WPB Dawg Fan Posted August 20, 2009 Report Share Posted August 20, 2009 It is such a shame that this has become the norm. Somebody (doesn't matter which side) spouts a line of propaganda, only to have the other side deny it completely and claim the initial post is nothing but unfounded attacks. It would be humorous, except for the fact that NEITHER person/side is totally wrong or totally right. While much of the propaganda posted (again, by both sides) is a bunch of hooey...it is often based on at least a little fact...and expresses the concerns of millions of people (warranted or not). To offhandedly dismiss it without at least considering where the truth is within the statement and the reason these people are concerned about the issues is just as short sighted/narrow minded as the person who buys it hook line and sinker. Take the health care issue: Millions of people are afraid of there being a panel that will decide if they live or die. Regarding that, there is propaganda that is saying that there will be such a panel and they will say you are too old and that you can't get treated. The denial is that there is no such panel and the panel that has been proposed is simply to weigh out options. The TRUTH is something in between. Believe it or not, the projected panel already basically exists within the Medicare system. They do NOT decide if you live or die...at least not directly. What they do is they decide what procedure are paid for and under what circumstances. If you want to look it up, go to www.cms.gov and look up something called LMRP's. The are the rules that identify which illnesses and qualify for which procedures/drugs. Also look up the NCCI and Mutually Exclusive edits...and then look at the Inpatient Only edits...and then look at the Inpatient Qualification edits....or you can take my word for it as this is my profession. Basically, if you do not have the proper diagnosis your procedure is not covered. If you do not have your procedure done in the correct setting (inpatient vs outpatient, etc) your service is not covered. If you have 2 surgeries done at the same time that they don't think SHOULD be done at the same time...your service is not covered. One of the interesting things is that the Inpatient Only procedures can only be done as an Inpatient (to get paid)...but even if you get one you may not qualify as an Inpatient according to the guidelines. Anyway...this is all to make a point. There are only $xxx dollars in Medicare (and in our new NHI). In order to make sure that they do not exceed those dollars, for every new procedure paid...another gets removed. So while it is NOT technically rationing...it is selecting which procedures will and will not get paid...and thereby which procedures will and will not get approved. This panel we are talking about will not say "you are too old, so just die quietly", but they will decide if the procedure you need (based on the PROCEDURE, not you) will be approved and thereby whether or not you will be able to receive it. This in effect creates a two tier system (not that we don't already have that) whereby people with the money to afford secondary insurances or are able to pay for a procedure will get them...while people who cannot afford these things will have to do without. Having a NHI does not solve the problem. It simply transfers the issue from "too many non-insured" to "way to many under-insured". We will see a transfer of millions of people who currently have adequate healthcare insurance into the ranks of under-insured...and yes, that means many of us will NOT get the healthcare we need when we need it. No propaganda...just telling you all what I know for FACT from Medicare...and how the new system is currently being prepared to be run. Link to comment Share on other sites More sharing options...
Mr. T Posted August 20, 2009 Report Share Posted August 20, 2009 Nice. Link to comment Share on other sites More sharing options...
calfoxwc Posted August 20, 2009 Report Share Posted August 20, 2009 There are only $xxx dollars in Medicare (and in our new NHI). In order to make sure that they do not exceed those dollars, for every new procedure paid...another gets removed. So while it is NOT technically rationing...it is selecting which procedures will and will not get paid...and thereby which procedures will and will not get approved. *********************************** Excellent post ! In Britain, they decided to not fund pain pills anymore, which will affect many, many older folks, and well as others. But some rationing will be affecting seniors, inadvertently? Rationing of ANY care because the gov can't afford to pay is a crime. That goes for expensive, high tech tests for young kids whose parents are on welfare, or the elderly, or anybody inbetween. This "Obamadoesn'tcare" bill does not solve any current problems with our current system. In fact, it will cause about 20 million to LOSE their current medical insurance, against their will. That is why Americans are outraged and frightened. Link to comment Share on other sites More sharing options...
Legacy Fan Posted August 20, 2009 Report Share Posted August 20, 2009 Great post John. Additionally, every physician will require an additional staff member to process these claims to make sure diagnosis and procedures are "filed" correctly, rather than administered to the patient properly. And the supplemental guys (artists formerly known as your primary insurer) will make it very difficult to get coverage (your money) because the separate claims will have to make sure they gel so that the supplemental can't loophole their way out of providing coverage for a procedure/treatment. Who pays for this opportunity cost? I'd prefer we move to a system where the patient and physician are in control of diagnosis, treatment and payment. Health insurance? What a farce. Take your $300/mo. - $600/mo. to a financial planner, to "save for a rainy day" If it never rains in your family, you get early/extra retirement fundage. You get greedy and take out the cash for something other than a medical procedure, tough. With regards to "how will we pay for those without insurance currently or money to invest" thats' where the gov't steps in. Tax credits for those beneath a certain income line. Oh, and stop buying shitty, failing car companies and banks; that ought to free up a little coin. Link to comment Share on other sites More sharing options...
Westside Steve Posted August 20, 2009 Report Share Posted August 20, 2009 Can't use the Thanks function on this stupid Mac but that was a good post WPB. WSS Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 I appreciate all the 2 way discussion this has brought up. Again...when you bring the facts it is amazing how nobody supporting the new NHI is willing or able to "discuss" it....but when you just post propaganda they are more than willing to cry that there is "no intelligent 2 way discussion". I look forward to anybody supporting this new NHI proposition to rebut the FACTS that I have laid out here. Unfortunately, I highly doubt there will be any rebuttals as you can't dispute the facts. All the laws and "edits" (which are basically guidelines to REJECT CLAIMS/PROCEDURES) that I pointed out already and truly exist and are implemented on a daily basis. I am constantly being asked to review these in order to assist elderly get the services they need...and am constantly regrettably informing them that I cannot bypass the rules and they do not qualify to get the service. It is scary (to me anyway) to think that I am potentially going to be forced to go into a system like this. It WILL NOT pay for anything that is considered elective (you don't NEED it, but it would help). It WILL NOT pay for anything that is cutting edge technology. It WILL NOT allow you or your MD to choose the latest drugs...and generally will force you into generic only. Rehab services are greatly diminished. These are just a few of the realities that Medicare patients already deal with...and many of us will likely face. For those of you pointing out correctly that current insurance companies also deny claims/services...yes, I agree. The difference is that you can actually FIGHT/RESUBMIT/SUE over these denials. With Medicare, their determination is FINAL. Again, looking forward to "discussion". Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 First of all John, ALL surgeries that are not emergency are elective. Secondly, I have fantastic health insurance {thank god} and it still took over six months to be operated on for what I was diagnosed with on day 1,ofcourse everyone ate up my wonderful insurance through every known test imaginable before they decided to take care of their sick patient,six months! Lastly no matter what you and your doctor discuss it is ultimately up to your insurance company to give you a thumbs up or down on anything prescription or testing. These are just a few points from someone unlike Steve who pays $650 a month for health insurance and still has to jump through a million hoops to be taken care of in a proper fashion in todays healthcare system. I cant imagine how folks with lesser insurance are treated let alone those WE pay for without insurance so the first step in all of this is to agree that some kind of reform is needed and im not saying that whats being hashed out right now will solve all of the problems but we have to get this right and yes something has to get done. By the way,callin me an idiot doesnt help if your serious about civil dialogue but you do make some good points. first...didn't call anyone in specific an idiot. If you feel you have been so labeled...then it would be because you have bought into one side or the others rhetoric...not because of my comment. Second...if you noticed, I never said the current system is good. In fact, I think it sucks. However, just because it needs to be changed doesn't mean I have to like what is currently on the table...which I don't. Third...change sometimes needs to take TIME...and I hate the fact that we are being pushed/rushed into this by an impatient president and congress. Don't tell me if it doesn't happen now it never will. That is pure rubbish. Maybe if it doesn't happen now it won't happen they way THEY want it...but it can happen a better way after we do more research. As to the "non-emergent" equals "elective". Sorry, that is not correct. I am in the field and I know the difference. Elective means you could have it but it is not necessary. You can have a necessary procedure that is non-emergent. For example, a rotator cuff repair of a non-functioning shoulder. It is non-emergent...but it is deemed necessary. Anway, the fact is, the current system is flawed...but I refuse to believe moving to another flawed system for the sake of change is anything but a waste of time and money. Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 Change takes time? 1994 till now is how many years? The AMA is the biggest lobbying group in the country and has spent millions against reform. I will argue with you that all non emergency surgeries are considered elective,its a malpractice thing more than the urgency of the procedure. My niece is a nurse practitioner and has had many discussions with me about how screwed up the system is so im not totally uninformed when it comes to this but since your in the field we can agree to disagree about electives. You wouldnt be the first to call me an idiot,im married 22 years and have been called much worse. ahhh...I just came back from anniversary #6 vacation and get the idiot card...and got it TONS the first time around from m ex. Anyway...NP is a tough job. Although I will say that the chances are under this plan that they will become a hot commodity as they only get 80% of physician reimbursement...so the NHI will push the use of them over MD's. Your Niece may well become very well off/busy if it passes. As I am sure you can imagine, the AMA (representing only 29% of MD's) will fight this tooth and nail as it will take work and money from them and give it to NP's. Everyone is protecting their own slice of pie. Link to comment Share on other sites More sharing options...
calfoxwc Posted August 20, 2009 Report Share Posted August 20, 2009 WPB, you make a ton of sense - I don't see the obamacare bill solving the problem of the current system having problems... What is your take on a solution that SOLVES the problem of Americans not having insurance, and that doesn't interfere with what DOES work just fine in our current system? **************************************************** "This panel we are talking about will not say "you are too old, so just die quietly", but they will decide if the procedure you need (based on the PROCEDURE, not you) will be approved and thereby whether or not you will be able to receive it. This in effect creates a two tier system (not that we don't already have that) whereby people with the money to afford secondary insurances or are able to pay for a procedure will get them...while people who cannot afford these things will have to do without. Having a NHI does not solve the problem. It simply transfers the issue from "too many non-insured" to "way to many under-insured". We will see a transfer of millions of people who currently have adequate healthcare insurance into the ranks of under-insured...and yes, that means many of us will NOT get the healthcare we need when we need it. No propaganda...just telling you all what I know for FACT from Medicare...and how the new system is currently being prepared to be run. " Link to comment Share on other sites More sharing options...
Mr. T Posted August 20, 2009 Report Share Posted August 20, 2009 While Obama is working his progressive/socialist ass off trying to create a whole new welfare system in the name of ObamaCare we see his true colors in an interview. Obama Would Refuse To Join ObamaCare The $64,000 question finally asked Various Sources 8-14-9 Yesterday on "ABC-TV" (better known as the all Barrack channel) during the "network special on health care".... Obama was asked: "Mr. President will you and your family give up your current health care program and join the new 'universal health care program' that the rest of us will be on?"..... (bet you already know the answer)... There was a stoney silence as Obama ignored the question and chose not to answer it.... in addition, a number of Senators were asked the same question and their response was..."We will think about it." And they did. It was announced today on the news that the "Kennedy health care bill" was written into the new health care reform initiative, ensuring that that Congress will be 100% exempt ! This should speak volumes to all of us. so, this great new health care plan that is good for you and me... is not good enough for Obama, his family or Congress...?? We (the american public) need to stop this proposed debacle asap! This is totally wrong !!!!! If you agree please pass this on .... If not plan to suffer with the Obama health care plan ....for free.... while our self-serving politicians make sure that they take care of themselves and their families at our expense. Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 WPB, you make a ton of sense - I don't see the obamacare bill solving the problem of the current system having problems... What is your take on a solution that SOLVES the problem of Americans not having insurance, and that doesn't interfere with what DOES work just fine in our current system? the best system I can think of is to offer the entire public well-care. That is free access to annual check-ups, childrens immunizations, and MEDICALLY NECESSARY care for minor issues such as infections via PRIMARY CARE NURSE PRACTITIONERS!!! This will allow people to have regular health care that will initiate treatments early enough to avoid long term/costly health care, inpatient stays for non-life threatening problems, etc. I think we should also offer a 'subsidized' expanded program that allows for more visits and drug plans. However, the OVERALL healthcare should remain via private insurance. Another avenue to reduce the overall cost issue is to place "mark up limits" within healthcare and the insurance industry. For example, if an insurance company exceeds an xxx% of profits, they must turn that into refunds and/or reductions in policy costs. A hospital or MD would only be allowed to mark up DME's and or implants a certain percentage. Controlling the costs, not the avenue of the coverage, is the key to this. Make the industry 'accountable' to the public and offer basic well care would go much further in correcting the issues than any major overhaul. Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 I am sure he would get blasted..but insurance companies are ALREADY the bad guys. And, the AMA has no dog in that fight...the don't like insurance companies any more than we do. Physicians are tired of having insurance companies and the government tell them how to practice medicine...so the thought that they would stick up for the insurance companies doesn't float. I agree with the importance of insurance for health being under-appreciated as well...but it is such a one way street. Car Insurance - required by law Home Insurance - required by financial institutes Health Insurance - get it if you can that is all f***ed up. So, like I said. Basic, preventative healthcare. Additional "expanded" NHI available for a low subsidized cost. Additional 'secondary' insurance available if you can buy it...but somewhat rate controlled by legislation...make it ala-carte. Each item you want covered costs xxx dollars a year. That way you can pay what you need...less when you are young..more as you get older....kind of like Life Insurance. Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 John, Your last post is definately something to build on,now if Washington could get us somewhere close to that we would all be in much better shape,pun intended! And I ain't even a politician!!! Hell, if I can come up with this...just imagine what an 'expert' could come up with. This current plan is over-thought and over-priced...and instead of supplementing, it screws with the entire thing. Don't "JUST DO IT".....DO IT RIGHT!!! Link to comment Share on other sites More sharing options...
DieHardBrownsFan Posted August 20, 2009 Report Share Posted August 20, 2009 After having carefully reviewed the health care plans being considered by the Obama Administration, I have to agree with the Obama Admin. It seems fair to me to cover all Americans. Japan, where I lived for many years has an excellent Government run health plan. I think we can do it if we stop the bickering and get down to cooperating with each other. I really think we need to make this work. It will help the country in the long run. The system we have now is not working. Link to comment Share on other sites More sharing options...
WPB Dawg Fan Posted August 20, 2009 Author Report Share Posted August 20, 2009 After having carefully reviewed the health care plans being considered by the Obama Administration, I have to agree with the Obama Admin. It seems fair to me to cover all Americans. Japan, where I lived for many years has an excellent Government run health plan. I think we can do it if we stop the bickering and get down to cooperating with each other. I really think we need to make this work. It will help the country in the long run. The system we have now is not working. You might want to look at the entire picture of the Japanese health care: Japanese Healthcare The biggest problem is that they keep lowering reimbursement to balance the budget...so no almost all Japanese hospitals are running in the red...which then adversely effects availability of services, waiting times, upkeep of equipment, and eventually the quality itself. Not a big fan of that. Link to comment Share on other sites More sharing options...
calfoxwc Posted August 21, 2009 Report Share Posted August 21, 2009 I disagree with the Obama approach. From what I have read, the obamacare bill has a disdain for the private insurance system, and in stages, gradually works to eliminate it from competition. Here's an expert who has a great idea - Dr. Brian Day, about what is wrong with Canada's Health care system(s). The funding idea "follow the patient" works for me. I was just wondering what WPB thinks about what Dr. Day says: Link to comment Share on other sites More sharing options...
Mr. T Posted August 25, 2009 Report Share Posted August 25, 2009 Hell, maybe we could all use some Free car insurance also. Sounds like a good hand out, and while were at it lets add in whole life, fire insurance, flood insurance and maybe free beer for everyone. Link to comment Share on other sites More sharing options...
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