It reduces reimbursement without regard to value or need.

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The government writes reimbursement checks without investigating claims, while private-sector health insurers monitor claims before they pay them.

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As the American Medical Association and others have pointed out, the board is charged with the contradictory mandate of cutting Medicare reimbursement rates to health-care providers, without reducing benefits or finding new ways to increase value.

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Doctors and patients will dodge the Medicare reimbursement bullet, and Silicon Valley billionaires will not go long without their research and development tax credits.

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"Some of these 36 million were being treated without any chance of receiving payment or with the chance of a minimum reimbursement from Medicaid, " Kramer says.

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