I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: billybags on March 22, 2010, 08:20:18 AM
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I live in the UK and I have been taking a little interest in Obama's Health care Reform. Can you tell me in simple terms what it means and why so many people seem to be against it and don't want it. To me it sounds like it will help a lot of people who can not afford insurance for health care, have I got it wrong?
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The conflicts are generally more philosophical than anything. Just about everyone agrees that the current system does not serve the American people very well. Those who are against the reforms feel that they are symbolic of government intrusion into the patient/doctor relationship and of a growth in the power of a centralized Government. Of course, Medicare is beloved here, much like the NHS is to the people of the UK, so government is already very much involved in the healthcare of many Americans. The cost is also an issue; our federal deficit is growing, and detractors fear that the cost of this bill will only add to it. The real bugbear is the soaring cost of medical care, and who pays for it, whether it be an individual, a corporation or the Government will quickly become irrelevant if costs are not contained. The US is a vast country; it is not small and containable like the UK where a central government can easily dole out funds to local health authorities based on need. For the US to do that, a large bureaucracy will need to be created, and that only adds to the fear of "Big Government". But we have large bureaucracies for just about everything else, anyway. What the net result of this new legislation will be still remains to be seen; we won't know for perhaps another decade just how things will pan out. But we do know that within a few months, insurance companies will no longer be able to use the "pre-existing condition" card to drop children from coverage. The same protection for adults will happen in 2014. It will be easier to move your coverage from one job to another, which is a huge improvement in the current job market. I'm sure you will get many more replies here, but it is not a simple matter! I personally would like to see a single payer system because I do not think it is economically wise to force businesses to offer insurance; it's a huge cost to small businesses that are the engine of our economy. Historically, businesses offered health insurance as an incentive to workers, and I think that that original purpose is obsolete
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Well Stated MM.
There are many other factors as well as to why so many didnt want healthcare to be put n place in the manner it was.
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I agree, PK. It is not so much what was passed as the way it was done. We watched the debates, nearly all day and the arguing and bickering were terrible. And, all of those people outside protesting, and have been protesting, and were completely ignored. The whole deal was, we are going to do this, whether you people like it or not.Between Obama and Pelosi, they just lied and lied. There are many things about this bill that I really think stink, but it is a done deal now. We will see what happens.
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MooseMom, Thanks for explaining this to me, I got a bit more of an in site into it. It is not straight forward is it. I agree a single payer system sounds good and ok it would take a long while to filter through, but at least it would be fairer to every one..
Jean your government sounds a lot like ours, they all lie through their teeth. We also have the EU to deal with, we got pushed into that also. We go to the election in May and to be quite honest none of the parties are worth a vote.They are all in it for what they can get out of it..
Thanks for your reply's.
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In the end, we as a nation debated this issue, we elected congresspeople to represent us, those congresspeople voted accordingly for/against the health bill, the majority won, and that's how our country works. I don't know if it is fair to quibble about the process just because you may not like the outcome. There are a lot of people who hate this bill because they believe it does not go far enough, and they probably feel ignored, too. People who said that this bill would establish "death panels" lied along with many others who just made stuff up to frighten people; these are often the same people who use words like "liberty" and "freedom" to gloss over inequity.
It has taken decades and decades to pass a healthcare bill that really is not that particularly strong, so it is hardly true that anything has been rammed down our throats. Much in the bill won't even come to pass until 2014. Some things that WILL change soon, though are: Prohibit NEW INSURANCE PLANS from dropping coverage for children due to pre-existing conditions, establish high risk pools for people with catastrophic illness, Prohibit NEW INSURANCE PLANS from kicking people off INDIVIDUAL policies (lots of fine print there), no more lifetime limits on all plans, tax credits for small businesses to help them purchase coverage, NEW PLANS will cover preventative care, everyone shall have better access to appeals processes in NEW PLANS, premium rebates for people whose insurance companies are paying too much in admin costs (read: CEO salaries). Not a lot is going to change soon for people who already have employer based insurance plans. But there are some good things here.
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The truth is they passed a healthcare plan written by a committee whose chairman says he doesn't understand it, passed by a Congress that hasn't read it but exempts themselves from it, to be signed by a president who hasn't read it and who smokes, with funding administered by a treasury chief who didn't pay his t...axe......s, all to be overseen by a surgeon general who is obese, and financed by a country that's broke.
There are some great things in this bill for sure. And there are many things in this bill that are big unknowns.
But if we look at the track record of what the government runs like medicare-the post ofice-social security-welfare programs they are all going bankrupt. They all are WAY OVER BUDGET by billions of dollars. Hell we pay $20,000 for a $20 toilet seat when it goes through congress.
We are going to cover an additional 32 million people with the same if not less doctors and nurses. People who work will end up picking up much of the fees for people who ccant afford insurance.
I dont know one person sho is against reform for our medical system.
But when pelosi and Obama BUY VOTES for billions of dollars then something isnt right.
It is done and all we can do now is wait and see. And lets remember republicans didnt hold this up for a year. It was the Dermocrats themselvs who couldnt get it done until the payoffs were dolled out. Which we the taxpayers end up paying for.
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I just also want to explain that unlike in the UK, access to health care in the US is for the most part tied to your job. The vast majority of us get our insurance through our employer/spouse's employer. Like most people, we do not tend to try to solve problems until they become an emergency, and once the economy tanked and so many people lost their jobs, the emergency was upon us. The matter became quite urgent, and that is one reason why it probably feels like this legislation was passed so quickly. We left it til the last minute. I am hoping that one result of this new bill will be more "portable" insurance because as things are now, too many people feel they cannot move or change jobs without risking their access to health care, and this is fundamentally un-American. We are held captive by our system; it deprives us of the freedom to move about or to look for more fulfilling employment if that is our choice. My husband's employer offers good insurance (for now), but I don't have a choice in which company his employer insures with. Since I have CKD, that's one whopper of a pre-existing condition, and I am therefore uninsurable should I choose to buy an individual plan. I doubt that any single person on this forum would be able to find an insurance company to underwrite his/her dialysis costs if he/she were to try to buy an individual plan. But in the US, dialysis costs are mostly paid for by Medicare, a government run, single payer entity. Ironic, isn't it!? Corporate insurance companies will underwrite those costs for only 30 months because after that, we no longer contribute positively to their bottom line.
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Yes, the "Louisiana Purchase", et al were offensive, and that's why they were stricken from the final bill, thank goodness!
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We are going to cover an additional 32 million people with the same if not less doctors and nurses. People who work will end up picking up much of the fees for people who ccant afford insurance.
Uninsured will not be covered until 2019 I believe.
Also some things to keep in mind are that as a nation we always pay for the less fortunate.
This has been necessary thing by government to build this nation.
Without it we would not have the roads, airports, clean water/sewer systems, schools, power grid, food safety etc etc.
Without government intervention these things would never have existed the way they do today and enabled this country to grow and flourish like no other in history. Without it we would still be some backwater third world country.
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I dont mind helping the down and out and the less fortunate.
I do however very much mind raising other peoples children through my hard earned monies. Paying people to live off the system when they could be contributing to society.
To many people feel entitled and that the government owes them something.
Then again maybe im the stupid one? Maybe since i qualify for disability i should quit my job and work the system like so many other people are doing.
Im all for supporting our vets and handicapped people. But to support the drug dealer driving in his nice car collecting SSI, or a crack mother having another baby so she doesn't get kicked off welfare this is what i dont agree with.
Oh and i also dont want my money going to anyone who is here illegally. But i dont get a say in any of that.
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Also some things to keep in mind are that as a nation we always pay for the less fortunate.
This has been necessary thing by government to build this nation.
Without it we would not have the roads, airports, clean water/sewer systems, schools, power grid, food safety etc etc.
Without government intervention these things would never have existed the way they do today and enabled this country to grow and flourish like no other in history.
BigSky, I have to say, on those points, I agree with you. (I just wanted to be able to type the words... BigSky, I agree with you ;D)
Somewhere along the way, we went from being a nation united to being a nation of individual rights. We need to find a happy medium in order to survive. The partisan politics on both sides have been odious to me for some time now, but I have learned to live with it and try not to buy into the hype from either side. It is not easy with so many people being so polarized, but I have learned that there are people I love who are just to the right of Atilla the Hun, and people who I love who are so far to the left of left that Mao himself would call her a lefty. These are people who have a lot of anger at the system for whatever reason, but they are still people with families, responsibilities, dreams and ambitions; politics alone should never define anyone.
The truth is, all of this is just a start. And as long as all of the vitriol keeps flying the only people who will profit will be the attorneys who file the litigation.
I just hope that one day in the future, people won't have to make the choice between feeding their family, paying the rent or going to the doctor. It is when they put off going to the doctor that catastrophe happens (like kidney failure) Medical care should not be a luxury in the land of the free.
Ok, I am jumping back out of the political threads... (if only we could fix health care without politics... sigh....)
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Unfortunately, we have not yet devised the perfect system that will weed out the scammers from those truly in need. We all want to help those who need a helping hand while not at the same time supporting the drug dealer with the fancy car. A lot of taxpayers' money is spent in tracking down and eliminating fraud, but fraud still exists. But that doesn't mean that we should never help anyone. Just because someone may feel entitled or may think the government owes them something doesn't mean that they will get it. There is nothing in the new bill that would guarantee coverage to those who are here illegally. What I want from this bill is for it to give people who are uninsured because they cannot afford their own private plan due to pre-existing conditions the opportunity to buy for themselves an insurance policy that will give them access to care. As things are now, profit making concerns are depriving us of our freedom of choice. We fool ourselves if we really believe that we are passing healthcare for the "less fortunate"; we should pass it for ALL of us because we never know when someone on some board somewhere will define you and me as "the less fortunate". We have ESRD; we ARE the "less fortunate" already.
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I just hope that one day in the future, people won't have to make the choice between feeding their family, paying the rent or going to the doctor.
Is that what happens now? See, as a very simple person it was this which really stood out for me. Everything else was gobbledy-gook. I can't understand why anybody would want to deprive anybody else of being able to see a GP and get medical care. I realise that's a terribly simplistic view of it, but that's the crux of the whole situation from where I'm reading.
I've been reading some of the comments on the Facebook group 'I bet we can find 1,000,000+ people who disapprove of the Health Care Bill' and also some of the comments on the BBC Have Your Say (international) site and I've found some of it difficult to stomach. It makes me sad (for many reasons). It also makes me realise that in many respects your culture and way of life is alien to me despite the fact that I 'know' so much about the USA from a lifetime spent devouring American books, tellybox shows, music and films.
Ok, I am jumping back out of the political threads...
As am I ... ;D
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But in the US, dialysis costs are mostly paid for by Medicare, a government run, single payer entity. Ironic, isn't it!? Corporate insurance companies will underwrite those costs for only 30 months because after that, we no longer contribute positively to their bottom line.
I was under the impression that Medicare pays for dialysis treatments for CKD patients regardless of age except that the government mandates that it is secondary to any private insurance someone may have for the first 30 months of treatment. If you have no other insurance, Medicare will pay 80% of the cost immediately. So, I thought it was Medicare that wouldn't pay for the first 30 months of treatments to save the government money. Dialysis providers usually absorb (write off) the costs which are unreimbursed by Medicare if the patient cannot afford to pay the rest of the costs.
In the case of a kidney transplant, my understanding is Medicare will only pay for the first 36 months of required drugs after transplant and then you are on your own for the cost of the drugs after that and thus you will need private insurance if you manage to live that long.
In my case Medicare never paid for any of my dialysis treatments for the nine months I was on dialysis nor did they pay any of the costs of my transplant operation and hospital stay. My post transplant medications and lab tests have also been paid by my private insurance.
It has always puzzled me what logical reason Medicare has to limit payment for required medications for transplant patients to 36 months. I have talked to people who let their transplants fail because they couldn't afford the drugs to prevent rejection and had to go back on dialysis (which costs more but then Medicare will pay again).
When I reach 65 years old in two years, I will be required to sign up for Medicare. However I will continue to need private insurance since Medicare only pays 80% of the allowed costs and I will be responsible for the rest. So I will have to begin paying a monthly premium for Medicare Part B ($100 plus monthly) in addition to the premiums I now pay for the private insurance to maintain the coverage I have now.
Hopefully, the health care reform bill won't result in my private insurance being required to adopt the Medicare rules.
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Uninsured will not be covered until 2019 I believe.
Also some things to keep in mind are that as a nation we always pay for the less fortunate.
This has been necessary thing by government to build this nation.
Without it we would not have the roads, airports, clean water/sewer systems, schools, power grid, food safety etc etc.
Without government intervention these things would never have existed the way they do today and enabled this country to grow and flourish like no other in history. Without it we would still be some backwater third world country.
I agree with Big Sky, too. :2thumbsup; Well said.
I also don't think that because I am on disability, that I am living off the system. I worked for a long time paying into S.S. and I am so grateful that now I can "withdraw" some of what I have put into it.
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Ahamner, your private insurance must pay 100% right now?
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Ahamner, your private insurance must pay 100% right now?
Yes it pays 100% of allowable charges, except for small co-pays.
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Between now and 2014 A temporary high-risk pool will be set up to cover adults with pre-existing conditions. Health care exchanges will eliminate the program in 2014 not 2019, for those who can't afford insurance now you should have access to coverage by 2014. For people with a Tx and no access to coverage you should have access through state high risk pools in 2011
For people with low income and who reside in the vast majority of states (Medicaid is a state administered program with rules differing from state to state) this bill is huge improvement. This bill will establish income eligibility for Medicaid at 133 percent of poverty irrespective of family status.
Today access to Medicaid depends both on the state where you live and your family status. For adults who are not parents, in 43 states you can be penniless and you’re ineligible for Medicare. Period. No review. No appeal. No kids/no coverage in 43 states. This bill does away with that and allows low income single adults access to Meidcaid based on need. This is huge for some people on dialysis and or living with a transplant and in itself nearly meets the need created by the lack of immunosuppressant drug coverage.
But there is more. Today, if you have kids the Medicaid Average income eligibility standard is 69 percent of poverty. In some states, it’s as low as 25 percent of poverty. Think about that - in half the states if you have kids and make 70% of the poverty level you are not eligible for Medicaid. That goes to 133% in all states, with the bill.
If you make more than 133% of the poverty level for your family size you can buy into the exchanges starting in 2014. Check out the Kaiser Family Foundation's premium calculator (http://healthreform.kff.org/SubsidyCalculator.aspx) to figure out your cost in the exchange. The question I can't answer is will the base policy in the exchange cover the basic immunosuppressant drugs someone would need post transplant? With the reconciliation bill that the Senate has yet to vote on the base plan is better than the one already voted into law sent to the President's desk for signing in the Senate Bill. After reconciliation the base plan will be pretty good but I do not yet have the definitive link on what the base plan will cover. I'd bet immunosuppressant are covered but ... still looking for a link.
ETA: 2014 is when the Medicaid changes go into effect too.
http://docs.house.gov/energycommerce/AFFORDABILITY.pdf (http://docs.house.gov/energycommerce/AFFORDABILITY.pdf)
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Billbags, you are very brave indeed. Recently, I asked for some kind American to explain their health system and provoked a raging argument on this site that lasted two weeks. I will be looking with interest at what develops here.
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I dont mind helping the down and out and the less fortunate.
I do however very much mind raising other peoples children through my hard earned monies. Paying people to live off the system when they could be contributing to society.
To many people feel entitled and that the government owes them something.
Then again maybe im the stupid one? Maybe since i qualify for disability i should quit my job and work the system like so many other people are doing.
Im all for supporting our vets and handicapped people. But to support the drug dealer driving in his nice car collecting SSI, or a crack mother having another baby so she doesn't get kicked off welfare this is what i dont agree with.
Oh and i also dont want my money going to anyone who is here illegally. But i dont get a say in any of that.
There does need to be some changes with the system.
Anyone convicted of a drug offense while on SSI should be banned from every receiving it. Among other things I also think earned income credit should be done away and that money applied to the costs of this bill.
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I live in the UK and I have been taking a little interest in Obama's Health care Reform. Can you tell me in simple terms what it means and why so many people seem to be against it and don't want it. To me it sounds like it will help a lot of people who can not afford insurance for health care, have I got it wrong?
It represents a fundamental shift in the nature of health care from being the responsibility of each individual to organize their access - the idea is you get health insurance through work, or you buy it on your own - to the government making sure you have organized your health care access.
But as far as actual impact we're talking about changing how 940 BILLION is spent over 10 years on a healthcare sector that will cost something like 40 TRILLION or more over that same period.
To put this in dollar terms that our minds can comprehend (I can't really comprehend a billion dollars let alone a trillion) it's as if you are saying that over next 10 years you'll spend $90 differently, out of $4,000.
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You have to answer this:
Is Health Care a "Right" or a "Privilege"?
If it is a "right" than the government pays for it. If it is a Privilege than you pay for it if you can afford it.
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You have to answer this:
Is Health Care a "Right" or a "Privilege"?
If it is a "right" than the government pays for it. If it is a Privilege than you pay for it if you can afford it.
Health care is a Right.
The Declaration lays out several unalienable rights, one of them being Life. Of which Republicans should have been behind reforming health care while they were in power because the Declarations Right to Life is one of the views that give when it comes to being against abortion.
That is why Roe v Wade is so flawed. It violates that principal of the Declaration.
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The proof will be in the pudding. There are major aspects that should cause all to sit back and take notice of the huge tax increases as well as the number of IRS agents hired should also tell us something. I simply do not have the confidence in our government to run anything, especially health care given the outcomes of CMS compared to other developed nations with CKD issues. Just call me skeptical, I will wait and see what they finally deliver. However, before we see what they will deliver 4 years down the road, we will see what happens with our economy long before it takes effect. We may find everyone has access to health care, but our jobs have gone oversees. So, we will all just have to wait and see what we face. I will remain skeptical until they deliver what they promise without imploding our economy. I am not sure that they can deliver all that they have promised. Remaining skeptical in Idaho.
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You have to answer this:
Is Health Care a "Right" or a "Privilege"?
If it is a "right" than the government pays for it. If it is a Privilege than you pay for it if you can afford it.
Health care is a Right.
The Declaration lays out several unalienable rights, one of them being Life. Of which Republicans should have been behind reforming health care while they were in power because the Declarations Right to Life is one of the views that give when it comes to being against abortion.
That is why Roe v Wade is so flawed. It violates that principal of the Declaration.
That's a Constitutional argument I hadn't considered but I think you can also make the point in terms of efficiencies but most importantly just having a country that you want to live in - like you said in an earlier post the whole point is to do things, I'd add the internet or the postal system or the national parks - that make this such a great place to live. It would be better if access to health care was a right, so why not make it a right.
And Peter the proof is in the eating not actually in the pudding. You'll need links for the number of IRS agent point.
ETA If you're interested in the revenue aka tax elements of the post reconciliation bill they're here:
http://docs.house.gov/energycommerce/REVENUE.pdf (http://docs.house.gov/energycommerce/REVENUE.pdf)
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Whoops Murf, What have I started? I don't think I will ever understand the American system.
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As I was listening to Congressman Stupak the other day, along with others who are pro-life, I couldn't help but wonder about how the health bill will affect those women who need prenatal care and do not have adequate insurance. It seems odd to me that there are many, many good and thoughtful people in this country who fight hard for the lives of the unborn WHILE THEY ARE STILL UNBORN yet do not seem to understand the role of good prenatal care. And if those babies are born with disabilities and their parents don't have access to adequate insurance, well, they don't seem to matter anymore. It seems that too many are willing to fight for their lives but not for their health. If you are truly pro-life, then you need to think long and hard about your stand on helping everyone have access to affordable healthcare.
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Dear MooseMom,
Having signed hundreds of WIC forms for Medicaid patients who not only get free prenatal care but also nutritional supplements, your comments simply do not have merit since those too poor to purchase their own health insurance already have access to health care in this at risk group.
I have looked at how other nations have done health care reform and America's current solution does not come close to some that actually did a good job doing this. In addition, I have seen the hand of the FDA in pharmaceutical price increases which are the largest segment of our rising health care costs, yet big Pharma made a sweet heart deal in our health care reform so pharmaceutical costs are not addressed except to limit Canadian imports and generics. It is business as usual for health care reform as far as big pharma is concerned, and may actually be better. Much more can be said about big unions and all of the special deals with all of the different states. This law will not apply to all citizens equally. Is that fair?
So, please do not interject humanitarian issues as a substitute for real political and economic issues that the majority of American people objected to. America is the biggest giving nation in the world in part due to our economic status. Many such as myself give large parts of our income to charity, so just because many oppose this version of health reform, it does not in the least impinge upon our own personal humanitarian efforts. Protecting the innocent unborn child in the womb is the greatest of these humanitarian efforts. Likewise, affordable health care for all people is in the same light, but I do not in the least believe that we achieved true health care reform with what just passed in Washington DC. Providing or not providing humanitarian health care needs is not why so many in America have objected to the political dealings in the health care deal. Let's talk apples to apples please.
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Dear Hemodoc, unfortunately, there are many people in this country who do not qualify for Medicaid or Medicare that still are underinsured and do not get the prenatal care they need or else do not have coverage for a newborn with lifelong developmental or physical disability. These are the middle class people who have lost their jobs or whose employers no longer provide health insurance. Much of the opposition to health care reform in this country comes from some perception that such reform is only for the "poor" and is nothing more than a benefits package, that it benefits "them" and costs "us". I do not see access to prenatal care and insurance for children as a "humanitarian issue". The majority of Americans do not object to prohibiting Corporate America from invalidating their policies due to "pre-existing" conditions or keeping kids on their policies until 26, or the temporary creation of high risk pools or no more aggregate limits. Yes, let's do talk apples to apples and quit equating humanitary actions with giving all Americans the opportunity to have access to affordable health care. I don't know what health insurance reform has to do with America's status as a charitable nation. "Reform" and "charity" are faaaaaar from synonymous in this discussion, and that you imply differently is quite disturbing. It's the "us" versus "them" undertone that is disconcerting.
Very few laws apply to all citizens equally. That's why ESRD victims get special provisions re Medicare.
OK, you can have the last word because I will not enter into further discussion on this. It feels inappropriate. I really do not enjoy arguing with people who, at least on some level, share the same illness, fear and anxiety thatI do. None of us need any more aggravation in our lives, especially from people who already have so much on their plates.
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Dear MooseMom,
I am afraid that you don't understand in the least the opposition to this specific health care package. Sorry you don't want to debate your own comments but so be it. I do believe that you are in error about those with disabilities since the ADA covers a wide variety of disabilities not the least of which is CKD issues. I worked for nearly two years with autistic children before going to medical school and their incenter treatment was covered through special education mandates of the school district. There are many levels of help to those disadvantaged in our nation already, but that is not what the opposition to health care reform was all about.
If people think that we have done a good job with this package, then go and look at how other nations have done health care reform without disrupting many aspects of our entire nation as this law has the potential. Many have gone before us, but it does not appear to me that America borrowed from the best ideas of the other nations. The uproar in this nation was and is over the special interest deals that made up much of this package. By the way, a law that does not apply equally to all of its citizens is not constitutional.
In any case, charity is one of the most profound markers of humanitarian societies and America ranks highest in this regard. Take a look at this PBS show on health care reform around the world. You have now seen the American version of health care reform, ask if we did better or worse than the others around the world. As I mentioned to Bill, they have made many promises both health care wise and economic wise with this law that I do not believe that they will deliver. Many do not at all share the optimism that the current congress got this bill right. I suspect that after the next election round in November, we will then enter into a Value Added Tax debate to finance this law that is by many analysts underfunded and will increase dramatically government spending and borrowing, the economics that they have sited simply do not add up to provide health care to all and reduce the budget deficits. In such, i am quite willing to simply come back to this debate a year from now and see what we are facing. I suspect as do others that a VAT is next coming down the pike.
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/
Will the new law create jobs or will more go oversees? Will comparative effectiveness research lead to higher standards or to truncated standards set arbitrarily by $/QALY? In other words, the bar is now set at $100,000 per added QALY with dialysis per year now rated at $96,000/QALY. The ESRD program is felt by many to be a failure and is used as the measuring stick of maximum medical benefit or medical failure in some eyes but this is not set in stone. This is the average cost analysis and those that are the sickest dialysis patients are set at nearly $500,000/QALY and many articles have already stated that they should not receive that benefit, it should be denied. If anyone is interested in what we shall see coming down the road, then all you have to do is look at the commentary of the NICE in the UK where medical decisions are based on politics and not by the doctors that desire new and effective treatments available in other nations but denied to those in the UK. Many examples of this are available for anyone that wishes to look.
This is not the end of the health care debate, it is in many ways just the start. The difference will be all American patients trying to move CMS to do that what is right and not just the dialysis population. I have not been impressed on how CMS has served our dialysis population with our last place mortality among the developed nations, now the same road blocks to optimal dialysis will be present for optimal care for all conditions in my opinion. Once again, just call me skeptical. I will simply wait to see how well they deliver on their promises but I will not hold my breath. I truly do not believe that they can or will deliver what they are promising on all fronts. Time will tell.
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OK. First off, I will tell you that I have an autistic child, and that I have lived in the UK and have received medical care in that country, in the US and in France. I can tell you that there is absolutely no way that an autistic child in the state of Illinois where I live has the same access to medical, educational, recreational, residential and occupational opportunities as an autistic child in the UK. That is why my son lives there and not here in the US. You can quote any statistic you want, but I've lived it.
I saw the Frontline episode of which you speak, and I do not think that any of the healthcare systems seen in those countries featured would be politically viable here. I am not sure I understood your post; are you advocating the inclusion of various elements seen in these countries' healthcare systems? I certainly would agree with you in such a case, but Americans would rail against anything smacking of the NHS in the UK (I don't think Americans really understand "socialized medicine" vs "single payer" vs "universal coverage") or the mandate to have insurance in Japan (which we are seeing here) or the non-profit "sickness funds" seen in Germany (No profit??? That's Communism!!!). What exactly do you want to see, Hemodoc? I agree with you that this healthcare reform bill is woeful as I would prefer to see employers freed from having to provide health care insurance (that's anti-business in my mind) and also see the profit-making incentive removed from the whole equation. The entire system should be scrapped and should be rebuilt using ideas like you've illustrated via Frontline, but oh wait...you've said that it must be done without "disrupting many aspects of our nation". Is that even possible? Have a single payer system and free employers from this huge financial burden, and you won't see so many jobs go overseas where health care costs are low or are subsidized. The NHS worked brilliantly for me and I wouldn't mind seeing it recreated here. Why don't you do me the favor of spelling out EXACTLY the nature of the opposition to the new bill, and while you are at it, outline EXACTLY the special interest deals that have you so incensed. You and I might actually be more in agreement than you think.
I still don't understand the line you are trying to draw tying charity with health care reform. So I'm a bit thick; sorry.
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I have not been impressed on how CMS has served our dialysis population with our last place mortality among the developed nations, now the same road blocks to optimal dialysis will be present for optimal care for all conditions in my opinion. .
Who has placed the road blocks to optimal dialysis, and why? What is the exact nature of these roadblocks?
Is there anything in the new bill with which you agree?
I would be most interested in your picture of the ideal American healthcare system that you think most citizens would support.
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I have not been impressed on how CMS has served our dialysis population with our last place mortality among the developed nations, now the same road blocks to optimal dialysis will be present for optimal care for all conditions in my opinion. .
Who has placed the road blocks to optimal dialysis, and why? What is the exact nature of these roadblocks?
Is there anything in the new bill with which you agree?
I would be most interested in your picture of the ideal American healthcare system that you think most citizens would support.
I think the answer is those who profit. Profit driven medicine has done a disservice to dialyzors and is bankrupting the country. This bill allows the medical profession the opportunity to do what they went to school to do - help people. I think this quote from Dr. Gawande (http://www.newyorker.com/online/blogs/newsdesk/2010/03/watching-the-health-care-vote.html) is spot on:
“We as a nation—and in particular those of us in medicine—now have work to do to defend and deliver on this promise and to address the legitimate concerns about costs while making health care better for everyone. But that is the remarkable thing. We have finally been given the work to do.”
I saw that quote on Maggie Mahar's blog:
Medical Professionals Must Lead: This is Your Revolution--Atul Gawande (http://www.healthbeatblog.com/2010/03/medical-professionals-must-lead-this-is-your-revolution--atul-gawnade-1.html)
Writing on the New Yorker’s “News Desk” today, Boston surgeon Atul Gawande laid out the challenge that health care reform poses for hospital administrators, physicians, nurses and every other professional in our health care system. (By professionals, I mean people who realize that they must put the interests of a sick person ahead of their own interests. I have met pharmacists, lab workers, home health care workers and many others who take this responsibility seriously. In many cases, this is why they chose the job.)
Gawande writes (http://www.newyorker.com/online/blogs/newsdesk/2010/03/watching-the-health-care-vote.html): “What made the passage of health reform historic is that, after almost a century of effort to reverse this, hope has arrived.
“We as a nation—and in particular those of us in medicine—now have work to do to defend and deliver on this promise and to address the legitimate concerns about costs while making health care better for everyone. But that is the remarkable thing. We have finally been given the work to do.”
Yes, this legislation gives medical professionals an opportunity to take the power back from the for-profit corporations that now, to a very large degree, run health care in this country. Today, even nonprofit insurers and hospitals are affected by for-profits. They must compete with them, and thus, in many cases, they have begun to imitate them.
But health care professionals can help only if they understand that reform is all about rewarding patient-centered, evidence-based medicine. Medicine should not be profit-driven. Those who think of medicine as a “business,” like any other, will be out of luck.
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So, Bill, you are saying that we dialysis patients don't get as much dialysis as we may need because it bites into corporate profit margins? But isn't making profit the American way? Or is that just on Ferenginar? :sarcasm; Dialysis is an expensive proposition. Who should pay for it? Who should pay for us here on IHD? Answer that simple question, Hemodoc, instead of darkening the waters with statements about Charitable America and special interests. Going back to the Frontline piece, out of the five capitalist democracies that were featured, not a single one based their health care system on profit. What has been rammed down our throats is this idea that we should entrust our access to healthcare to Corporate balance sheets. If you want to rail against special interests, let's start there.
Thank you, Bill, for your post.
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The bill that the President signed into law yesterday addresses the profit in the provision of health care insurance and it provides tools to evaluate the value of medicine, the comparative value. Health care isn't directly changed, however, there are plenty of pilots and studies. But to get from there to a take over of medicine you have to assume the new data will be used to achieve these unlikely outcomes.
I've actually called for comparative effectiveness research in an official capacity - I served on a panel that CMS put together (http://www.cms.hhs.gov/apps/qmis/tepdetails.asp?SetName=5) to look at developing Quality Measures for dialysis in the area of Fluid Weight Management. It was an interesting process on a topic I am specifically very interested in and think is important but there is not a lot of data to base decisions on - comparative effectiveness research is critically important because I think there are devices and approaches that are available today that would improve the provision of dialysis as measured by the standard mortality rate and/or the standard hospitalization rate.
However, it is not enough that my gut tells me one device or approach is supperior to another, you have to have data. Comparative effectiveness research provides data. The objective is not obscured in the 2,400 page bill. CMS's objective is to reimburse efficient and clinically outstanding care.
One part of this bill that I haven't heard any mention of is that preventive care is reimbursed @ 100%, not even the standard 80%. And things like a yearly physical are reimbursed through Medicare. The CBO gave no credit for these preventive measures saving money, but I think that is paying doctors to keep people well and should save money.
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Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.
As far as workable systems, privately owned nonprofit healthcare competing among each other as in Switzerland is a very interesting proposition since I have seen how well a nonprofit can run when it is run well. My experience with Kaiser was over all positive with some issues I simply learned how to get around like in any system. On the other hand, my experience in the last 6 months with Group Health up here in Idaho which is affiliated with Kaiser has been very negative. Switzerland has only non profit medical groups and that is the right place to start as well as keeping them privately owned and not government owned. It keeps market place solutions in place as well as real patient choice. What we have in this bill is no where near what they accomplished in Switzerland from what I can see.
As far as docs taking charge, we have one more 600 pound gorilla in the exam room now that the government has stepped in. Private practice is nearly a dead form of medical care, so the docs have long since lost their power to lead in so many ways. I agree that docs need to take the lead and that has been my main theme at DSEN with optimal dialysis and nephrologists. Unfortunately, the old fashioned doc who places the patient first is becoming a dinosaur and is headed for extinction. I have written about the new medical ethics at DSEN and they are nearly uniformly accepted by the younger generation of docs who are schooled in rationing their resources especially from those in the ER and basing decisions on utilization of the population instead of what is best for the individual before you in the exam room. It is a completely different philosophy of practice that removes the doctor as the patient advocate.
Once old fashioned docs like me die off, then the patient advocate doc will become quite rare indeed. So, I echo your sentiments that the docs should lead, but now it will be the politicians that will be making coverage decisions and taking the lead. They will make their decisions based on population needs, not individual needs. The new medical ethics have now been politicized. I know personally from my years protecting patients from early discharge and recommended less costly treatments as well as those that now advocate for me with my renal disease how important it is to have doctors in charge of medical care. Today docs are rated on how well they manage groups of patients which means the individual is often at the mercy of how much the docs has already spent on other patients ahead of him. The way they did it in our group was to simply publish your ranking on specific issue such as antibiotics, CT scans, etc. What happens is that the mean keeps dropping every time they report since you don't want to be in the highest 10% who receive reprimands without looking at the individual cases and their merits for each. Treating the population is much different than treating the individual. But that is the new way to do medicine.
We will now use CER as the measuring stick at a central CMS site instead of individual decision making in the exam room. Primary care will likely be the big winner with rightly placed attention to preventative medicine and specialty care will be the loser with expensive breakthrough treatments less easily adopted. Unfortunately, preventative measures have failed in so many instances due to individual health choices and lifestyles. There is a limit to how far preventative care can go, important but limited. The health care may be great if you stay healthy, but I will wait to see how the chronically ill fair under this. As I said before, I remain skeptical that they can keep all of their promises without imploding our economy at the same time. That is not a spring board for debate, just where I am looking for future developments. Once again, time will tell. Still skeptical.
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Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.
I wish I had a dollar for every time the President said that what he wanted was for the American people to have exactly that, the same FEHBP that he has. That was not only what he campaigned on, but that's what he was saying up until the final vote last week. Why do you think that is not what we ended up with? Looking at the FEHBP, I don't see anything there that most Americans would not gladly have. In fact, there have been moves in the past to extend the FEHBP to all Americans, but it hasn't happened yet, and I'm not sure why. Of course, since the Federal Government is the employer, that means the Federal Government is subsidizing up to 75% of the premiums, but I don't see why all employers couldn't offer the same sort of package and/or choices. But then what do you do about the self-employed or the small business owners who do not have the numbers of employees that the Federal Government has? If you extend this plan to all Americans, who exactly would be paying that 75% premium subsidy? Not the Federal Government, surely.
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Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.
I wish I had a dollar for every time the President said that what he wanted was for the American people to have exactly that, the same FEHBP that he has. That was not only what he campaigned on, but that's what he was saying up until the final vote last week. Why do you think that is not what we ended up with? Looking at the FEHBP, I don't see anything there that most Americans would not gladly have. In fact, there have been moves in the past to extend the FEHBP to all Americans, but it hasn't happened yet, and I'm not sure why. Of course, since the Federal Government is the employer, that means the Federal Government is subsidizing up to 75% of the premiums, but I don't see why all employers couldn't offer the same sort of package and/or choices. But then what do you do about the self-employed or the small business owners who do not have the numbers of employees that the Federal Government has? If you extend this plan to all Americans, who exactly would be paying that 75% premium subsidy? Not the Federal Government, surely.
http://www.a-s-t.org/files/pdf/public_policy/BCHRU_March24.pdf (http://www.a-s-t.org/files/pdf/public_policy/BCHRU_March24.pdf)
The bill would require the federal Office of Personnel Management, which currently administers the Federal Employees Health Benefit Program, to contract with private health insurers to offer at least two nationwide plans, one of which must be non-profit, through the exchanges. OPM would be responsible for negotiating with insurers and ensuring that the plans meet minimum standards, just as it does for FEHBP. FEHBP would remain a separate program with its own risk pool.
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Dear MooseMom, I would accept a health care plan that the members of congress, the senate and the President sign up for themselves.
I wish I had a dollar for every time the President said that what he wanted was for the American people to have exactly that, the same FEHBP that he has. That was not only what he campaigned on, but that's what he was saying up until the final vote last week. Why do you think that is not what we ended up with? Looking at the FEHBP, I don't see anything there that most Americans would not gladly have. In fact, there have been moves in the past to extend the FEHBP to all Americans, but it hasn't happened yet, and I'm not sure why. Of course, since the Federal Government is the employer, that means the Federal Government is subsidizing up to 75% of the premiums, but I don't see why all employers couldn't offer the same sort of package and/or choices. But then what do you do about the self-employed or the small business owners who do not have the numbers of employees that the Federal Government has? If you extend this plan to all Americans, who exactly would be paying that 75% premium subsidy? Not the Federal Government, surely.
Dear MooseMom,
Yes, who will be paying is exactly the question at the heart of those that opposed what is now the law of the land. I see that the Senate took quick action on reconciliation. A year from now if they tack a Value Added Tax on to everything every American buys, you will have your answer on who will pay. Welcome to the new United States of Europe. I believe we have actually come full circle on why the majority of American's opposed this law and it had nothing to do with the separate abortion issue although some did object on that issue. Abortion was not what this battle was about.
Once again, I remain quite skeptical especially about the economic aspects of this new law as promised in the debates over the last week. But our opposition unfortunately did not secure an affordable health reform, so it will be time to pay the piper so to speak. I believe in January 2011, the issue will be the VAT. Only a guess and it is not my original supposition, but I simply do not see the financial promises made in the last week every coming together to lower the deficit. The solution will have to be added taxes. The VAT will most likely be the next contested battle over health care reform. I don't see the state opposition mounting to something that will be overturned by the Supreme Court, but you never know. Not much more to say about that, only time will tell. Still skeptical in Idaho.
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But Hemodoc, you didn't answer my question. If you got what you want, which is FEHBP for all, the question still remains...who subsidizes that 75%? Do you think the American people would accept having the OPM negotiating with insurance companies like they do for current federal employees (as pointed out by Bill) Isn't that more "big government intervention"? As for VAT, well, I lived in the UK and survived with VAT, and if you had a VAT here, it wouldn't by definition make us "European". That's the sort of rhetoric that takes people's attention away from the real issues at hand. In the UK, there are many things that are not subject to VAT such as food (that you buy in supermarkets, not the food you eat in restaurants), children's clothing, newspapers, equipment for the disabled..all of these things are zero rated but taxed pretty highly in the US. There are other goods that have a lower VAT, too. Of course, the problem here would be that states would squawk because they have their own tax rates whereas in the UK, there's not an Essex sales tax, for example. Of course the issue here was never really abortion, but there are people who, again, want to merely avert our attention. I'm really interested in your ideas on who would pay for the subsidized premiums payable to insurance companies that participate in FEHBP if what was available to Federal employees were made available to all of us. I'm sorry if I didn't follow your post, but I don't believe you answered that question. You said that, yes, that was the question...I know that, but what are your ideas regarding the answer? In our present volatile political climate, what do you think the people would accept as the answer?
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Dear MooseMom,
I already answered what system I believe has done the best and that is the one in Switzerland.
Who will pay? That is quite simply you and me and everyone else.
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Dear MooseMom,
I already answered what system I believe has done the best and that is the one in Switzerland.
The Swiss have mandated universal coverage. That seems to be a real sticking point here in the US; how would you go about convincing Americans that mandatory insurance does not impinge upon "liberty and freedom"? And insurance companies in Switzerland are not allowed to make profit on basic care provisions; do you think that would fly here in the US? Switzerland also does not have employer-based insurance plans like we do here in the US, so how would you go about taking employer provided plans out of the equation? I personally agree that either the Swiss system or the expansion of FEHBP would be very nice, but then you'd get into major upheaval which you stated you wanted to avoid. If you were president, how would you present the Swiss template to Americans? How would you make it politically palatable to the Glen Becks and Congressman Boehners of the world?
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Dear MooseMom,
I have aqlready answered who I thought did the best job in their countries health care reform. That I believe is the Swiss. The issue is not should we improve our system but how. We now have mandated health insurance for all with IRS penalties to those who don't comply, not sure what point you are trying to make. The reason that I like the Swiss model is it is based on market competition among the insurance companies who are all non profit. The advent of for profit health care in America is actually a new issue in the last generation or so. I remember clearly the stories of I believe Humana coming on board with a for profit company. The history of American medicine is that of nonprofit hospitals and groups that depended on charity. I worked for 11 years at Kaiser which had more money available to the patient than the for profit companies we competed against. The NHS in the UK looked at how well Kaiser accomplished the job of taking care of patients at the same level of payment per patient with Kaiser able to deliver much more than the NHS.
I have no problem with a shared burden for all to carry when it comes to the responsibility of our health care. However, time will tell if Glenn Beck is correct on how this bill will affect Americans. I believe he is correct on how it will effect our economy in the long run. I usually watch his program every day and his main focus is on the historical aspects and how they affected people in the past and he extrapolates that to the future. Once again, ask me these questions in 5 or 10 years.
As far as the politics, my view is that there is simply too much corruption on both sides of the aisle so I will pass on answering the political issues without having an honest group of people representing us. We have long since left the provisions of a republic which is rule by law. The founders deliberately rejected rule by the majority otherwise called democracy because of the history of democracy which always leads overtime to dictatorship.
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How far are things going to get before it is declared "Unconstitutional" to force someone to purchase a policy. I don't know if people are going to worry about paying a fine if they are in danger of losing their home. What is the role of the individual states? As things are now the each state offers different levels in services for such things as education. Using autism as an example, things can vary from county to county with in a state. I live in Pennsylvania which offers a low cost health insurance for children. There are also low cost plans for adults through the state, but very long waiting lists. How low cost these plans actually are, I don't know. For a family on a low income it might seem like a fortune. I personally don't have a problem with tax dollars used for people that truely need it. I do have a problem with people abusing the system. I don't want to pay for the health care of people that aren't here legally. I have sympathy for their plight, whatever they suffered to want to leave their country. Come to the U.S. the way our ancestors did, the legal way. What is going to stop employers from downsizing so they won't have to offer an employer plan? Kind of rambling, but my opinion.
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Romona, no one wants their tax dollars going to people who are here illegally, but if such a person shows up with his kid at the ER, what would you have a doctor do? It puts doctors in an untenable position if you make them establish a patient's legal status before giving treatment. And employers are already downsizing, and have done for years, to avoid having to pay for their employees' expensive health care. That's why so many jobs leave the US, and that's why I personally would like to see single payer and allow businesses to come out from under this particular cost of trade.
Hemodoc, we long ago stopped being a democracy. We are ruled by Corporate America. Profits come first.
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Its highly doubtful it would be ruled unconstitutional to make people buy plans as precedence shows that mandatory insurance is not unconstitutional.
The medical community loses millions of dollars a year because people cannot pay their bills. 60% of all bankruptcies are the result of medical bills.
Take that into account with the numerous accounts that are past due that are sent to collections. Now if everyone has medical coverage, its very reasonable that costs would go down because the medical community is not losing millions of dollars a year and thus would not have to raise prices to cover that loss.
If one drives its mandatory they have auto insurance.
Now if one seeks medical care they must have health insurance.
And EVERYONE seeks medical care at one time or another in their life.
Under the bill abortions are not covered nor are illegals.
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Dear MooseMom,
No one in America is denied treatment in any ER do to economic status or citizenship. It is regulated under legislation called EMTALA and it has very hefty fines that all docs take great care to comply with.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act
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Dear MooseMom,
No one in America is denied treatment in any ER do to economic status or citizenship. It is regulated under legislation called EMTALA and it has very hefty fines that all docs take great care to comply with.
http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act (http://en.wikipedia.org/wiki/Emergency_Medical_Treatment_and_Active_Labor_Act)
People across the south are being relegated to the emergency room for dialysis because they are illegal and/or do not have insurance. The ER is not the appropriate venue for routine health care. After the Affordable Care Act at least those with citizenship will be able to get routine health care outside the ERs which should take a tremendous burden off of them - not that worried parents won't still show up with kids sniffling but people generally will begin to look to community clinics and their own physicians for ongoing care.
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Email from Troy Zimmerman at the National Kidney Foundation.
=======================================================
An Update on Health Care Reform
Health Care Reform Update
With Senate approval of health care reform on March 25, 2010, we wanted to highlight some of the provisions contained in the underlying bill and in the corrections bill (or "reconciliation bill"). (The legislation signed by President Obama on March 23, 2010 was the underlying health reform bill and identical to what the Senate passed on December 24, 2009; the corrections bill made changes to the underlying bill, under agreement with House and Senate leaders.)
The National Kidney Foundation (NKF) did not advocate for or against a specific health care reform bill throughout the process. However, we signed various letters of support on specific provisions (such as eliminating lifetime benefit caps) that were coordinate by coalitions and organizations. We believe that the legislation will benefit Americans with kidney disease or at risk of developing it. Here are some of the well-known features of the health care reform package that should have a positive impact on the population we serve.
1- Enhanced access to health insurance for individuals who are identified as having pre-existing medical conditions (including living organ donors) and who have been barred from coverage, or who could only obtain health insurance with premiums they cannot afford.
2- Elimination of annual and lifetime caps on the cost of services that health insurance will cover. (This could ensure continued access to care and to all treatment options for individuals who have been on dialysis for several years and received two or more kidney transplants.)
3- Reduction in out of pocket expenses for Medicare beneficiaries who have prescription drug coverage through Part D, by closing the "coverage gap" or "donut hole" by 2020, beginning next year.
4- Health insurance premium assistance for individuals or families earning less than 400% of Federal Poverty Level (approximately $88,000 a year for a family of four).
5- An estimated 31 million fewer Americans will be uninsured by 2019 than what would have occurred without reform, resulting in 94% of non-elderly having coverage (this estimate excludes unauthorized immigrants).
6- Prevention services expanded to include coverage of annual wellness visits.
7- Most coinsurance requirements for Medicare prevention services and wellness programs are eliminated.
8- Medicare Accountable Care Organizations created to better coordinate care.
Many of you monitored our efforts to expand Medicare coverage of immunosuppressive drugs for kidney recipients. NKF pursued a concerted effort, with many other organizations representing transplant candidates, recipients, and health care professionals, to leverage the health care reform movement in order to obtain relief from the 36 month limitation on Medicare coverage of the medications needed to prevent transplant rejection. The initiative bore fruit when a provision to expand Medicare coverage for these expensive immunosuppressive medications was included in the health care reform bill approved on the floor of the U. S. House of Representatives in November, 2009. However, the immunosuppressive provision was not contained in the Senate passed bill in December, nor was it included in the "corrections" or reconciliation package that the Senate approved on March 25, 2010. Nonetheless, we are optimistic this is only a temporary setback, as evidenced by the House support in November.
We are committed to pursue every opportunity, whether this year or next, to achieve this extension of Medicare coverage for transplant medications. The gradual expansion of Medicare benefits for transplant recipients over the last 25 years gives us further confidence that we will be able to claim victory in the near future. We hope we can count on every member of the NKF Board of Directors and our professional and patient advocates in our efforts to meet this challenge.
We will monitor the implementation of the health reform provisions to make sure that individuals with kidney disease or at risk of developing it will achieve the maximum benefit from these positive developments. If you have any questions about the legislation, please contact Dolph Chianchiano dolphc@kidney.org or Troy Zimmerman troyz@kidney.org
Thank you.
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Hemodoc, Romona stated that she does not want to have to pay for the health care of illegals. I pointed out that she already does everytime an illegal goes to the ER because he cannot go anywhere else for care. As Bill pointed out, it is much more of a burden to taxpayers to treat people in the ER instead of allowing them access to primary/preventative care
Like you, I would be happy with a Swiss system that encourages market competition between companies that are non-profit, but this idea has been roundly defeated by those on the right side of the political spectrum. I do not listen to Glen Beck...what do you think his view would be re introducing the Swiss system as the template for American health care? A hypothetical question, to be sure, but I'd be eager to hear what you think his views would be. I may be wrong, but I suspect that in his world, "not-for-profit" is synonymous with "socialist"...
I don't think, however, that we can/should entrust our health care to charity.
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I guess I sound cruel saying that someone in this country illegally should be denied. If they are ill treat them and bill country of origin.
I hope all of this works. People do need health care.
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my biggest thing is i want coverage for the 20% that medicare doesn't cover, and i'm willing to pay for it. however as things stood i was unable to purchase a supplemental policy, as things stood all insurance agencies considered me uninsurable. as long as this changes, i'll be happy.
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Email from Troy Zimmerman at the National Kidney Foundation.
=======================================================
An Update on Health Care Reform
Health Care Reform Update
With Senate approval of health care reform on March 25, 2010, we wanted to highlight some of the provisions contained in the underlying bill and in the corrections bill (or "reconciliation bill"). (The legislation signed by President Obama on March 23, 2010 was the underlying health reform bill and identical to what the Senate passed on December 24, 2009; the corrections bill made changes to the underlying bill, under agreement with House and Senate leaders.)
...
We are committed to pursue every opportunity, whether this year or next, to achieve this extension of Medicare coverage for transplant medications. The gradual expansion of Medicare benefits for transplant recipients over the last 25 years gives us further confidence that we will be able to claim victory in the near future. We hope we can count on every member of the NKF Board of Directors and our professional and patient advocates in our efforts to meet this challenge.
We will monitor the implementation of the health reform provisions to make sure that individuals with kidney disease or at risk of developing it will achieve the maximum benefit from these positive developments. If you have any questions about the legislation, please contact Dolph Chianchiano dolphc@kidney.org or Troy Zimmerman troyz@kidney.org
Thank you.
So if people are getting full insurance via this myriad of programs why do we need to still work for the extensions?
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So if people are getting full insurance via this myriad of programs why do we need to still work for the extensions?
Go ask Troy.
8)
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Dear MooseMom,
I am not trying to pick on you, but you simply don't represent well what you are saying about the conservative right in some of your comments. Privately owned non-profits are not socialististic which instead implies either government control or government ownership depending on the political definition of your choice. Once again, the history of hospitals in America was that of non-profit, usually religious organization run corporations that was the back bone of developing the excellence in medical care that America is known for. The for profit industry developed after the infusion of monies from the government during the 1960's and is to blame for many of the practices that many such as Bill have loathed. The very nature of medical care in my mind is the greatest humanitarian intervention that one man can do for another that is in pain and suffering. My personal view is that this should always be done as a viable non-profit venture. The very nature of for profit organizations is the corporate bottom line which leads to less care to the patient. As a physician and now as a patient, the business of medicine was always an issue that I placed well below the importance of treating the patient to the highest level possible, at least that was always my goal.
As far as Glenn Beck, he has very much a libertarian philosophy so I cannot speak for him, but libertarians advocate for the smallest effective government to prevent anarchy, but allow the maximal personal freedom which also entails personal responsibility. Yet, if we must and will have universal health coverage, the least intrusive is privately owned non-profit medical corporations that compete among each other to provide the highest level of care. In my mind, that is the least of all the evils.
Now, let me take issue with your statement that the non-profit idea was roundly defeated by the right wingers. Since the right wing was not included in the health care debate, and a completely partisan bill was passed by rather dubious process, how can you say that the right excluded this as an option. The health care bill as passed is completely left wing democratic law with minimal allowed input from the right. The debate over health care passage was among the democrats for over a year, not the republicans with the super majority in congress and the senate. Up until February, the Republicans could not even mount a filibuster.
If the president and congress wanted to give all Americans what they have as health care benefits, they have had that majority since the day that President Obama took office. Yet they have specifically excluded themselves from this duty that we are all now under. I just heard today that coverage for children's pre-existing conditions was not including in this sizable law meaning we will need further fixes to the health care law. Bill can correct me if that is incorrect, but that is a report that I heard on Fox news today.
I spoke on the issue of the ER in response to your comment that docs are too busy to burden themselves checking for citizenship before treating patients in an ER setting. We have had EMTALA for nearly 30 years so this is not at all an issue to the treating doc. I have long understood that the bill for $100.00 for a single band aide in the hospitial was to cover the care of the indigent and those that could not pay, but yet the hospital was mandated to care for. The artificially elevated costs of private health insurance was a hidden tax in insurance premiums that lead in part to the elevated cost of care in America. However, the reports that I am hearing from Verizon is that health premium costs will go up substantially and benefits will be reduced since passage of this law. If we are getting a massive infusion of Federal dollars to care for those that do not have coverage, why then is the private insurance costs now going up since they no longer have to also cover the costs of the uninsured? Shouldn't the uncompensated Federal mandates of the last 3 decades now be offset so that health care premiums would go down?
Lastly, charity such as the MDA telethon, breast cancer research and many other charities have played an important role in advancing health care in America which offsets that of other nations who have not been as generous as Americans in general. I had a patient with Myasthenia Gravis, which is a neuromuscular condition, who received a free wheelchair from the Jerry Lewis organization. The Ronald McDonald foundation has provided amazing care for families of those undergoing cancer treatment. Dialysis advocacy has likewise greatly benefit from charitable donations as well. In fact, the history of charitable benefit to the health care of this nation has a long standing benefit over hundreds of years. The advent of government intervention into health care is only a few decades old and has yet to surpass the accomplishments of charity in health care in America. It does have that opportunity before it right now and in such, I will simply hold my final judgement until they prove if they can keep all that they have promised. That is a tall order without at the same time causing economic collapse of our companies and ruining the last vestiges the best aspects of our health care system that came about by the historical benefit of charities and citizens who held personal accountability to provide health care for themselves and for their neighbors.
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Medicare has helped fewer people than charity? Medicaid has helped fewer people than charity? The VA has helped fewer people than charity? Childrens health insurance has helped fewer people than charity?
Politics is a confusing business but it would be hard to watch the process for the last year and not understand that Senators like Baukus, Lincoln, Nelson, et al the so called blue dog democrats would have agreed to anything if six Republican senators or thirty house republicans would have agreed to a compromise. The reason Grassley couldn't reach a compromise with Baukus is that he couldn't guarantee a single republican would come along and one Senator alone is not politically viable.
Take just the weeks after Brown's victory in Jan - it was just two months ago. If you pay any attention to politics you know that if six R senators had come to the "moderate" Dems with a compromise package it would have been embraced. That didn't happen because the Republicans decided in January 2009 that their best hope would be if Obama was seen as a failure. Where is the accountability for their predictions that have already turned out to be not true: as soon as it passes the Dems will attempt to change the subject; it will be signed in the middle of the night; the more the American public know about the bill the less they'll like it. They made the frequent claim that CNN polling had 59% against the bill without explaining that they were conflating opposition from the right and the left - if you just listened to sources from the right, this week must have been very confusing.
I looked on the Fox News website and didn't see a story about kids not getting insurance - they already are largely covered through SCHIP, this existed before the Affordable Care Act was ever signed, so I don't know what that is reference to.
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Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements. I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees. You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see. I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism. Anything that the current administration does is defined as "socialistic'' in their worldview. There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill. I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect. There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative. I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.
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Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements. I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees. You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see. I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism. Anything that the current administration does is defined as "socialistic'' in their worldview. There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill. I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect. There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative. I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.
For instance the mandate and the exchanges are Republican ideas.
ETA a link (H/t Yglesias (http://yglesias.thinkprogress.org/)):
From (http://feedproxy.google.com/%7Er/CapitalGainsAndGames/%7E3/iqEUGOZH_3A/did-aei-muzzle-its-scholars) Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework (http://www.heritage.org/Research/Testimony/Laying-the-Groundwork-for-Universal-Health-Care-Coverage) for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:
But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.
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pt 2. Effective in September, insurers will no longer be allowed to exclude children because of pre-existing conditions. For current policies, the pre-existing conditions exclusion must be rescinded. This will not be the case for adult policyholders until 2014. I am stunned that a man as obviously as intelligent as you get your news from Fox and Glen Beck. You're just making stuff up!
If you are so impressed by the importance of charity in our healthcare system, why not rely solely on that virtue for your dialysis treatments? Charity certainly helps certain groups or individuals at certain times, but certainly not enough for anyone to feel secure solely on that one revenue stream.
"Libertarian" is code for "As long as I've got mine, screw you." Just about everyone on this forum is either on Medicare, will soon be on Medicare or is taking care of someone on Medicare because of their dependence on dialysis. Medicare is about as "big government" as you can get. You and I are the very ones about whom the healthy speak as being without "personal responsibility" because we are dependent upon the American taxpayer to subsidize our lifesaving treatments, and many of us cannot work because of illness.
I know you are not picking on me because it is evident that you really haven't read a word I've written.
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For instance the mandate and the exchanges are Republican ideas.
Exactly, so please stop making stuff up, Hemodoc, and I'll stop picking on you. This business of not allowing republicans to submit ideas or that the bill was completely partisan is a right old load of bollocks. Certain Republican congresspeople have abdicated their role of "loyal opposition" and instead have taken up one of partisan politician. Plus they just make up stuff...
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Bill, my reference to charity is that as the basis for our medical development over the first part of the last century and it is a good and rewarding history. The history of government intervention is too young to see how it will be viewed historically. If it continues to advance the ideals and effectiveness that was instilled in our institutions before the advent of government intrusion into American health care, then it shall likewise be held with as high a regard. The change from a predominantly private health care system to a government run system is a major change. If it leads to health care rationing and diminishing of our health care standards, will it be able to lay such a claim as the improvement of health care standards that was developed with our predominantly private system based originally on charity?
The ideals of altruistic medicine are something that I caught the tail end of during my medical training and was in many ways the predominant ethics of my military experience since we were freed from any economic constraints. Our only admonition was to do what was right for the patient. As I have noted at DSEN, we have a new medical ethics that is not at all pretty in its application. DRG's were a big part of the development of the new medical ethics that supplanted the altruistic medical ethics that in my opinion was an extension of the charity established American health care industry from prior to the 1960's. We are finally seeing the end of this altruistic, charity derived medical ethics and it is now supplanted by population medicine where cost/QALY is the new standard. I am not in the least diminishing the people that the VA, medicare, medicaid and other programs have to date helped, I am simply pointing out that we are now embarking on a new health care paradigm in America that goes away from our historical charity based foundations. The impact that this will have in 5, 10, 15 or 20 or more years has yet to be written.
As far as the issue on childhood coverage, it was a quick mention by one commentator this morning, so I will likewise see if this shows up again in this discussion.
As far as politics, I do not have much trust in any of these folks whether Republican or Democrat. I see that the Republicans have a new statement to rrepeal and replace. What are they going to replace this with if they get the majority in November? The history of the Republicans is that they almost never undo what the Democrats did in their years of strength. Health care reform is here to stay. Will it be to our betterment? As I continue to say in all my posts, I am going to sit back and see if they can keep their lofty promises.
What I fear is that this will be a severe economic stress to our already stressed economy. A little off topic is how the great depression occurred in the eyes of many by the banking policies which contracted the supply of money coupled with the expansion of taxes at the same time. This double insult to our economy is what many analysts say caused the next 10 plus years of not only American economic collapse, but throughout the entire world. Since the 2008 Wall Street collapse, the Federal Reserve has tightened the money supply. We now have this huge increased tax burden of the health care upon us as well as several other programs that will significantly increase the tax burden upon all, not just the rich. What will be the result of all of these increased burdens to our economy? As far as time lines, it is now the equivalent of 1931 with the depression ripping away in 1932/1933. By the time the health bill takes effect in 2013, we should have the effects on the economy whether good or bad. Is this chicken little? Is this crying wolf? I actually hope that my opposition and fears are completely in error. If so, you will have earned a convert.
I believe that we will know within months where we are headed if not one or two years since the corporations in America must now start to comply with this new law even though it does not come on line until 2013. I believe that we are in the process of living through history again and not for the best. If the Democrats have judged correctly, this will be an unjustified fear when we get to 2013. If they are wrong, then increased unemployment rates and home foreclosures will be the topics at hand leading up to the November elections and beyond. Were there other ways that we could have improved access to care? Well, that is really not a topic of debate anymore since we are already starting this brave new experiment. All I am saying is, there are a whole lot of health related and economic related promises made by this administration with this law. Well, I hope that they can deliver on these promises since there is much more at stake than just health care. It is now in their court to deliver since he is my president as well.
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Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements. I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees. You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see. I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism. Anything that the current administration does is defined as "socialistic'' in their worldview. There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill. I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect. There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative. I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.
For instance the mandate and the exchanges are Republican ideas.
ETA a link (H/t Yglesias (http://yglesias.thinkprogress.org/)):
From (http://feedproxy.google.com/%7Er/CapitalGainsAndGames/%7E3/iqEUGOZH_3A/did-aei-muzzle-its-scholars) Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework (http://www.heritage.org/Research/Testimony/Laying-the-Groundwork-for-Universal-Health-Care-Coverage) for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:
But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.
Bill, the exchanges were Republican ideas once the so called public option was defeated not only by Republicans, but also by many Democrats. It is my understanding that the far left opposition to not having the public option was the realization that the exchanges would essentially establish health care utilities which are under the control of the government anyway. There are many Republicans which opposed the exchanges as well.
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What I fear is that this will be a severe economic stress to our already stressed economy. A little off topic is how the great depression occurred in the eyes of many by the banking policies which contracted the supply of money coupled with the expansion of taxes at the same time. This double insult to our economy is what many analysts say caused the next 10 plus years of not only American economic collapse, but throughout the entire world. Since the 2008 Wall Street collapse, the Federal Reserve has tightened the money supply. We now have this huge increased tax burden of the health care upon us as well as several other programs that will significantly increase the tax burden upon all, not just the rich. What will be the result of all of these increased burdens to our economy? As far as time lines, it is now the equivalent of 1931 with the depression ripping away in 1932/1933. By the time the health bill takes effect in 2013, we should have the effects on the economy whether good or bad. Is this chicken little? Is this crying wolf? I actually hope that my opposition and fears are completely in error. If so, you will have earned a convert.
...
Just to clairify the Great Depression started in 1929 and was exacerbated in 1930 by the passage of the Smoot–Hawley Tariff Act. The response of the Fed in 2008 and on to contain what was nearlyt a depression was to massively inflate the money supply. There has been very little tightening - basically the repayment of TARP funds could be considered tightening, it took money out of circulation and returned it to the Fed - instead we are in a period of historic flood of money into the economy, that's Keynesian economic policy.
The economy has been growing for the last two quarters. If someone thought that another collapse was coming there is a lot of money to be made, just go short on the market. The DOW is up 27% since 1/1/09, maybe on Wall Street they don't know what's going on.
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Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements. I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees. You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see. I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism. Anything that the current administration does is defined as "socialistic'' in their worldview. There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill. I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect. There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative. I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.
For instance the mandate and the exchanges are Republican ideas.
ETA a link (H/t Yglesias (http://yglesias.thinkprogress.org/)):
From (http://feedproxy.google.com/%7Er/CapitalGainsAndGames/%7E3/iqEUGOZH_3A/did-aei-muzzle-its-scholars) Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework (http://www.heritage.org/Research/Testimony/Laying-the-Groundwork-for-Universal-Health-Care-Coverage) for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:
But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.
Bill, the exchanges were Republican ideas once the so called public option was defeated not only by Republicans, but also by many Democrats. It is my understanding that the far left opposition to not having the public option was the realization that the exchanges would essentially establish health care utilities which are under the control of the government anyway. There are many Republicans which opposed the exchanges as well.
From a September 2009 Kaiser Health article (http://www.kaiserhealthnews.org/Stories/2009/September/16/GOPBills.aspx):
At least three comprehensive GOP bills have been introduced: one by Sen. Tom Coburn of Oklahoma, Sen. Richard Burr of North Carolina and Rep. Paul Ryan of Wisconsin; another by Rep. Tom Price of Georgia and a third by Rep. John Shadegg of Arizona.
All three bills have a few themes in common with their Democratic proposals. For example, they create health insurance exchanges to make it easier for the uninsured and small businesses to find affordable insurance, although the exchanges have less regulatory authority than do the proposals outlined by the Democrats.
The actual legislation is know as the Coburn/Ryan Bill
ETA: Here is a discussion during the election in 2008 (http://campaignstops.blogs.nytimes.com/2008/10/07/insurance-exchange-is-a-good-idea-but-not-at-the-national-level/) with the Heritage Foundation saying a national exchange would be a bad idea - Obama should use state level exchanges. Well that's what happened.
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pt 2. Effective in September, insurers will no longer be allowed to exclude children because of pre-existing conditions. For current policies, the pre-existing conditions exclusion must be rescinded. This will not be the case for adult policyholders until 2014. I am stunned that a man as obviously as intelligent as you get your news from Fox and Glen Beck. You're just making stuff up!
If you are so impressed by the importance of charity in our healthcare system, why not rely solely on that virtue for your dialysis treatments? Charity certainly helps certain groups or individuals at certain times, but certainly not enough for anyone to feel secure solely on that one revenue stream.
"Libertarian" is code for "As long as I've got mine, screw you." Just about everyone on this forum is either on Medicare, will soon be on Medicare or is taking care of someone on Medicare because of their dependence on dialysis. Medicare is about as "big government" as you can get. You and I are the very ones about whom the healthy speak as being without "personal responsibility" because we are dependent upon the American taxpayer to subsidize our lifesaving treatments, and many of us cannot work because of illness.
I know you are not picking on me because it is evident that you really haven't read a word I've written.
Come come MooseMom, I stated my source, asked Bill if he had heard this, acknowledged it was only one commentator and that I would see if it comes up again. By the way, there really is a reason why Fox is killing the others in the ratings. And it is not the only source of my information as it is my habit to do my own research on many issues of interest to me. My entire reason I even commented on this thread is because you have several times over badly misspoken on what the opposition to this law was on the right. I understand I am pretty much a lone dissenter, but please allow me to speak our views clearly without propaganda distortions that you have placed several times. I have in fact read every word that you speak, but you continue to misrepresent my views and those of the opposition. Am I not allowed to correct you and state properly our opposition?
As far as the issue of dialysis payments, what would have happened to American dialysis if the government had not payed for it, but had established that it was no longer experimental and was standard of care instead? We did this with EMTALA which has cost many more billions than the entire ESRD CMS program that provides care for every patient that enters the ER no matter there ability to pay or even what nation they are from. Would the health care industry have sought out the most optimal and economical way of keeping people out of the hospital to lower costs instead of putting money in their pockets from the government by providing less and less care to the patient? If you compare how the American government program stacks up to the other developed nations, who will argue that we could have done a lot better job. The government and their payment incentives to dialysis providers is complicit with this historical lack of care compared to other nations. How did it go so wrong here in America when so many other nations do better? The government no doubt plays an important role in our lives, but I firmly believe it is a great error to place all of our trust in them alone. History bears this out.
Actually, I was fortunate to have full coverage through my employer without any Medicare dollars when I started on dialysis. There are actual success stories in the private sector as well. In fact, about 85% of people were satisfied with their coverage before this law took place. The ball is in the hands of the current administration to see where that number is in 5 to 20 years. Must I remind you that you folks one this debate? Let us at least respectfully display accurately what our opposition is all about with out your continued misrepresentations of my views. Trust me, it is not at all I got mine, screw you.
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Hemodoc, it very much appears that you have a preconceived notion of what I have been saying, and you have completely missed the boat; I am very much interested in your opinions and have been asking more questions than making statements. I have asked you several times how you would broker a deal with the American people whereby we could have a healthcare system more like that in Switzerland or have one like that enjoyed by federal employees. You have argued against the process whereby the current bill has been passed, so I would like to know how YOU would enact the changes you would like to see. I understand what "non-profit" means, but all too many people do not, and THEY see it as socialism. Anything that the current administration does is defined as "socialistic'' in their worldview. There are a lot of progressives that dislike the fact that the President invited the GOP to bring their ideas to the table and incorporated some of those ideas into the final bill. I do not know who you describe as "right wingers", but to deny that Republican ideas were not welcomed and put into the bill is absolutely, positively incorrect. There are too many republican congresspeople who wanted to participate even MORE in the bill but were threatened with losing their jobs if they were seen to be in any way cooperative. I agree with you that the "business of medicine" should be "placed well below the importance of treating the patient", but there is a multi-billion dollar industry that profoundly disagrees with you, and they have more say than you or I do, unfortunately.
For instance the mandate and the exchanges are Republican ideas.
ETA a link (H/t Yglesias (http://yglesias.thinkprogress.org/)):
From (http://feedproxy.google.com/%7Er/CapitalGainsAndGames/%7E3/iqEUGOZH_3A/did-aei-muzzle-its-scholars) Bruce Bartlett, here’s the Heritage Foundation’s Stuart Butler laying out the framework (http://www.heritage.org/Research/Testimony/Laying-the-Groundwork-for-Universal-Health-Care-Coverage) for a regulate/mandate/subsidize approach to universal health care back in 2003 congressional testimony:
But as part of that [social] contract, it is also reasonable to expect residents of the society who can do so to contribute an appropriate amount to their own health care. This translates into a requirement on individuals to enroll themselves and their dependents in at least a basic health plan – one that at the minimum should protect the rest of society from large and unexpected medical costs incurred by the family. And as any social contract, there would also be an obligation on society. To the extent that the family cannot reasonably afford reasonable basic coverage, the rest of society, via government, should take responsibility for financing that minimum coverage.
The obligations on individuals does not have to be a “hard” mandate, in the sense that failure to obtain coverage would be illegal. It could be a “soft” mandate, meaning that failure to obtain coverage could result in the loss of tax benefits and other government entitlements.
Bill, the exchanges were Republican ideas once the so called public option was defeated not only by Republicans, but also by many Democrats. It is my understanding that the far left opposition to not having the public option was the realization that the exchanges would essentially establish health care utilities which are under the control of the government anyway. There are many Republicans which opposed the exchanges as well.
From a September 2009 Kaiser Health article (http://www.kaiserhealthnews.org/Stories/2009/September/16/GOPBills.aspx):
At least three comprehensive GOP bills have been introduced: one by Sen. Tom Coburn of Oklahoma, Sen. Richard Burr of North Carolina and Rep. Paul Ryan of Wisconsin; another by Rep. Tom Price of Georgia and a third by Rep. John Shadegg of Arizona.
All three bills have a few themes in common with their Democratic proposals. For example, they create health insurance exchanges to make it easier for the uninsured and small businesses to find affordable insurance, although the exchanges have less regulatory authority than do the proposals outlined by the Democrats.
The actual legislation is know as the Coburn/Ryan Bill
Bill,
As always, I have the greatest respect for your knowledge of the political process especially where health care issues come to which is far beyond my own dabbles into the political elements of health care. In addition, I try to avoid confronting you on these issues since we have respectfully agreed to disagree with the greater importance of the agreement that we share for how to improve healthcare from the renal dialysis medical perspective. I am also not all beyond educating or correcting. Once again, I would not have commented at all on this thread were it not for the gross misrepresentations by others of the reasons why I and others with my shared perspective were in opposition to this law as written. I believe that I have stated those aspects succinctly in the last few posts. My main forte is with the the medical aspects of optimal health care and not the political arena. I will sign off this thread at this time and just hope that your optimism is correct and that my pessimism is incorrect since the time for debate is actually over. It is now our new reality.
As always,
Most sincerely,
Peter
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No worries. Remember we first met in person when I was in Spokane as an Obama delegate at the Washington State convention. You didn't hold it against me then either ;)
This legislation is pretty centrist - most of the concern I've heard expressed rely on bad actors at some point making decisions that are not politically viable. The idea of Medicare rationing care based on age isn't politically realistic, for instance, we all plan on being old some day.
2/3rds of the access expansion in this bill is through getting people into private insurance plans, 1/3 into Medicaid. Right now the coverage market is about 50/50 so this makes our national market more private, less government run. Math is bipartisan.
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No worries. Remember we first met in person when I was in Spokane as an Obama delegate at the Washington State convention. You didn't hold it against me then either ;)
This legislation is pretty centrist - most of the concern I've heard expressed rely on bad actors at some point making decisions that are not politically viable. The idea of Medicare rationing care based on age isn't politically realistic, for instance, we all plan on being old some day.
2/3rds of the access expansion in this bill is through getting people into private insurance plans, 1/3 into Medicaid. Right now the coverage market is about 50/50 so this makes our national market more private, less government run. Math is bipartisan.
I guess that is why some call us the odd couple of dialysis advocacy.
Cheers,
Peter
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Hemodoc, I sincerely regret that the national discussion re health care reform has morphed into an "us vs them" monster. I don't want to be regarded as "you folks" who "won". Lastly (and this WILL be my final word on this), that 85% are "satisfied" with their current coverage is just not good enough for this great nation. Fortunately, many Americans do NOT ascribe to the "I've got mine, so screw you" mentality and want everyone to have access to health care outside of the local ER. I understand that your focus is on the medical aspect of legislation, and I am glad for that. Perhaps my interest is more in the political aspect because 1, I am not a doctor and 2. how people think, and why they think the way they do, when it comes to great social issues is intellectually interesting to me. Having lived in various countries with various health care systems, I am interested in how populations form their social values and then go about honoring them. I am formed by my life experiences just as you are.
I think you and I are actually more in agreement than it may at first appear. I understand your mistrust in government. My mistrust is more aimed at Corporate America.
Sincerely,
MM
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Thank you MooseMom
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http://www.mixx.com/stories/12564555/insurers_might_delay_covering_pre_existing_conditions_nytimes_com (http://www.mixx.com/stories/12564555/insurers_might_delay_covering_pre_existing_conditions_nytimes_com)
Coverage Now for Sick Children? Check Fine Print
By ROBERT PEAR (http://topics.nytimes.com/top/reference/timestopics/people/p/robert_pear/index.html?inline=nyt-per)
WASHINGTON — Just days after President Obama (http://topics.nytimes.com/top/reference/timestopics/people/o/barack_obama/index.html?inline=nyt-per) signed the new health care law, insurance companies are already arguing that, at least for now, they do not have to provide one of the benefits that the president calls a centerpiece of the law: coverage for certain children with pre-existing conditions.
Mr. Obama, speaking at a health care rally in northern Virginia on March 19, said, “Starting this year, insurance companies will be banned forever from denying coverage to children with pre-existing conditions.”
The authors of the law say they meant to ban all forms of discrimination against children with pre-existing conditions like asthma (http://health.nytimes.com/health/guides/disease/asthma/overview.html?inline=nyt-classifier), diabetes (http://health.nytimes.com/health/guides/disease/diabetes/overview.html?inline=nyt-classifier), birth defects (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/birth_defects/index.html?inline=nyt-classifier), orthopedic problems, leukemia, cystic fibrosis (http://health.nytimes.com/health/guides/disease/cystic-fibrosis/overview.html?inline=nyt-classifier) and sickle cell disease (http://health.nytimes.com/health/guides/disease/sickle-cell-anemia/overview.html?inline=nyt-classifier). The goal, they say, was to provide those youngsters with access to insurance and to a full range of benefits once they are in a health plan.
To insurance companies, the language of the law is not so clear.
Insurers agree that if they provide insurance for a child, they must cover pre-existing conditions. But, they say, the law does not require them to write insurance for the child and it does not guarantee the “availability of coverage” for all until 2014.
William G. Schiffbauer, a lawyer whose clients include employers and insurance companies, said: “The fine print differs from the larger political message. If a company sells insurance, it will have to cover pre-existing conditions for children covered by the policy. But it does not have to sell to somebody with a pre-existing condition. And the insurer could increase premiums to cover the additional cost.”
Congressional Democrats were furious when they learned that some insurers disagreed with their interpretation of the law.
“The concept that insurance companies would even seek to deny children coverage exemplifies why we fought for this reform,” said Representative Henry A. Waxman (http://topics.nytimes.com/top/reference/timestopics/people/w/henry_a_waxman/index.html?inline=nyt-per), Democrat of California and chairman of the Energy and Commerce Committee.
Senator John D. Rockefeller IV (http://topics.nytimes.com/top/reference/timestopics/people/r/john_d_iv_rockefeller/index.html?inline=nyt-per), Democrat of West Virginia and chairman of the Senate commerce committee, said: “The ink has not yet dried on the health care reform (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html?inline=nyt-classifier) bill, and already some deplorable health insurance (http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/index.html?inline=nyt-classifier) companies are trying to duck away from covering children with pre-existing conditions. This is outrageous.”
The issue is one of many that federal officials are tackling as they prepare to carry out the law, with a huge stream of new rules, official guidance and brochures to educate the public. Their decisions will have major practical implications.
Insurers say they often limit coverage of pre-existing conditions under policies sold in the individual insurance market. Thus, for example, an insurer might cover a family of four, including a child with a heart defect, but exclude treatment of that condition from the policy.
The new law says that health plans and insurers offering individual or group coverage “may not impose any pre-existing condition exclusion with respect to such plan or coverage” for children under 19, starting in “plan years” that begin on or after Sept. 23, 2010.
But, insurers say, until 2014, the law does not require them to write insurance at all for the child or the family. In the language of insurance, the law does not include a “guaranteed issue” requirement before then.
Consumer advocates worry that instead of refusing to cover treatment for a specific pre-existing condition, an insurer might simply deny coverage for the child or the family.
“If you have a sick kid, the individual insurance market will continue to be a scary place,” said Karen L. Pollitz, a research professor at the Health Policy Institute at Georgetown University (http://topics.nytimes.com/top/reference/timestopics/organizations/g/georgetown_university/index.html?inline=nyt-org).
Experts at the National Association of Insurance Commissioners share that concern.
“I would like to see the kids covered,” said Sandy Praeger, the insurance commissioner of Kansas. “But without guaranteed issue of insurance, I am not sure companies will be required to take children under 19.”
A White House spokesman said the administration planned to issue regulations setting forth its view that “the term ‘pre-existing’ applies to both a child’s access to a plan and his or her benefits once he or she is in a plan.” But lawyers said the rules could be challenged in court if they went beyond the law or were inconsistent with it.
Starting in January 2014, health plans will be required to accept everyone who applies for coverage.
Until then, people with pre-existing conditions could seek coverage in high-risk insurance pools run by states or by the secretary of health and human services. The new law provides $5 billion to help pay claims filed by people in those pools.
Federal officials will need to write rules or guidance to address a number of concerns. The issues to be resolved include defining the “essential health benefits” that must be offered by all insurers; deciding which dependents are entitled to stay on their parents’ insurance; determining who qualifies for a “hardship exemption” from the requirement to have insurance; and deciding who is eligible for a new long-term care insurance program.
As originally conceived, most of the new federal requirements would have taken effect at the same time, in three or four years. The requirements for people to carry insurance, for employers to offer it and for insurers to accept all applicants were tied together.
But as criticism of their proposal grew, Democrats wanted to show that the legislation would produce immediate, tangible benefits. So they accelerated the ban on “pre-existing condition exclusions” for children.
Consumers will soon gain several other protections. By July 1, the health secretary must establish a Web site where people can identify “affordable health insurance coverage options.” The site is supposed to provide information about premiums, co-payments and the share of premium revenue that goes to administrative costs and profits, rather than medical care.
In addition, within six months, health plans must have “an effective appeals process,” so consumers can challenge decisions on coverage and claims.
Seems to me insurers are looking to delay implementation via taking this to court. I can't say I've read the language in question (and it's not likely I'd understand it if I were to read it) but politically I'm not understanding the wisdom of picking this issue to dispute.
But then it was the announcement of 40% rate hikes after the Brown election that propelled the legislation forward in February, so I 'm not sure how strategic the insurance industry really is.