedom and liberty.' They dare talk about Death Panels?

Oh, well:

Connecting to GDP reflects the overall health of the economies of single payer systems. This doesn't have to be a denial of care issue.

But it'll be demagogued in 2014 and 2016 without looking at the larger picture. Because the media and many people are refusing to discuss what PBO wants us to consider for the path to take:



PBO believes we will not let those 50 million people down in 2014.

It will be hard to get honest discussion of this anywhere.

[ProSense]

75. The fact that the efforts to repeal this are being pushed by Republicans says a lot.

One Senator, Mark Pryor?

He voted against the health care law.

[GlashFordan]

88. Why attack Dr. Dean?

He's principled, progressive and likeable.

He would have been a more formidable candidate than John Mittens Kerry.

Have Dean get to work in January 2005 and the disaster that was Shrub II may have been averted.

[ProSense]

90. Wait

Why attack Dr. Dean?

He's principled, progressive and likeable.

He would have been a more formidable candidate than John Mittens Kerry.

Have Dean get to work in January 2005 and the disaster that was Shrub II may have been averted.

...posting his op-ed and disagreeing with him is an "attack"?

"John Mittens Kerry"?

[GlashFordan]

91. John Mittens Kerry

Came across as a blue blooded elitist. Bush 2004 was weak and a different candidate would have won. Or maybe it was because Kerry was FOR the war before he was against it lol.

Dr. Dean is a great man. But he will never be elected because he doesn't meet the corporate cookie cutter mold. For the same reason, Elizabeth Warren is one of the most noble progressives in the country but the corporate and MIC overlords will never let her rise...

[ProSense]

94. Well, the RW certainly hated Kerry.

Still, what does anyone of that have to do with Dean's op-ed?

[karynnj]

106. Bush came into 2004 stronger than Reagan or Clinton - he was at 60% in December 2003

Last edited Mon Jul 29, 2013, 09:18 PM - Edit history (1)

It doesn't matter if everyone you know hated him - more than half the country didn't. Now, you can say that his numbers fell to slightly below 50 and that many self proclaimed sage pundits said that anyone below 50 was very likely to lose. In fact, at the time I knew this was a "rule" based on NO Presidential data - there were no Presidents before that were in the high 40s. My fear was that some of those who did not approve were people like Buchanan - not approving of Bush, but extremely right wing and very likely to vote for him. (This is also why Obama polled ahead of Romney while under 50%)

Polls in January 2004 showed that Dean polled less well against Bush than generic Democrat. Kerry, polled in February polled better than generic Democrat. (Kerry was not polled in January as no one thought he could get the nomination and after Iowa Kerry was the one polled.) Nice that you repeat a Republican smear from 2004 - Kerry was not for the war - any more than Dean was.

I have no problem with Dean, he and Kerry were the candidates that I wanted to win. As to not being "corporate cookie cutter", I suggest you google Kerry BCCI investigation. The fact is that he was more liberal and fought powerful people in the Democratic party far more than Dean did as a centrist Democratic governor of Vermont.

[ProSense]

114. Excellent comment. n/t

[freshwest]

117. Thanks for bringing facts and reason to DU.

[Cha]

134. Hello! Dean is doing the Attacking on Obamacare and it's

been posted. Then a discussion ensues. Do you agree with Dean's position or not?

[AllINeedIsCoffee]

93. Before or after he howled at the moon? nt

[freshwest]

118. Hey, I loved that howl. But Kerry had a longer track record. He would have been a great POTUS.

Well, either of them would have been, but Kerry earned his bonafides back in the VVAW days and since then.

Enough to make the RW machine have to invent a new smear tactic called Swiftboating.

Different from Atwater's racist Southern Strategy, but similiar to Segretti's Ratfucking method.

Which they have never stopped using, as they did all the time Clinton was in office as well as Obama.

The GOP is the party of dirty tricks, law breakers and chicken hawks. It pays so well.

[Rex]

105. I'm sure some idiot will mention the "Dean scream".

Since that is about as far as their intellectual capabilities go.

[ProSense]

115. It's interesting how much the topic is being ignored n/t

[ProSense]

116. Updated OP. n/t

[BumRushDaShow]

119. Dean appeared on Martin Bashir this afternoon

http://video.msnbc.msn.com/martin-bashir/52614936#52614936

Edit to add he appears about the 5:45 min. mark

[ProSense]

122. Thanks.

He repeats his claims from the op-ed. It's a complete mischaracterization of the IPAB.

[SunSeeker]

136. Thanks. Dean does not repeat his rationing line, just saying it won't save costs ( false).

But Bashir does not challenge him on his claim that IPAB doesn't work, which the LA Times pointed out on Monday is not true. And he even says he wants to get rid of the mandate--which will kill cost control since then only the sickest will get insurance. Again, no challenge from Bashir. I really like Dean, but it is SO disappointing to hear him parrot healthcare industry talking points-- and be a lobbyist for the healthcare industry.

Bashir does not call him on any of that. Pretty softball interview, not Bashir's best work.

[LeftyMom]

120. You have an interesting set of enemies.

[ProSense]

121. Always interesting to see the comments from those who can't deal with reality. n/t

[LeftyMom]

123. Strangely enough, I think Dr. Howard Dean has a pretty good grasp of health policy.

Aside from the whole medical doctor thing, his record on health care policy implementation is excellent.

So yeah, I think he knows more about the reality of health care implementation than you.

You're running out of prominent Democrats who aren't on the enemies list, btw.

[ProSense]

124. Fine, but I can disagree with him, can't I? n/t

[bhikkhu]

125. I like Dean, but it is ironic that he is a health industry lobbyist now

From some points of view, lobbying for corporate interests is the anti-thesis of "Progressive".

In any case, I still like Dean, and I think he is probably speaking from a well informed perspective for the best interests of people in general. It is possible to do that sometimes, even when one has industry ties, conflicts of interest, and monetary incentives.

[last1standing]

126. Are you trying to mislead people into thinking Dean called the IPAB "death panels"

or are you saying that you think they're death panels?

Your quotes would lead a reader into believing Dean said this when he absolutely did not. That makes this thread a big lie, doesn't it?

Why are you claiming that Dean said something he didn't? What purpose does that serve other than right wing causes?

[ProSense]

127. "Death panels" is what Republican call it. The repeal effort is being led by Republicans.

I didn't claim Dean used the term "death panels."

Still, he's using the same line of attack, rationing.

He mentioned the Republican effort to repeal the panel (see the OP).

[last1standing]

128. Prosense: Oh my, Dean attacks "death panels." Any thoughts on the issue?

Where did you say that Dean wasn't the author of the quote you delivered directly after his name? This makes your OP false and purposefully misleading. That means this OP is a lie and you as its author are propagating lies.

There's a name for those who purposely spread lies but I'll let others come to their own conclusions as to what that name is.

[ProSense]

129. Yup, that's what I posted. Spin it any way you'd like.

I'm detecting a bit of desperation in that spin.

[last1standing]

130. You need another meter then.

You've posted a bald faced lie. That's desperation.

[ProSense]

131. No, I didn't, but you're desperately are trying to push that claim.

[SunSeeker]

135. The LA Times ripped Dean: "No, Howard Dean, Obamacare doesn't ration Medicare"

From Monday's LA Times editorial:

Republicans have said hyperbolic things about the 2010 healthcare law's Independent Payment Advisory Board so many times -- e.g., former Alaska Gov. Sarah Palin's declaration that it's a "death panel" -- that I've gotten inured to it. Nevertheless, it was a little startling to see some of the same facts-be-damned assertions coming from a liberal Democrat on the op-ed page of the Wall Street Journal.

Former Democratic Party Chairman Howard Dean took to the Journal on Monday to attack the IPAB with the same blatant mischaracterizations that have been the hallmarks of the GOP attacks. The only real difference is that Dean did so after saying there was "much to applaud" in the 2010 law, including its (extremely expensive) push for universal health insurance coverage.

"The IPAB is essentially a healthcare rationing body," Dean blithely writes, despite the fact that the law flatly states the board cannot ration care. Specifically, any proposal the board makes to control Medicare's costs per beneficiary "shall not include any recommendation to ration healthcare, raise revenues or Medicare beneficiary premiums under section 1395i–2, 1395i–2a, or 1395r of this title, increase Medicare beneficiary cost-sharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria."
...
The most remarkable -- and remarkably false -- critique in Dean's piece is the statement that the Congressional Budget Office has projected that the IPAB "won't save a single dime before 2021." That's because the CBO projects that Medicare costs per beneficiary will rise so slowly over the coming decade, they won't reach the threshold set in the law for the IPAB to act. It's not that the board will be ineffective, as Dean implies. It's that it won't be activated.
...

http://www.latimes.com/news/opinion/opinion-la/la-ol-howard-dean-obamacare-ipab-wrong-20130729,0,6790127.story

Dean lied about the ACA. Sad.